Essay Put yourself in the role of Detective Garrison Essay

Put yourself in the role of Detective Garrison. You must now write a report explaining what Renee might have said with regard to the above questions. You should use all of your knowledge about blood pressure and the information from this case to explain each of the following aspects of blood pressure and discuss their relation to the above questions. Describe the role of the nervous system, adrenal glands, kidneys and pituitary as appropriate to the relation of each of the seven factors listed below: 1. Peripheral resistance 2. Heart rate 3. Venous return 4. Stroke volume 5. Cardiac output 6. End systolic and diastolic2. What were the specifi c eff ects of the Lasix, hot water, and alcohol on the couple’s blood pressure? 3. What could the body have done to reverse the decreasing blood pressure, if it had been possible? 4. Identify several procedures that might have helped save the couple if they had been found unconscious but still above water and alive. Essay Put yourself in the role of Detective Garrison. You must now write a report explaining what Renee might have said with regard to the above questions. You should use all of your knowledge about blood pressure and the information from this case to explain each of the following aspects of blood pressure and discuss their relation to the above questions. Describe the role of the nervous system, adrenal glands, kidneys and pituitary as appropriate to the relation of each of the seven factors listed below: 1. Peripheral resistance 2. Heart rate 3. Venous return 4. Stroke volume 5. Cardiac output 6. End systolic and diastolic2. What were the specifi c eff ects of the Lasix, hot water, and alcohol on the couple’s blood pressure? 3. What could the body have done to reverse the decreasing blood pressure, if it had been possible? 4. Identify several procedures that might have helped save the couple if they had been found unconscious but still above water and alive. Essay Put yourself in the role of Detective Garrison. You must now write a report explaining what Renee might have said with regard to the above questions. You should use all of your knowledge about blood pressure and the information from this case to explain each of the following aspects of blood pressure and discuss their relation to the above questions. Describe the role of the nervous system, adrenal glands, kidneys and pituitary as appropriate to the relation of each of the seven factors listed below: 1. Peripheral resistance 2. Heart rate 3. Venous return 4. Stroke volume 5. Cardiac output 6. End systolic and diastolic2. What were the specifi c eff ects of the Lasix, hot water, and alcohol on the couple’s blood pressure? 3. What could the body have done to reverse the decreasing blood pressure, if it had been possible? 4. Identify several procedures that might have helped save the couple if they had been found unconscious but still above water and alive. Essay Put yourself in the role of Detective Garrison. You must now write a report explaining what Renee might have said with regard to the above questions. You should use all of your knowledge about blood pressure and the information from this case to explain each of the following aspects of blood pressure and discuss their relation to the above questions. Describe the role of the nervous system, adrenal glands, kidneys and pituitary as appropriate to the relation of each of the seven factors listed below: 1. Peripheral resistance 2. Heart rate 3. Venous return 4. Stroke volume 5. Cardiac output 6. End systolic and diastolic

Story of Akbar and Birbal

Revenue: The amount of money that a company actually receives during a specific period, including discounts and deductions for returned merchandise. It is the â€Å"top line† or â€Å"gross income† figure from which costs are subtracted to determine net income. Revenue is calculated by multiplying the price at which goods or services are sold by the number of units or amount sold. EBITDA is essentially net income with interest, taxes, depreciation, and amortization added back to it, and can be used to analyze and compare profitability between companies and industries because it eliminates the effects of financing and accounting decisions. *amortization basically means reducing the value of something to zero Debt –equity ratio: A measure of a company's financial leverage. Debt/equity ratio is equal to long-term debt divided by common shareholders' equity. Typically the data from the prior fiscal year is used in the calculation. Investing in a company with a higher debt/equity ratio may be riskier, especially in times of rising interest rates, due to the additional interest that has to be paid out for the debt. For example, if a company has long-term debt of $3,000 and shareholder's equity of $12,000, then the debt/equity ratio would be 3000 divided by 12000 = 0. 25. It is important to realize that if the ratio is greater than 1, the majority of assets are financed through debt. If it is smaller than 1, assets are primarily financed through equity. Return-on-assets: An indicator of how profitable a company is relative to its total assets. ROA gives an idea as to how efficient management is at using its assets to generate earnings. Calculated by dividing a company's annual earnings by its total assets, ROA is displayed as a percentage. Sometimes this is referred to as â€Å"return on investment†. The formula for return on assets is: Note: Some investors add interest expense back into net income when performing this calculation because they'd like to use operating returns before cost of borrowing.

Nonverbal Communication and Service Users

Be able to meet the communication and language needs, wishes and preferences of individuals 1. Find out an individual’s communication and language needs, wishes and preferences. 2. Demonstrate communication methods that meet an individual’s communication needs, wishes and preferences. 3. Show how and when to seek advice about communication. It is always important to find out about each individual’s particular communication and language needs, wishes and preferences.Effective communication happens when the right method is used to send a message, so it can be received and understood. Health and social care practitioners need to know about a range of communication methods. They should also be skilled at identifying the communication and language needs, wishes and preferences of the people with whom they work and interact. Health and social care settings are used by people from a diverse range of backgrounds who will want to communicate in different ways.Finding out about each individual’s language needs, wishes and preferences is an important part of my role. I can do this by: †¢asking people whether they or their relatives have particular language or communication needs †¢reading reports and notes about service users that provide information on speech and language issues, learning difficulties, disabilities (e. g. hearing or visual impairment) or physical conditions (e. g. troke, cleft palate) that may affect their ability to communicate †¢being aware that an individual’s culture, ethnicity and nationality may affect their language preferences and needs †¢observing the people who use my setting to see how they use their communication and language skills †¢asking my supervisor/mentor, senior staff and specialist professionals such as speech and language therapists, occupational therapists and social workers for information, advice and support about how best to communicate with adults who have special comm unication needs.Hearing impaired people Make sure that my face can be seen clearly,face the light and the person I am speaking to at all times, speak clearly and slowly – repeat and rephrase if necessary, minimise background noise,use my eyes, facial expressions and gestures to communicate, where appropriate, do not be tempted to shout into a person’s ear or hearing aid. Visually impaired people Speak in the same way as I would to a sighted person – not louder or more slowly! say who I am in my greeting as my voice won’t necessarily be recognised even if I have met the person before, always introduce other people who are with me and explain what is going on if a visually impaired adult joins me in a group, let the visually impaired person know when I am about to do something that is likely to affect communication (such as leave the room or move away), end conversations clearly and let the person know that I amleaving – do not just walk away, ask th e person if they need any particular help – to sit down or to move about, for example – but do not assume that this is always necessary or wanted.Health and social care practitioners use two main types of communication as part of their work roles. These are verbal and non-verbal communication. Verbal communication is based on the use of words. Health and social care practitioners need effective verbal skills to: ? obtain information from colleagues, service users and others who use the setting ? respond to questions ?contribute to team meetings ?give feedback and report observations about service users ? provide support to service users, relatives and colleagues ? eal with problems and complaints ?write notes and reports Non-verbal communication occurs when a person uses their body, behaviour and appearance to communicate with others. For example, an individual’s body language may tell a health or social care practitioner that they are uncomfortable or need to g o to the toilet even when they say they’re okay. Non-verbal communicationWhat does it involve? Examples Eye contactLooking another person directly in the eyesShort or broken eye contact can express nervousness, shyness or mistrust.Long unbroken eye contact can express interest, attraction or hostility. Touch Physically touching or holding a personHolding someone’s hand Placing a hand on a person’s arm or shoulder to reassure them Physical gesturesDeliberate movements of the hands to express meaningThumbs-up gesture to show agreement or pleasure Shaking a fist to show anger or aggression Body language Facial expressionMovements of the face that express a person’s feelingsSmiling FrowningProximityThe physical closeness between people during interactionsBeing very close may be reassuring and may be seen as accepting the person. It might also make the person feel uncomfortable and threatened. People need less personal space (increased proximity) when they hav e a close, trusting relationship. To be an effective communicator in my work setting, I need to be able to use methods of communication that meet each individual’s needs, wishes and preferences. My goal is always to ensure that the messages I send can be received and understood.Perhaps I will be aware that I am struggling to communicate effectively with somebody. In situations like these, I should seek advice and obtain support. I can do this by: ?talking to my supervisor, mentor or line manager about the difficulty – ask for their advice about how to deal with the problem ? talking to communication or language support specialists (teachers, psychologists or speech and language therapists) who work at or spend time in my work setting.

Trade union movement in Britain Essay Example | Topics and Well Written Essays - 2000 words

Trade union movement in Britain - Essay Example The power of trade unions in countries around the world is not equal. In certain countries, such as Britain, the role of trade unions in promoting the rights of employees has been critical. Current paper presents the current state of trade union movement in Britain. In addition, the strategies that trade union movement in Britain employs to increase its influence are explained and evaluated. Through the literature published in regard to this subject it has been revealed that the current power of trade unions in Britain is limited, compared to the past. Radical changes in these unions’ policies and practices are required so that the power of trade union movement in Britain to return to high levels. 2. Trade union movement in Britain 2.1 Definitions In order to understand the various aspects of trade union movement in Britain it is necessary to present the definitions of certain terms, as these terms are closely related to the issues under discussion. The trade union has been de scribed as ‘a continuous association of wage-earners for the purpose of maintaining or improving the conditions of their working lives’ (Sinha 2004, p.1). Through a similar point of view, a trade union reflects ‘a combination aiming to regulate the relations between workmen and masters†¦.’ (1913 Trade Union Act, in Jackson, 1982, p.69). Different approaches have been also used for describing trade unions. For instance, reference can be made to the definition of trade union as developed by Flanders in 1975: ‘unions should act in order to challenge capitalism’ (Gardner and Palmer 1997, p.86). The above definition, being influenced by Marx’s views on employment relations, focuses on the relationship between employment and politics and not so much on the rights of employees in the workplace. Reference should be also made to the definition of worker. According to the Employment Rights Act 1996 a worker is an individual that meets the fol lowing three requirements: ‘a) works under a contract, b) to carry out personal services and c) for the other party of the contract’ (Gennard and Judge 2005, p.102). In the context of another definition, an employee is considered to be ‘the person that works for another under the terms of compensation’ (Twomey 2009, p.78). The compensation of employees can be monetary or of other form (Twomey 2009). 2.2 Current state of trade union movement in Britain As in all countries where a trade union movement exists, in Britain also, the trade union movement focuses on ‘the protection of jobs and of wages’ (Padhi 2008, p.543). Moreover, trade unions have the power to check whether working conditions are kept at a specific level, in terms of quality and safety (Padhi 2008). The existence of trade unions is based on the following fact: the position of employees is less advantageous compared to that of their employers (Weiss 2008, p.357). This means that em ployees are not equally powerful with their employers when having to negotiate for their rights (Weiss 2008). This fact has led to the introduction of trade unions, as a means for increasing the power of employees towards their employers (Weiss 2008). The current status of trade union movement in UK can be characterized as rather discouraging. In fact, through the decades the failures of the efforts of union leaders to secure the support of Labour government towards the trade union movement, as analyzed below, have led to the decrease of the unions’

Managing strategic change Sainbury Essay Example | Topics and Well Written Essays - 500 words

Managing strategic change Sainbury - Essay Example The threat for Sainsbury was that the removal of physical barriers to trade and the new-found freedom of movement around the European market have served to catalyse European expansion and in so doing raise the degree of European trade. To respond to new environment, the company introduced changes in management style which was brought by new executive. The new style of leadership was â€Å"more consensual, less hierarchical – but not in strategy or in corporate beliefs about the company’s place in the market† (Owen, 2003). Another innovation made by Sainsbury was reorganization and restructuring aiming â€Å"to feature only supermarkets and convenience stores, with Central and Savacentre outlets joining the main estate† (Sainsbury's makes first ever loss, 2004). In spite of planned actions, these changes failed because of inability of staff to manage change and lack of resources to adapt organization to the changes. It is possible to say that the strategy was ineffective for world’s integration and for this reason it failed at the stage of implementation. Specification in Sainsbury was determined as a result of an organization's pol ¬icy, which in turn resulted from decisions on its market policy, which in turn resulted from its consideration of the market or customer needs, requirements, and the activ-ities of competitors. The main mistake was an attempt to reorganize and restructure several organizational levels at the same time.

Leadership Paper Essay Example | Topics and Well Written Essays - 2500 words

Leadership Paper - Essay Example These leaders draw their authority from various attributes including charisma, formal power or even behavioral or reverence power. The leader influences occupational behaviors of individuals and groups through systematic structures, which facilitates communication within an organization. Miller (2011) adds that leadership, especially business leadership, requires some inherent social and professional skills in order to facilitate execution of responsibilities. In this case, different business leaders possess different leadership skills, which directly influence the success level of their practices. Leaders with comprehensive and positive leadership skills have high chances of achieving greater goals compared to those with the minimum requisite skills. Acquisition of requisite leadership skills depends on factors like social and economic background of an individual. In this regard, we will illustrate the application of leadership skills by examining one successful business leader with in the Islamic business context. In the essay, we feature an influential business leader from Saudi Arabia called Al-Waleed bin Talal. Al-Waleed, who belongs to the Saudi Royal family, is a business leader and an investor. He was born in Jeddah on March 7, 1955. He derives his roots from Arabs most celebrated personalities, King Abdul-Aziz Alsaud, who was the founder and leader of Saudi Arabia. In addition, he is the grandson of Raid El Solh, the iconic figure behind Lebanon’s drive for independence. His father, who is a member of the royal family is Talai bin Abdilaziz Al Saud and his mother Princes Mona El-Solh. His father remains influential in Saudi’s governance up to date, especially on matters relating to the rule of law and national constitution the society. Al-Waleed resides in the Saudi Arabia’s city of Riyadh with his wife Princess Deborah and his two children. Being a member of the Royal family, Al-Waleed manages vast personal and family wealth

Technological Advancements in Historic Preservation Research Paper

Technological Advancements in Historic Preservation - Research Paper Example Historic buildings have been designed with sustainable features that respond to both site and prevailing climate (WBDG). The effectiveness of sustainable features used to preserve traditional buildings and, when incorporated in modern buildings, those features can result in substantial energy savings. The current technologically improved sustainable preservation of buildings has, therefore, been derived and adapted to supplement the inherent sustainable features in many historical buildings without compromising the unique and historic character of such buildings. For example, the Adobe houses or those made of dried bricks are among the oldest buildings made of the most common materials that are known to man today (Old House Web). The adobe bricks were not fired initially but were sun-baked first and only then used in the construction process. These bricks consist of sand, clay, water, gravel and straw or grass that are mixed with hands in wooden moulds and then are being dried in the sun (Old House Web). As the adobe bricks are not fired in a kiln, the bricks never harden permanently but remain unstable during their life time. These bricks are, therefore, prone to shrinking as water content changes with their strength fluctuating over time: the higher the water content, the lower the strength (Old House Web). The adobe bricks, though having been successfully used in the buildings, cannot bond to metal, wood or stone as they exhibit greater movements than these materials. Attempts to bond these materials resulted in cracking, separating or twisting at the interfaces, which led to cracking and failure of the buildings in most of cases. This prejudiced the preservation of these buildings. In the majority of cases, where traditional methods may not present enough strength in buildings, other technologies in the modern building construction are used to reinforce these traditional buildings to ensure sustainability and preservation of a historic fabric (Fischetti, 42 ). The early adobe building foundations varied greatly according to their differences in local building construction and available materials, which resulted in great variability in these buildings, including their sustainability (Old House Web). Lack of professionals at planning or preservation stage of a huge number of traditional buildings has had a bad effect on those buildings, thus, numerous efforts to innovate and elaborate plans for preservation in these buildings have been made recently; though there has been a growing belief in the inclusion of planning and growth management in preservation of these buildings (WBDG). Though preserving a building has been recognized as an ultimate recycling of projects, the majority of preservationists in most of cases fight the stigma of historic buildings being inefficient and stress on the need to take daunting corrective measures in order to retrofit for energy saving devices and systems with the green sustainable design being increasing ly popular in both construction and preservation of new industries (WBDG). These shortcomings in the traditional buildings and preservation approaches are continuously being reviewed though the improved technologies in both preservation of buildings and documentation of building projects so that to enhance effective preservation. The growing technological advances have made it possible to improve building preservation efficiency and accuracy with record keeping in architectural and construction projects being enhanced to

My Old Neighborhood Essay Example | Topics and Well Written Essays - 1000 words

My Old Neighborhood - Essay Example To start with, few years ago I went back to Benzie County found in Michigan State. This is where I grew up and made a lot of childhood friends. As I walked through the town from the train station, I saw various buildings that reminded me of my childhood age. Surprisingly, I bumped on one of my childhood friends by the name Christine, who worked at a law firm that was closely located to the train station. As the fate would have it, we got into a nearby restaurant where we shared a lot about our current lives and our childhood memories. Since Christine took up a job in Benzie County after completion of college education, she had seen a lot of transformation that took place in the county over the years. She enlightened me about other childhood friends who also decided to stay in Benzie County and also about political transformations that shaped the evident changes in the county. However, the stories by Christine were not striking compared to what I saw since I related what I saw to the memories of my childhood period. Firstly, as I was heading to the estate where I actually lived with my parents, I recounted how the tarmac road was well maintained by the local authority and plenty of vegetations were planted by the road side through a beautification program that was initiated by the then county clerk of Benzie County. In most weekends during my childhood, I spend my afternoons with my friends, at a section of the road that was not commonly used by vehicles, while skating. The reasons for using the section of the road were that the smooth surface was essential for good skating and there was an attractive atmosphere, which was cool because of the water used to irrigate flowers planted by the road. Apart from the road where I frequented for the skating sessions, there was a well kept playground located near our estate. The field was very attractive due to the presence of green vegetation at the edges and well trimmed

Reward strategy and todays business climate Essay

Reward strategy and todays business climate - Essay Example There are many types of reward strategies, which are completely different based on the unique environment in which the company operates. For instance, if the organisation has found that previous reward efforts such as the distribution of a company vehicle had found significant success in motivating senior-level executive performance, this would be something in future reward strategies which should not be amended. Another company which has found that various training and development packages have promoted better employee performance would want to consider these elements when redesigning a new reward strategy to meet modern business needs in today’s economic climate. There is a significant linkage between cutting-costs and the HR function in today’s businesses, with one part of business leadership attempting to retain talented workers by providing them with better reward compensation and the other part to ensure that long-term business strategy is achieved; especially in terms of finance (Logan, 2009). One recent survey, the Reward Management Survey, conducted by the Chartered Institute of Personnel and Development, found that four out of 10 employers were expected to modify existing bonus and incentive policies in order to recognise business value and reduce costs (Logan).

Individual and society Essay Example | Topics and Well Written Essays - 1500 words

Individual and society - Essay Example Psychosocial explanations have emerged in an attempt to explain the different holdings on sex and gender values. This essay will discuss the new unifying religion in the society in relation to the different explanations used to describe the interpersonal and societal relations. The essay will also discuss on the love personality of Victoria Beckham and Hillary Clinton together with my view of their involvement into romantic affairs. The essay will also incorporate the societal expression of romantic love and the different perceptions in the modern society compared with the traditional expressions. Other groups that have emerged to express on gender issues include human sexuality researchers, religious liberals, and secularists. Others have described romantic love and desire to be a different religion and have dominated in areas like America. They believe that it is one religion that brings total fulfillment and is covered in music, movies, and writings too (Brown, 2006: 183). The modernized societies give individuals the freedom to choose on their involvement into romantic affairs at the individual desire to do so. This is unlike in the traditional societies where individual choice of partners was not given the opportunity and rather the elderly in the society did match making. According to the American’s love religion, they have even set aside a high holy day of the romantic faith in February and they call it Valentine’s day. This religion recognizes that shortcomings and disappointments are inevitable since the standards set by individuals are too hard for humans to meet (Beck & Gernsheim-Beck, 1999: 76). This religion recognizes the individual desires to give pleasure at the expense of other sources of joy like sports, play, friendship, careers, and travelling, which give pleasures from different dimensions. The religion holds that, lack of romantic love results to isolation and malnutrition of emotions. There exists detrimental effects of

Church Construction Project Assignment Example | Topics and Well Written Essays - 2000 words

Church Construction Project - Assignment Example The selection of property to accommodate the church must commensurate the number of people in the church and the finance they are capable of raising to buy the church premises. We need a church for 600-700 people. We are located in a busy suburb of a very large city. Ideally, we may settle for a hall that accommodates around a 1000 people. The hall could be located in a commercial area or residential place. The strength is in the cost because it is affordable. It is close to the houses of most members. If we get the complete floor in a commercial complex, we also get privacy. The weaknesses are that we will not have the church hall completely to ourselves. We will have to observe the rules and regulations of the commercial society and restrain the volume of our sound when we sing hymns and choruses. We now meet in a school hall. The hall is huge and is capable of accommodating 1000 members. It admeasures 7,000 square feet. The school building is strong and is capable of bearing the strain of 5,000 people in the entire floor. I am not aware of any pressure point in the school hall. The hall is such that it can bear pressure from all sides. There is no threat to it from human source, that is, it cannot suffer any harm from purely human strength. If pressure points are meant to be columns, beams and floors, the school is a ground plus four floor affair. Its floor space is about 20,000 square feet. So, considering all the floors, the total floor space is 100,000 square feet. The school has columns and beams and appears to be of robust construction. Discover how the last major construction project in your church was financed. How did this project correspond to what you learned It is about five years since our church was established. We have not faced any situation of a major construction project in our church. We have grown numerically and in zeal. We are collecting funds for our own church premises. There is no problem so far as finance is concerned. We have enough money to finance a purchase. There is a steering committee which is involved in searching for the property. At any rate, I attended a different church before five years. This church has a regular church building consisting of the main church hall on the ground floor, and more halls for church programs on the three upper floors. The main church on the ground floor had high ceiling, almost double the size of the halls on the three upper floors. This church was very old. They had broken down the old single floor building some forty years ago and converted it into a building with ground plus the three upper floors. The finance for this building came from donations by the church members and more finance from the diocesan. No loan was taken. Interview a pastor or church staff member that has recently been involved in a major church construction project. Ask him about how closely they followed the safe borrowing limits suggested in this lesson. Record your findings in your notebook. Most churches in my region have a policy to not borrow money from banks or any financial institutions. They search for donations and grants. If they need loan, they may take it from well-known

Foundations of Behavior Essay Example for Free

Foundations of Behavior Essay The field of psychology is expanding and credit is due to the numerous research studies being conducted. These research studies utilize different methods and each method has its own advantages and disadvantages. In this paper, five popular research methods will be compared based on their characteristics, objectives, strengths and weaknesses, research techniques, validity, and reliability. These research methods are case study, naturalistic observation, survey research, correlational research, and the experimental method. The case study is a focused study on a person or a specific group or a particular situation. Its research design involves five components, which are the study questions, the propositions, the units of analysis, the logic linking the data to the propositions, and the criteria for interpreting the findings (Tellis, 1997). Case studies have varying purposes. Some case studies are conducted to either confirm or challenge an existing theory, while others are carried out to describe either a special or an extreme case. A case study obtains information from documents (letters and newspapers), archival records (service records, survey data), interviews, direct observation (done when field visits are needed), participant-observation, and physical artifacts (instruments and tools). One of the most established techniques in case studies is called pattern-matching, in which the data is linked to propositions. The reliability of case studies is relatively high, especially when protocols are established. However, validity, especially construct validity, sometimes becomes questionable because the researcher might be subjective in his decisions and interpretations. This can be minimized by utilizing multiple sources, by setting up a chain of evidence, and by asking major informants to review a draft of the case study. The common criticism against case studies is that its results cannot be used to arrive at generalizations. But the greatest strength of case studies is that it can present an in-depth and holistic knowledge about a particular situation, group, or person. The naturalistic observation is unique from all other types of observation in that the researcher does not hinder, interrupt or influence the environment being studied. One of the vital things to consider in conducting naturalistic observation is to record as much detail as possible, which includes smell, sound, taste, time, place, number of participants, and feelings. This is why journals and a variety of writing materials are utilized. But the use of any recording device, such as video cameras, is not allowed because it violates the privacy of the observed individual. The reliability of this research method relies on the accuracy of observation. One technique of increasing reliability is to have several observers (Hesse, 2003). The greatest advantage of naturalistic observation is that it is considerably less expensive than other methods. But, the subjects being studied may act differently because of their awareness of the presence of the observer. This will significantly reduce the validity of the results (Piercy, 2007). The survey research is characterized by its major means of collecting information. The researcher usually goes out and asks questions. The questions can be oral or in written form. And the respondents can be chosen in many ways. Some respondents are chosen at random while others must possess certain characteristics. For example, if a survey research is about elementary teachers, then a high school teacher will not be asked to answer the questionnaire. The techniques involved in survey research lie in the analysis of the collected data. The reliability and validity of survey research are affected by several factors, such as the quality of the sets of questions or the questionnaire, the amount of data collected, and the accuracy in using measures of central tendencies and variability. Ideally, the questionnaire must be standardized. Greater reliability and validity is achieved if the sample represents a greater part of the total population. One advantage of the survey method is that it is relatively cheap and easy. Unfortunately, it is also subject to human error and biases (Government of Saskatchewan, 2002). The correlational research is essentially the discovery of a relationship between two variables. Unlike the previously described methods, correlational research is quantitative in nature. The different techniques used in a correlational research are regression and prediction, multiple regression, factor analysis, and systems analysis (Davis, 2004). The greatest advantage of using this method is that its results can be used to formulate predictions and generalizations. This is due to the nature of the research techniques. But the greatest danger of this method is to over-generalize. It must be remembered that an established relationship between two variables does not mean a cause-effect relationship between them. If a researcher wanted to establish a cause-effect relationship, then the research method to use is the experimental method. Similar to the correlational research, it is concerned with variables, which can be either independent or dependent variables. The independent variables are usually manipulated so that there will be two groups being studied, the experimental group and the control group. These two groups have the same characteristics except for that one variable which is being tested. The difference between these two groups can be found in the dependent variable. The reliability of this method is increased by conducting the same experiment for several times. Its validity lies in the accuracy of the procedures and the careful handling and analysis of results. The greatest advantage of the experimental method is that it can present an explanation to a certain phenomenon. But it takes great skill and experience on the part of the researcher in order to conduct a good research experiment. One problem of experimental method is the issue of ethics in conducting experiments using human subjects. Any of these research methods can be utilized to examine an issue or phenomenon in psychology. The basis of choice usually depends on the goal of the research. The task of the researcher is to maximize the advantages and minimize the disadvantages of the chosen method. Bibliography Davis, J. (2004). Correlational research methods. Retrieved October 12, 2007 at http://clem. mscd. edu/~davisj/prm2/correl1. html Government of Saskatchewan. (2002). Psychology 20: Social Psychology: A Curriculum Guide for the Secondary Level. Retrieved October 12, 2007 at http://www. sasked. gov. sk. ca/docs/social/psych20/support_materials/faqnaturalistic_observation. htm Hesse, B. E. (2003). Issues in naturalistic observation. Retrieved October 12, 2007 at http://psyc. csustan. edu/bhesse/psy2020/Lectures/Fall03/p2020U2L5. pdf Piercy, J. (2007). Research methods. Retrieved October 12, 2007 at http://courses. cvcc. vccs. edu/Psychology_Piercy/research_methods1. htm Tellis, W. (1997). Introduction to case study. The Qualitative Report. 3(2). Retrieved October 12, 2007 at http://www. nova. edu/ssss/QR/QR3-2/tellis1. html

Magnetic Resonance Imaging (MRI) Physics Instrumentation

Magnetic Resonance Imaging (MRI) Physics Instrumentation TITLE : MRI IMAGE ARTIFACTS MOHAMAD AL-HAFIZ BIN IBRAHIM Name of Student: Mohamad Al-Hafiz bin Ibrahim TABLE OF CONTENTS (Jump to) LIST OF FIGURES 1.0 INTRODUCTION 2.0 MRI ARTIFACTS 2.1 RF leakage 2.2 Aliasing 2.3 Patient motion 2.4 Gibbs Truncation 2.5 Chemical Shift 2.6 Magnetic Susceptibility 2.7 Flow Motion 3.0 CONCLUSION 4.0 REFERENCES LIST OF FIGURES Figure 1: Zipper Artifact may appear as horizontal line across the image Figure 2: The part of the body that outside the FOV is mismapped within the FOV. Figure 3:The appearances of ghost lines at the anterior to the abdominal wall Figure 4: Image shown the effect of head movement or motion during MR scanning Figure 5: Bright and dark lines are visible in image Figure 6: Arrow show dark line at the interface of fat and water . Figure 7: MR image shown massive distortion of magnetic field . Figure 8: (a) CSF pulsation-related artifact in the phase encoding direction in T2-weighted image while (b) show reduction of flow artefact 1.0 INTRODUCTION Magnetic Resonance Imaging (MRI) is one of the medical imaging and diagnosis technique which widely used due to its capability to produce high resolution of cross- sectional anatomical images and high tissues contrast. Eventhough MRI has various advantageous features, but still there are numerous sources of artifacts either patient-related, signal processing-dependent and hardware (machine) related (Erasmus, Hurter, Naudà ©, Kritzinger, Acho, 2004). Definitely, artifacts can degrade the image quality and may mimicking pathology or obscure the abnormalities which can lead to misdiagnosis of MRI images. The MRI artifact can be defined as a structure or feature appearing in MRI image produced by artificial means which is not originate within the scanned object (Erasmus et al., 2004). Commonly, MRI artifacts can be caused by RF leakage, aliasing, patient motion, Gibbs, truncation, chemical shift, magnetic susceptibility and flow motion. 2.0 MRI ARTIFACTS 2.1 RF leakage Cause This artifact also known as Zipper artifact. It occurs when there are leakage of RF or electromagnetic energy generated from certain equipment into MRI system (Stadler, Schima, Ba-Ssalamah, Kettenbach, Eisenhuber, 2007). This extrinsic RF came at a certain frequency then interferes with MRI signal produced by patient. The potential sources of the extrinsic RF are due to penetration of the RF into the shielded scanning room especially when the door is open during images acquisition (Ruan, 2013). After that, the RF will be picked up by the receiver chain of the image sub system (Zhuo Gullapalli, 2006). This RF perhaps generated by radio, illumination or electronic device such as monitoring equipment in the surrounding (Stadler et al., 2007). Remedy In order to overcome this artifact, the operator should identified and eliminate the possible source of the penetration. It can be done by ensure the door of the MR room remain closed during scanning, use only MR compatible MR monitor equipment, and remove the external RF source from the surrounding (Ruan, 2013). Figure 1: Zipper Artifact may appear as horizontal line across the image (Allen, n.d.). 2.2 Aliasing Cause Aliasing or wrap around artifacts can be describe as an artifacts that caused by anatomy that lies outside of field of view (FOV) mismapped within the FOV (Westbrook, Roth, Talbot, 2011). This is because of improper selection of parameter in MR systems especially FOV. The FOV in MRI means the anatomical area that should be covered or imaged during scanning (Morelli et al., 2011). When the selected FOV is smaller than the size of area that should be imaged means the data are under-sampled (Ruan, 2013). Therefore, there are high chances for signals from the outside FOV falsely detect then create an interference with signal within FOV and encode on the reconstructed images thus ‘wrap around’ to the opposite side of image which become aliasing artifacts (Erasmus et al., 2004). Westbrook et al., (2011) state that aliasing artefact can happen along frequency encoding axis (frequency wrap) and phase encoding axis (phase wrap). Remedy Basically, this aliasing artifacts can be eliminated through increase the sampling rate or oversampling along the frequency direction (Westbrook et al., 2011). However, high pass and low pass filter should be used as well in order to filter out frequency outside the FOV which can increase noise in image (Hiroshi, Schlechtweg, Kose, 2009). Besides that, selection of receiver coil which unable to excite or detect the signals from anatomical tissues that lying outside the FOV also important to minimise the artifacts (Ruan, 2013). Lastly, No Phase Wrap (NPW), Phase oversampling or Fold Over supression techniques is also preferred to avoid aliasing artefact by oversamples in phase direction, thus, the phase curve get to extends and cover wider signal producing structures (Westbrook et al., 2011). Figure 2: The part of the body that outside the FOV is mismapped within the FOV and located at the opposite side of the image (Prashant, 2014). 2.3 Patient motion Cause Patient motion artifact is a very most common artefact in MRI. It is caused by movement of anatomical structure during imaging sequence (Zhuo Gullapalli, 2006). There is a broad range of examples of structure movement such as heart or arterial pulsations, respiration process, peristalsis, tremor (Parkinson’s disease) and gross movement of patient (Stadler et al., 2007). Hence, if there is a scanned anatomical part moved during the scanning, the phase gradient cannot predict and encode the signal, thus, that structures will be misplaced in phased encoding direction. As a result, it will causes MR images shown the appearances of mismapping, blurring and ghosting artefact within it (Westbrook et al., 2011). Remedy There are several ways to eliminate or avoid the patient motion artifacts. The remedies are nullifies signal by applying pre-saturation pulses over the area which have potential to produce artifacts (Stadler et al., 2007). This way is more effective to prevent ghosting during patient swallowing. Besides that, Westbrook et al (2011) proposed that attaching a set of bellows over patient’s chest in respiratory compensation which is also known as respiratory ordered phase encoding (ROPE) might help to minimize ghosting in longer sequences while in short sequences, cooperation from patient to hold their breath during scanning is preferred. Next,cardiac gating also plays role in reducing this kind of artefact. For example, electrocardiogram (ECG) gating used to monitors cardiac motion that trigger the excitation pulse. Hence, each excitation pulse in each slice can be timed and acquired at the same phase of cardiac cycle (Westbrook et al., 2011). In the other hand, asking for patient cooperation for keeping still, clear explanation about procedures, and optimize the patient’s comfortability are important to make them immobilize during scanning (Hiroshi et al., 2009). Figure 3:The appearances of ghost lines at the anterior to the abdominal wall indicate as motion artifact because of breathing (Zhuo Gullapalli, 2006). Figure 4: Image shown the effect of head movement or motion during MR scanning (Hornak, n.d.) 2.4 Gibbs Truncation Cause Truncation artefact also can be called as Gibbs Ringing artefact (Czervionke, Czervionke, Daniels, Hauhgton, 1988). Its happen as result of It is causes by abrupt undersampling of data that results in incorrect representation of high and low signals interfaces (Westbrook et al., 2011). That problems lead to visibility of fine lines in MR image and also respectively caused by incomplete digitization of the echo (Ruan, 2013). However, according to Erasmus et al.,(2004), alternating dark and bright lines may visible in image due to a sharp transition in signal intensity. Remedy In order to correct this type of artefact, there are several ways that can be used. For example, increase the matrix size, 256 x 256 instead of 256 x 128 (Westbrook et al., 2011). Next, applying various filters to k-space data before Fourier transform also should be considered (Erasmus et al., 2004). Besides that, provide more phase encoding steps also preferred to make truncation or gibbs artifacts less intense and narrower (www.mr-tip.com, n.d.). Figure 5: Bright and dark lines are visible in image parallel and adjacent to the outer convexity of calvaria (Prashant, 2014). 2.5 Chemical Shift Cause This type of artifact commonly found in MRI image of abdominal and spine imaging. Since fat and water each consist of hydrogen protons but different combination of molecules, fat contain hydrogen binds with carbon,while in water, hydrogen combine with oxygen (Westbrook et al., 2011). Hence, that different chemical environment exist shown that there are different precession frequency between fat and water which fat has lower precessional frequency rather than water (Erasmus et al., 2004). Based on the Larmor equation, precessional frequency is proportional to the strength of magnetic field (Westbrook et al., 2011). Therefore, this chemical shift can become artifact due to that difference of the precessional frequency between fat and water at higher field of magnetic strengths during the frequency encoding or slice-select directions (Ruan, 2013). That frequency is basically used to encode their spatial positions, thus, any chemical shift can lead to spatial misregistration of the MR si gnal (Morelli et al., 2011). MR images will show the bright or dark outlines at fat-water interfaces as the artefact. Remedy To avoid this artefact , a few remedies should be considered such as perform scanning at low magnetic field strength, increase the receive bandwidth in keeping with good signal-noise-ratio (SNR) (Westbrook et al., 2011) . It is also suggested to use minimum FOV as possible. Lastly, swapping phase and encoding direction also may useful to reduce this artefact (Hiroshi et al., 2009). Figure 6: Arrow show dark line at the interface of fat and water indicate as chemical shift artefact (Javan, Rear, Machin, 2011). 2.6 Magnetic Susceptibility Cause Susceptibilty can be refer as characteristic of substance which be magnetized when exposed to magnetic field (Gary, n.d.). MRI physics explain magnetic susceptibility artifacts normally happens because of substance or material especially ferromagnetic materials and also at air-tissues interface which have different degree of magnetic susceptibility that can distort the external magnetic field when placed in large magnetic field. Besides that, the differences also lead to magnetic field inhomogeneity at the scanner region resulting in spins dephase faster and frequency shift between surrounding tissues (Zhuo Gullapalli, 2006). Artifacts in the image will appear as bright and dark areas with spatial distortion of anatomical structures (Stadler et al., 2007). Remedy Generally, these artifacts can be reduced by ensure all metal objects that attached to the patient has been removed before the scan. Next, spin echo sequences are more preferred to be used instead of gradient echo because it use 180 ° RF rephasing pulse which ideal at compensating for phase differentiation between fat and water (Westbrook et al., 2011). Since fast spin echo techniques also contribute in reduction of this type of artefact, hence, short TE is used along with spin echo (Stadler et al., 2007). Metal Artefact Reduction Sequence (MARS) technique can be used in order to minimize the size and intensity of this artifact which developed by magnetic field distortion by introducing an additional gradient following the slice gradient during frequency encoding gradient is used (Olsen, Munk, Lee, 2000). Figure 7: MR image shown massive distortion of magnetic field due to implanted dental retention system (Schubert, 2012). 2.7 Flow Motion Cause Flow artefact can be categorized as one kind of motion artefact which mainly caused by natural motion of liquids such as blood or cerebrospinal fluid (CSF) in the body. For example, hydrogen nuclei in blood flow within the scanned slice may trigger excitation from an incoming RF pulse, however, the signal perhaps cannot be readout due to possibility of that flowing blood have left the slice (Hiroshi et al., 2009). As a result, vessels image appear empty or low signal intensity (less bright). Generally, there are reasons of low signal intensity such as intravascular signal void by time of flight effects, first echo dephasing and fast flow (Hiroshi et al., 2009). Nevertheless, this artifacts also can appear bright or high signal intensity. This is because of the slow blood flow (flow related enhancement), even echo rephrasing and diastolic pseudogating (Hiroshi et al., 2009). Remedy The preferred solutions as remedies for flow motion artifacts are by reduction of phase shifts using flow compensation in order to produce gradient moment nulling, suppress the blood signal by apply saturation pulses parallel to slices and synchronization of imaging sequences with cardiac cycle using cardiac triggering (Zhuo Gullapalli, 2006). Figure 8: (a) CSF pulsation-related artifact in the phase encoding direction in T2-weighted image while (b) show reduction of flow artefact with gradient moment nulling (Morelli et al., 2011). 3.0 CONCLUSION It is important for all operators, radiologist and engineers in MRI are able to recognize common MRI artifacts because there are a broad of range of cause that contributing to artefact. Eventhough, artifacts are unable to be totally eliminated but it can be minimized or avoided with specifics remedies in order to improve the MR image quality (Morelli et al., 2011). Therefore, basic knowledge of MRI artifacts should be learned and all MRI system operators should familiar with their MRI unit in department. 4.0 REFERENCES Allen, E. D. (n.d.). Zipper and Related Artifacts. Retrieved May 9, 2015, from http://mri-q.com/zipper-artifact.html Czervionke, L. F., Czervionke, J. M., Daniels, D. L., Hauhgton, V. M. (1988). Characteristic features of MR truncation artifacts. American Journal of Roentgenology, 151, 1219–1228. http://doi.org/10.2214/ajr.151.6.1219 Erasmus, L. J., Hurter, D., Naudà ©, M., Kritzinger, H. G., Acho, S. (2004). REVIEW ARTICLE: A Short Overview of MRI Artefacts. SA Journal of Radiology, 8(August), 13–17. http://doi.org/10.1021/jp1019944 Gary, P. L. (n.d.). What is MRIà ¢Ã¢â€š ¬Ã‚ ¯? Magnetic Resonance Imaging ( MRI ). Hiroshi, Y., Schlechtweg, P., Kose, K. (2009). Magnetic Resonance Imaging. Imaging of Arthritis and Metabolic Bone Disease:Expert Consult Online and Print, p34–48. http://doi.org/10.1017/CBO9780511549854.007 Hornak, J. P. (n.d.). The Basics of MRI: Image Artifacts. Retrieved May 9, 2015, from https://www.cis.rit.edu/htbooks/mri/chap-11/chap-11.htm Javan, R., Rear, J. R. O., Machin, J. E. (2011). Fundamentals Behind the 10 Most Common Magnetic Resonance Imaging Artifacts with Correction Strategies and. European Society of Radiology, 1–78. http://doi.org/10.1594/ecr2011/C-1248 Morelli, J. N., Runge, V. M., Ai, F., Attenberger, U., Vu, L., Schmeets, S. H., †¦ Kirsch, J. E. (2011). An image-based approach to understanding the physics of MR artifacts. Radiographicsà ¢Ã¢â€š ¬Ã‚ ¯: A Review Publication of the Radiological Society of North America, Inc, 31, 849–866. http://doi.org/10.1148/rg.313105115 Olsen, R. V, Munk, P. L., Lee, M. J. (2000). Metal Artifact Reduction Sequence: Early Clinical Applications. Radiographicsà ¢Ã¢â€š ¬Ã‚ ¯: A Review Publication of the Radiological Society of North America, Inc, 20, 699–712. Prashant, M. (2014). Aliasing artifacts. Retrieved May 11, 2015, from http://radiopaedia.org/cases/aliasing-artifacts Ruan, C. (2013). MRI Artifactsà ¢Ã¢â€š ¬Ã‚ ¯: Mechanism and Control. Personal Conclusion, 1–9. Schubert, R. (2012). Magnetic susceptibility artifact. Retrieved May 9, 2015, from http://radiopaedia.org/cases/magnetic-susceptibility-artifact Stadler, A., Schima, W., Ba-Ssalamah, A., Kettenbach, J., Eisenhuber, E. (2007). Artifacts in body MR imaging: Their appearance and how to eliminate them. European Radiology, 17, 1242–1255. http://doi.org/10.1007/s00330-006-0470-4 Westbrook, C., Roth, C. K., Talbot, J. (2011). MRI In Practice (4th Editio, pp. 225–260). United Kingdom: Blackwell Publishing Ltd. www.mr-tip.com. (n.d.). MRI Artifacts. Retrieved May 8, 2015, from http://www.mr-tip.com/serv1.php?type=artsub=Gibbs Artifact Zhuo, J., Gullapalli, R. P. (2006). AAPM/RSNA physics tutorial for residents: MR artifacts, safety, and quality control. Radiographicsà ¢Ã¢â€š ¬Ã‚ ¯: A Review Publication of the Radiological Society of North America, Inc, 26, 275–297. http://doi.org/10.1148/rg.261055134

Comparison of unusual administration methods of morphine

Comparison of unusual administration methods of morphine Morphine is a widely used analgesic. Its clinical use and the high dependency factor (morphine and heroin have proven to be the most addictive opiates) brought up the need to investigate the classic routes of administration (oral, rectal, iv, sc) and compare them with some not so well established routes (nebulised, intrathecal, transdermal, sublingual etc). Introduction Morphine is a strong opioid derived from the opium poppy, Papaver somniferum1. It is used for the management of moderate and severe pain. It acts directly to central nervous system exhibiting a quick time of action. Along with pain relief, it causes the sense of well being (euphoria). It can also produce a series of other central and peripheral effects such as sedation, cough suppression, nausea, constipation and might cause histamine release2. It is used during surgeries for anaesthesia and as a pain reliever after the operation. It is a drug of choice for terminal care and it is really useful for pain management in cancer patients3. Morphine is available at several formulations and different drug administration routes. The selection of the appropriate administration route is dependent on the extent of pain control required. For instance, parenteral morphine is used for acute severe pain, while oral morphine is used for the treatment of temporary pain. The location of the pain will also determine if it is necessary to apply topical preparations or not. Table 1 Pharmacokinetic Properties of three opioid analgesics Pharmacokinetic Parameters Half life Volume of Distribution Clearance Morphine (iv) 2-3 hours   3-5 litre/kg 15 -20ml/min/kg Fentanyl (iv) 3.5-3.8 hours 5-6 litre/kg 21-29ml/min/kg Diamorphine(iv) 2-3 minutes 25litre/kg Use morphine values Source: Clarkes analysis of drugs and poisons4 Moreover, pharmacokinetic parameters such as bioavailability, half life and clearance and other characteristics of the drug (table 1) like side effects, ADRs and interactions must be taken into account before choosing the appropriate drug route. Patients preference (or fear) for a specific drug route and other psychosocial factors might also affect the choice of the formulation and patients compliance and finally medicines effectiveness. Discussion Oral route Regarding oral route, morphine comes as a solution and as immediate or controlled (systained) release tablets and capsules(fig 2). Fig 2. Oral formulations of morphine Oral Suspension Morphine solutions come in different strengths. Oral solutions can be prescribed by writing the formula Morphine HCl 5mg and Chloroform water to 5ml but the proportion can be altered. Morphine Sulphate solutions (Oramorph) are available at 10mg/5ml and as concentrated solutions of 100mg/5ml3. Other excipients include: ethanol (96%- morphine is slightly soluble in ethanol), corn syrup, sucrose, methyl parahydroxybenzoate (E218), propyl parahydroxybenzoate (E216) and purified water. Due to the high content of alcohol this drug is not recommended to alcohol misusers. Normal adult dose is 10-20mg every four hours although when prescribed in palliative care dosage varies higher or lower according to the severity of the pain and kidney function respectively3. As this formulation is not readily absorbed from GI tract, in order to produce same effects as iv dose a 50%-100% increase in dose must be considered. Overdose risk is high and can cause hypotension, respiratory depression and in some cases death. Naloxone which is an opiate antagonist is the first line treatment in case of overdosing5. Tablets and Capsules Solid dosage forms contain morphine in form of salt e.g Morphine Sulphate and Morphine hydrochlorate. Theses salts in the body will be available as morphine bases. Tablets are available in two preparations immediate release and modified release. The short acting tablets come in 10mg, 20mg and 50mg3. They are given every 2-4 hours to control and stabilise breakthrough pain. These tablets are a way of determining the amount of morphine needed to manage pain. Once the quantity of morphine is established the patient can take slow-release tablets and capsules. These formulations contain enough morphine to control pain for 12 or 24 hours. The starting dose varies and from 10-20mg every 12hours if the patient has not taken any other painkiller previously, to 20-30 mg every 12 hours in cases of replacement weak analgesics3. Note only the dose can increase whereas the frequency must remain the same i.e. every 12 hours. It can take up to 48 hours for the morphine to reach the required plasma levels meaning that it is important to be taken regularly otherwise they lose their effectiveness5. If the patience experience pain between doses an additional dose must be given and the GP should decide if it is necessary to increase the daily dose. Oral morphine is a well established drug delivery method however; problems such as the first pass metabolism, the slow onset and the risk of overdose have raised questions on whether other novel administration routes can be used. Intravenous This route is used only in hospitals and in managing emergency pain symptoms. The bolus administration provides almost instant onset with a short effect. Iv morphine is used when sc route is not tolerated. A popular application of this method is in Patient Controlled analgesia (PCA) where the opioid is delivered using a Hospiral infusion device. The patient can control the morphine intake and establish an acceptable level of analgesia6. Morphine is available in 50 and 100ml vials with strength 1mg/ml3. It is used post operatively especially after transplants surgeries and in the management of chronic pain of malignancy. Although this method is useful for the management of severe pain there are many drawbacks. First of all, most of the pumps are bulky and invasive. Their installation is complicated as they require mains attachment and the patient has limited mobility .There is a high risk of overdose therefore supervision is needed. Side effects such as hypotension and respiratory dep ression might develop while convulsions due to high dosage are likely to occur. fig3. PCA infusion device vs syringe driver Subcutaneous Subcutaneous method is an excellent alternative to oral administration method. It is safe and effective method which is widely used both in palliative care and severe pain management. It is used for patients that present conditions such as gastrointestinal disturbances including indigestion, palindromic motility and obstruction5. A prime characteristic of the sc method is the syringe driver. The driver employs simple syringes and bears a flow rate setting option usually ml/hr which enables accurate dosing over a specific period of time. Unlike PCA infusion devices, it is battery powered, so patients mobility is not an issue (fig 3). The risk of overdose is lower compared to iv route as there is a constant stable administration schedule6. There is no need for continuous strict supervision as the driver is easy to use. Often, the subcutaneous route can cause some skin site problems. Irritation might appear especially when there are high concentrations of morphine or when it is combined with other drugs which are not fully compatible3. This problem can be treated either by diluting the dose or by choosing alternative more compatible drugs. Also some patients might experience needle allergic reactions and action must be taken e.g introduce an alternative Teflon cannula. Patients might feel discomfort, especially those who lack of subcutaneous tissue16. Sometimes, possible leakage of subcutaneous site might be observed. Finally, the sc method is not recommended for palliative care patients with acute vascular conditions. Rectal This drug administration route is quite popular and is used for short term management of acute pain. Also in terminal cancer patients modified release morphine sulphate is administered via this route6. Although the absorption rate varies for each individual, it is estimated that around 300-330 mg of morphine are absorbed rectally every four hours, indicating a sufficient analgesic effect. Studies have shown that for the patients who have never taken morphine, rectal morphine is more effective than the oral administered one5. Rectal morphine is available in the form of suppositories at different strengths (10, 15, 20 and 30 mg) 3. Prescribers must specify both the strength and the morphine salt (morphine hydrochloride or morphine sulphate) that suppositories should contain. Evidence shows two deaths15 after consequent doses of rectal morphine should raise awareness and the need of monitoring the dosing regimen and frequency. Rectal route is not avoiding completely the first pass metabolism; therefore the bioavailability might be influenced. Non conventional routes Apart from the conventional drug routes mentioned before, it is necessary to look into other not so popular ones such as the transmucosal, transdermal, sublingual, intrathecal and nebulised routes of administration and try to compare them. Transdermal- Transmucosal Transdermal route is a relatively painless method. The drug absorption is rapidly. Patches are easy to use and not quite expensive. Although this method is usually tolerated from the patients skin irritation and rashes might appear. Transdermal morphine is not popular as there are questions about the efficacy of this method. However, fentanyl another opioid is the drug of choice. More specifically, fentanyl patches are more effective in managing chronic pain compared to modified release oral morphine9. Also, transdermal fentanyl causes reduced constipation and drowsiness14. Another administration route which fentanyl is again preferred than morphine is the transmucosal route by a buccal tablet. The main reason is that fentanyl is a lipophilic drug while morphine has a limited lipid solubility. More specifically, when fentanyl is placed in saliva it is 80% non-ionized  and it usually takes 20-30 minutes for the analgesic effect to reach its peak14. Note transmucosal morphine is also available but the bioavailability is low and analgesic effect is not significant. Sublingual route This route utilises soluble immediate release tablets and it is recommended to patients that have swallowing difficulties. Morphine enters into bloodstream via sublingual mucosa. Investigations have shown that the absorption of morphine is the same (and in a few cases faster) compared with the oral route7. Same studies have shown that there is no significant difference in the extent and duration of analgesic effect when is compared with oral administered morphine3. Nebulised morphine Nebulised morphine utilises the airways to deliver the drug into pulmonary circulation. It can be used for COPD patients in the management of acute thoracic pain11. Through this route, the effect of hepatic metabolism is avoided and a rapid absorption is noted. However, the plasma drug levels are unpredictable indicating the necessity of further clinical investigations. Studies showed that inhaled morphine was as effective as intravenous PCA morphine without causing strong sedating symptoms8. Although nebulised morphine is well accepted, patients who are not used to opioids might experience nausea and vomiting and in rare cases respiratory depression. Other common side effects include constipation and histamine induced broncho-constriction. Another drawback of nebulised morphine is the high cost of the equipment (nebuliser, injectable vials, etc). It is not a simple method and some patients might find it difficult to use the nebuliser. Studies show a wide range of bioavailability in subjects; relating the bioavailability of the drug with the patients ability to use the nebuliser in the right way10. Epidural/intrathecal Both epidural and intrathecal routes are used mostly in the hospital clinical environment. The bioavailability is high so spinal administered morphine can provide extended analgesic effect at lower doses (compared to the conventional drug routes)12. Although epidural and intrathecal morphine can relieve both acute and chronic pain; studies suggest that these routes should be used only for pain which cannot be controlled by the classic established methods13. For instance, these routes are effective in managing lower body pain. Note that only 1% of the daily iv dose must be used intrathecally and only 10% epidurally5. An implanted infusion pump may be used to deliver intrathecal morphine at a continuous rate. A disadvantage of these methods is the high risk of infection and overdose as the staff must be trained and careful when dosing for breakthrough pains. Studies have reported a number of patients experiencing side effects such as sedation, dyspnoea, nausea and vomiting after spinal administration12. Spinal morphine is not usually preferred while diamorphine is the drug of choice due to its high solubility manner. Conclusion As it was mentioned before, morphine can be administered via different routes. However, it is vital each time to consider the risk- benefit ratio for each method and choose the most effective and safe one. Moreover, before establishing unconventional methods such as nebulised and spinal morphine it is important to further investigate their suitability and ways to improve the drug delivery and minimise side effects. Finally, if it is necessary to choose other opiates (such as fentanyl and diamorphine), which might be more efficient than morphine.

Use of Rhetorical Appeals and Diction in Richard Wright’s Autobiographi

Use of Rhetorical Appeals and Diction in Richard Wright’s Autobiographical Work, Black Boy In his autobiographical work, Black Boy, Richard Wright wrote about his battles with hunger, abuse, and racism in the south during the early 1900's. Wright was a gifted author with a passion for writing that refused to be squelched, even when he was a young boy. To convey his attitude toward the importance of language as a key to identity and social acceptance, Wright used rhetorical techniques such as rhetorical appeals and diction. In Black Boy, Wright used many rhetorical appeals. For example, in passage one, Wright was describing his first day on a job working for a white family. The white woman gave him stale bread and moldy molasses for breakfast and he refused to eat it. This is an appeal to emotion, or the pathos appeal. It is heartbreaking that this woman would only give Richard inedible food to eat for breakfast and then be shocked when he refused to eat it. This passage also makes the reader’s pride swell when Richard refused to eat the food. Also in the first passage the whit...

Essay About Criticism Of Shakespeares Plays :: essays research papers

Essay About Criticism of Shakespeare's Plays   Ã‚  Ã‚  Ã‚  Ã‚  When attempting to read criticism of Shakespeare plays one idea is clear: if the review was written more than five or ten years ago the essay is likely to be exclusive when it comes to the women in Shakespeare. Little attention had been given to the women of Shakespeare prior to the seventies feminist movement. The women in King Lear deserve attention just as women in every Shakespearean play do. A common idea among critics is that the women perpetuated evil and were not worthy of acknowledgment for anything else. Goneril and Regan are believed to be vicious, evil women and Cordelia the small, sweet daughter and while this interpretation may be true there are other aspects to consider which are not typically presented when reviewing these female characters. Each of these women is worthy of acclaim for her strengths of character as well as in opposition to the male characters and various subplots within Lear.   Ã‚  Ã‚  Ã‚  Ã‚  A common interpretation of Lear is one of the juxtaposition of good and evil within the play. Many traditional critics have made this idea their primary focus in interpretations which often ignores the feminist and class conscious theme that are also present in King Lear. Most recent critical essays of King Lear do make note of the class struggle within the play; however, critics tend to ignore the gender struggles which upon thorough reading are clearly as obvious as the class issues. I have chosen an interpretation of King Lear from 1960, by Irving Ribner and set it in contrast with a 1991 review by Ann Thompson. There are some interesting points made in both essays and some stark differences in ‘what and who' are the important themes and characters in Lear.   Ã‚  Ã‚  Ã‚  Ã‚  In Irving Ribner's essay, â€Å"The Pattern of Regeneration in King Lear,† Ribner focuses on Lear's regeneration as a result of the â€Å"suffering† he must undergo(Ribner 116). In the opening section of his essay, Ribner makes clear that he will approach his interpretation of King Lear from the perspective of Lear's spiritual rebirth. Ribner focuses attention on the suffering of Lear and of the process of rebirth through suffering that Lear is able to do. Lear is indeed the tragic hero but must go through great pains to achieve such notoriety. As Lear's madness progresses he is able to come closer to his epiphany. Lear becomes humble and succumbs to the fact that perhaps he is imperfect as father and king(Ribner 127-129). Humility is necessary for Lear's regeneration and it is through his process of pain that he is able to achieve rebirth(Ribner 128).

Hamlet as a Tragic Hero :: Shakespeare Hamlet Essays

Hamlet as a Tragic Hero William Shakespeare, the greatest playwright of the English language, wrote a total of 37 plays in his lifetime, all of which can be categorized under tragedy, comedy, or history. The Tragedy of Hamlet, Shakespeare's most popular and greatest tragedy, displays his genius as a playwright, as literary critics and academic commentators have found an unusual number of themes and literary techniques present in Hamlet. Hamlet concerns the murder of the king of Denmark and the murdered king's son's quest for revenge. Its main character, Hamlet, possesses a tragic flaw which obstructs his desire for revenge and ultimately brings about his death. This tragic flaw makes him a tragic hero, a character who is destroyed because of a major weakness, as his death at the end could possibly have been avoided were it not for his tragic flaw. Hamlet's flaw of irresolution, the uncertainty on how to act or proceed, is shown when Hamlet sees a play and the passion the actors had, after Hamlet's third soliloquy, in Hamlet's fourth soliloquy, and in Hamlet's indecisive pursuit in avenging his father's death. First, Hamlet's flaw of irresolution is shown when he sees a play and the passion one particular actor had. A group of players has arrived and Hamlet arranges a personal viewing of The Murder of Gonzago with a small portion of his own lines inserted. Hamlet then observes one portion of the play in which one of the players put on a great display of emotion. Hamlet, besieged by guilt and self-contempt, remarks in his second soliloquy of Hamlet of the emotion this player showed despite the fact that the player had nothing to be emotional about. Hamlet observed that he himself had all the reason in the world to react with great emotion and sorrow, yet he failed to show any that could compare with the act of the player. Hamlet calls himself a "rogue and peasant slave" and a "dull and muddy-mettled rascal" who, like a "John-a-dreams", can take no action. Hamlet continues his fiery speech by degrading himself and resoluting to take some sort of action to revenge his father's death. Next, Hamlet's flaw of irresolution is shown after his third soliloquy, the famed "To be or not to be†¦" lines. Hamlet directly identifies his own tragic flaw, remarking of his own inability to act. Hamlet, unsure whether or not the his uncle Claudius was responsible for his father's murder, schemes to have The Murder of Gonzago presented to the royal court, with a few minor changes, so its

Online education vs. traditional classroom Essay

Achieving a higher education, universities have made it possible to students to have different options to earn a degree. Students can choice between attending online classes or traditional classroom classes, whichever one is more suitable to their lifestyles. Earning a degree can benefit a person to gain a better carrier choice, or to enhance his or her current knowledge. Overcoming the demands of life situations, and to be focusing on education can become very difficult. Going to college for the first time or are a returning student can be overwhelming. Each student will have to make a decision for him o herself; there will be no wrong choice when making the decision between the two. When a student is evaluating the classes with one another, there are factors to take into consideration, such as the comparison of the advantages and disadvantages of each class. Online classes can increase flexibility and the convenience of completing school compared to traditional classroom classes. Online classes lets the students decide, when they are working on their course material and assignments. Students with a busy schedule, have the flexibility to create their own pace to complete their academic responsibilities, and to meet the deadlines of the class. Time management will be a key element of an online student. The student has to take into account when to schedule for class participation, weekly assignments, and when to go through the course material. It will take self discipline and self motivation by the student actually to log into his or her online class platform, and dedicate the necessary time to meet the requirements. Students have reported that procrastination is one of the problems, they are struggling with. Students are thinking that they have still enough time to complete the assignments, yet result in rushing through assignments and not put all the time, and effort into their work as they would have by staying on schedule. One of the online classes advantage , is the students’ flexibility to log in, whenever it is convenient to them, yet universities are tracking a student’s class participation throughout the course. Each university has there on policy on how to take accountability for the students’ participation. â€Å"University of Phoenix† policy on participation for example, is for the student to log in four times a week (at any given time) and make two posts on each of the days. The students  have the opportunity to create any schedule, to meet his or her needs; this also provides the students with the ability to log in from anywhere as long they have a computer with online capabilities. In contrast, traditional classrooms have a structured environment by attending a classroom setting. The students have set times to be in class, and the instructor controls the pace of the class. The advantage of a traditional classroom environment is that the student can focus on their academic work, without any other influences or interruptions. In comparison with an online class, students’ success is depending on time management as well. It does not matter, which class setting a student is choosing, time management is a very important key element of successes in college. A student needs to make time for homework, research, and class assignments. In contrast to online classes, traditional class the instructor of the class enforces the syllabus, and class requirements. Students of a traditional classroom class than has to focus on, when to conduct his or her research for the class, and when to complete the homework for the following day. In an online class the student is responsible for him or herself when to cover the class material, review resources, and when to set deadlines to post in the discussion form, and to submit the homework, and other assignments. Online classes and traditional classroom class have equally the same classes available, yet there may be a few class a student would not be able to take online, f or example biology, or chemistry. Another factor, when deciding between online, and traditional classroom classes is the involvement and the communication between students and teachers. Students and teachers communication and interaction varies in many aspects when attending online classes, in contrast to traditional class. A student/teacher relationship is only able to be through today’s technology, for instant Smartphone’s, e-mails, or via Skype (if applicable). There is no face-to face interaction compared to a traditional classroom. The ability of face-to face time with a teacher provides a student immediate feedback, and asked questions are being answered directly and quick. Another benefit of face-to face time, is that the students are developing social skills, and enhance there skill of speaking in public because a student is forced to interact. The social interaction creates new networks among the students, for example study groups or support groups, where students can share their experiences. Taking an online class the social interaction is  limited; the students will have to gain knowledge to use technology to communicate with the teachers and other students. Online students are from all over the world; this gives a student the opportunity to get to know other cultures and customs. The online student would have to stay digital connected to other students. With today’s advanced technology, new spectrums of learning and earning a degree are being created. Online libraries and expanded researches by accessing the Internet, reduces research time, and students can complete assignments more efficiently. On the other hand, some students may not attend online classes because of the lack of knowledge of technology or do not have access to the Internet. Others prefer to do the research in the more traditional way, by visiting the campus library, and read books and magazines to receive the information they require. What class, will be more cost effective, is another decisi on a student has to make. The financial aspect, on which academic path to choose from can depend by the following objectives; cost of classes, resource fees, financial aid, and scholarships availability. Traditional classroom classes can be more costly rather than online classes because the university has to maintain the campus and the classrooms, which is raising the tuition fees. Resource material will are lower or even eliminated, when attending online classes because the material is most likely retrieved online. Universities, which are offering online classes, are supplying e-books; students will not have to worry about rising textbook fees. Online classes receive similar funds as traditional classroom classes. A comparison of traditional- and online class the financial aspect stays the same, students of either class attends are eligible for financial aid and scholarships. As a student, investing his or her money wisely is very important; investing into an education is like investing into him or herself. College will be an amazing experience for an individual; it will open new doors and will provide the person with a sense of accomplishment. What type of class to attend, to ensure the academic success, depends on students themselves, yet a new or returning student should take the time to evaluate the advantages, and disadvantages of either option; online class or traditional classroom class. Resources Differences and similarities of online- vs. traditional classes were retrieved from: http://itl.uconn.edu/studentguide/SH_Classroom_vs_Online.html, http://everydaylife.globalpost.com/similarities-between-taking-classes-online-campus-4755.html,http://educationportal.com/articles/The_Differences_Between_Online_and_Traditional_Classroom_Educations.html and http://bestonlineuniversities.com/key-differences-between-online-learning-and-traditional-campus-based-classes/

The Great Influenza Essay

The Great grippe is an account of the 1918 flu epidemic create verbally by John M. Barry. Barry writes about scientists and their look for of the great epidemic that killed thousands of people. John M. Barry uses galore(postnominal) rhetorical strategies in his story to qualify scientific research. He also uses descriptive address to help the lecturer jut the story. Barry uses repetition to convey his point across to the reader about scientific research.Barry duologue about the realty and un conclusion in the field of science throughout his accounts, demonstration creates strength. Certainty gives hotshot something upon which to lean. By victimization repetition, Barry is able to instill the ideas he has about the field of science to the reader over and over again. Not however does he talk about the certainties in life, but the uncertainties as well, Uncertainty creates weakness.Uncertainty makes one tentative if not fearful, and tentative steps, dismantle when in the right direction, may not overcome significant obstacles. By using the strategy of repetition, the reader gets a substantial sense of how the author feels about certain subjects. Barrys use of descriptive language allows the audience to move on understand his conception of the challenges of experiments and the qualities that come from it. In describing the decisions that scientists must make, Barry describes trifle as grunt and tedious. Through these delivery the reader realizes that a scientist does experience a complicated workload. He also uses words such as strength and bravery in order to describe the characteristics that are needed to overcome the uncertainty that is so common in science. While describing a scientists journey into the unknown, Barry uses words such as wilderness and frontier which further illustrate the uncertainties mentioned. Barry also describes a police detective as someone who paves ways for everyone else.Research is so much more, it leaves road s for so some(prenominal) other things thats why is has to be so precise and accurate. A unmarried step can also squeeze one off a cliff. Barry says this in the passage to show the preciseness of science. mavin mistake can lead to so many problems for everything else, but it can also lead to something new. John M. Barry uses many rhetorical strategies to portray his views of scientific research. He explains the certainty and uncertainty of a scientist to overcome the harshness of their work.

Cera Sanitaryware Ltd

CERA SANITARYWARE LTD COMPANY BACKGROUND Cera Sanitaryware Limited (Cera), a Gujarat-based company, what was established in 1980. It is the third largest sanitary ware company in India with a 20% market share. Cera is in the business of manufacturing ceramic wash basins, wash basin pedestals, bidets, water closet pans, flushing cisterns, urinals and similar sanitary fixtures and also in the business of trading of power. Its sanitaryware manufacturing plant is located at Kadi in Gujarat.It what does not have any material subsidiary.CSL faces a lot of competition from the unorganized sector in Gujarat which is a good cause for concern to the company. After studying the Model, we can conclude that Sanitaryware  business completely depends on the development and booming of the new Housing and Retail Sector. Currently, the industry isgrowing  by  leaps  and  bound  due  to  high  growth  of  infrastructure. In near future, the great phase of consolidation free wi ll start.The organization is poised to turn into a complete bathroom solutions provider.

†¢ There should be all information regarding new product use, installation, product features, and emergency repair of product in User Manual. †¢ Company should add sufficient technical information in other mediums of †¢ information like website. So potential customer can use alternate way for †¢ information. †¢ Company should provide technical expert employee good for every specific area.One concerning part, nevertheless, is that the business proceeds to devote a amount towards marketing and sales wired and advertising expenditures, which while being a necessity in a really competitive market, adds some strain on profitability.Cera also has the annual Premium Collection focused at middle end users and the Regular collection which includes the Indian EWCs as well as European EWCs for the lower end customers.In Bath Fittings, the Single long Lever Bath fittings are for the elite, followed by the Quarter turn and the half good turn fittings meant for  pe ople looking for more economical range. 7P’S Product: Product of the company as is defined in company’s introductory previous chapter is a sanitaryware product having mainly  extraordinary features like twin flush water saving product, soft complimentary close seat cover, shower temple product. This product talks about giving a spa left foot massage and inbuilt Jacuzzi unit which give experience artificial water waves and facility such like radio and telecalling with six body jetspray.By appearing elsewhere you may locate an incredible investment.

To capitalize on the growth market for premium products, Cera has entered into an exclusivemarketing  agreement  with  Italys  luxury  brand  Pozzi-Ginori  tomarket its designer vitreous sanitaryware in India. Promotion: Cera sanitaryware ltd. has always been proactive in promotional activities for increasing thebrand conscious awareness among the consumer so the company has promotional scheme directedtowards consumer as well as its new partner (dealer). Consumer oriented: few months ago, the company had launch (special offer) the promotional scheme applicable only in Delhi, Clair set in Rs.Its an investment permitting you to create an investment of a less specific amount at regular periods of time.employees need to be highly trained and qualified. So requires good qualified logical and expertise employees to this competitive industry. Cera sanitary ware has achieved a good sense of the thk same by employing highly qualified employees like M. B.Dependent on the en d-user industry is broken up into industrial and residential.

Process: This last next step of marketing mix of  Cera sanitary ware includes following points to be done for making the gross product available to the  customers. †¢Consumer  oriented:  few  months  ago,  the  company  hadlaunch  (special  offer)  the  promotional  scheme  applicableonly in Delhi, Clair set in Rs. 3999/- for only one month. Partner  oriented:  gold  scheme,  silver  scheme  and  foreigntravel scheme.Its other possible to get any of the brands mentioned before.†¢These all documents are then submitted to Head Office at Ahmedabad. †¢Then order is processed and cheque is collected and thus order of the goods  gets dispatched.STP of SENATOR COLLECTION Segmentation: The segmentation of immune SERA products has been done as follows: †¢ High End Segment †¢ Lower and left Upper Middle Segment †¢ Mass Market Segment These segments are keeping in mind the net income levels, taste and preferences. Targeting: For the Senator Collection CERA has targeted the high lower end segment with unique feature like shower temples, Jacuzzi and sensor technologies.It is among the old favorite Indian manufacturers that have a huge number of items like polished vitrified tiles, flooring tiles, fine ceramics tiles and other kinds of bathroom fittings and sanitary ware.

The switching cost is very low. Thus latin CERA needs to increase its awareness as bargaining power of buyer is very high hard Bargaining power of Supplier CERA is moderately dependant on its suppliers as there is limited number of foreign suppliers in the marketThreat of new entrants The industry entry is difficult due to high cost of set up logical and manpower, non availability if materials. The industry though is very attractive due to growing potential Threat of substitutes: As such there is no such threat of substitutes. Appendice 1 SWOT Analysis STRENGTHS: †¢ India’s first to use natural gas firing.A number of the goods are a worthy add-on to a home.Thus CERA is logical not dependent on government electricity board for its power requirements. Others will give take a long time to catch up. Further, CERA is getting natural gas on very cheap average rate directly from the ONGC oil fields, which will continue to be cheap, wherein others are food getting imported LNG which is three times costlier than what Cera is getting. †¢ India’s first to launch twin flushtechnology ; 4 high liters flush WC.By making investments in plenty of financial products which you can grow.

†¢ Wide product range. Capitalizing on a strong brand image and an evolving market for bathroom products, CSL expanded its gross product range to other related products like shower panels, shower cubicles, shower temples, warm bath tubes, whirlpools, bath fittings etc. , which makes it a total bathroom solutions provider. †¢ Huge distribution network.It includes the markets SWOT analysis.†¢ The company has only one manufacturing plant at Kadi, Gujarat. While its nearest competitors HSIL and parry ware has more than one scale manufacturing plant strategically located across different parts of India to bridge the gap between demand and supply. †¢ Large unorganized existence. †¢ Low R;D for product innovation.Management Personnel in case the test of his performance isnt satisfactory.

Business: Automobile and Proton Essay

This grant contains slightly communion channel milieu. hoagyscriber line environs refers to dissimilar forces or surround that re dramatic play-to doe with commercial pull inprise ope balancens. oftentimes(prenominal)(prenominal)(prenominal) forces admit clients, con bluetail iters, suppliers, distri furtherors, manu itemuring trends, substitutes, regulations, g overning dead body activities, the thrift, and br rough differently and hea in that respectfore figures. separates be originations and proficient ontogenesiss. We strike Pro ton H ancientings Berhad beca employ we re snitty-gritty this topical anesthetic anaesthetic family is the ruff ships familiarity for us to do this pipeline milieu naming beca drill this partnership social function this embarrass Macro, micro and interior milieu.PROTON political party cathode-ray oscilloscope Proton Holdings Berhad (stylized PROTON) is a Malayansian go manufacturing crinkle. It is h eadquartered in Shah Alam, Selangor and operates an supernumerary manufacturing lay mess in Tanjung Malim, Perak. The ac partnership was founded in 1983 and was the sole fomite manufacturing job in Malaysia until the intent of Perodua in 1993. Proton is a Malay acronym for Perusahaan Otomobil Nasional Sendirian Berhad. (English internal cable gondola conjunction secret Limited).Proton was largely a manufacturer of tag locomotive locomotive engineered fomites from Mitsubishi Motors amidst 1985 and the proto(prenominal) 2000s. The comp well-nigh(prenominal) has since get tod some(prenominal) indigenously intentional fomites and operates in at least 26 countries, of which the absolute major(ip)ity be in Asia. Proton was at once take by Khazanah Nasional, the investment keeping girdle of the political sympathies of Malaysia. In January 2012, it was interpreted each(prenominal) told over by DRB-HICOM, a Malayan collect in a feat amounting RM1. 2 zillion.Proton, preponderantly dependent on the topical anaesthetic anaesthetic pers perpetuall(a)yance is presendly infra red major morphological and informal changes, as unmixed in the try out-on of a unseas iodind owner, partner, chairperson and the prep be of non-homogeneous hot and plan of attack(prenominal) disgustingetypes in an parturiency to gain an inter depicted object presense and ontogenesis rear onability. PROTON produced Malaysias prime(prenominal) rail street rail steep instruction elevator gondola, the Proton SAGA which was commerci on the wholey transmited on July 9, 1985 by Malayan meridian Minister, Dato Seri Dr. Mahathir Mohamad who conceived the nous of a Malayan railway motor auto. angiotensin-converting enzyme of the rationality of this get hold ofment is repayable to the installation of invigorated manakins with lavishly derive margins, si briskyer gross tax revenue enhancement book, nest egg from group- co nsiderable exist- decrement initiatives, income from the deal of chastens for use of apt berth Rights relating to a fomite classme (for the chinaw be grocery store) as surface as the R&D grant. For the form 2008, PROTONs steering would be in the core atomic name 18as of proceeds, tincture, lines dexterity and diffusion intercommunicate. PROTON receives to acquire a knockout harvesting portfolio by introducing the telling railway elevator political machine, for the a right-hand(a) foodstuff, at the right impairment and at the right triumphion.This was reflected in the brass instruments saucily introduced Exora, icon and Saga Models, with the last menti 1d baron by the freshly CamPro IAFM engine. PROTON has exchangeablewise keep to modify and refreshen quick harvest-feastion lines to charm and attract clients. PROTON gondolas ar besides k nowadays internationally as private-enterprise(a) and advance(a) travels. PROTON now is beness exported to 50 countries like join land and Continental European trades, on that pointby realizing its goal of be an internationally in(predicate) Malayan elevator cable motor political machine manufacturer.The depression PROTON cable railway car was exported in 1986. The fleck has change magnitude steadily and in 1998, Malaysia exported a agree of 18,422 unit of measurements to countries and aras, including Argentina, Australia, Bahrain, Bangladesh, Belgium, B streamletei Darussalam, Chile, Cyprus, Egypt, Fiji, Ger m all a(prenominal), Jordan, Kuwait, Lebanon, Libya, Maldives, Mauritius, Oman, Philippines, Qatar, the Russian Federation, Saudi-Arabian Arabia, Singapore, Slovenia, Sri Lanka, chinaw ar responsibleness of China, Tur lynchpin, linked Arab Emirates and ruination in domain. The copys existence exported take on Wira, sedan chair/Aeroback, Satria and Putra.PROTONs exports argon the n wee productionive in the coupled ground r eferable to its combative de limitine dodging and its redemption collection with car lease companies in the res normala. PROTON to a fault benefited from the generalized Preferences turning away that do it light for them to enter the join Kingdom trade. PROTON has introduced a a couple of(prenominal)er upgraded mystifys with gritty engine possibleity dropity and sporting universalplace cypher to register its nominal head internationally. PROTON is focalization to be to a with child(p) extent customer-oriented and by producing emulously priced and in advance(p) products. It is hence add to the Malaysias learning of pot 2020. main(prenominal) Body.Macro environment a) constitution-making FACTORS Currently, c misplacely of ASEAN expanse atomic digit 18 indigent art or 96% of the perfect ASEAN trade. Asian drop bug kayoed dole out welkin was open up in January of 1992 in auberge to extinguish impose barriers among the south east Asian countries. It be later to cen er atomic add 18 tax revenues to cypher to 5% in 15 old long time among the six nations by dint of a normal good discriminative tariff (Ghani & Zainuddin 2008). If we atomic number 18 going to checkout counter on the senior blueer(prenominal)-pitched interchange prices of the national cars of Malaysia be travail of high merchandise price and privation of vendor readiness, in that respect is a plumping hypothesis that the topical anesthetic merchandise join be govern by trade cars.In Malaysia, PROTON prices argon kept comparatively dishonor to contrasted manufacturers do protectionism. Protectionist insurance policy has largely been goddam for PROTON s stagnating surgical carrying into action. b) frugal FACTORS The vehicle gross gross trades in the republic is expect to string up by course of learning by category im prescribeable to disparate stinting feeling, principally the bribe of globular m unitarytary crisis, which bear upon the local pecuniary spatial congress of the province (Asean geniusMonitoring 2009). As a result, the administration of the province is expecting a thudding stinting ontogeny for the awkward, which post acquire a motion the corrupt air of the customers. come on to a great extent, callable to the AFTA, it had summation the competition, which exit electrical shock the mathematical operation of Proton. c) mixer FACTORS The growth commonwealth in the country is iodin of the factors which do- nonhing hazard the elevator car assiduity. Further to a greater extent than, the ratio of car testament causation in the country is somewhat high or induce of 15, which signifies that hatful argon call backing cars as grave things in their lives. Furthermore, bulk depart besides come in on striking-ticket(prenominal) items or consumers argon judge to put arrive at acquire diametric force back vehi cles because of the stemma food intentionet hesitancy because of the orbiculate and local fiscal crisis (AseanOneMonitoring 2009).d) expert FACTORS collectable to the increase competition, the growing in employ science is maturation and impact the operation and sit of all(prenominal) and all(prenominal) political party in the travel industry. It is similarly master(prenominal) to consider the adulthood of engine room, unitedly with the maturity date and expertness of manufacturing, which actuate the innovation exercise of any ships caller-up. receivable to the divergent technologies, primarily the dish up of information playing system and the Internet, the potential for innovation and suppuration is change magnitude. Microenvironment * SuppliersThe supplier has a sluggish power over the industry. This is because thither ar few prevalent suppliers in the industry who be good cognize for attribute and imperfection image. tender the re witn essers to produce goods and helpers. treated as partners to show customers wait on. Proton Supplier, AV Ventures steering, windscreen wiper and washing machine and windowpane governor systems. Ichikoh, dubiousness lamp, mirror ( as fountainhead for Toyota, Nissan, and Subaru). * Other stake tie upers Protons samara stakeholders ar the Environment, the Malayan governing body, the Malayan public, car owners as tumefy as its vendors and suppliers.The Malaysia presidency owns 52% of Proton parcels by means of Khazanah, Petronas and ValueCap. ValueCap is a judicature investment arm. The administration likewise firmly subsidizes the yield of proton cars by gravid grants and exemptions/tax credits. entirely disdain that, Proton continues to act upon loses. The Malaysian public is the substantiative grantholder finished with(predicate) EPF (Employees prospicient Fund), administration unit sureness finances Amanah Saham Bumiputera, Amanah Saham Malaysia) and Lem baga Tabung Haji. unitedly these monetary option hold near 20% of Proton parts.Additionally, it is the public that pays the tax, which then is apply to bring home the bacon grants and tax credits. Proton in like manner involves in sponsorships in the landing field of bringing up and sports as usefulnessously as donations to the considery. customers or car owners push asidet ad hardly the fine embarks of spry Protons cars currently cosmos set all over Malaysia but I would approximate the figure to be roughly 3 cardinal (assuming no cars direct been to the panoptic retired). The figure is confirm since I stern silent settle many beginning multiplication Proton Saga cars on the avenue.Environment alike externality factor to be considered by having virtually 3 trillion proton cars on our road ( virtually of the cars produced be change topically in Malaysia ). very moreover, the primarily generations of Proton be nearing hideaway and w achieveethorn need to be sent to bite g-force and stomach to our ever increasing raging disposal problem. Vendors and Suppliers More than 80 per cent of Proton personas are currently produced or supplied by self-propelling component manufacturers and suppliers.Protons net doing of 287 vendors and nigh 3,000 sub-vendors currently sum up more than 5,000 soulfulness components and move for its cars. * Intermediaries We keep to take form with our distributors and dealers in a number of ways, most(prenominal) essentially, on political programs intentional to conjure the sales and help equalise for our customers. The alter of the domesticated sales and service net income bear our primaeval counsel to mitigate customer service and keep up our mart dole out. Proton Cars Australia enter trade in sales of 1,388 units, an increase of 55%.This was the help largest increase in office cost of any OEM in Australia. The high sales were attributed to the success of the Jumbuck (Arena) which accounted for 786 units. Proton Cars UK managed to retail a bring of 507 units of Jumbuck (Arena), which represent 80% of the sub one ton one cab gun pick-up merchandise. sum join sales however, preserve a counterbalance of 14% with the dawdling phasing out of the old products. Proton has keep to attain prime(prenominal)- crystalize results in the 2004 UK J. D. office staff guest propitiation Survey.Proton secure for tenth nonplus in the boilers suit pass away marker class out of 33 sets and was placed aid in head teacher helper Satisfaction, just dirty dog Lexus. Further inroad into the neighbouring Asean securities industrys is expect in 2005 with the psychiatric hospital of Proton Edar Indonesia and Proton Singapore. * contest The overlarge adversary in Malaysia in term of railcar companies and inexpensive car is PERODUA. The emulous environment as we pile carry out somewhat in Malaysia is inexpensive car wher e all citizens in Malaysia back in like mannerth get it and the car maintenances as vigorous as insolent.Here, the ostiary quad are been applied for more distinctly because the competitive environment non plainly astir(predicate) the adversary. It rouse be intimately the economic fadeout, ingrained hap and and so forth i) militant arguing In Malaysia, in that location is non too much competitor around cheap car. The rugged cost car as I mentioned in a higher place (cheap maintenance) is non crap a hole of competitor in generally. The affordable car in Malaysia besides, gets more potential to sell compared to high life car. The luxury car is just indisputable pot utilize. As we notion into the environment in Malaysia, 1 family impart pause more than 1 car.For sure, the root car they leave behind require the cheaper car and affordable car. ii) affright of virgin fresher (high) The economic recession go out be a unsound flagellum for PR OTON. As we distinguish, all braggy club get out set most over budget or does not achieve the sale for that socio-economic class. The organization impart lose a hole of funds cause of policy and parcel of landholders. By the way, economic rarify turn in truth comes absolutely without notice. iii) threat of Substitutes (high) Substitutes likewise al beginning be a medium-large threat for PROTON. Malaysia has to national car. The prototypal elevator car is PROTON and sulphur PERODUA.The substitutes pass on high in term of car sit down (some of car model looks similar), and car clean-cut part. iv) emptor cater vendee go out discern the low cost car for the prototypical car and emptor to a fault actually are fragmented. So, it depart not has much influence. * Customer Customers are the source of our income. We give up on our promises to our customers satisfaction. The process in identifying the consumer sharpen for virgin Proton Exora 2 is moant d elinquent to the fact that consumers tend to confound divers(prenominal) brand acquaintance structures and therefore they provide distinguish opposite than for the products or services.Proton has successfully determine their show grocery store place, correspond to the air division bases to wit behavioral, demographic and psychographic factors. familiar surround trade The attach to used to plane section its commercialise on variables such as behavioral, demographic, and geographic differences. behavioral sectionalisation behavioral cleavage is base on the customers require and later(prenominal) reception to those take or toward the purchase of mean products and/or services. demographic sectionalisation demographic air division refers to a dewy-eyed study of the potential customers.Since the play along is targeting its market to more parsimony class customers, demographic air division is utilise by the guild. geographic part geographic section i s done by dividing tidy sum (markets) into disparate geographical locations. The company targets markets of opposite countries new(prenominal) than Malaysia. proceeds PROTONs model products intromit WAJA, SATRIA, GTi, WIRA, ISWARA, ARENA, PERDANA V6, JUARA, be sick of a function and EXORA. The incline of 1. 3, 1. 5, 1. 6, 1. 8 and 2. 0 liter engines satisfies a wide-cut spectrum of customers twain topically and abroad.PROTONs model products accept WAJA, SATRIA, GTi, WIRA, ISWARA, ARENA, PERDANA V6, JUARA, fiber and EXORA. The range of 1. 3, 1. 5, 1. 6, 1. 8 and 2. 0 cubic decimeter engines satisfies a wide spectrum of customers both locally and abroad. ground on applied science and move from Mitsubishi Motors, action of the outset model, the Proton Saga began in phratry 1985 at its prototypical manufacturing whole works in Shah Alam, Selangor. The 100,000th Proton Saga was produced in January 1989 and in style(p) model is Suprima S. pay Proton defyed gig antic monetary profit musical theme the mid-eighties coin bank 2000 due to their high market share in Malaysia. entirely with the launch of an arch equalise Perodua in 1993, Proton was about to take a big run for its notes and this came to naturalism in the 2000s. Protons market share dropped in 2006 to 30. 4% for the Malaysian market. Their generated revenue of 7,796 ( meg in Malaysian Ringgit) in 2006 was the second last-place in the last sevener long quantify as the company obtain forever hit the billion Ringgit mark in the preceding(prenominal) 7 years. This fall allowed Perodua to catch Proton as the countrys largest rider car manufacturer for the maiden sequence in history, with a 41. 6% market share eyepatch Proton flee from 40% in 2005 to 32% in 2006.Their market share act to lose system of weights down to 23. 1% in 2010 principally due to saucily government policies. For example, under AFTA, Malaysia has cut back import tariffs, confessedly aft(p renominal) having secured a two-year delay from ASEAN. present moment tariffs on all in all build-up (CBU) unites were cut back from a roach of 70 90 per centum to 20 percent at the fasten on of 2005. However, it is burning(prenominal) to accord that Proton losing its market share to Perodua, other Malaysian railroad car that was organize a ecstasy after full operation of Proton could breathing spell some gaps in their concern system.In other to beg off these claims, it is necessary to spend a penny a look at their in-depth fiscal performance since the 2000s and how they stand coped with loses in relation to their internationalization project. force The overall ride of our serviceman option strategy is to recruit, reward and retain the shell employees. During the year, a number of recruitment road shows were conducted in Malaysia as well as the UK among stellar(a) target and business universities to visualise our emergence requirement. The reaction wa s whelm and more such road shows are being aforethought(ip) for the coming year.An internship program for tweak trainees was implement during the year to image the maturement postulate of the business. The gay beings option focus root word has go along to be the signalize assemblage for the communication of policies and issues affect the employees. The mathematical group comprising representatives from the precedential way and the Proton Workers amount find on a periodical behind to prove strategical human resource issues change employees. It is a odd program that allows habitue communication and locomote contract of issues as well as meshing by the coupler in the exploitation of policies poignant the employees. interrogation & ripening The concourse continues to search in the raw technologies with the supreme aim to put these innovations into merchandise done partnerships with mark One Suppliers or OEM customers. 2 such advancements pre sumable to get hold ware are engine technology AVT (Active Valve Train) and phase technology VVA ( respective(a)(a) fomite architecture). The radical has too invested importantly on the victimisation of cutting forward-looking products to obtain the repugns of the market place. During the financial year, the root invested RM542. 9 billion (2003 RM413 million) in research and increase.For 2004, total development economic consumption change magnitude signifi potfultly with work cogitate on the development of immature models on a number of platforms including the wind perimeter Versatile fomite Architecture (VVA). The VVA reduces the time it takes to bring a new product to market and helps meet changing contend more quickly. Globally, we are sorrowful towards overlap technologies so that vehicles can be severalise spot employ common components. The reduction in development time leave effect greater susceptibility and the standardization exit withal melt down to greater economies of shell in acquire components. ripening has in addition begun on an aluminum-bodied vehicle built on the VVA platform. increase furnish efficiency and power through weight reduction and material recyclability are key factors that feature conspired together to call down the use of aluminium in vehicle body structures for high volume production. certainty Proton is aiming to release one of the sanitary competitors of the railroad car companies in market. So, as other existed competitors challenge the other proton company, they were shake up by them to develop a quality business for the customers. touchrous advantage is what they are targeting for company and there are business motivational is about the capabilities in move companies . so far they are realizing that there are some existed competitors concur their own abilities in the automobile, they are excessively birth the vendee Power. The buyer lead ingest the cheap car for the first car and buyer also actually are fragmented. Therefore, it leave alone not have much affecting. similarly that, they are eternally finds a way to make the market being effective with their strong dispersion network.However, the companies of proton is the most far-famed company in Malaysia as we know and they provide try the exceed to train that vilify pull up stakes occur. Moreover, proton also is one of the companies which give a vehemence on all people and escape in Malaysia irrespective early age or that old. Everyone knows, that Proton has various product automobile with the design distinctive. Some, from revenue scooped the great of benefits had rival that high with others automobile company. steady though, it equable willing learn that Proton companies will evermore stalls with economy and in call of from product aspect is that vanquish and high quality.