Life On Earth Is Extremely Diverse Consisting Of Thousands

Life on Earth is extremely diverse consisting of thousands of distinct ethnic groups around the world (CIA World Fact Book). Peace or violence, communion or war, these are the two options of divergent groups living amongst each other. In Rwanda, the ethnic tribes have lived through both scenarios of harmonious unity and brutal division. Before colonialism, ethnic tribes inhabiting Rwanda, the Tutsi, Twa,and Hutu, coexisted and assigned jobs to each ethnicity in order to survive and thrive in a peaceful environment. Unfortunately, this commune was interrupted by German colonists who claimed control of the small country, disturbing the peace. The colonists differentiated the three ethnicities inhabiting Rwanda, sprouting seeds of jealousy,†¦show more content†¦A well-off Hutu was able to wed a Tutsi girl as their wife in order to cast off his being Hutu. This shows the ease and ability to move up on the social scale. It also shows the lack of hatred and differentiation of the ethnicities. If hatred had been prevalent before colonialism, the racist views between ethnic tribes would have halted the marriages which combined ethnicities. The ease and peace between the tranquil tribes took a turn for the worse when colonists invaded Rwanda. First colonized by the Germans, Rwanda was soon transferred to Belgium due to a treaty between the nations. Both sets of colonists sought to convert the ethnicities to Christianity and to claim land for colonial trade. The German and Belgian colonial presence and ideals began to construct the separatism of the ethnicities, differentiating them, and causing ethnic tensions to grow. As colonialism differentiated the ethnicities, a hatred began to emerge. After World War I, Belgium controlled Rwanda as a token of war and treated the country as such. Belgian administrators falsely speculated that governmental power in Rwanda should be organized by ethnic groups. Abruptly, they decided to establish a state run by the Tutsi tribe because they thought of the Tutsi as the natural rulers of Rwanda. In order to only have Tutsi governmental officials, the colonizers convinced the ethnic tribes that there were physicalShow MoreRelatedMicroorganisms Inhabit Every Sphere of Our Planet Essay1598 Words   |  7 Pageskingdom Animalia such as rotifers and planarians. Viruses also fall under this category, i.e., microorganisms but some researchers even consider viruses as non living (Rybicki 1990) (LWOFF 1956). Microorganisms inhabit every sphere of this planet Earth. They inhabit the most extreme environments where no other living organisms can survive. Such microbes are known as â€Å"Extremophiles†. 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Informative Speech On Nutrition And Exercise - 1495 Words

Home PAGE: You have arrived at Landed Health, where we are dedicated to be your one stop for everything you need to know about good health. Not only will you find everything that you need regarding nutrition and exercise, we will showcase the best products around to help you meet your health needs. You can peruse our blog in order to find out the latest that is going on in the health industry. Perhaps you are wondering about what foods you need to eat each day in order to look and feel your best. If so, then you should check out the information we have on our page regarding nutrition. There, we will provide you with the best food suggestions to meet your health needs. We know that there is a lot of conflicting information on the web today. That is why we have sought to simplify the reality of good nutrition for you. You can learn about what foods you need to eat, and how much of them. Additionally, our nutrition information can help you if you have a special situation, such as needing to lose weight. You need to find the right balance of calorie intake and how many calories you burn in order to shed those extra pounds for good. We can provide you with the foods to eat that will help you to feel full while getting the nutrients your body needs to function optimally. You will discover that losing weight does not have to be a chore. The fact is that when done right, you will have more energy and mental clarity than many of the modern diets allow. Do not forget to check outShow MoreRelatedObesity Essay887 Words   |  4 PagesAshli Wright Communications Informative Speech Obesity In America Obesity can be an issue for any age group in America, adults, adolescents and children. The obesity rate in the last 30 years has more than tripled. 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My Two Cities Final Free Essays

Africa, which is a third world country. Therefore, Livingston is less technologically advanced and there is a lot more poverty. Although it may not seem the greatest being in a third world country, Livingston definitely has some great perks. We will write a custom essay sample on My Two Cities Final or any similar topic only for you Order Now For example, it has Victoria Falls, which is one of the seven great natural wonders of the world. You can also go on local safaris there and see animals up close such as lions, elephants, cheetahs, hippos and so on. Orlando, has Walt Disney World, one Of the biggest theme parks in the world. It also has many other theme parks such as universal and Pepco and a lot of other tourist attractions. Another great thing about Orlando is that it is only about an hour drive away from the beach, where as Livingston is surrounded by other countries so there are no beaches close by. Orlando has a downtown, where there are a lot of sky scrapers and a mix of everything such as big corporations, restaurants, parks, and a nightlife scene. In Livingston, there is no downtown or sky scrapers, but there is the area called â€Å"town†, which is where all the local businesses are located. Livingston is a very small city, therefore everything is about a five to ten minute drive away and every day the local businesses close around five in the evening. Everyone there lives a pretty slow-paced lifestyle. Orlando, on the other hand, is a very big city, where it can take up to half an hour or forty-five minutes to reach a specific destination and some businesses can be open up to ten or eleven at night. It may not be such a rushed lifestyle, but it is definitely faster paced than Livingston. Despite their differences, these cities can also be pretty similar. Starting off with the weather, although there are both on opposite ends of the equator, the weather is pretty similar with hot summers, rainy seasons, and no-snow winters. Another similarity is that both cities also have soccer teams, Livingston has a team called The Copper Bullets and Orlando has a new and upcoming team called Orlando City Soccer. They both also have reptile farms, Orlando has Coastland and Livingston has The Crocodile Farm, which were both my favorite places to go to as a child. Something new in Livingston is a all that they have built and also a new movie theater with comfortable seating and showings of 3-D movies, which of course Orlando has a couple of malls and movie theaters. Livingston may not have a big nightlife scene, but they do have couple of lounges and bars that are similar to Orlando nightlife. For example, there is a martini bar called Rhapsody’s which is really similar to the Blue Martini in Orlando. The last similarity between the two is the transport systems. Most people drive cars, but there are also public buses and taxis which people rarely use. Livingston is an up and coming city, bringing in just as much tourism because of Victoria Falls as Orlando does from the theme parks, pretty soon there will be a lot more similarities between the two cities. For me, these two cities are my home. I believe they represent the best of both worlds for me. They are both very unique and also filled with fun stuff to do. Orlando is a busy life for me and Livingston is slow and more relaxed. I go back and forth between the two cities often and they keep me pretty balanced between their differences and similarities. How to cite My Two Cities Final, Papers

Management of Information Technology for Tacit - myassignmenthelp

Question: Discuss about theManagement of Information Technology for Tacit Knowledge. Answer: Organization 1 Application In the opinion of Mao, et al., (2016), a proper criterion while appointing a new employee will help the organization to gather useful information about the employees and this knowledge will further help the organization in making efficient utilization of such employees. The organization is using employee handbook for maintaining a proper record of the knowledge of employees and internal audit for analyzing the performance of employees within the organization. In this way, organization 1 is storing the knowledge about both the employees i.e. new appointments and the existing employees. Obeidat, et al., (2017) identifies that the objective behind the introduction of knowledge management is to make the performance of the organization effective. He defines knowledge as explicit and tacit. Tacit knowledge is the knowledge that can be in written form or that can be codified. Tacit knowledge can be stored. On the other hand, the thinking of people is termed as explicit knowledge. It is impo ssible for a company to store such knowledge. An organization can transfer tacit knowledge but the transfer of data is not possible in case of explicit knowledge. Van Esch, et al., (2016) claimed that knowledge management helps in the organization to achieve competitive advantage. An organization cannot achieve competitive advantage by just acquiring the most valuable resources. The organization should have the knowledge regarding the effective utilization of such resources. Now, the world is not just dependent upon the natural resources, it is moving towards the era of knowledge about increasing the skills and efficiency of the employees of an organization. Organization 1 is focusing on internal audit to identify the areas in which the employees are lacking. With the use of this information, the organization can help the employees to improve the areas where they are lacking. This helps the employees to increase their efficiency and this process ultimately increases the efficiency o f the organization and in this way the organization can gain competitive advantage. As per the opinion of Bir, J.S. (2016), previously capital and both human and natural resources were considered as the basic resources for an organization but now knowledge is considered as basic resource. Martinez-Conesa, et al., (2017) stated that an organization is required to use an IT software to integrate and store the knowledge at one place so that that knowledge can be used to increase the efficiency of the organization as well as reuse the stored knowledge in the future if needed. According to Daghfous and Zoubi (2017), IT and knowledge management are inter-related to each other. Technology is playing very important role in the operations of an organization. The computer system eliminates the manual storage of information. IT helps the organization to perform any task in very less time as compared to the time taken by employees to perform the same task. In todays world, IT has also increased the competition. Every organization is using the technological software for the storage, maintenance and retrieval of data. IT helps the company to sustain in the competition and hence, achieve competitive advantage. IT also helps in data mining which means the information about the most and least efficient employees can be separated using data mining feature of information technology. As per the response of organization 1 IT reduces the human resource requirement of the organization and hence reduces the cost to employees for the organization. Organization 2 Application Organization 2 is not relying on information technology for the management of knowledge and as per the response of the organization; it does not think that such management of knowledge can only be done through IT. Organization 2 is maintaining the knowledge by a software named workday. But the organization is not using IT for storage, maintenance and retrieval of knowledge. Organization 2 believes that knowledge management is not a necessary component for the achievement of competitive advantage. In the opinion of Dong, et al. (2017) its not necessary for the maintenance of knowledge management. The managers can just observe their employees and determine the areas in which they are lacking. It is not always necessary to store the knowledge about the employees. It is the responsibility of the managers to store such information in their mind and work on it. This is the objective behind the appointment of managers. IT requires a huge investment also so if the same work can be done manua lly then there is no need to spend huge amount on IT software. The knowledge gathered by managers is more effective than the knowledge gathered by IT. The employees work under the managers so managers are more aware about how the employees are performing than the software installed. Serenko and Bontis (2017) explained that only knowledge management is not important for competitive achievement. Competitive advantage is not just gathering knowledge about the employees but the organization should focus on making the most effective utilization of the employees. The information systems are only used for gathering more and more information and it only stores tacit information, explicit knowledge is left untouched. With the help of IT, an organization cannot get the exact knowledge about each and every employee. IT takes into account a common issue faced by the employees. Information system always takes all the employees together but every employee has his or her own sense of working so th e knowledge also differs from one employee to another. IT software will work as per the commands given to the software. If any changes in the environment take place then such software cannot consider such changes so the result of software is sometimes not accurate. Comparison The operating style of organization 1 and organization 2 is completely different. Both the organization is relying on knowledge management but in different ways. Organization 1 is managing the knowledge with the help of specific interview criteria for new employees and performing internal audit for existing employees and the organization is making an employee handbook to store the knowledge. In case of organization 2, the organization is gathering the knowledge with the help of workday. Workday is internal software used by organization 2 which contains all the information about the employees of the company. But as per the responses of organization 2, the organization does not think that management of such knowledge results in the achievement of competitive advantage and at the same time the organization 2 is not relying upon information technology for the management of employee related knowledge (Dayan, et al., 2017). If we talk about the literature review of organization 1 then each , et al. believes that competitive advantage can be achieved with the help of such knowledge as such knowledge helps in the improvement of the performance of employees and if the employees performance is improved then it will also increase the performance at organization level. But as per the literature analysis of organization 2, only knowledge management cannot lead to competitive advantage. There are a number of factors which can affect the sustainability of the company. But the competitive advantage cannot be achieved without information technology. AS competitive advantage means the organization is required to prove itself superior in terms of its competitors. In todays world every organization is making use of technology to make itself superior (Heisig, et al., 2016). If organization 2 will not rely on information technology then in such case the company cannot achieve competitive advantage. Organization 1 is relying on information technology for the knowledge management but a s per the literature analysis of organization 2, information technology cannot gather the exact information about the performance of the employees. IT takes into account the nature and structure of the organization and will identify the performance on the basis of these factors but if the managers are physically performing the internal audit then they will consider all the factors which are related to the performance of the employees like social relations, working hours, emotional aspects of employees and many more. After proper comparison between literature analysis of organization 1 and organization 2, it is analyzed that organization 2 will face the problem of competitive advantage in the future because as per the response of organization 2, the organization cannot believe that knowledge management helps in competitive advantage (Lopes, et al., 2017). But in real, the human resources i.e. the employees are directly linked with the sustainability of the organization. Knowledge man agement helps the organization to properly analyze the weaknesses of employees and help them to convert such weaknesses into strengths. If the performance of employees improves then the organization will also improve. IT technology is just a way to make this process easier. It will involve investment at the time of installation of the software but this investment will return as increased performance at organizational level. In recent years, the importance of knowledge management has increased because now organization is focusing more on human resources as compared to natural resources. After the literature analysis of both the organization, it is analyzed that both knowledge management and IT are important for the organization and it results in achieving competitive advantage (Lee, et al., 2016). References Bir, J.S. (2016) Knowledge, Attitude and their Effect on the Recently Graduated Employees Financial Management Practices and Satisfaction, Economic Literature, 12, pp.69-81. Daghfous, A. and Zoubi, T. (2017) An Auditing Framework for Knowledge-Enabled Supply Chain Management: Implications for Sustainability, Sustainability, 9(5), pp.791. Dayan, R., Dayan, R., Heisig, P., Heisig, P., Matos, F. and Matos, F. (2017) Knowledge management as a factor for the formulation and implementation of organization strategy, Journal of Knowledge Management, 21(2), pp.308-329. Dong, Y., Bartol, K.M., Zhang, Z.X. and Li, C. (2017) Enhancing employee creativity via individual skill development and team knowledge sharing: Influences of dual?focused transformational leadership, Journal of Organizational Behavior, 38(3), pp.439-458. Heisig, P., Suraj, O.A., Kianto, A., Kemboi, C., Perez Arrau, G. and FathiEasa, N. (2016) Knowledge management and business performance: global experts views on future research needs, Journal of Knowledge Management, 20(6), pp.1169-1198. Lee, V.H., Foo, A.T.L., Leong, L.Y. and Ooi, K.B. (2016) Can competitive advantage be achieved through knowledge management? A case study on SMEs, Expert Systems with Applications, 65, pp.136-151. Lopes, C.M., Scavarda, A., Hofmeister, L.F., Thom, A.M.T. and Vaccaro, G.L.R. (2017) An analysis of the interplay between organizational sustainability, knowledge management, and open innovation, Journal of Cleaner Production, 142, pp.476-488. Mao, H., Liu, S., Zhang, J. and Deng, Z. (2016) Information technology resource, knowledge management capability, and competitive advantage: the moderating role of resource commitment, International Journal of Information Management, 36(6), pp.1062-1074. Martinez-Conesa, I., Martinez-Conesa, I., Soto-Acosta, P., Soto-Acosta, P., Carayannis, E.G. (2017) On the path towards open innovation: Assessing the role of knowledge management capability and environmental dynamism in SMEs, Journal of Knowledge Management, 21(3), pp.553-570. Obeidat, B.Y., Tarhini, A., Masa'deh, R.E. and Aqqad, N.O. (2017) The impact of intellectual capital on innovation via the mediating role of knowledge management: a structural equation modelling approach, International Journal of Knowledge Management Studies, 8(3-4), pp.273-298. Serenko, A. and Bontis, N. (2017) Global ranking of knowledge management and intellectual capital academic journals: 2017 update, Journal of Knowledge Management, 21(3). van Esch, E., Wei, L.Q. and Chiang, F.F. (2016) High-performance human resource practices and firm performance: the mediating role of employees competencies and the moderating role of climate for creativity, The International Journal of Human Resource Management, pp.1-26.

Moral Messages from a Thousand Splendid Suns Essay Example

Moral Messages from a Thousand Splendid Suns Paper Imagine growing up in a world devoid of innocence, spending your young life navigating the complex repressive forces that have trapped you in poverty, fear and confusion. Now ratchet that sensation of despairing entrapment up 10 notches and you have taken your first step into the world of A Thousand Splendid Suns. The moral message from this book shows â€Å"We should be grateful for what we have, by never taking the people that bring happiness and fulfilment in our lives for granted. A thousand splendid suns is a satisfying story written by Khaled Hosseni, it gives a little more insight and more personal sense of what has happened in Afghanistan in the last thirty years and this is exactly the effect his novel has had on me. The story follows Mariam and Laila, two young women struggling to survive in Afghanistan as they negotiate the mine-littered road of sexual hierarchy, nonstop war and overwhelming guilt. Constantly intersecting the characters in third person and personal narratives, showing the hardships of their marriage to the same man, Rasheed, your typical cruel husband who beats and reduces the freedom of his wives. As Hosseni is writing about a culture where women are denied education, the right to work, the right to move freely, accesses to adequate healthcare, the situations these characters are placed it highlights the injustice faced by Islamic women. We will write a custom essay sample on Moral Messages from a Thousand Splendid Suns specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Moral Messages from a Thousand Splendid Suns specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Moral Messages from a Thousand Splendid Suns specifically for you FOR ONLY $16.38 $13.9/page Hire Writer The patriarchal nature of the Islamic culture is obvious in the higher value clearly given to men in Laila’s family. Laila’s mother is all consumed with love for her sons, but cannot give the same attention to her daughter. This is illustrated through the truncated sentences when mammy grieves over her son Noor â€Å"it was something to see, And Noor. Oh Noor. My poor Noor. † The audience is reading from a third person’s perspective which is shown through the repetition â€Å"they† which creates distance with the audience and empathises with Laila. Hosseni’s intended purpose was to show â€Å"a story that transports, characters who engage, and a sense of illumination, of having been transformed somehow by the experiences of the characters and to walk away with a sense of empathy for Afghans†. Throughout Mariam life she’s constantly betrayed by the men in her society, however when Laila joins the family she forms a close friendship which leads to Mariam sacrificing herself to save Laila â€Å"Mariam is in Laila’s own heart, where she shines with the bursting radiance of a thousand splendid suns†. The story title â€Å"a thousand splendid suns† is symbolic of Mariam, which captures her morals of looking out for her family. Despite the times she had been betrayed by her father yet she still loves Laila even though they aren’t related, which shows how Mariam drew strength from her friendship with Laila. Hosseni deliberately created two strong central characters to allow the audience to empathise and make personal responses. Hosseni quoted â€Å"I realized that telling the story of these two women without telling, in part, the story of Afghanistan from the 1970s to the post-9/11 era simply was not possible. The intimate and personal was intertwined inextricably with the broad and historical. And so the turmoil in Afghanistan and the country’s tortured recent past slowly became more than mere backdrop. † Looking from a 16 year olds perspective from the 21st century, it has made me realize how lucky I am to be surrounded by the people I love, with encouraging parents and friends. Whilst reading this book it has made me aware with what I have, and not taking the simplest of things for granted.

The Defining Elements of Leadership

The Defining Elements of Leadership Free Online Research Papers What is effective Leadership? What is your leadership style? Provide examples where you have show leadership skills? I believe that a leader is only as good as his followers. Being a leader means not only being capable yourself but also developing the skills of your people. It is the task of a leader to develop the members into a united team, leverage their strengths and mitigate their weaknesses. A leader must take complete ownership of the people under him. Polaris Software Lab Ltd. grappled with the problem of completing the Jamaica Central Securities Depository project. My penchant for focusing on the big picture meant I relished the opportunity to lead the design change and integration of the project that was using core and advanced Java and AS/400. I realized that with the increased focus on time-to-market, cost reduction and quality implementation, I had to form a high-performing team that would believe in the power of common purpose, value interdependence and emphasize responsiveness and creativity. My mission was daunting yet challenging: setup a 6 member, diverse (in terms of experience, expertise and culture) team and ensure commercial and technical expertise. The team members were enthused by the stretch goals that we faced. We had to pilot a proof of concept, but before that we had to finalize the architecture, setup monitoring and reporting systems, resolve technical issues, train the new members and do all this and more within a month! Yet, the team posed its peculiar set of problems. Discussing relatively routine tasks in meetings became fraught with interpersonal friction when people were staying up past their bedtime. Opinion differences were taking centre stage, and hostility and annoyance had replaced trust and respect. As senior member of the project, I immediately arranged a week long face to face meeting and struck a fine balance between team empowerment and upfront leadership. I decided to establish a leadership position by focusing on business goals, establishing good relationships and building team spirit. To this end, I tried to create an open comfortable work environment for my team. I built their trust in me by listening to their problems and providing them the support they needed to improve their skills and their performance. I motivated them by publicly praising their efforts and by encouraging them to be creative and take more initiative. I concentrated on building team spirit by celebrating the team’s successes as a group and by encouraging them to share best practices with each other. We delegated responsibility based on synergy and interest. The team developed a bulldog mentality. It was no longer a matter of if we succeed, but when we succeed. With a clear goal in mind, we rolled up our sleeves and the first pilot was completed in 38 days. The team-momentum became both self sustaining and overwhelming. In the next 3 months, our team was in the constant limelight with successful change implementation and integration of the project. We were recognized for delivering with speed, and meeting targets. There is no greater example of leadership and teamwork than the successful manned mission to the moon in July 1969. Drawing inspiration from this event and eager to explore new frontiers, our team had also taken a small step in helping open new ways in which Polaris Software Lab conducted business. Research Papers on The Defining Elements of LeadershipThe Project Managment Office SystemTrailblazing by Eric AndersonOpen Architechture a white paperAnalysis of Ebay Expanding into AsiaResearch Process Part OneRiordan Manufacturing Production PlanThe Hockey GameMarketing of Lifeboy Soap A Unilever ProductIncorporating Risk and Uncertainty Factor in CapitalBionic Assembly System: A New Concept of Self

Role of Power in Policy Development and Implementation Research Paper

Role of Power in Policy Development and Implementation - Research Paper Example There is a significant role of power in the society. Those people who are given the power to govern have the authority to impose rules, create programs or decide important matters that involve the welfare of everyone. When we try to look around us we see people like the presidents, prime ministers, or kings who are given the power to rule over their countries. When one has power, the authority is given to that person to decide on things in behalf of the whole nation. Major Types of Power Power is being categorized into certain types to determine its nature and the way that it is obtained. French and Raven in the year 1959 (as cited in â€Å"Five Bases of Power,† n.d.) were the social psychologists who formulated the five bases of power, which are the following: Positional Power Positional power is the authority given to people who have a position in an organization or society. It is considered as the most important among all the other types of power. This type of power is comm only present in organizations, appointing an individual to act as the leader so that jobs are performed well. Reward Power The basis of which is the capability of an individual to give rewards to those who deserve to be given one. It is somehow related to legitimate power. Those who are in high corporate position have the power to offer rewards to their subordinates like bonuses, promotions and incentives to name a few. Personal Power Personal power is the power to persuade others through the interpersonal skill of an individual. It is the ability of someone to influence others by simply using their charm to attract people’s attention. Most political leaders possess this type of power. Expert Power This is inherent to those who are intelligent people. The mastery on a specific body of knowledge is considered as expert power. This may bring someone to higher positions like in the government or organizations. Coercive Power This is considered as a negative type of power for it is more influenced by fear. This gives an individual the right to impose punishments and even stop someone from receiving benefits. Examples of Power Experienced In the Society The most prevalent type of power present in our district is positional power. In the field of politics, the power is vested upon those people who qualify specifically for a government position by means of an election. In every district, a governor is elected who serves as the leader and decision-maker. The authority given to the governor is affiliated with great responsibilities. Practically as what the word position implies, positional power is dependent upon the position of an individual. So if the person is into the higher rank like in the case of a governor, then there is greater amount of power given. The higher the position, the greater power is attained. Another common type of power present in the district is personal power. There are many of those successful people who have this quality of building re lationships to other people, through the use of their persuasive and at the same time charismatic approach. Business owners have the ability to influence a consumer’s decision upon purchasing through their flowery statements. Well politicians also have their way of

Borderline Personality Disorders Research Paper

Borderline Personality Disorders - Research Paper Example Often patients who are difficult are labeled with the disorder without fully exploring all other possible explanations for behavior (Wirth, 2001). While it is considered one of the most often diagnosed conditions in the clinical setting with 10% of the population suffering from the disorder, one of the problems in asserting a defined prevalence of the disorder is that often it is associated with addictive behaviors or misdiagnosed (Swift 2010). There are three primary theories that guide the treatment of borderline personality disorder. Clinicians look to biological, cognitive-behavioral, and psychodynamic causes in order to approach an effective course of treatment (Gunderson and Links, 2008). In the assessment of behavior disorders, finding a cause can be an illusive prospect. One of the predominant issues with the disorder is the overwhelming feminization of the condition, the diagnosis being one of the first areas of concern when treating a female patient. The relationship that w omen have with their social environment is a primary concern in the diagnosis of borderline personality disorder. ... The disorder can define the future of those who suffer from its effects with a series of unstable and unsuccessful relationships. Self-destructive behaviors will also be common creating an inability to find success and move forward into a stable and secure life. The criteria for diagnosis will appear in early adulthood marked by a variety of effects within variations of context. The primary diagnostic criteria include emotional instability, inappropriate or intense anger, self-destructive acts, impulsivity, unstable relationships, identity disturbance, and chronic feelings of emptiness or boredom (Wirth-Cauchon, 2001). These basic criteria is further defined by a list of contexts from which a refined diagnosis can be assessed (see Appendix 1). The condition has the highest prevalence amongst women, one of the primary causes appearing to be sexual abuse in childhood with a variety of effects then manifesting as a result later in adulthood. As well, other forms of abuse such as neglect , emotional abuse, or physical abuse have appeared as precursors to the development of the disorder. In a study that compared other patients to BPD patients, 71% had suffered traumas of physical abuse while 68% had suffered sexual abuse, while 62% had witnessed serious domestic violence (Wirth-Cauchon, 2001, p. 66). The most common comorbidity associated with BPD is that of substance abuse. However, according to Lee, Bagge, Schumacher, and Coffey (2010), the effects of BPD are no higher or lower in substance abusers as they are in non-substance abusing patients. Therefore, the substance abuse seems to be a part of the of the self-destructive behavior rather than a

Summarize Strategic Management in a Healthcare Organization Research Paper

Summarize Strategic Management in a Healthcare Organization - Research Paper Example Additionally, Strategic management has a combination of elements that are correlated and are crucial to achieving the predetermined objectives. Strategic management is important in healthcare organizations because it plays a fundamental role in correctly predicting the future and establishing mechanisms for dealing with emerging issues (Hunger & Wheelen 2010). Ideally, strategic management assist healthcare organizations in identifying potential opportunities as well as challenges and establishes mechanisms for dealing with the inherent situations (Hunger & Wheelen 2010). Strategic management is essential for healthcare organizations because it aids in planning for various activities and operations effectively discarding frustrations. Healthcare organizations are constantly faced with external threats, and strategic management provides a solution to this challenging event. Ideally, strategic management aid in determining external pressure by coming up with effective solutions to deal with the issues (Hunger & Wheelen 2010). Strategic management is important in a healthcare organization because it is growth oriented. Essentially, the role of strategic management is to constantly seek for opportunities that are effective for success (Hill et al., 2012). Healthcare organizations require strategic management plans as a consequence of remaining relevant in a dynamic environment. The tool can aid healthcare organizations in planning, monitoring development programs and the implementation of processes. Consequently, healthcare organizations are capable of predicting the future and responding to the inherent challenges and

Contrast Media and Intravenous Urography

Contrast Media and Intravenous Urography Introduction The practice of clinical diagnostic radiology has been made possible by advances not only in diagnostic equipment and investigative techniques, but also in the contrast media that permit visualisation of the details of the internal structure or organs that would not otherwise be demonstrable. The remarkably high tolerance of modern contrast media has been achieved through successive developments in chemical pharmacological technology. A single dose of X-ray contrast medium commonly contains upwards of 2000 times as much iodine as in the total physiological body content, and yet it is cleared from the system rapidly and naturally, usually with no adverse effects at all. The choice of contrast medium has always been a matter of debate, but is ultimately the responsibility of the radiologist. In order to be able to make a rational decision as to the selection of contrast media, it is necessary to have some understanding of the physical and physiological principles involved. The objective is to provide a background for non-specialists on this complicated specialist subject. Why contrast media are necessary Different tissues within the body attenuate the beam of X-rays to different degrees. The degree of attenuation of an X-ray beam by an element is complex, but one of the major variables is the number of electrons in the path of the beam with which it can interact. The number of electrons in the path of the beam is dependent upon three factors: The thickness of the substance being studied Its density The number of electrons per atom of the element (which is equal to its atomic number) In a complex mixture of elements, which is of course what we are concerned with in the organs of a patient, the degree of attenuation is particularly influenced by the average of the atomic numbers of all the atoms involved. Where there is a considerable difference between the densities of two organs, such as between the solid muscle of the heart and the air in the lungs, then the outlines of the structures can be visualised on a radiograph because of the natural contrast that exists. Similarly, if there is a difference between the average atomic numbers of two tissues, such as between soft tissues, which are composed of elements of low atomic number, and bone, which is partly composed of the element calcium, with a rather higher atomic number, then the outlines of the different structures can be seen by natural contrast. However, if the two organs have similar densities and similar average atomic numbers, then it is not possible to distinguish them on a radiograph, because no natura l contrast exists. This situation commonly occurs in diagnostic radiography, so that, for example, it is not possible to identify blood vessels within an organ, or to demonstrate the internal structure of the kidney, without artificially altering one of the factors mentioned earlier. Two of the factors important in organ contrast can be artificially altered, the density of an organ, and, more usefully, the average atomic number of a structure. The density of a hollow organ can be reduced by filling it with gas or air, providing negative contrast. This is mainly of historical significance, but is still used when, for example, gas is introduced into the stomach or colon during a double-contrast barium examination. The average atomic number of hollow structure such as a blood vessel can be increased by filling the cavity with a liquid of much higher average atomic number (such as iodine containing contrast medium) than that of blood. In fact this is the principle by which contrast media consist of solutions or suspensions of non-toxic substances that contain a significant proportion of elements of high atomic number, usually iodine. EXAMINATION USE CONTRAST MEDIA common are described below. It should be noted that the volume, strength, as well as the type of contrast medium, will vary between patients according to the examination type and radiologists requirements. 1. Angiography Angiography is the general term which describes the investigation of blood vessels. Usually a distinction between arteriography and venography is made, depending on the kind of blood vessel (artery or vein) which is examined. Arteriography In arteriography a contrast medium is introduced via a catheter into an artery, which makes the lumen of that vessel opaque to X-rays. The natural flow of blood carries the contrast medium peripherally, and by taking a series of radiographs the radiologist can obtain images akin to a road map of the blood supply to an organ, or a limb. Localised narrowing or obstruction of an artery or a pathological circulation in a tumour can then be identified. Sometimes the radiologist may then proceed to treat the patient using the catheter system, which was introduced initially for diagnosis. Arteriography is relatively time consuming for the radiologist depending on the complexity,  ½ hour 2 hours, or even longer can be spent on the procedure. Venography (phlebography) The natural flow of blood in veins is towards the heart, and by injection of a contrast medium into a peripheral vein, a map of the venous drainage of a limb can be obtained. The larger size and greater number of peripheral veins, and the fact that the flow of blood is much slower in veins than in arteries,means that it is usual for the radiologist to take several radiographs of each area with the limb in different positions. The commonest indication for venography is to confirm a suspected diagnosis of deep venous thrombosis of the leg. Venography is also performed on organs within the body by introducing a catheter into a peripheral vein and manipulating it into an organ. Digital subtraction angiography (DSA) A special type of angiography is digital subtraction angiography (DSA). These procedures involve the use of specialised electronic equipment, computing and radiographic hardware to produce rapid sequential images. The DSA image is produced by electronically subtracting images without contrast media from images after contrast media injection. The result of this subtraction process is the visualisation of contrast filled vessels which are free from the distraction of overlying structures. 2. Intravenous urography (IVU), intravenous pyelography (IVP) When injected intravenously, most contrast media are rapidly excreted by the kidneys, and a series of radiographs taken after the injection will demonstrate the urinary tract. Intravenous urography is still the basic radiological examination of the urinary tract. The main indication is to assess the morphology of the kidneys. Further indications are: detection of kidney stones and calcifications in the ureter or bladder, assessment of obstructed urinary flow and investigation of patients with haematuria (the passage of blood in urine). Children may be investigated for congenital abnormalities of the urinary tract. In recent years for some investigations of the urinary tract, particularly uncomplicated infection, an ultrasound examination and plain abdominal radiograph have replaced intravenous urography as the initial investigation of the urinary tract. 3. Computed tomography (CT) Since 1973 an imaging technique known as computed tomography (CT) has developed to become one of the most important radiological examinations in the industrialised countries. CT uses conventional X-rays in a thin nondivergent beam to produce cross sectional images of the body. The X-ray tube and an array of detectors mounted within a supporting framework, rotate round the patient with each scan. CT produces digitalized images, although these are usually printed onto hard copy film in a format that is useful for transfer and viewing throughout the hospital. By electronic means CT improves via a higher contrast sensitivity, the natural radiological contrast between organs. However, it cannot create contrast where none exists naturally. CT is exceptionally sensitive to contrast media and can detect abnormalities, caused by disease, following an injection of an intravenous dose of contrast medium. This procedure is known as enhancing the scan. About 43% of all CT procedures involve the use of a contrast medium. CT is widely used throughout the body but the most frequently investigated areas using this technique are neuroradiology (brain and lumbar spine) and general radiology of the chest, abdomen and pelvis. It is particularly useful for the diagnosis, staging and follow up of malignant disease. 4. Myelography The spinal cord and the attendant nerve-roots which radiate from it cannot be visualised using conventional X-rays alone without the use of contrast media. They can be visualised directly using magnetic resonance imaging (MRI). They can be visualised if contrast medium is injected in the cerebrospinal fluid (CSF), which surrounds the spinal cord, rendering the CSF radio-opaque but not the cord of nerve roots. Specific contrast media have been developed for this examination. The majority of myelograms (or radiculograms) were performed to examine the lumbar region to confirm the clinical suspicion of a prolapsed intervertebral disc. However, CT and MRI have now largely replaced myelography as the initial investigation of the lumbar spine. Myelography, particularly combined with CT scanning is still used however to investigate the cord and cervical region and its nerve roots in difficult cases when other investigations are equivocal or normal. Interventional Techniques/Procedure Many radiologists are now specialised in therapeutic procedures that have bee developed from radiological diagnostic techniques using catheters and guidewires. These procedures include: The dilation of pathologically narrowed arteries angioplasty, percutaneous transluminal angioplasty (PTA). The deliberate occlusion of arteries supplying abnormal areas such as tumours, aneurysms and vascular malformations, so depriving them of their blood supply. The placement of artificial tubes or stents into blood vessels, bile ducts or ureters to bypass a pathological narrowing. These procedures often necessitate the use of high doses of contrast medium, because several examinations of the same vessels may be required during the control of the therapeutic process. Safety of Contrast Media Contrast media are among the safest of all of the pharmaceutical products available to the doctor today. They are anomalous in that they are not intended to have therapeutic activity: indeed, the ideal contrast medium would have no pharmacological activity at all. For this reason the concept of therapeutic ration, which can be applied to medicines, does not apply to contrast media. The development of a contrast medium from the first design of the molecule through to product licence takes many years. The minimum period of time that can reasonably be allotted to preclinical and clinical development is six years, and in practice it is not uncommon to take nine years or even more. During this long period, the tolerance of the medium is rigorously tested by collecting data from various preclinical and clinical trials to establish a profile for the product. One critical area examined during its development is the incidence of adverse reactions. The rate of adverse reactions to iodinated co ntrast media on the market is extremely low, but such reactions do occur just as they do with every pharmaceutical product. The adverse reactions associated with contrast media can be divided into two groups: Those reactions that are clearly dependent on the dose and concentration of the contrast medium administered and those that are almost independent of dose and concentration. Dose-dependent adverse reactions are mostly due to the physiochemical effects of the contrast medium, such as its osmolality, or electrical charge. Possible adverse reactions include heat, pain, vasodilation, cardiac depression and hypotension. The adverse reactions which are almost independent of dose and concentration are nausea and vomiting as well as allergy-like or hypersensitive reactions such a urticaria (hives), certain cardiovascular reactions, bronchospasm and laryngospasm, but there is little evidence of any antigenantibody interaction. These reactions cannot be predicted and their underlying cause remains unknown. For clinical purposes it is meaningful to divide contrast media reactions into three categories: Minor e.g. Flushing, nausea, vomiting, pruritis, mild rash, arm pain Moderate e.g. More severe urticaria, facial oedema, hypotension, bronchospasm Severe e.g. Hypotensive shock, laryngeal oedema, convulsions, respiratory and cardiac arrest Most contrast media reactions are minor and need no treatment. Moderate reactions are encountered rarely (about 1%) and severe reactions very rarely (about 0.1%), but all moderate and severe reactions require adequate treatment. Deaths following contrast media administration are extremely rare. Reported mortality rates vary between 1 in 10,000 and 1 in 169,000 averaging around 1 in 75,000. Katayama et al. (Radiology 1990; 175: 621-628) found that there is a reduction in adverse reaction rate of about four times using low osmolar contrast media (LOCM) for intravenous injection compared to high osmolar contrast media (HOCM). There is surprisingly no documented difference in mortality between intravenous LOCM and HOCM in large series from Japan and Australia. It is not usually possible to predict severe reactions, even by looking at the effect of a small test dose of a contrast medium. Guidelines have been produced for the use of low osmolar contrast agents. Risk Renal adverse reactions Contrast media-induced nephropathy is defined as impairment in renal function (an increase in serum creatinine by >25% or 44à £Ã¢â€š ¬Ã¢â€š ¬mol/L (0.5mg/dL) occurring within 3 days following the intravascular administration of contrast media in the absence of an alternative etiology Risk factors include raised s-creatinine levels particularly secondary to diabetic nephropathy, dehydration, congestive heart failure, age over 70 years old, concurrent administration of nephrotoxic drugs, e.g., non-steroidal ant-inflammatory drugs Systematically effective 1. Adequate hydration in terms of oral fluid intake or intravenous normal saline (depending on the clinical situation) at least 100 ml per hour starting 4 hours before to 24 hours after contrast administration is recommended. Concurrent administration of nephrotoxic drugs should be stopped for at least 24 hours. High osmolar contrast media, large doses of contrast media, or multiple studies with contrast media within a short period of time should be avoided. Alternative imaging techniques that do not require the administration of iodinated contrast media should be considered. Recent work in preventing and ameliorating contrast medium-induced nephropathy with N-acetyl cysteine 4-6 and various hydration regimens including use of sodium bicarbonate has been promising but is not conclusive yet. No measure has yet resulted in avoidance of its occurrence in all patients.Non-renal adverse reactions.These are generally classified as idiosyncratic or chemotoxic. Idiosyncratic (i.e., anaphylac toid) reactions occur unpredictably and independently of the dose and concentration of the agent. Most anaphylactic reactions relate to the release of active mediators. Conversely, chemotoxic-type effects relate to the dose, the molecular toxicity of each agent, and the physiologic characteristics of the contrast agents (i.e., osmolality, viscosity, hydrophilicity, calcium binding properties, and sodium content). Chemotoxic-type effects are more likely in patients who are debilitated or medically unstable 2. Acute reactions to contrast media can be divided into minor, intermediate, and severe life-threatening. Minor reactions include flushing, nausea, arm pain, pruritus, vomiting, headache, and mild urticaria. Such reactions are usually mild in severity, of short duration, selflimiting and generally require no specific treatment. Intermediate reactions are more serious degrees of the same symptoms, moderate degrees of hypotension, and bronchospasm. The reactions usually respond readily to appropriate therapy. Severe life-threatening reactions include severe manifestations of all the symptoms described as minor and intermediate reactions, plus convulsions, unconsciousness, laryngeal oedema, severe bronchospasm, pulmonary oedema, severe cardiac dysrhythmias and arrest, cardiovascular and pulmonary collapse. The prevalence of adverse reactions with lowosmolar contrast media is less than with high-osmolar contrast media by a factor of 5-6. Lethal reactionsrarely occur. The actual risk of death is less than one in 130,000 at most 3. The incidence of severe adverse reactions increases in patients with previous contrast medium reaction, bronchial asthma and allergy requiring medical treatment. Premedication with corticosteroid prophylaxis has been proved safe and effective in preventing minor adverse events in high-risk patients when ionic agents are used 4. The data indicating a protective effect of corticosteroid prophylaxis are less established when non-ionic agents are used. Opinion is divided about the value of premedication when nonionic agents are used. Even if it is given, there is a wide variety of regimes with different doses, number of doses, and frequency for corticosteroid prophylaxis. 5. A variety of symptoms (e.g. nausea, vomiting, headache, itching, skin rash, musculoskeletal pains, fever) have been described, but many are unrelated to the contrast medium. Allergy-like skin reactions are welldocumented side effects of contrast media, with an incidence of approximately 2%. Most late skin reactions after contrast medium exposure are probably T-cellmediated allergic reactions. Patients at increased risks are those with history of previous contrast medium reaction and those undergoing interleukin-2 treatment. Most skin reactions are usually mild to moderate, selflimiting and likely resolve within a week. Treatment is symptomatic and similar to the treatment of other druginduced skin reactions.Extravasation of contrast material is a well-recognised complication. The introduction of automated power injection has increased the incidence because power injection may result in extravasation of large volumes in a short period of time and may lead to severe tissue damage. Intravenous Urography Introduction Intravenous urography is a radiographic study of the  urinary system  using an intravenous contrast agent (dye). It is a medical procedure used to visualise the kidney and lower urinary tract to help diagnose problems such as infections. A contrast dye is injected into a vein on your hand or arm, and then x-rays are taken. The dye helps to outline more clearly the structure of the kidneys and lower urinary tract. The  kidneys excrete the contrast into the urine, which becomes visible when x rayed (radiopaque), creating images of the urinary collection system. An intravenous urogram is ordered to demonstrate the structure and function of the kidneys, ureters, and bladder. Patients complaining of abdominal pain radiating to the back may require this exam to rule out  kidney stones. Hematuria may also be an indication of kidney stones,infection, or tumors. Patients with high blood pressure (hypertension) and recurrent bladder infections may also require an intravenous urogram (b ut hypertension usually is imaged with MRA or nuclear medicine imagery and this exam is done when renal artery stenosis is the suspected cause of refractory hypertension). Sometimes the exam is ordered to evaluate the function of the kidney in a renal transplant patient. The transplanted kidney is located in the iliac fossa, so special films of the pelvis area are done instead of the normal routine views. The radiographic technologist may also be required to take x rays in the operating room when a retrograde pyelogram is ordered by a urologist during a C and P (cystoscopy  and pyelography). Indication A normal intravenous urogram indicates no visible abnormality in the structure or function of the urinary system. The radiologist looks for a smooth non-lobulated outline of each kidney, no clubbing or other abnormality of the renal calyces (collecting system), and no abnormal fluid collection in the kidneys that could suggest obstruction. The ureters must contain no filling defects (stones) or deviations due to an adjacent tumor. The bladder must have a smooth outline and empty normally as visualized on the post-void film. Abnormal results include hydronephrosis (distension of the renal pelvis and calices due to obstruction) as a result of tumors or calculi (stones). Cysts or abscesses may also be present in the urinary system. A delay in renal function can also indicate renal disease. An abnormal amount of urine in the bladder after voiding may indicate prostate or bladder problems. Intravenous urograms are often done on children to rule out a rapid developing tumor in the kidneys, called a Wilms tumor. Children are also prone to infections of the bladder and kidneys due to urinary reflux (return back-flow of urine). Procedure The patient will be required to change into a hospital gown and empty his or her bladder. The x-ray technologist will verify that the patient has followed the bowel preparation and complete a detailed questionnaire on the current medical history of the patient. This includes previous contrast reactions, known  allergies, risks of  pregnancy, and current medications. The x-ray technologist will explain the exam in detail to the patient as well as the risks of the contrast material that will be injected intravenously. All departments require that the patient sign a consent form before the examination is started. The x-ray technologist will relay this information to the radiologist who will decide on what type of contrast will be used. Patients who have had an injection with no reaction can be given less expensive iodine based contrast, whereas patients who take various  heart  medications or those with known allergies or  asthma will be injected with a more expensive contrast agent (known as non-ionic contrast) that has fewer side effects. Some departments use the non-ionic contrast exclusively. The patient will be instructed to lie supine (face-up) on the x-ray table and a preliminary KUB will be done. This is an abdominal view of the kidneys, ureter, and bladder used to verify patient preparation, centering, and the radiographic technique needed to demonstrate all the required structures. Kidney stones may or may not be visualized on the preliminary film. The x-ray technologist prepares the required amount of contrast to be used depending on the weight of the patient (1 ml per pound). This is normally 50-75 cc of contrast for an average-sized patient. The contrast will be injected all at once (bolus injection) or in some cases, through an intravenous drip. Some radiologists prefer to start an intravenous drip with saline as a precautionary measure while others inject with a small butterfly needle. The needle usually remains in place for 10-15 minutes, in case more contrast is needed or in case drugs need to be administered because of an allergic reaction. Most reactions occur immediately but some can take place 10 or 15 minutes after the injection. The first film is taken immediately after the injection to see a detail of the renal outline (nephrogram). Films are usually taken at five-minute intervals depending on the routine of the radiologist. Compression may be applied to the lower abdomen with a wide band to keep the contrast material in the kidneys longer. This creates a more detailed image of the renal collecting system. When the compression is released after approximately 10 minutes the contrast material drains quickly and a detailed, filled image of the ureters is obtained. Films done in the upright or prone (face-down) position may also be ordered to better visualize the lower ureters. Some departments require routine renal tomographic images to be done as well when the kidneys are well visualized. This allows the kidneys to be seen free of gas or fecal shadows. Sometimes the radiologist requires oblique views of the kidneys or bladder to determine the exact location of calculi (stones). At approximately 20 minutes aft er the injection a film centered on the bladder may be required. The x-ray tube is angled slightly caudad (towards the feet) so that there is no superimposition of the pubic area of the pelvis over the bladder. The films are shown to the radiologist and if no further films are necessary the patient will be asked to void (urinate) and a post-void film will be taken. The exam can take from 30 minutes to one hour depending on the number of films required. If the kidney is obstructed, delayed films may be required to complete the exam. Patient care The x-ray technologist must work in conjunction with the doctors and nurses in making sure the patient has not had a previous allergic reaction to a contrast agent. All hospitals have an emergency team ready to react in such a situation, so the technologist must be aware of the procedure to follow when assistance is necessary due to a severe reaction. Details of patient preparation must also be communicated to the hospital wards. In some hospitals the radiologic technologists are trained to give injections, but if this is not the case nurses may be asked to install an intravenous drip before the patient is brought to the radiology department. The x-ray technologist must explain the risks of an allergic reaction to each patient even though severe reactions are extremely rare due to the advances made in the preparation of contrast agents. The x-ray technologist explains to the patient that a warm, flushed feeling or a metallic  taste  in the mouth are normal reactions in some patients. Breathing instructions are also important since the kidneys change position depending on the phase of respiration and to prevent motion artifacts. Sometimes an emergency patient with renal colic (acute abdominal pain) is asked to urinate through a special filter used to trap small stones. All radiographic technologists must be certified and registered with the American Society of Radiologic Technologists or an equivalent organization. Continued education credits are mandatory to remain registered. Risk and side effect Some of the side effects and possible complications including minor reactions to the contrast dye. It may include flushing, warmth and a metallic taste in the mouth. These usually resolve quickly. These symptoms are much less common with the newer contrast dyes. Some patient might experience severe allergic reactions. It may occur in a small percentage of the population. Symptoms range from relatively mild to severe, and can include hives (skin rash), breathing difficulties, swelling of the lips and tongue, low blood pressure and loss of consciousness. There is case when a patient experienced acute renal failure  but it occurs in less than 0.5 per cent of cases. Risk factors include advanced age, diabetes, dehydration and a past history of kidney disease. For patients with these risk factors, extra intravenous fluids, pre-treatment with acetylcysteine, and a reduced dose of contrast dye may be recommended, or they may undergo different procedures altogether. Problems that found There are several limitations of ultrasonography, CT, and MRI: lack of visualization for large portions of the urinary tract with ultrasonography, necessity of contrast agent administration and excretory images with CT, inability to visualize subtle urothelial abnormalities with sufficient spatial resolution with both CT and MRI, and insufficiency in visualizing calcifications with MRI[1]. Additional disadvantages of MRI are inconspicuousness of small intrarenal calculi, susceptibility artifact due to metallic objects that interfere with the visualization of ureteral segments, flow-related artifact in some sequences, and interference of hemorrhage into renal collecting system with static-fluid MR urography[8]. The patient effective dose, and therefore radiation risk, of CT urography is 1.5 times that of conventional urography. The increased radiation risk from a CT urography compared with an IVU should be considered in the context of the amount of information that is necessary for th e diagnostic task. Radiation risk is increased for smaller patients in CT urography and for larger patients in IVU[5]. Although CT falls short of IVU in the evaluation of urothelium, helical CT technology continues to evolve with introduction of multidetector row scanning (MDCT)[3,9]; MDCT may eventually replace IVU for the evaluation of hematuria[2,4]. Finally, there is not an optimum or ideal examination technique for CT urography[10] or MR urography. Examination techniques must be constructed according to suspected pathology of the patient and urinary system status. Although advances in imaging technology have given CT and MR urography advantages over IVU, many centers still use IVU as a part of routine radiological practice. Therefore, techniques or modifications for improving application and diagnostic capabilities of IVU should still be considered. For decades, intravenous urography has been the primary imaging modality for evaluation of the urinary tract. In recent years, however, other imaging modalities including ultrasonography (US), computed tomography (CT), and magnetic resonance (MR) imaging have been used with increasing frequency to compensate for the limitations of intravenous urography in the evaluation of urinary tract disease . Like intravenous urography, however, these examinations have their limitations. Large portions of the urinary tract are not visualized at US; CT requires contrast material administration and excretory images (at times with a prolonged delay), often with image reformatting for evaluation of the urothelium; and MR imaging may not demonstrate calcifications or show the urothelium with sufficient resolution for evaluation of subtle abnormalities. Thus, despite increasing use of these alternative modalities, the ideal global urinary tract examination remains controversial . Axial imaging with con trast material opacification of the urinary tract will likely evolve as the most efficient imaging evaluation. However, the declining use of intravenous urography in clinical practice reduces the opportunity to learn important interpretive skills. Formal urography (or the urographic equivalent of conventional radiography of the urinary tract following administration of contrast material for CT) is frequently performed in the evaluation of hematuria. Urography may also be performed in the pre- or posttherapeutic evaluation of stone disease that has been discovered with other modalities. BARIUM SWALLOW Introduction A barium swallow and meal is type of X-ray test that allows your doctor to examine your throat, oesophagus (the pipe that goes from your mouth to your stomach), stomach and the first part of the bowel (duodenum). X-rays usually pass straight through parts of the gut such as the oesophagus, stomach and bowel and so these structures dont show up well on plain X-ray images. However, if the gut wall is coated with barium, a white liquid that X-rays cant pass through, a much clearer image of the outline of the gut can be captured. If your stomach is being examined, the test is called a barium meal. If your oesophagus is examined at the same time, its called having a barium swallow and meal. A barium swallow and meal test can help work out why youre getting symptoms such as difficult or painful swallowing, heartburn, reflux and abdominal pain. The tests give your doctor information about the swallowing action, and

Comparing King Louis XIV of France and King Philip II of Spain :: King Louis XIV, France, King Philip II, Spain

The palace of Versailles was built by King Louis XIV of France and the Escorial was built by King Philip II of Spain. The two kings each had their differences about their beliefs on how to rule, yet there are some similarities. Louis XIV believed in showing off his power and being open. Philip II was a simplistic guy devoted to Catholicism. They both had military to spread their beliefs and ideas. Despite the kings’ beliefs, their palaces reflected their ideals. King Louis XIV was a showy and self-absorbed king. His palace was representative of his personality and ideals. The Versailles palace architecture displayed Louis XIV ideals of secular issues. He cared more about spending money to show off his power. Unlike the Escorial, Versailles was centered on â€Å"The Sun King† instead of religion. At one point Louis XIV stated that â€Å"he was the state†. This statement was saying that Louis XIV represented the center and best of France. An example of this was that King Louis XIV lived in the middle of Versailles. Versailles was also very ornate and had the atmosphere of freeness. However, the Escorial was very basic like Philip II. On the other hand, King Philip II was a more careful and simple king. The Escorial was more compact and closed in unlike the Versailles. Like the Versailles, the Escorial demonstrated Philip II ideals of religious issues. In the center of the palace, where Philip II would spend most of his time, was the church and monastery. Philip II considered himself King of Spain second and Catholic first. He preferred to sit in the monastery to look at historical records rather than Louis XIV’s conception of a king. Both palaces were Catholic but religion had a bigger role at the Escorial Palace. Also at the Escorial palace you saw more military surrounding it as for the Versailles it wasn’t as guarded. While the two kings had many differences their militaries were surprisingly similar. They both had military troops that guarded and walked around the palace. The kings’ military was not only used for protection but also for spreading their beliefs and ideals. Their military was alert and ready to protect if there was to be an attack on the palace. King Louis XIV and Philip II both would have enough troops to go to war and express their thoughts but also enough to protect the palace.

Edward Marshall Boehm Essay

Edward Marshall Boehm is a farmer, veterinarian and nature lover living near New York. He is in the art porcelain business. His product is well-known of its quality and uniqueness. The Boehms wanted to position the company for the long run. Their goals for the company were â€Å"to make the world aware of Mr. Boehm’s artistic talent, to help world wildlife causes by creating appreciation and protection for threatened species, and to build a continuing business that could make them comfortably wealthy, perhaps millionaires. There are two main issues facing by the company. First, the process of making these porcelain products is complicated and required detailed technical skills; the company does not have enough skilled staffs and producing power to meet the demand from the market. Second, the company lacks of enough distribution channels to raise awareness of its brand and the uniqueness of its products. The contribution of the case to strategic management is that Edward Marshall Boehm wants to set a detailed demographic where everyone in the world would be able to see. In order for him to show off his demographic he has to go through special procedures in order to do so. There are levels to managing his creations how he wants to sell them and who how he want to sell them to. In strategic management you must know your target market and area. You must also know that it takes certain levels of skilled workers in order to compete with major competition. Recommendations for solving the problem of the company can be to try to reduce costs by using other materials at a lower cost or developing a faster production process. Due the fact that the most competitive advantage of the company is the uniqueness and high quality of the product, the company should preserve its quality instead of using cheaper materials or faster production time that may violate the value of its products. First, the company should hire more staffs and train them to produce the products in order to increase production of lower priced products. Meanwhile, it should find more distributors to raise awareness of the company with larger markets.

A Guide For Students Writing A Great Discursive Essay

A Guide For Students Writing A Great Discursive Essay Discursive Essay: Topic and Structure Many people have at least one impartial friend. A disinterested friend is one who is exceptionally mature, never takes sides, and fair in all situations. That friend is similar to a discursive essay that we will elaborate in this article. Discursive essays are well known for being impartial; they take distance from complex issues. These essays would consider all possible outcomes from any given situation and makes conclusions based on the analysis. Discursive essays are more or less the same as that impartial friend you have who is willing to listen to your situation but avoids being emotionally attached in the issue under consideration. On the other hand, there is that friend we have who cant avoid taking sides on issues and will quickly get emotionally attached to a problem. This particular folk react readily and would always find a side to support. They would argue in support of this given side they have chosen until the end. This individual is very different from the discursive essay but conforms to the values of an argumentative essay. At times, they can relate to a persuasive essay. After reading this article, you will understand the best way of drafting a flawless discursive essay. It will be easier for you handling assignment on the discursive essay and will help you get a passing grade or even more. What is a Discursive Essay? A discursive essay is a kind of essay that would seek to explain all possible views and positions in a given topic, subject, or issue at hand. The main issue why students are given discursive essays is to determine whether a student can remain neutral on a given issue and overlook on the most charged opinions (How to Write an Amazing Discursive Essay (2019 Guide), 2019). You need to demonstrate to your teacher that even though you have your stand on some issues, you are capable of putting them aside and look at things logically. The most unusual types of discursive essays take silent steps and examine every shade of an issue. Example of an impartial friend still applies. You may decide to go to your best friend and inform him/her how your roommate failed you for lunch despite confirming to come. No matter how you present your statement, that impartial friend will still remain impartial and would replay and say: Well, in one perspective, that sounds rude and was not the best thing to do more so after confirming attendance lunch. In this modern time, there is no point why one would fail to give notification of not attending to your invitation. Communication is straightforward and just sending a text message was enough to settle everything. However, looking at the issue from another angle, you might find out that your friend got a demanding task that left her little time to even communicate to you. I have heard her complain severally that her cellular device is poor while in office. Besides, her parents are such strict, so she seems, to have weird issues when it comes to disappointing people. Like an impartial friend, discursive essays do not jump into conclusions even when an issue seems to be in black and white. Even when something appears to be simple, it is never that simple. Just a fraction of items in the whole world is simple. Thus, discursive essay gives students an excellent opportunity to critically look at issues and identify any connection existing in them. Structure of a Discursive Essay Nothing is unique when it comes to formatting. A discursive essay has similar structure like other essays you know. In your introduction, you need to start with a hook that connects to the rest of the essay and motivates the reader to continue reading. Other sentences would then discuss the background of the issue and how it connects to the current world. A discursive essay is one of the most challenging writing tasks as you need to develop a thesis statement that does not side with any part. I am sure you are used to writing those thesis statements that are definitive and would easily guide readers towards the direction the paper takes. The thesis statement for your discursive essay should maintain your two sides throughout your piece. For instance, you can decide to give a thesis like this: Although many people believe that death penalty should be eliminated as it is morally wrong, there are those who think that it should be administered as failure to administer it would deny victims justice. The above thesis statement has taken into consideration two possible perceptions that would be discussed. Every paragraph should not mix the two discussions but rather dwell on one. For example, if you are discussing on the immorality of death penalty, you need to equally have other two paragraphs that discuss on the pros of the death penalty. Also if you decide to write one paragraph for the death penalty, you will also have to write another one article to counter your claim. This should be effectively achieved regardless of your actual beliefs of the claim. Each side should be treated equally and should be similar in size and even word count. Concluding a discursive essay is different from the past conclusions students are conversant with while writing their assignments. But with this essay, you will start your conclusion by assessing all your evidence. While doing this remember not to define your stand but make more sense in your writing. Again, we make our references to an impartial friend who never takes sides no matter what. An impartial friend will never take a side but will weigh on issues and provide a response based on reality. In the above case of missed lunch, a disinterested friend will claim that it was not right for someone to lose lunch when plans had been made early. Though the friend might not be in a position to call or text, she could have sent you an email. All in all, we are human beings and one need to consider many options. The dream job your friend tried hard to get turned distracted her from her social life. She can work for almost 12 hours a day. In this statement, the conclusion will give more clarification but does not take sides with the issue. Also, in other essays, you will have to talk about your main points discussed in your body but using a new version of the language to avoid sounding repetitive. Some instructors will advise their students to give their viewpoint at the end of a discursive essay. This is not a true discursive essay but rather a semi-discursive essay. A purely discursive essay will not take sides even in conclusion. The ability of the composition to remain neutral throughout makes it strong compared with other essays that would change its focus at any point. A Template For Discursive Essays A hook sentence (quote or statistics) aimed at capturing the attention of your readers while showing them the purpose of your essay Background sentence Background sentence that is linking two discursive sides of your essay Transitional sentence Thesis statement: looking at truthfulness of the two sides Topic sentence that supports a give side of your topic Discussion on the relevance of your claim Supporting information on the details provided Detailed explanation on why you view is valid Topic sentence to support supporting the other view that opposes the thesis statement Important descriptions Further description or supportive information Discussing relevance of your opinion A nuanced discussion on the two opposing sides, stating validity of the two viewpoints without taking any concrete stand Revisit the first major point Revisit the second major point Revisit the third major point Revisit the fourth major point Connect the two perspectives of your thesis statement to a wide issue in existing either in the world or humanity. Steps of Writing Discursive Essays You need to choose a popular topic so you will have more content to write on. On your rough book, note down all basic points that will support one side of your thesis. Repeat the same for the remaining part of your thesis. Look for available quotes or statistics that are in line with your topic. Identify the one you like most and make it a hook for your readers. In this step, use two or three sentences to discuss the background of your issue. Design a thesis statement that summarizes the two sides of your topic. Use the first paragraph of your body to discuss on one perspective of this topic as well as the main points supporting it. Go deep and make your readers understand that you know the aspect inside out. (If you teacher wants a more extended essay, make sure to add paragraph). Repeat this in the following paragraph. Write an exciting opening sentence to conclude your work that revisits all that has been discussed in your essay. Do this is a way that will clarify your essay your points. Summarize your main points and give if possible your preference but do not be so open to it. Connect your points to the rest of your paper on the particular issue in the society, larger picture, or human existence. Topics on Discursive Essay Are two-parent homes more superior compared to single-parent homes? Do you believe that middle children in the family are under-achievers? Do you believe that exposing young children to violent media prepare them to the future realities in life or it will make them more violent like what they see? Do children growing with pets behave in a more adjusted life in their adulthood? Should religious institutions be taxed? Do social media have a role to play in controlling online bullying and troll irrespective of the first amendment bill? Do you believe that people who walk to work or ride on their bicycle should have reduced tax? The best teacher is a failure. Largest governments on the planet always try to stifle the economy of the country it controls. Children who are grown in the suburbs might not reach their full potential as these areas lack enough experiences children need. Example of a Discursive Essay Success is a lousy teacher. It seduces smart people into thinking they cant lose. This is a basic statement that was spoken by the richest man on earth, Bill Gates. If you sample some wealthiest people on earth, they seem to have one common understanding about success. They think that success is fickle in giving useful lessons that should be used while giving instructions. Any critical person will agree that failure has its own lessons to teach people. Even if it offers instructions, is it a better teacher than success? Both success and failure have lessons to teach us in life. But the main question remains if one is best compared to the other in a personal level development. In this essay, we will examine each experience in a more detailed way giving values of both failure and success in forcing one to develop. Failure gives us instant lessons with the majority of them being the regular lessons. Failure will show brilliant individuals that they are can also fail. Not all projects they venture it will eventually be successful, or like by the public. Failure is a mirror in peoples lives, and it helps them to re-examine themselves on the mistakes they might have done in the past. One will think of where something was overestimated/underestimated or even miscalculated. Failure will teach you and endure all levels of success like introspection that we tend to avoid. If allowed, the collapse will usher in a series of mistakes. All these mistakes should be fixed first before proceeding with the journey. Thus, failure is experiential learning that gives us an accurate picture of what we expect to get if we behave in a specific manner. The moment a person decides to embrace failure; he/she will endure all moments of break-down encountered on the way. This is experimentation that paves in great innov ation and discoveries that has changed the planet. Additionally, it makes one venture in the possible growth of emotional intelligence. This is because failure is accompanied by a sense of embarrassment.   Failure leaves you with nothing but to pick yourself up and try again. This will help but rather force one to forge ahead concerning grit, character, and resilience. On the other side, we have neglected the power success has to teach on the right paths of life. As one renewed entrepreneur said, you can own success but rather rent it, but even after renting it you have to understand that its rent is due every day. That is why we find successful people competing with each other daily. They have noticed that their success is not everlasting and they need to work hard in order to maintain their success. Success has forced them into a competition on a rigorous playing ground bringing them to this challenging battle. If they have to succeed in their ventures, then they need to be phenomenal. All successful individuals learn in a rather quick manner, and they leave their practices that do not make them succeed quickly to focus forward. In conclusion, both failure and success give specific opportunities and lessons for our growth. Identifying which one is best to use is very hard and might take quite a long some time. On the one hand, failure comforts one to confront failure with more energy and approach every situation experimentally. On the side of success, it offers individuals constant power to work smarter to maintain their excellence. In the process, they connect with other successful people whom they share ideas with. Both experiences drawn from the two offers an individual opportunity to grow. Failure should be treated as a circumstance that is unavoidable if one has to succeed in life. A discursive essay provides one with an opportunity to step into another persons impartial friend. When in this position, you get a chance to examine all places that may be surrounding a given situation or idea. Many people will not do these easily. Also, discursive essays give one the freedom not to argue or convince readers on a particular idea. Instead, your work is to shed light on some ideas that are not well understood by the public. If you need professional feedback regarding your essay or you need help with writing, we are here for you. Feel free to contact us at any time. Whether you need feedback or assistance with your essay, remember you are the reason why we are here. Our professional writers will help you any time you need to write a flawless article that will impress your instructor.

Motivating Employees Essay

Motivating Employees Essay Motivating Employees Essay Motivating Employees Today many forms of motivation are used in the work place to get employees to be motivated in doing their tasks at work. When talking about motivating employees you are talking about intrinsic and extrinsic motivation. Each one of these forms of motivation works in its own way to get the employee to accomplish whatever task that needs to be done. Intrinsic motivation is defined as the form of motivation that comes from within a person and not from money or any other form of reward. Someone that is intrinsic motivated will do something because they love doing whatever the task is and want to finish the task. Although someone is intrinsic motivated, understand that by no means that it means that the individual would not seek out what is considered an external reward such as money, prizes, or a payment of some sort. A good example of someone who is intrinsic motivated would be a parent. The reason why I say this, is because a parent accomplishes many tasks without expecting to be thanked or receiving an external reward. Extrinsic motivation is defined as the form of motivation that does come from an outside source such as money, prizes, or rewards. There are many forms of external rewards and they can be very simple to very extreme. Once again though this does not mean that an individual who is pushed by an external reward does not love what they are doing. I have to use myself as an example. I do my job as a night counselor because I enjoy getting a