Essay on Passion Essay

Well, the saying goes â€Å"Do what you love and love what you do†, but how many of us truly practice this in our everyday life, as much as we preach it? In every nook and corner, we have a student cursing his school and probably the examinations that come along with it or a teacher complaining about her incorrigible class or a software engineer taking out the frustration over his boss on his computer – many more such sights! We are the Homo sapien sapiens, the most dominant species on Earth (apparently). Why then do we not have dominance over our own happiness, over what we do and what we want to? (And by dominance, I mean controlling and not bossing over something.) What is it that holds us back from following our heart? Financial background. Preconceptions†¦ and the list is endless. But is that passion of yours not worth giving a shot? If no is your answer, then forget about it; it was not your true passion in the first place. Some say they are not really passionate about one particular field or thing. These ‘some’ can be categorized into two categories, namely the ‘doers’ and the ‘despisers’. The doers are the ones are who enjoy almost everything they do that they cannot put their finger on one as their passion. So, it is highly unlikely that you find a doer, disliking what they do, while the despisers are quite the opposite. They are those who have a complaint against most things around them that they do not see the point in being passionate about anything. The reasons behind such an attitude of theirs could be rooted to their family upbringing, huge disappointments despite a lot of hard work or merely the fact that they are sensitive-perfectionists who possess an utopian vision of the world and hence, hate it when even when the tiniest of things is out of place (by probably a few millimeters, if we were to measure it). At this point, I certainly agree with what the great Lincoln once quoted, â€Å"Most folks are as happy as they make up their minds to be†. The despisers seem to have a problem at every step, at every sight. They, sadly, fail to look at the brighter side of things. They should be able to come to terms with the fact that nobody and nothing is perfect. Since we are the cause of our own happiness, the onus is upon us as to whether we view the glass half empty or half full or (like the Gujarat Chief Minister) as half filled with water and the rest with air. Now, on re-analyzing the opening quote, I have come to realize what it could also mean†¦ In case, you are unable to do what you really love, then start loving what you are doing at present. In the process, you end up doing what you love. If you’re the engineer, then remind yourself that it is the job that you are more interested in than your boss’ scornful words and hope and pray against all odds that your boss is in a good mood today or that someday you can grow deaf to only his words (the mean ones, not the ones with instructions). If you’re the teacher, then you should jolly well know that not all students are alike and have an interest in the subject, and hence, must be cut some slack. And if you’re the student then, take yourself down a few years, back to when you were a little, kindergarten kid, and the starry-eyed expression that you bore whenever the teacher narrated a story. That story was completely new to you yet, you loved to know what happened next. Bring this child back into you the next time you are preparing for an exam. And for this reason, there is still a ray of hope, rather, many rays of hope for those despisers- hope that soon, they will start loving what they do and prove to the world at large, that we truly are the ‘dominant’ ones. And once you have found your passion (or if you are the passionate-one who’s reading this article) then there’s one piece of advice I could give you, something that I stumbled upon on the internet- When there is something you really want, fight for it; don’t give up no matter how hopeless it seems. And when you’ve lost hope, ask yourself in ten years from now†¦ you’re going to wish you had given it just one more shot because the best things in life, they don’t come free! So spread your wings, and fly to your heart!

Botox: Almost Trouble-Free New Faces

Botox: Almost Trouble-Free New Faces Synopsis The Botox case illustrates the accidental success of a product developed for an entirely different purpose. Originally, Botox was used in the treatment of crossed-eyes, but ophthalmologists quickly learned that it would also erase wrinkles and frown lines around eyes. It wasn’t long before doctors across the United States were using Botox for treating wrinkles even though Allergan could not promote the product for this use.The case discusses the advantages (fewer frown lines) and disadvantages and side effects (drooping eyelids and the need to repeat treatments) of Botox; explains what the product is; lists potential target markets; selling of the product at â€Å"Botox parties†; use of Botox treatments to attract customers to resorts; Allergan’s marketing of Botox once it was approved for cosmetic purposes and the use of Botox to support the new strategy of Allergan to become a major player in the pharmaceuticals ind ustry.It closes with the observation that the formula for Botox is one of the most closely guarded product secrets in the world—along with the formula for Coca-Cola. The case is especially useful for discussing added value and the creation of customer satisfaction.It raises questions about the difference between needs, wants, and demands; what constitutes value; is useful for illustrating the difference between a marketing oriented company (Allergan after Botox) rather than a non-marketing oriented company (Allergan before Botox); the potential benefits of marketing and raises questions about societal marketing (should Botox be promoted for cosmetic purposes? Should it be sold through parties? ) The case can also be used to illustrate relationships in the marketing paradigm—between Allergan and doctors, Allergan and final consumers and doctors, and final consumers.Allergan’s marketing efforts are two-pronged in order to successfully promote to both markets. It i s important for students to realize the pivotal role of the doctor in this purchase process in which consumers do not buy the product directly. Teaching Objectives 1. To illustrate the effect of publicity on product success. 2. To raise questions about the differences between needs, wants, and demands. 3. To challenge students to define added value and how it relates to consumer satisfaction. 4. To demonstrate the importance of target market selection (not just for women! ). . To illustrate the marketing of a pharmaceutical product and the importance of the doctor in the marketing process. 6. To illustrate consumer-oriented marketing. 7. To raise questions about the social impact of a marketing success such as Botox. 8. To illustrate the role that marketing plays in the development of company strategy. Answers to Discussion Questions 1. What are the needs, wants, and demands of consumers for Botox products in its dif- ferent treatment markets? What value does Botox deliver in each m arket? How does value affect the price for Botox?The use of Botox for ocular treatment illustrates a classic need. The consumer has a defect that needs treatment. When used for crossed-eyes, the product not only has strong physical properties, but social properties as well. Patients can see better, but they may also feel much better about themselves as their appearance improves. This can have a strong impact on their ego and social needs. Of course, this also illustrates wants. People with crossed eyes can still read and function. The want here is not that they will expire from lack of the drug, but that they want to look better and feel better about themselves.The value of this is undeniably high. What probably constitutes the major portion of the value are the social and ego wants. One can live without it, but does one want to? Because the value is high, the price can be high. But in this market, insurance reimbursements may operate to lower the price that consumers are willing to pay. After all, they don’t have to have the product. Although there is need, want is also high. Botox for cosmetic purposes is quite different. This situation illustrates want. We can all live with wrinkles, but we want to be rid of them. Want drives the purchase process.Given American’s obsession with appearance, the value of improving appearance would be very high. Again this value would primarily be ego (I look better) and social (others think I’m younger). And one would pay for it. As the case indicates the cost of Botox is quite high and unlikely to be covered by insurance companies for cosmetic purposes. The Botox example illustrates want and need are quite different and they affect value. Unfortunately many U. S. consumers place a higher value on ego and social wants than physical needs which accounts for the run-away success of Botox. . When Allergan sold Botox as a specialty drug for ocular problems, what marketing management orientation was it employi ng? When it sells Botox as a cosmetic treat- ment, is it employing the same or a different orientation? One could argue that Botox as a specialty drug for ocular problems illustrates the product concept. The focus of the company was on eye and skin treatments. Thus, it developed products within those categories and sold them on a product need basis to doctors. The success of Botox cosmetic has forced the company to become more marketing oriented.The company is now focusing on target markets and developed promotional efforts aimed at final consumers as well as promotion to doctors. The company has found a new use for an existing product that lies outside their tradition product focus. 3. When doctors treat patients with Botox in their office, is that an example of a selling concept or marketing concept? When they hold parties for patients in private homes? The answer to these questions depends on what the Botox is used for and the motivations of the doctors.When doctors are prescribi ng Botox for ocular problems, this would seem to be the marketing concept because they are focusing on the needs of the consumer. The same could be said for Botox cosmetic. Parties, however, seem to be different. Here the doctor’s motivation seems to be on selling a greater quantity of the product. That resembles the selling concept. This is not a focus on the needs of individual consumers as treating individual consumers in the office would be. The goal seems to be to increase revenues by cutting costs and serving multiple customers at once. . Apply the concepts of customer lifetime value and customer equity to Botox. How do doctors and Allergan improve the way they manage customer relationships? Because customers need an on-going series of treatments, Botox has the opportunity to provide lifetime value over and over. The value added will depend on how well Botox continues to work and aging consumers’ desire to appear young. The efficacy of Botox over time is a proble m for Allergan. At this point, no one knows how Botox treatments will work over a period of years. Will their effectiveness decrease?Are there side effects, unknown at this time, to continued use of Botox cosmetic? Eventually, consumers may be more willing to live with their wrinkles and/or tire of paying for Botox. One advantage that Allergan has is that many consumers may only recognize the Botox name with the result that loss of efficacy will not affect sales of other Allergan products. Consumers may be quite willing to buy other Allergan products even if they become disenchanted with Botox. The issue of efficacy affects equity. If the brand does not continue to work, it loses equity over time. Equity represents the brand’s share of the consumer.If Allergan built a strong corporate brand, it could have more equity with the consumer who buys a variety of Allergan products. On the other hand, having individual brands for various products avoids negative brand carryover. 5. H ow does Allergan connect with its customers (doctors)? How does it connect with final consumers? How does it connect with the world around it? What could it do to improve these connections? Doctors: Allergan has beefed up its sales force to increase promotion to doctors and developed clinics in which doctors are taught the appropriate use of Botox.Final Consumers: It has increased advertising to final consumers. Allergan has developed Web sites that target both doctors and consumers. This is especially the case for Botox. When one goes to the Botox Web site, one finds information for doctors (more technical information on the product and how to prescribe it) and information for final consumers including how to find a physician—especially important because final consumers cannot buy the product directly. The site for consumers shows results, give beauty tips, and is fairly interactive as consumers have the opportunity to participate in surveys and polls and view the results.Th e information is much less technical and much more oriented to appearance. Global: The Allergan Web site (www. allergan. com) first pops up asking the viewer to pick a country. Choices are France, the United States, Germany, Japan, the United Kingdom and Canada. Although the Internet is a major means of promotion for Allergan and Botox stimulating demand from both consumers and doctors, Allergan seems to be making a major push primarily in the more economically advanced countries around the globe. This is logical for a company that has only recently begun to grow.It is far from saturating global markets and would do well to deal initially with more affluent markets as many of its products are expensive. To improve its connections, it could develop Web sites for more countries and cross-sell more products. A logical product extension might be skin care products. At present, it is suggesting the use of various types of skin care products, but it would seem that a line of Botox skin pr oducts would sell very well. This could increase the equity of the brand and strengthen the relationship with the consumer. Teaching SuggestionsIn assigning this case, ask students to read it and to think about the societal issue. Should a company market a product such as Botox for what some consider a seemingly frivolous use? This should stimulate students to begin thinking about the value of the product and the impact extension marketing of it has on consumers. In class, begin the discussion by asking students what they knew about Botox before they read the case. This should illustrate the value of publicity and also the potential for misunderstanding the product and naturally leads to questions about the value of the product—what it consists of and how that affects satisfaction.You might follow the order of the questions at the end of the case. When you get to the last question, go to the Web sites (www. allergan. com and www. Botoxcosmetic. com). Work through the Web site and focus on the differences in the â€Å"pitches† to final consumers and doctors. This will provide plenty of opportunity to discuss the stimulation of wants, relationship with customers, etc. At the end of the discussion, you might ask students how they feel about the extension promotion of Botox. Should it be heavily promoted for cosmetic purposes?Is doing so good for society? The class might even be divided in those who favor heavily promoting Botox and those who don’t to debate the issue. It’s important to emphasize the needs and wants of consumers as part of a social system. There is always an opportunity cost to buying Botox. If consumers are spending so much on it, what are they not buying? Should this product be promoted to consumers with incomes of $50,000 as opposed to $150,000. What is the spillover impact on consumers with lower incomes? Would that be detrimental to such consumers? Society?

Prone Positioning On Critically Ill Health And Social Care Essay

In my nursing experience, I have worked in both the neonatal intensive attention unit ( NICU ) and the paediatric intensive attention unit ( PICU ) . When I worked in the NICU, our babies were positioned prone ( face down ) for comfort grounds for the bulk of a 24 hr period. Our neonatologists seldom used sedation or trouble direction resources for our automatically ventilated patients. In the PICU I presently work in, all of our automatically ventilated patients are given uninterrupted medicines for both sedation and hurting, nevertheless prone placement is about ne'er used. When I have positioned patients prone in the past, most nurses look cross-eyed at me as though I have done something incorrect. Past research has suggested that prone placement is a curative manoeuvre that improves oxygenation in both paediatric and big patient populations ( Curley et al. , 2006 ) . However, some clinical tests in both paediatric and big populations have demonstrated that there is no betterment in clinical results for the patient ( Curley et al. , 2006 ) . In other surveies, when a patient is placed in the prone place, it has been shown that there is an increased in terminal expiratory lung volume and improved ventilator-perfusion fiting taking to better oxygenation ( Gattinoni et al. , 2001 ) . As you can see, there is assorted informations from many surveies proposing prone positioning leads to break clinical results for patients. Besides, as I was researching, I truly could n't happen a survey or literature that was new within the last 5 old ages. There is a current demand for updated research surveies and information. Hopefully I can carry through and add to the research with my proposed survey.Purpose, Aims, and HypothesissThe intent of this research survey would be to bring forth informations to assist infirmaries develop a policy, process and protocol for prone placement in critically sick, paediatric patients. The informations collected from this survey can add to the literature and hopefully convey current evidence-based pattern to PICUs across the state. Harmonizing to Polit & A ; Beck ( 2008 ) , purposes can be defined as the particular accomplishments a research worker would trust to accomplish by carry oning a research survey. My proposed survey has two specific research purposes.Aim 1To prove the effectivity of prone placement in automatically ventilated, critically sick paediatric patients, related to betterments in oxygenation.Aim 2To analyze techniques in airway direction of a automatically ventilated, critically sick paediatric patient, to find the safest nursing pattern in prone placement.HypothesissFor Aim 1, the hypothesis is that paediatric patients, who are critically sick and automatically ventilated, will hold better positive clinical results related to betterment in oxygenation in prone placement than in supine placement. The void hypothesis is that there is no difference in prone or supine placement in patient clinical results. For Aim 2, the hypothesis is that there will be safe techniques in airway direction in prone placement for the automatically ventilated, critically sick paediatric patient. The void hypothesis is that there is no safe technique in airway direction in the prone place based on continued, critical inauspicious events.BackgroundThe reappraisal of literature on the effects of prone placement in automatically ventilated patients has mixed ideas. Surveies conducted by Dr. Martha Curley and her research squad from Boston Children ‘s Hospital have refuted and so accepted the usage of prone placement in automatically ventilated, critically sick paediatric patients. Curley et Al. ( 2000 ) researched the physiologic alterations of automatically ventilated paediatric patients and evaluated the safety of prone placement who experienced acute lung hurt. The information was collected from a single-center prospective instance series from October 1997 to March 1999. The sample was 25 paediatric patients with bilateral paranchymal disease necessitating mechanical airing with a partial force per unit area of arterial oxygenation ( PaO2 ) to the fraction of divine O ( FiO2 ) ratio of less than or equal to 300 millimetres of quicksilver ( mm Hg ) ( Curley et al. , 2000 ) . The patient ‘s ages ranged from 2 months to 17 old ages. The participants were placed prone for 20 hours a twenty-four hours â€Å" until clinical betterment or decease occurred † ( Curely et al. , 2000, p. 156 ) . After run intoing eligible standards, informations collected consisted of arterial blood gases, critical marks ( temperature, bosom rate and arterial blood force per unit area, and cardinal venous force per unit area. Ventilator scenes and the figure of staff utilized and the clip it took to turn a patient were besides collected. The research workers besides collected informations on the medicine profile, particularly comfort medicines such as morphia and diazepam, and assessed force per unit area ulcers and presenting. â€Å" Features of the survey population are expressed as frequences, mean ( +/- SEM ) , or average with interquartile scopes ( IRQs ; 25th and 75th percentile ) † ( Curley et al. , 2000, p. 158 ) . The survey revealed that when prone place informations measurings were compared to the patient ‘s supine measurings, there were immediate and cumulative betterments in oxygenation ( Curley et al. , 2000, p. 161 ) . The research workers conclude that their survey suggests informations that prone placement is both safe and effectual in paediatric patients with ALI. Dr. Curley and her co-workers believe that this survey provides a foundation for a hereafter randomized survey to look into early and repeated prone placement for this paediatric population. Dr. Curley and her co-workers took on a prospective, multi-center randomized survey from August 2001 to April 2004. The hypothesis of this survey was that kids with ague lung hurt treated with prone positioning would hold more ventilator-free yearss than those treated with supine placement. Patients were included if they were age 2 hebdomads to 18 old ages old, intubated and automatically ventilated with a ratio of a PaO2 to FiO2 of 300 or less, bilateral pneumonic infiltrates, and no clinical grounds of left atrial high blood pressure ( Curley et al. , 2005 ) . Exclusion standards included patients less than 2 hebdomads of age, less than 42 hebdomads post conceptual age, had relentless hypotension or intellectual high blood pressure, cardiac related respiratory failure, and a figure of other medical conditions listed by the writers in their article. Of 8017 patients screened, merely a sum of 102 participants were included in the survey. A information and safety supervising board stopped the test at the interim analysis based on the futility fillet regulation. Ninety-four patients had completes the 28-day survey period. Of these 94, 47 were in each of the groups. After statistical analysis had been done, it was determined that if the survey had reached the planned registration of 180 patients, the chance of showing a difference in ventilator-free yearss between intervention groups was less than one per centum ( Curley et al. , 2005, p. 232 ) . The survey found that there was no statistically important difference of ventilator-free yearss between supine and prone placement in paediatric patients with acute lung hurt. Dr. Curley and her co-workers do non back up the continued usage of prone placement of paediatric patients as a curative intercession to better results in acute lung hurt ( Curley et al. , 2005, p. 236 ) . This province counters the research decisions drawn from Curley et Al. ( 2000 ) . Interestingly, Dr. Curley continued her research by executing a secondary analysis on this information collected in 2006. The intent of this secondary analysis was to depict the effects of prone positioning on airway direction, mechanical airing, enteric nutrition, hurting and sedation direction and staff use in paediatric patients with acute lung hurt ( Curley et al. , 2006 ) . The research workers suggest that their informations really shows that prone placement can be accomplished safely in critically sick paediatric patients. The research workers besides province that they believe patients can be safely assess and managed piece maintained in the prone place for drawn-out periods of clip, every bit long as 20 back-to-back hours ( Curley et al. , 2006, p. 417 ) . In this article on secondary analysis performed by Dr. Curley and her co-workers ( 2006 ) , they province that prone placement should go on to be used in critically sick kids as a enlisting manoeuvre in acute lung hurt to better oxygenation, lessening force per unit area wounds, and decreased bronchopulmonary compaction. These research workers besides province that this is the first survey to clearly show that prone placement can be accomplished safely. After researching prone placement in critically sick, automatically ventilated paediatric patients, I wholeheartedly agree. I believe that this is why these surveies could be replicated to assist formalize the protocols developed by Dr. Curley and her co-workers.SignificanceThe significance of a research survey on prone placement in paediatric patients is overpowering. In my ain personal experience, there has ne'er been grounds presented to my nursing co-workers or myself on whether prone placement is really safe and effectual. As ant ecedently stated, in reexamining the literature, there are really few clinical surveies that would be considered good mentions as true province of the art, evidence-based nursing pattern. In fact, I can non believe that merely Dr. Martha Curley has taken this undertaking on for the paediatric population. This proposed survey will be able to place the effectivity of prone positioning on improved oxygenation in a automatically ventilated paediatric patient. From survey informations aggregation, techniques in safe air passage direction could assist ease the usage of prone placement in paediatric patients of all ages and sizes and possibly advance more positive clinical results. In my survey, I hope to retroflex Dr. Curley ‘s methods utilizing her protocols, with some minor tweaking. This proposed survey should add to the organic structure of literature. The significance of this survey could assist formalize Dr. Curley ‘s protocols from her past surveies and besides assist make a criterion of pattern for prone placement.Research MethodsSample, Setting and RecruitmentThe mark population to be studied would be critically sick, paediatric patients runing from ages 2 hebdomads to 18 old ages of age. Inclusion standards will besides include patients with acute respiratory hurt necessitating cannulation and mechanical airing. Exclusion standards will be patients with respiratory hurt or failure of cardiac nature. Patients will besides be excluded if they have spinal instability or hold had abdominal surgery, as it would non be safe for these patients to be prone positioned. Patients with tracheotomies will be excluded. I would trust to include patients on conventional airing and high frequence hovering airing. Patients will be excluded if they weigh over 200 lbs, as the protocol will merely utilize three staff members to turn the patient, and this may be insecure in a patient of this size. The survey participants will be recruited from paediatric intensive attention units from infirmary centres willing to take part. In day-to-day unit of ammunitions, we would allow the paediatric critical attention doctors determine if the patient ‘s medical position was stable plenty to be eligible for survey standard. Randomization of patients will be done between prone placement and supine placement by utilizing a consecutive figure system. Centers will be provided envelopes with cards denominating between prone and supine placement and assign as each new participant is eligible. A sample size that would mirror Dr. Curley ‘s would be ideal. I hope to obtain at least 100 participants, but purpose for 200 participants. With 200 participants, the hope is to duplicate the original sample size, duplicate the figure of prone-to-supine and supine-to-prone bends, and increase the cogency of the research.Data Collection and InstrumentationFor my research survey, I hope to develop a systematic extension reproduction of the old surveies done by Dr. Curley and her research squad ( Curley et al. , 2000 ; Curley et al. , 2005 ; Curley et al. , 2006 ) . Dr. Curley and her co-workers ( 2006 ) developed a prone placement protocol for bedside nurses to follow in respects to analyze participants. The protocol is attached in Appendix1, nevertheless a brief drumhead is provided to assist assistance in the shaping of informations aggregation and instrumentality. When a patient has been met standards and is designated as eligible for the survey, informations will be collected based on the Pediatric Risk for Mortality III ( PRISM III ) ( Pollack et al. , 1997 ) . Demographics such as age, race, and ethnicity will be categorized. An anteroposterior thorax radiogram, in the supine place, should be obtained to document and guarantee that the endotracheal tubing ( ETT ) is positioned decently in the deep windpipe. The security of the ETT shall be assessed every bit good, based on the establishments current protocols. The size of the ETT, whether it is cuffed or uncuffed, and arrangement shall be paperss as Ten centimetres ( centimeter ) at the gum, as in â€Å" the patient has a 4.5 cuffed ETT, taped firmly at 12 centimeter at the gum † . The turnup of an ETT should be inflated with the minimum leak technique: inflate turnup until an air leak is ascultated at end-inspiration while maintain turnup force per unit area & gt ; 25 millimeter Hg ( Curley et al. , 2006, p. 420 ) . Security of the ETT and arrangement at the gum will be documented after each bend from the supine-to-prone and prone-to-supine placement every bit good as every 4 hours while in the prone place. The nurse or respiratory healer will doc ument whether or non the patient had a nonelective extubation during the bend. In respects to soothe and clamber unity, the patient ‘s should hold separately sized caput, thorax, pelvic, and leg shock absorbers to place the patients while prone ( Curley et al. , 2006, p. 419 ) . The end is to hold the patient positioned prone, with their shoulders, hips and lower limbs supported while their venters has room to stick out ( towards the bed ) and custodies can be tucked under the venters. The existent shock absorber will be difficult to set up, as every infirmary uses different positioning devices, nevertheless, I will offer the thoughts of slackly rolled covers or the Eggcrate stuff cut to the appropriate size. It will be documented if the patient has developed a force per unit area ulcer, and the ulcer will be staged harmonizing to National Pressure Ulcer Advisory Panel ‘s ( NPUAP ) description. The NPUAP ( 2007 ) established four phases of force per unit area ulcers. The first phase includes force per unit area sores that include non-blanchable inflammation, with integral tegument, normally over a cadaverous prominence. Phase two includes shoal, unfastened ulcers with a ruddy or pink pigmentation, without sheding of the tegument. Stage three ulcers include a full thickness tissue loss. Hypodermic fat is normally seeable at this phase and shedding may be present. In a phase four ulcer, the ulcer is stage three with seeable bone, musculus or sinew. A patient will stay positioned prone for 20 hours of the twenty-four hours and supine for 4 hours a twenty-four hours. The length of clip a patient is prone and supine will be recorded. Ongoing measurement will be done on all organic structure systems, including pneumonic and circulatory. Arterial blood gases will be obtained 1 hr prior to a patient being positioned prone and 1 hr after the patient has been prone. To maximise safety, staff will use bedside nurses and respiratory healers during chances for turning. The respiratory healer should be responsible for the unity of the tubing and turning the patients head, bedside nurse 1 shall be responsible for the turning of the shoulders, thorax and weaponries, and beside nurse 3 shall be responsible for the turning of the hips and legs. The prone positioning protocol that is attached as Appendix 1 which will be at the bedside of every patient for the nurses and respiratory healers to follow consequently.Datas AnalysisHarmonizing to Polit & A ; Beck ( 2008 ) , there are two wide categories of statistical trials, parametric and nonparametric. Parametric trials normally involve the appraisal of parametric quantities, require measurings on an interval graduated table, and presume that the variables for distributed usually for a population. These trials are frequently considered the most power and are normally preferred by research workers ( Polit & A ; Beck, 2008, p. 591 ) . Nonparametric trials do non gauge parametric quantities, normally used when the sample size is little or the information is considered non-normal. Figure 22.5 in Polit & A ; Beck ( 2008, p. 592 ) is a speedy mention for choosing bivariate statistical trials. Harmonizing to Polit & A ; Beck ( 2008 ) , the Fisher ‘s exact trial will be used to prove the significance of the differences in the two interventions ( Polit & A ; Beck, 2008, p. 601 ) . Fisher ‘s exact trial or x2 trial will be used to compare prone and supine groups in their baseline features and results that will be calculated on an single patient footing. Based on the categorical informations, such as the oxygenation of the patient, related to the arterial blood gases, I think a Fisher ‘s exact trial will be the best trial. The accidental extubation rate during bends will be calculated utilizing an exact binomial trial for comparing the rates of two Poisson procedures. For prone patients, Wald ‘s statistic, distributed as a qi square, will be calculated based on results evaluated after alterations in placement. The figure of staff utilized and the length of clip involved in the place turns will be analyzed utilizing signed rank trials such as a Wilcoxon rank trial. Once all information has been collected, synthesized and analyzed, the research will be drafted into a manuscript and submitted to the Pediatric Critical Care diary. Before the survey begins, it will be reviewed, and hopefully approved, by the IRB. Before a patient becomes a participant of the survey, written informed consent will be obtained from a parent or legal defender. Both female and male patients will be utilized, and the exclusion standard is entirely based on patient safety. The participants will be allocated to the prone and supine placement groups reasonably by utilizing random assignment. Complete decrease of prejudice can non be established because it will be impossible for the clinicians to non cognize whether or non their patient is positioned prone or supine. With the assorted placement protocols and adjustments with pressure-reducing stuffs, I hope to diminish the incidence of compromised tegument unity and uncomfortableness. This survey does non object, and encourages the usage of sedation and hurting medicines while the participants are automatically ventilated.

Critics of the World Bank Case Study Example | Topics and Well Written Essays - 2250 words

Critics of the World Bank - Case Study Example Still there remain a lot of issues that point out at the loopholes. Though the World Bank in known for its achievements over the past few decades, it has been subject to various criticisms over the years for its policies, functions and activities. The World Bank is attack from all sides by critics on grounds that it is not efficient, not accountable or responsible, not democratic or legitimate, and most importantly that the World Bank is not relevant in a global economy which is presently subjugated by private capital, production and ideas. This paper focuses on the critics faced by the World Bank. Ever since its establishment, it has been subject to various criticisms. At this stage it will be useful to give a brief overview of how the world bank functions and what are the divisions of World Bank. The World Bank is the largest public development institution in the world. The World Bank lends about US$ 25 billion each year to developing countries or various developmental activities with the main purpose of reducing poverty. The main goals of the World Bank, as outlined in Article One of its Articles of Agreement, are: "to assist in the reconstruction and development of territories of members by facilitating the investment of capital for productive purposes" and "to promote the long-range balanced growth of international trade and the maintenance of equilibrium in balances of payments by encouraging international investment ... thereby assisting in raising the productivity, the standard of living and conditions of labour in their territories" (Bretton Woods Project, 2005a). The World Bank is a group of five closely associated international organizations responsible for providing finance and advice to countries for the purposes of economic development and eliminating poverty. Its five agencies are: International Bank for Reconstruction and Development (IBRD); International Finance Corporation (IFC); International Development Association (IDA); Multilateral Investment Guarantee Agency (MIGA); and International Centre for Settlement of Investment Disputes (ICSID). The World Bank's activities are particularly focused on economically backward developing countries. Each of these organizations has their own aims and objectives. The International Bank for Reconstruction and Development (IBRD) aims to reduce poverty in middle-income and creditworthy poorer countries by promoting sustainable development through loans, guarantees, risk management products, and analytical and advisory services. The IBRD and IDA provide loans at preferential rates to member countrie s, as well as grants to the poorest countries for developmental activities. The main activities of the IFC and MIGA include investment in the private sector and capitalizing insurance respectively (Wikipedia, 2007). In the recent years criticism of the World Bank and the IMF on various issues has been a cause of concern to the Bank. These criticism in general centre on the fear about the approaches adopted by the World Bank and the IMF in defining their policies. Especially the socioeconomic impact these policies have on the population of countries who benefit themselves of financial assistance from these two institutions. To be more specific it can be said

Flip The Funnel Reflection paper Research Example | Topics and Well Written Essays - 1250 words

Flip The Funnel Reflection - Research Paper Example The book named ‘Flip the Funnel’ shows a triangular relationship between good old-fashioned fundamentals of business, future-focused vision of the business leaders and most importantly, common sense. This book allows the development of a totally new way of thought thinking and provides space for turning the existing conventional practices upside down in order to develop a new way of thinking (Jaffe, 2010, p. 270). This new methodology has taught me the way in which businesses can expand through shrinking costs. Reduction in costs would also allow shrinking the financial budget. It helps managers to adopt strategies about achieving higher yield from making less investment and incurring lesser costs. This new process focuses not only on profit maximization but also on the needs of the customers, so as to induce them to satisfy their needs by spending their money with the particular company. Underpinnings of the new theory According to my perception, the Flip the Funnel the ory concentrates on two underutilized constituencies in the marketing field; the customer evangelists and the employees of the company. This theory on one hand focuses on the prospective customers that are not exiting customers of the company but who might become loyal customers of the brand in future. On the other hand, it also focuses on the employees. Employees are also customers at the other end of the funnel. This potential has remained unexplored and if exploited can yield good benefits. The method of flipping the funnel is different from the acquisition principle of the traditional marketing funnel that emphasizes on generating new business from new customers (Court, Elzinga, Mulder & Vetvik, 2009). In difficult times the company does not have the opportunity of mitigating risks, cutting costs or make a tradeoff between quality and quantity, since quality helps the company to keep its reputation alive. On the contrary, the company has to improve its commitment and make wise i nvestment decisions. All activities of the business affect customer decision and therefore affect the future performance of the business. Although for big businesses the effect of these activities sometimes appears to be insignificant, often actually they are game changing. I have learnt from the book that customer experience, short term interactions between the company (its brand, products and customer service) and its customers and long term business performance, are inter-related. Therefore these activities are potential enough to significantly impact future sales; both in terms of repeat purchases by the existing customers and also new business generated from the existing customers. Therefore, Jaffe has put it convincingly that there should be no hesitation regarding flipping the funnel in modern business activities but, the doubt should be cleared regarding the appropriate time at which the funnel can be flipped. Also the question, that how much the tunnel should be flipped, ha s to be answered well ahead of actually practicing the method of turning the traditional marketing tunnel (Jaffe, 2010, p. 271). This new method advocates a strong idea; a company-customer pact should be followed that imbues the idea of partnership between these two parties. New approaches to marketing The book demonstrates several examples by

Evaluations and Assessments Essay Example | Topics and Well Written Essays - 500 words

Evaluations and Assessments - Essay Example The purpose of these assessments is to ensure that students are acquiring the essential skills, concepts and subject knowledge in social studies; that they have the opportunity to engage in a broad range of social topics that include civics, economics, geography, history, and general social studies skills. The plan is to eventually these across the state by 2008-09 in order to measure student learning in social studies. 9 CBAs are targeted for elementary school. They are believed to be better able to assess the subject as compared to standardized multiple choice and short answer questions for instance as well as have other advantages. The main component of the CBA is the rubric page. This details how a student can reach proficiency for the particular assessment. Besides this, the CBA mentions support materials, provides a student checklist, suggested resources etc. Both formal and informal assessments are similar in that they seek to provide a measure of student performance, usually as a summative assessment of learning. However, formal assessments are conducted under stricter exam conditions because their scores are noted on the student records. On the other hand, informal assessments are typically used to provide students with practice for the real formal assessments and may not be conducted under such strict conditions. The CBA issued by the Office of Superintendent of Public Instruction are formal assessments. Any other student assessments conducted entirely by the teacher would be considered as informal. The Content and Regional Focus for GLEs for grade 1 is based as Families and the concepts of near and far, now and then; for grade 2 is based on Community and the same concepts. A simple example of a pre-assessment question is given below. Another question could test the student’s knowledge and understanding of a

Second Assignment PS 321 Introduction to Political Economy

Second PS 321 Introduction to Political Economy - Assignment Example In political science, it simply implies the level of actors at which a researcher will aggregate the data. In any study, the choice of actors or the unit of analysis has a bearing on the final generalization that is given by a study. In this perspective, the emergence of fallacies on the conclusion of a study will be as a result of not properly identifying the unit of analysis. In a study about the geopolitics of a country, for instance, the focus of the research could be trade relations. The selection of the actors in this study due to the interest and ideas about the actor could lead to a level of complications like cross referencing or fallacies (Babbie 2013). This article examines the possible set of units that relate to a research question about the geopolitics of China and its international partners in trade. Specifically, the units of analysis that relate to the research are discussed in details. It also observes the relevance of the units of analysis that will be selected for the investigation on the topic. Depending on the research question and the motivation of the researcher, the development of the appropriate actors or even the units of analysis could be difficult or just impossible. In this case, the use of cross-referencing is used to create a correlation of the available information to the unit of analysis that has been selected. The difficulty in obtaining the data about the unit of study may also lead to the absence of this ambiguity which seldom happens, the choice of the unit of study is simplified. Problems like the ecological fallacy that results from using data that is meant for a group to make generalization is avoided. In the case of geopolitical analysis of China and the trade relations, the major unit of analysis is the country which is China. This choice is provoked by the fact that much of the data that will be collected on the topic for purposes of analysis will have to do

How do corporations use e-learning Term Paper Example | Topics and Well Written Essays - 1250 words

How do corporations use e-learning - Term Paper Example based training that is aimed at enhancing their working capabilities and, overcome challenges through putting together different systems, as well as measure their profits on these investments. According to (Zoeller & Berg, 2008), e-learning is any teaching or training via digital technologies as a way of distributing and conveying material or information to employees. From teaching or training videos published on DVDs to computer-based courses, eLearning has developed over the years. On the other hand, with the growth of the Internet, computer-based training has appeared at the top of eLearning, and growing figures of employees are being trained via the World Wide Web at the present (Zoeller & Berg, 2008). Presently business activities in a real-time world are becoming more complex and innovative for instance, presently organizations have competitors appear from the entire areas, innovation rules, knowledge offer more influence than capital, as well as the previous policies no longer be relevant. Presently each business requires a competitive edge in the business. Now organizations want those process, tools, and technique that will offer them the benefits over their marke t competitors. Corporate e-learning solutions and training courses are aimed at providing corporate the business training that is required for staying ahead of as compared to other market competitors (E-learningCenter, 2009) and (Morch, Engen, & Asand, 2004). According to Schweizer (2004), e-learning is putting back face-to-face learning interaction and emerging the trend of e-learning in business or organization. On the other hand, the quality of interaction, a helpful e-learning educational culture, the cost-effectiveness of modern and up-to-date technology, a development of the Internet, an augment in online courses, smaller business cycles, unions and rising competition support business and organization to make use of e-learning (Schweizer, 2004). According to (Commonwealth of Australia,

Anti-venom Essay Example | Topics and Well Written Essays - 250 words

Anti-venom - Essay Example Snake venom consists of more than 50 enzymes and peptides with digestive and neurotoxic properties. Therefore, the toxicity of venom is dependent on the type of snake and amount of venom injected. For this reason, an antivenom will be prescribed to an individual depending on the nature of snakebite and amount of venom injected in a person. According to PBS (2013), anti-venom is produced by injecting a small amount of venom in an animal such as horse, sheep, rabbit, or goat. These animals are immune to venom, therefore, will produce specialized antibodies to counteract the effects of poisonous proteins in venom. When scientists collect these specialized antibodies from the animals, they help in the development of anti-venoms. Thus, anti-venoms act by fighting the venomous proteins in venom, using the antibodies, which is their main ingredient. The anti-venom also prevents the venom from circulating to different parts of the body and through the bloodstream. This way, the anti-venom neutralizes the activity of venoms and prevents any further health complications or death of the affected

Maya Angelou Essay Example for Free

Maya Angelou Essay In Maya Angelou autobiography I know why the caged bird sings many themes and issues are looked at. This autobiography shows the difficulty of a black woman growing up surrounded by discrimination and poverty, but also shows her determination, joy and hope. Maya Angelou describes her relationship with many character, this in it self is a theme of her writing, the way she sees people in her own light. Some characters that may be seen to be good people are changed by Mayas opinion. A good example of this is the contrast between Mayas mother and Mayas fathers girlfriend. If both these characters were described, the fathers girlfriend maybe considers the better person. This is not the case after reading this book, as Maya has a way of making the reader see these characters as she sees them. After the separation of Maya Angelous parents she and her brother Bailey were sent away to live with her grandmother when Maya was only three. This must have been a terrible experience for a young child to go through, which some may think would have left Maya with resentment towards her mother. In fact this was quite the opposite. When Maya meet her mother again after she left her, Maya discarded the fact that she sent her away. She describes how as soon as she saw her mother, the nights she spent crying for her was forgotten. I knew immediately why she had sent me away. She was too beautiful to have children. (Maya Angelou, 1984, P58) This was Mayas way of justifying her mother actions. Even if it maybe considered a bad thing what her mother did, Maya still thought she was wonderful. Later on in this book Mayas mother did another bad thing. She shot someone twice, which again maybe considered a bad thing to do. Since she had intended to shoot him (notice: shoot, not kill) she had no reason to run away, so she shot him a second time. He had been shot, true, but in her fairness she had warned him. (Maya Angelou, 1984, pages 202 and 203) The language used when Maya describes this event show she thinks that this is not a major or bad thing that has happened. Maya again shows her mother as not a bad person even though what she has done is wrong. Mayas mother was also believed to be a prostitute; Maya believes this too but again discards the idea because she knew that if that were true then she wouldnt be able to live with her, which she wanted to. Even though Mayas mother could be considered a bad mother, Maya thinks extremely highly of her. This can be seen from the choice of lexis, Maya uses to describe her mother. Maya always used nice words such as beautiful, warm, glorious. Maya is also enthusiastic when talking about her mother. At one point Maya goes to stay with her father and his girlfriend. Maya believed that being her mother was so beautiful, any woman her father was with after her mother would have been just as beautiful if not more. This was the start of Mayas disappointment when meeting her stepmother. Maya disliked Dolores (her stepmother); you could tell this from the contrast in tones, from the happy tone when see talks about her mother to the dull and spiteful tone used when describing Dolores. If Dolores had been a little less aloof, a little more earthy She was mean and petty and full of pretense. (Maya Angelou, 1984, pages 222 and 223) Dolores theoretically was a good, honest person. She was a good, hardworking wife; she took Maya into her home and treated her well. Even though this, she is still seen as the bad one by the end of this part, from the way Maya talks about her. Maya uses mean words to describe Dolores, and is also sarcastic towards her when talking about her and their home. She was on close terms with her washing machine and ironing board. (Maya Angelou, 1984, P221) This shows one of the sarcastic phases used by Maya Angelou. It also shows that Maya was not the innocent party in her conflict with her stepmother. Maya went out of her way to irritate Dolores and to make her jealous of Maya relationship with her father. Dolores still comes of as the bad one at the end, after an argument with Maya. Maya tries to be nice to Dolores, but Dolores ends up calling Mayas mother a whore. Even though this is possibly true and Maya questions this, she still defends her mother. It is Maya that makes the first attack on Dolores; Maya justifies her behaviour, which leaves her looking the better person. What did she expect if she called my mother a whore? (Maya Angelou, 1984, P239) Another character who has an unexpected outcome is the dentist, Dr Lincoln. At one stage Maya, as a child was in a lot of pain with toothache. At the Maya was living with her grandmother in Stamps. The nearest Negro dentist to them was twenty-five miles away, which was too far for Maya to travel in such pain. As a result Mayas grandmother took her to a dentist near by that owed her a favour. Many would believe a dentist to be a respectable, good, reliable person. This was not the case of Dr Lincoln. He refused to help a child in pain, even though Mayas grandmother stopped him losing his business by lending him money. When speaking to Mayas grandmother, Dr Lincoln was very abrupt and rude to her. He did not even acknowledge Maya, or the fact her face was swollen and she was in pain. Id rather stick my hand in a dogs mouth than in a niggers'(Maya Angelou, 1984, P184) This was the harsh phase that Dr Lincoln used. This also shows discrimination and racism, another major theme in Maya Angelous autobiography. After Dr Lincoln refuses to help, Mayas grandmother follows him in his office. When she later describes what happened she says that Dr Lincoln and the nurse were as thick as thieves. This is a simile used to accentuate Dr Lincoln characteristics. From the way Maya Angelou has written her autobiography I know why the caged bird sings she has managed to successfully express peoples true characters. People that may be considered to have a good character such as Dr Lincoln have been shown for who they really are. This has been done by the choice of lexis and the tones that she has used to create different atmospheres when describing certain characters.

The Introduction To Medical Tourism Tourism Essay

The Introduction To Medical Tourism Tourism Essay A patient going to a different country for either urgent or elective medical procedures is called medical tourism. Medical tourism is a term that has risen from the rapid growth of an industry, where people from all around the world are traveling to other countries to obtain medical, dental, and surgical care, while at the same time touring, vacationing, and fully experiencing the attractions of the countries that they are visiting. Medical tourism is next booming sector in India as information technology. Patients going to a different country for either urgent or elective medical procedures are fast becoming a worldwide, multibillion-dollar industry. The reasons patients travel for treatment vary. Many medical tourists from the United States are seeking treatment at a quarter or sometimes even a 10th of the cost at home. From Canada, it is often people who are frustrated by long waiting times. From Great Britain, the patient cant wait for treatment by the National Health Service but also cant afford to see a physician in private practice. For others, becoming a medical tourist is a chance to combine a tropical vacation with elective or plastic surgery. And more patients are coming from poorer countries such as Bangladesh where treatment may not be available. Medical tourism is actually thousands of years old. In ancient Greece, pilgrims and patients came from all over the Mediterranean to the sanctuary of the healing god, Asklepios, at Epidaurus. In Roman Britain, patients took the waters at a shrine at Bath, a practice that continued for 2,000 years. From the 18th century wealthy Europeans travelled to spas from Germany to the Nile. In the 21st century, relatively low-cost jet travel has taken the industry beyond the wealthy and desperate. Countries that actively promote medical tourism include Cuba, Costa Rica, Hungary, India, Israel, Jordan, Lithuania, Malaysia and Thailand. Belgium, Poland and Singapore are now entering the field. South Africa specializes in medical safaris-visit the country for a safari, with a stopover for plastic surgery, a nose job and a chance to see lions and elephants. Health tourism is another name or synonym for medical tourism. However it is sometimes used in the context of wellness, where people are looking to make healthy lifestyle choices such as eating better, practicing yoga or undergoing spa treatments. Medical Travel is another name or synonym for medical tourism. Medical Wellness and Spas Medical Spas and Wellness is sometimes called Health Tourism. Medical Wellness and Medical Spas have become an accepted industry within healthcare. Peoples wellness in general has been seen as a way to heal the body naturally. Many hospitals around the world have started to integrate medical wellness. Sometimes these medical wellness and spa treatments are called complementary or alternative treatments. The mayo clinic recommends for certain people the following forms of medical wellness for cancer patients, Acupuncture, Aromatherapy, Biofeedback, Exercise, Hypnosis, Massage Therapy, Music Therapy, Relaxation, Tai Chi, and Yoga. Medical Packages The health care sector in India has witnessed an enormous growth in infrastructure in the private and voluntary sector. The private sector which was very modest in the early stages has now become a flourishing industry equipped with the most modern state-of-the-art technology at its disposal. It is estimated that 75-80% of health care services and investments in India are now provided by the private sector. An added plus had been that India has one of the largest pharmaceutical industries in the world. It is self sufficient in drug production and exports drugs to more than 180 countries. Bone Marrow Transplant Brain Surgery Cancer Procedures (Oncology) Cardiac Care Cosmetic Surgery Dialysis and Kidney Transplant Drug Rehabilitation Gynecology Obstetrics Health Checkups Internal/Digestive Procedures Joint Replacement Surgery Nuclear Medicine Neurosurgery Trauma Surgery Preventive Health Care Refractive Surgery Osteoporosis Spine Related Urology Vascular surgery 1.2 Medical Tourism in Karnataka Situated in the southern part of India, the state of Karnataka spreads over the Deccan Plateau. At 300 BC., it had formed the southern tip of the Mauryan Empire. Its boundaries enlarged or receded swaying to the drum beats of history today it accounts for a sixteenth area of India has a population of about 45 million. Its language is Kannada its people are known as kannadigas. The three distinct regions are a narrow coastal area along Arabian Sea; high hills, the Western Ghats; sprawling plains towards the east. Karnataka popularly known for Carnatic Music through out the World has given much more to the World than Carnatic Music, a unique form of Classical Music patronized by many across the continents. Karnataka with all its richness in culture and traditional grandeur is also one of the fastest growing states in terms of industries and facilities. Karnataka is also known as the Capital of Agarbathi (Incense Sticks), Arecanut, Silk, Coffee and Sandal Wood. All this is apart fro m the fact that it has been the culture center for hundreds of years and its testimony stands spread across the state pulling millions of tourists from all parts of the world to Karnataka. Karnataka was known as Karunadu (elevated land) in ancient times. It is also believed that the name Karnataka has come from Kari-nadu meaning the land of black soil say the scholars some others hold that Karunadu also means beautiful country; either way the land is celebrated as beautiful throughout its ancient literature. The western strip across the Arabian sea is humid warm in summer, water-soaked in monsoon, profuse with coconut grooves paddy fields criss-crossed by strips of silvery streams sparkling stretches of sand. The hilly uplands of Malanad, One of the wettest regions of the world, where the bamboo flourishes wild areca, teak, rosewood matti are grown. It is also the home of the stately gaur langur. In its southern reaches frequent kheddas are held to capture roaming groups of e lephants. Also the swift deer the deadly tiger, roam animatedly in the forests. The east of the ghats is strikingly bare. This elevated stretch is supposed to be the oldest land on the earth where ancient rocks of earth are seen jutting in out odd shapes. Rivers like Cauvrey, Sharavathi Ghataprabha pass through upgraded valleys resulting in water-falls occasional rapids. 1.2.1 The Capital par excellence The capital par excellence Bangalore today has become an Industrial Metropolis. It is also called Indias science city. Sophisticated industries in the public sector employ thousands and thousands of workers. It is also called the Electronics city because most of the countrys basic electronic industries are based here. It is the fastest growing city in Asia. Aircraft building, telecommunication, aeronautics, machine manufacture, etc., have taken giant strides here. Bangalore was known for its salubrious climate, which however is now being debated because of the accelerated progress of modern industry. It is also called an air-conditioned city and a pensioners paradise. Karnataka is beautiful not only in the eyes of her sons and daughters. She captivates any one who sets eyes on her. It was the great Mauryan Emperor Chandragupta who traversed all the way from Magadha to distant Sravanabelagola to lay his remains in this land before entering the Kingdom of God. The course of Karnatakas history and culture takes us back to pre-historic times. The earliest find of the Stone Age period in India was a hand axe at Lingasugur in Raichur district. The Ashokas rock edicts found in the state indicates that major parts of Northern Karnataka were under the Mauryas. Chandragupta Maurya, the great Indian emperor abdicated the throne and embraced Jainism at Sravanabelagola. Adding new dimensions to the cultural and spiritual ethos of the land, many great dynasties left their imprint upon the aesthetic development of Karnatakas art forms. Prominent among them were the Chalukyas, the Hoysalas and the mighty Vijayanagara Empire. The Chalukyans built some of the very early Hindu temples in India. Aihole turned up as an experimental base for the dynamic creations of architects. The Hoysalas who ruled from the 11th to the 13th century chiseled their way into the pages of glory by building more than 150 temples each one is a masterpiece in its own way. The amazing dexterity and fluidi ty of expressions at Somnathpur, Halebid and Belur open themselves to the wide-eyed wonder in ones eyes. Vijayanagara, the greatest of all medieval Hindu empires and one of the greatest the world over, fostered the development of intellectual pursuits and fine arts. The eye of the pupil has never seen a place like it and the ear of intelligence has never been informed that there existed anything to equal it in the world is what Abdur Razaaq the Persian ambassador had to say about Krishnadevarayas time. The Vijayanagara Empire with its capital at Hampi fell a victim to the marauding army of the Deccan Sultan in 1565 A.D. As a consequence of this, Bijapur became the most important city of the region. This city is a land of monuments and perhaps no other city except Delhi has as many monuments as Bijapur. The Bahmani Shahis and the Adilshahis of Bijapur have played a notable part in the history of Karnataka by their contribution to the field of art and architecture and also by their propagation of Islam in the state. Hyder Ali and his valiant son Tipu Sultan are notable figures in the history of the land. They expanded the Mysore kingdom on an unprecedented scale and by their resistance against the British, became personages of world fame. Tipu was a great scholar and lover of literature. His artistic pursuits were also many and he made rich gifts to the Hindu temples. Tipu Sultan Tiger of Karnataka was killed in 1799 A.D., and the Mysore throne was handed over to the Wodeyars. The wh ole of Karnataka came under the control of the British in the beginning of the 19th century. The new state was named as new Mysore and the Maharaja of Mysore was appointed Governor by Independent India. This unified state was renamed as Karnataka on November 1, 1973. 1.2.2 Karnataka on global medical map Karnataka and especially Bangalore is now an acknowledged global medical destination. This is because of referral quality health services supported by qualified and experienced medical professionals, reputed medical research institutions, well connected for travel, conducive climate and cost of treatment being just one tenth that of global hospitals. Between 2005 end and 2006 August, the state has also witnessed a funding of 445 crore from leading corporate hospitals as a part of the brownfield and green field projects. These include a Rs. 200 crore from the Manipal Health Systems, Rs. 140 crore from Wockhardt Group of Hospitals, Rs. 100 crore from One World Hospital and Healing Centre promoted by Maureen Berlin and Rs. 5 crore by HealthCare Global Enterprises Limited (HCG), a leader in oncology care in the private sector in India. Bangalore has been acknowledged as the city with the highest number of multi speciality medical centres which have successfully treated a large number of international patients. These hospitals have proved the clinical competence and clinical delivery systems, In the last 18 months, there has been a major growth in the healthcare sector in the state. From new hospitals to expansions and partnerships, the healthcare sector is on an upward swing both at the government and private levels, stated the health minister. Under the state governments medical tourism project, six ISO 9000 certified district hospitals strategically located at tourist spots in Mandya, Hubli, Chitradurga, Kolar, Belgaum and the Vani Vilas Hospital in Bangalore are now ready to administer treatment during tourist emergencies. One of the main reasons why patients from the west come here is the long waiting period for a surgery in their country. Hence healthcare in Karnataka is on an expansion mode, stated Vishal Bali, vice president, Wockhardt and president, Confederation of Indian Industry (Healthcare). The state attracts foreign tourists in large numbers right through the year and many of the medical facilities can provide treatment on par with international standards. The team of qualified doctors, paramedics and extremely low treatment costs open up a huge business potential arising out of the difference in the cost of treatment. The ISO processes has helped in putting in place standardized protocols for functioning in a ll the departments of the hospitals in terms of processes and work instructions which are drawn from handling patients from reception to discharge. This has allowed the state to offer medical tourism services, stated Bali. Foreign tourists can cash in on the treatment cost factor which is one tenth lesser than in other countries stated Premachand Sagar, vice chairman and CEO, Sagar Hospital. Bangalore is also known for its leading medical facilities in all disease segments which include cardiac, nephrology, oncology, mental health, neuro care, orthopedics, ophthalmology, general medicine. Hospitals here get patients from Bangladesh, Pakistan, Sri Lanka, the Middle East and several African countries. Patients come here even from the UK and the US, informed Dr. Nagendra Swamy, Manipal Hospital. The hospitals identified for the medical tourism project are A.J Hospital and Research Centre, Bhagwan Mahaveer Jain Hospital, Hosmat Hospital , Mallige Medical Centre, Mallya Hospital, Manipal, Sagar Apollo, St.. Johns Medical College Hospital, Bangalore Institute of Oncology, Bangalore Kidney Foundation, National Institute of Mental Health and Neuro Sciences, Rajan Speech and Healing Centre and Shekar Nethrayalaya. Besides, the International Holistic Health Centre (IIHC), headed by Dr. Issac Mathai. IIHC where its health and medical centre referred to as Soukya a recognised exclus ive world class therapeutic facility which adopts the concept of holistic healing combining all systems of medicine and therapies is also a recognised centre by the Union government. Soukya-India is a full-fledged health and medical facility at Whitefield near Bangalore which is thronged by patients from 42 countries. More hospitals, better services and corporate management have all created more jobs in the healthcare sector in Karnataka not just for doctors, nurses and technicians, but managers, administrators and IT-enabled services as well, stated government sources. For 2006-07, MHS will invest around Rs. 200 crore for setting up new hospitals and acquisitions. In Bangalore, a 300-bed facility will come up in 2009 neat the new international airport at Devanahalli in Yelahanka. This will be a one-of-a-kind Quardinary Care Centre focussing on multiple organ transplant among other specialities. We need to deploy a combination of concepts in healthcare management like mergers, acqui sitions and new investments which is an approach to survive in a high-risk business besides chalk strategies to keep ahead. In terms of bed strength, MHS is the highest in the country with a capacity of 5,000, informed R Basil CEO, Manipal Hospital. Wockhardt Hospitals Group has commissioned its state-of-the-art second hospital in Bangalore which is on the Bannerghatta Road. The multi specialty 400-bed facility with cardiac care, brain spine, bone joint and womens health is expected to touch Rs. 140 crore investment once it is completed. The facility will have the highest intensive care unit of 75 beds. For paediatric cardiology it will become the National Referral Centre with a neonatal ICU of 15-bed. Between the two hospitals in Bangalore, the Group will have 520-bed offering. It will have the latest equipment from medical technology majors like Medtronic, GE Healthcare, Philips and Siemens and with the best medical professionals. A 200 bed One World Hospital and Healing Centre promoted by Maureen Berlin at an investment of over Rs. 100 crore on a 10 acre area within the premises of the leading 1,200 bed missionary medical centre, St. Johns National Academy of Sciences campus. Is expected to be commissioned in late 2007. Thi s is a multi super specialty hospital with eight operation theatres, 44 intensive care unit beds. The treatment and therapy is based on the blended medicine concept proven and tried by Dr. Earl Bakken co-founded Medtronic, Inc. and inventor of the first transistorized cardiac pacemaker and founder, the North Hawaiian Hospital in the Big Islands, Hawaii. Hence the hospital will integrate modern medical practices along with yoga, Pranic healing and Reiki besides aqua-therapy proved by the western healthcare specialists HealthCare Global Enterprises Limited (HCG), a leader in oncology care in the private sector in India, has raised Rs. 5 crore in equity from IDFC Private Equity Fund II, a fund managed by IDFC Private Equity. The funds are to develop a nationwide network dedicated to oncology. Under the first phase of the project which entails an investment of Rs. 1.5 crore , 13 new cancer treatment centres at various locations and expansions to Bangalore Institute of Oncology will be m ade. Besides, PET-CT centre and GMP radiopharmaceutical unit and Central reference laboratory and clinical trials management centre will be set-up, stated Dr. Ajai Kumar, Chairman and Promoter of HCG Enterprises. 1.2.3 Dual Purpose Tourism According to an official from the Karnataka Tourism Department, healthcare in Bangalore came into the limelight when Noor Fatima from Pakistan came to Narayana Hrudayalaya in July 2003, and was operated on by Dr Devi Shetty. After that, there was no looking back for the city. Her surgery was a landmark because not only did it help in thawing the hostility between the two neighbouring countries, but also drastically reversed the table in the medical scenario of the city for the better. Hospitals and corporate establishments in the city have realised the potential of this niche market and have accordingly channelised their needs and facilities. Travel agents and hotels are structuring their packages and holiday schemes in accordance with the inflow of foreign patients coming into the city. Corporate bigwigs like Apollo have collaborated with travel agents to come up with SitaCare in a bid to attract more tourists to the city. Its not just the Indians and the NRIs from the neighbouring countries who are streaming into India for medical treatment. Apart from NRIs, foreign patients mainly come in from the Gulf, Europe (mainly UK) surprisingly from South East Asia and the US. They come to Bangalore with a dual strategy in mind to get their medical treatment at one-third the cost and to explore Bangalore. A spokesperson from Thomas Cook India informs, International patients mainly go to Coorg, Mysore, Hampi, Ketur, Belgaum and Bagalkot. In the long run, they add to the foreign exchange of the country. The idea is to kill two birds with one stone. 1.2.4 Bangalore as a destination From being a global outsourcing centre, Bangalore has now become a health giver to the world. Medical tourism as a phenomenon is only eight to ten years old in the city. Compared to metros like Mumbai and Chennai, Bangalore was a late starter in the race. However, considering the entrepreneurial spirit of the city, it has caught up. Today, the city aims to become the numero uno in attracting foreign patients from all across the world. So the question is, why Bangalore? How has it managed to emerge as the hot seat for healthcare both for domestic and for offshore patients? Experts point out myriad reasons. Dr Kishore Murthy, CEO, Hosmat Hospital explains, Bangalore is a well-known brand in the world. It is a knowledge city, has the top hospitals and also offers pleasant weather for patients coming here for treatment. Vishal Bali, CEO, Wockhardt Hospitals echoes, Bangalore has a tremendous impact in the world. Today, people abroad associate India with Bangalore. There is a lot of new h ealth infrastructure. Courtesy the IT industry it is known as the knowledge hub and the hospitals here are internationally acclaimed. According to a spokesperson from Manipal Hospital, The weather of Bangalore is perhaps the biggest factor for foreign patients coming into the city. It suits almost all patients. Patients say that unlike other cities, they are extremely comfortable with the weather here. Vittal Murthy, Secretary, Kannada Culture Information and Tourism throws light on another aspect. Bangalore has always been the hub for healthcare since the British era. Now, it has become the centre of attraction primarily because of the large number of top hospitals in the city and the innumerable medical institutes and colleges. Hence, the number of medical experts and professionals are also increasing by the day. Another source from Karnataka Government Tourism points out, Most of the hospitals in Bangalore have capitalised on the growth of the floating population and the growth o f the income bracket. Additionally, holistic health centres in the city also offer alternate systems of therapy like yoga, Art of Living courses and Ayurvedic therapies. Moreover, most experts from the industry acknowledge the fact that the cost of surgeries like cardiac surgeries, cancer treatment or an orthopaedic surgery is one-third the cost charged in developed countries like the US or the UK. There is also a close nexus between technology and the healthcare sector in Bangalore. There have been cases in our hospital where a patient had not been diagnosed of a particular disease abroad but when they came here their disease was detected, adds the same spokesperson from Manipal. Online appointments with doctors and specialists have made treatment easier and the waiting period for patients has considerably reduced. This in turn has led to an inflow of foreign patients into the city, informs HOSMATs Dr Murthy. The concept of telemedicine is being used on a large scale by hospitals s uch as Manipal and Narayana Hrudayalaya. Resumes of doctors are displayed online so that international patients can choose their doctors. 1.2.5 International Collaboration Internationally-acclaimed doctors and specialists choose to venture out in this city-this is yet another feather in the cap for the city, which till date was only associated with IT. This is not all. Hospitals are having tie ups with internationally acclaimed medical brands. Bali adds, Perhaps the plus point for Wockhardt is its association with Harvard Medical International (HMI), which has a reputation across the world for the quality services rendered to its patients. This in turn has led to more foreign patients coming into our hospital. International patients are very discerning. Before venturing out for treatment to another country, they see to it that they are well informed and not kept in the dark. At the end of the day, patients are always on the look out for quality services, and that is exactly what hospitals in Bangalore are aiming to achieve-to strike the perfect equilibrium between quality and quantity. 1.2.6 Different Strokes for Different Folks Different hospitals adopt different strategies to attract overseas patients. Sagar Apollo Hospital, for instance, has systematically planned its strategies. We have standardized almost all protocols in terms of smoother licensing with international system of integrated health-oriented value additions, holistic health solutions as well as conceptual health-oriented options. For instance, we have started with a system of cashless payment with providers and working on a new concept healthcare focusing not only on the highest international standard healthcare but also on integrated health and hospitality snergy where the services are not just promoted as a package. It is rather positioned as an effort to highlight Bangalore as just not a medical hub but as a place which in technology travellers in taking their healthcare beyond boundaries at their personal standards. Hospitals in Bangalore are now providing the services usually provided by a five-star hotel. Accommodation in hotels, whic h is usually a herculean task for foreign patients, is provided both for the relatives as well as the patients. HOSMAT Hospital even has a building within its campus to accommodate relatives of patients. Airport drops and pick-ups for patients and relatives are all rendered by the hospitality division of the hospital. Most of the hospitals have come up with a travel desk to cater to foreign patients and their relatives. Manipal Hospital, for instance, has an International Patient Care Centre. Additionally, a lot of emphasis is laid on the infrastructure of their hospital. Manipal, for example, has specially designed delux rooms, with posh dà ©cor and offers myriad facilities like pantry service and a wireless Internet connection. HOSMAT Hospital is coming up with two floors in its premises dedicated to international patients. These two floors alone have around 80-100 beds. This is indicative of the growing realisation about promoting medical tourism in the city. 1.2.7 Government Does Its Bit Apparently the Karnataka Government is taking a slew of initiatives in promoting medical tourism in the state. An expert says, Not just the Karnataka Government, but State Governments all across the country are realising the potential and the benefits that can come about through medical tourism. Most experts from the industry have acknowledged the fact that the State Government is supportive and enthusiastic in promoting medical tourism in the city in particular and the State as a whole Commissioner, Department of Tourism, Karnataka, states, We have regular annual meets wherein we talk with the medical industry on a one-to-one basis. We do have plans to form a council of the medical community, but it is in a nascent stage as of now. The Karnataka government right now is working in a meticulous manner. They first conduct research to study key players in the field, which include not just the top hospitals but travel agents and consulates in the city. Their performance over the year is reviewed and simultaneously suggestions are taken. Consulates and travel agents have their networks abroad. So, it is easier for us to have international conferences and contacts, adds Tourism commissioner. Vittal Murthy also gives an interesting bit of information. After the advent of the IT industry in Bangalore, the IT park was opened up. On similar lines, with the advent of the healthcare industry here, we are contemplating opening up a health park. However, the endeavour is still in its ideation stage and will take some time before it takes shape. The Government also holds health tourism expos. A recent one was held at Bahrain. Such meets are a platform for the Government to meet international experts from the medical fraternity and brief them about the competence of Indian healthcare industry. Its not just the State Government which is putting in a lot of interest. The Central Government, realising the potential of this sector, has come up with a national agenda and is holding tourism trade fairs at regular intervals around the year. This has given new impetus to medical tourism. Naik diplomatically adds, We are open to anything that will promote medical tourism. Ultimately, it is the doctors and experts from the medical fraternity who are responsible for the boom of medical tourism in the city. This remark is indeed a testimony to the positive nexus of private healthcare with the government. 1.2.8 Travel Reaps the Fruits It is not just the hospitals which are grabbing the limelight. Travel agents and hotels are cashing in on the situation and are coming up with schemes and packages to attract foreign patients to the city. They are gradually realising that immense benefits can be reaped. The Leela Palaces and Resorts, Bangalore, which purely caters to the corporate class, have now decided to spread its wings according to the change in times and trends. The five-star hotel group has decided to tie up with Manipal Hospital. Nitienaa Arif, Head- PR and Communications, Leela Palaces, Bangalore mentions, We are a business hotel, but understanding the need for medical tourism in the city, we have tied up with Manipal. Everything is in the processing stage. This is not all. The five-star hotel has also joined hands with Globe Health Tours. Air Travel Enterprises (ATE) also offers a whole lot of packages to foreign patients. EM Najeeb, Chairman and Managing Director, ATE, points out, We offer packages for car diac surgery, plastic surgery, dental surgery, Ayurveda and orthopaedic surgeries. In addition to this, ATE has a meticulous plan chalked out. We first identify patients who want medical treatment in this part of the country. We then recommend them to hospitals. Their arrival, departure and accommodation are all handled by us. An important point to remember is that the role of travel agents and hotels is only in its elementary stage. Purnima Castelino-Dabreo, Public Relations Executive, Taj Hotels Resorts and Palaces, Bangalore, states, Medical tourism is in a nascent stage, but we are looking at cultivating it as a potential segment. The opening of the international airport in the city has attracted the attention of not just the tourists but even players in the hotel industry. Altogether, there are 39 projects coming up in the city. This, in the long run can eradicate problems of accommodation in the city. It will take some time before these agents become one of the major forces in promoting healthcare in Bangalore. Vigilance and patience are the keywords-perhaps the means to achieve that end. 1.2.9 Hurdles to Overcome The grass always looks greener on the other side of the fence. But the fact remains that for any upcoming trend, the journey is not smooth sailing. There are always two sides to any story. As of now, the major obstacle that might hamper the growth of this promising trend is the unsystematic infrastructure of the city. Due to increase in the floating population, the roads are congested and traffic snarls have become the order of the day. Hene, commuting in the city has become a major problem. Paucity of hotel accommodation within the city for patients and relatives also poses an obstacle for international patients coming to the city. Despite an increase in service flats and a boom in the real estate business, there is no change in the problem. International flights have commenced in Bangalore, but there is connectivity only to a few countries. Bali points out, The first impression is lasting in the mind of a person visiting Bangalore for the first time. International patients in parti cular get dismayed at the appalling conditions of Bangalores infrastructure in contrast to the plush dà ©cor of the hospitals. Daniel gives another interesting aspect, In case of medical evacuationswhere patients have to be airlifted, at least eight seats have to be reserved. Most of the time, this is not possible. Moreover, a lot of money is required to transport the doctor, the attendants the patients and their relatives. 1.2.10 Possible Solutions Government officials have chalked out a solution to this problem. In another one to one and a half years, the international airport in Bangalore will have connectivity with almost all the major countries across the globe, predicts Murthy. He further adds, We are also coming up with a Metro Rail Project and five townships in the city to ease congestion. There are plans to launch air ambulances and helipads to facilitate easy transport of patients from other countries. And as far as the problem of accommodation is concerned, most hospitals are coming up with accommodation within their premises for patients as well as t

A Separate Peace Essay -- essays research papers

A Separate Peace: by John Knowles   Ã‚  Ã‚  Ã‚  Ã‚  During World War II in the struggle for peace among nations comes a smaller, but still significant struggle, in a prep school boy becoming a man and waking up to reality.   Ã‚  Ã‚  Ã‚  Ã‚  In the book A Separate Peace, the author John Knowles, creates the image of two sixteen-year old boys struggling to keep what little sense of peace they know, even though there is a war going on all around them. Gene Forrester, the narrator of the story also struggles with an inner conflict of his secret resentment of his best friend Phineas (Finny). Phineas struggles with the disbelief that he can never be of any use to the war efforts with a â€Å"busted leg.†   Ã‚  Ã‚  Ã‚  Ã‚  Gene Forrester, the main character in the book, returns to his old prep school-Devon- that he attended some fifteen years earlier. While there he remembers the incident that changed his life. In the summer of 1942, Gene and his friends stayed at their prep school for the summer session. His best friend in those days was a boy named Phineas, or Finny. During that time World War II was going on and the sixteen-year old boys were trying to preserve the peace in their lives, before they would be old enough to be drafted into the war-just one year later. One day Finny, the best athlete in the school, came up with the crazy idea to jump out of a tree into a river. All of the seventeen-year olds had accomplished this task because it was a mandatory test for the war. Phineas, naturally was the first sixteen-year old to conquer this feat; so Gene was the second. None of the other boys ever tried the jump. After a while the two made it an almost day-to-day activity. The two boys were a lot alike, but Gene had this underlying resentment of Finny and he felt that Finny was deliberately trying to make him do badly in school because he was constantly dragging Gene along with him to go jump out of the tree. One time Finny decided that he and Gene should do a double jump, since that had never been done before. While up on the limb, Finny is the further out then Gene, and Gene gets this sudden impulse to shake the limb, which sends Finny plummeting into the shallow part of the river, breaking his leg. After the accident, Finny could never play any sports again; merely being able to walk is a blessing. For the duration of the ... ...t contribute to any of the war efforts himself. He wrote to every group that was associated to the war and fighting for the peace, but he always got the same reply saying that they had no use of a person with a crippled leg. Gene finally wakes up to reality when Finny dies. He realizes the way of life that he was living while a Devon, and the type of person that he had become. After Finny died though, Gene discovers that he created a war between himself and Finny that never existed.   Ã‚  Ã‚  Ã‚  Ã‚  The author gets his point across and does a very good job at it. The book was very interesting and enlightening. It makes the reader think about their friendships and their life in general. People should not let little things rule their lives. Underlying resentment could build up to something very dangerous and destructive. The reader also learns from this book that there is a big world out there and one needs to become mature enough to fulfill their adulthood duties. The author lastly shows that everyone is fighting their own personal war, but how someone handles it is based on their maturity and their knowledge of knowing the difference between imagination and reality.

Indecision, Hesitation and Delay in Shakespeares Hamlet - Procrastination :: GCSE Coursework Shakespeare Hamlet

Hamlet's Procrastination In William Shakespeare’s Hamlet, Hamlet’s tragic flaw is his procrastination. From the first time Hamlet was acted until now, critics have fought over the reason for Hamlet’s procrastination. Some say that the cause is due to Sigmund Freud’s theory that Hamlet has an "Oedipal Complex," which is his love for his mother. Others argue that he just never finds the right time to carry out the revenge of his father’s murder. The Oedipal Complex theory in regard to Hamlet’s situation seems more likely because of the amount of times Hamlet has to kill Claudius but always fins a reason not to kill him. If it is not the case, then the cause of the procrastination remains a mystery. There is no reason for Hamlet not to kill Claudius, whom he hates, and was ordered by a higher power to destroy, other than the fact that subconsciously, Hamlet needed Claudius to keep him away from his mother. Hamlet procrastinated only because of his fear of intimacy with his mother, knowing that Claudius was the only person separating he and Gertrude. Although Hamlet has a pious duty to avenge his father’s murder, his desire for his mother is too strong for him to leave an open pathway to her. He tries to find excuses to postpone his killing Claudius. First, he tries to discover whether or not Claudius really did kill King Hamlet, which gives him some time. After he has convinced himself that Claudius is to blame, he attempts to murder him just twice. The first time, he finds Claudius praying, and uses that as a scapegoat so he can again put off his pious duty. Later when he is alone with Gertrude, he thinks that Claudius is behind the curtains, and kills the man there. Unfortunately, Polonius becomes the victim of Hamlet’s dagger. The only time when Hamlet does not hesitate to carry out his pious duty is when he is in the bedroom with Gertrude. Unfortunately by mere coincidence, Polonius is the man behind the bedroom curtain, not Claudius. Hamlet stabs Polonius instinctively because he is where he truly desires to be, with his mother. This is the only time when Hamlet actually has the courage to try to kill Claudius, thus opening the path to Gertrude. All of the other times in the play, Hamlet is either alone or with people who he needs to hide his desire from.

Inflation :: essays papers

Inflation Hyperinflation The term "hyperinflation" refers to a very rapid, very large increase in the price level. Measurement problems will be too minor to notice on this scale. There is no strict formal definition for the term, but cases of hyperinflation tend to be expressed in terms of multiples rather than percentages. "For example, in Germany between January 1922 and November 1923 (less than two years!) the average price level increased by a factor of about 20 billion." Some representative examples of hyperinflation include "Hyperinflation 1922 Germany 5,000% 1985 Bolivia *10,000% 1989 Argentina 3,100% 1990 Peru 7,500% 1993 Brazil 2,100% 1993 Ukraine 5,000%" These quotations from other web pages are given mainly as examples of what people have in mind when they talk about hyperinflation, and I cannot say just how accurate the figures are. In any case, figures for the purchasing power lost in hyperinflations can only be rough estimates. Numismatics (coin and currency collecting) gives some examples of just how far hyperinflations can go: an information page for currency collectors tells us that, in the Hungarian hyperinflation after World War II, bills for one hundred million trillion pengos were issued (the pengo was the Hungarian currency unit) and bills for one billion trillion pengos were printed but never issued. (I'm using American terms here -- the British express big numbers differently). The story behind the German hyperinflation illustrates how all hyperinflations have come about, and is of particular interest in itself. After World War I, Germany had a democratic government, but little stability. A general named Kapp decided to make himself dictator, and marched his troops and militias into Berlin in an attempted coup d'etat known as the "Kapp Putsch." However, the German people resisted this attempt at dictatorship with nonviolent noncooperation. The workers went out in a general strike and the civil servants simply refused to obey the orders of Kapp and his men. Unable to take command of the country, Kapp retreated and ultimately gave up his attempt. However, the German economy, never very sound, was further disrupted by the conflict surrounding Kapp's putsch and by the strike against it; and production fell and prices rose.

Pilot Fatigue and its role in Aviation Safety Essay

ABSTRACT The aim of this paper is to observe the growing concern of pilot fatigue and the role it plays in aviation safety. A brief assessment of the effects and possible solution to this problem will be carried out. A mention of some of the incidents from the past will also find its place in this paper. Introduction   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Aviation industry is on a growing spree and in the times to come there are going to be more and more airlines filling the sky. As we move steps further towards globalization we are going to need this service more frequently which further increases the pressure on our airlines. To tackle with this situation, especially when the availability of trained pilots is less than required, the pilots are forced to fly more frequently and for longer hours. This causes physical as well as mental stress to buildup as a result of which the efficiency of pilots decreases. This non-pathologic state resulting in physical and mental stress is known as ‘Fatigue’. Human body is always in need of rest, especially in the form of sleep, after regular intervals of time. Any lack in the required rest causes fatigue to be developed in one’s body. Due to fatigue there can be a feeling of sleeplessness, tiredness or exhaustion in a person. This feeling if effective during flight hours can be really dangerous not only for the pilot but also for the lives of the passengers traveling with him and can cause accidents. The only solution to this problem that has been known so far and will ever be known in the times to come is sufficient amount of sleep. This unfortunately is what the pilots are not getting these days and are not expected to get at least in the near future.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  The findings from the past have shown that fatigue was responsible for a large number of aviation accidents. According to a study carried out by the National Transportation Safety Board (NTSB) of flight accidents related to flight crew in US from 1978 to 1990, one of the findings related the accidents to fatigue by stating that   â€Å"Half the captains for whom data were available had been awake for more than 12 hours prior to their accidents. Half the first officers had been awake for more than 11 hours. Crews comprising captains and first officers whose time since awake was above the median for their crew position made more errors overall, and significantly more procedural and tactical decision errors.† (Strauss, n.d.). Sleep and Sleep Loss   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   It is essential for a human body to get the required amount of sleep. Sleep is considered to be an essential ingredient of our life without which it is not possible to survive. Whenever a person does not get enough sleep a signal is sent by brain to the body which results in Sleepiness. Eyelids start to get heavier and there is fatigue in the whole body. A person starts to loose concentration and may even go to sleep while he is on a job. If there is a deficiency in sleeping hours of a person and suppose every day a person looses 1 hour of sleep known as â€Å"Sleep Loss†, then it goes on accumulating over days and results in what is known as â€Å"Sleep Debt†. This debt if not cleared can cause serious problems ultimately resulting in fatigue. It has been found in researches that before flying a plane it is necessary to have sufficient amount of sleep (about 8 hours) for the pilots. If they are allowed to fly continuously without getting the required amount of rest (or sleeping hours) in between their flying schedules, then fatigue is most likely to develop in them resulting in, loss of concentration, memory   and   alertness, slow reaction time, reduced decision power, and bad mood. All these factors are basic ingredients of making mistakes and thus causing accidents. Crew rest   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Fatigue starts to build up from the time one gets out of sleep. Development of fatigue also depends on the amount of time a person was awake before the actual flight operation. Some times there are delays in flight timings due to several reasons ranging from weather conditions to mechanical problems. This means that a pilot has been â€Å"on duty† for a long time before boarding in the plane. Although he may be flying the plane for the normal length of time but delay in flight timing has resulted in him being involved in the activities for much longer, which also results in the pilot being fatigued. Similarly there may be a case of airport congestion as a result of which a pilot cannot land and has to hover in the air for a long time or due to bad whether the plane needs to be redirected to some other destination causing him to fly for longer duration than normal. These instances also cause fatigue to be developed. Overall the fact is that ample amount of rest is essentially required by the human body to keep it fit and fatigue free.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   â€Å"A brief review of US Federal Aviation Administration (FAA) flight time and rest rules for scheduled domestic commercial carriers (US Code Title 14, part 121.471) are as follows† (Strauss, n.d.).: Crewmember total flying time maximum of: 1000 hours in any calendar year. 100 hours in any calendar month. 30 hours in any 7 consecutive days. 8 hours between required rest periods. Rest for scheduled flight during the 24 hours preceding the completion of any flight segment: 9 consecutive of hours rest for less than 8 hours scheduled flight time. 10 hours rest for 8 hours or more, but less than 9 hours scheduled flight time. 11 hours rest for 9 hours or more scheduled flight time. Diet and nutrition   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   People all over the world use coffee as a stimulant to remain awake for longer periods of time. Same is the case with pilots. To remain alert they normally consume coffee. The problem with coffee is that although it keeps a person alert, it cannot prevent body from getting tired and thus fatigued. The body still is in working condition for all these hours and hence the effect of coffee is temporary alertness and not a solution to fatigue. Also coffee is diuretic which means that it discharges more fluids than what it takes in and hence results in dehydration which is a cause of fatigue. It is always good to keep your body fit by exercising but there should be a sufficient amount of rest and consumption of water followed by it as exercises cause a lot of dehydration. However dehydration can also be caused by the fact that inside the cockpit humidity is very. There is always a balanced diet recommended for not only pilots but everyone. A pilot should always ensure a healthy diet which provides sufficient energy as well as nutrients for his body. Hypoglycemia, which is caused by low blood sugar levels, is a major cause of feeling sleepiness. A healthy diet ensures sufficient levels of blood sugar and thus energy, preventing hypoglycemia.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚     Ã¢â‚¬ËœFinally, alcohol is known to disrupt sleep dramatically and therefore contributes to the poor quantity and quality of sleep obtained on trip nights. Alternative approaches to the use of alcohol to unwind after duty and promote sleep should be identified and offered (e.g., relaxation skills)’ (Rosekind, 1994). Other causes of fatigue   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   One of the most important factors of causing fatigue, other than sleep debt, is the flight deck environment. Inside the deck there are a lot of factors contributing to fatigue such as lesser availability of space, variation in air flow, low atmospheric pressure, low humidity and presence of a lot of noise and vibration. Also in modern aircrafts a number of additional features and systems have been incorporated which means that the pilots have to handle multiple systems resulting in more stress. History of incidents There have been incidents in the past where fatigue has proved to not only be dangerous but also fatal. A legend in aviation refers to an incident when a pilot went to sleep with his autopilot on and found on waking up that the plane was 2 hours from the nearest destination with only one hour of fuel left. This may just be a story but in many cases researches have proved fatigue to be a cause of dangerous and fatal accidents. Some of the cases have been listed below:- In June 1999 there was a runway accident of American Airlines Flight 1420 in which 11 people died, including the aircraft captain, and many injuries among the 145 passengers and crew aboard the flight KAL Flight 801 crashed in Guam on August 6, 1997, was mainly due to a lack of situational awareness resulting in â€Å"controlled flight into terrain (CFIT).† The captain prior to flying to Guam had flown from Seoul to Australia, back to Seoul, to Hong Kong, and then back to Seoul again before his fateful trip to Guam, including only a few hours of rest in between. Cessna 177B Cardinal was flown by Joe Reid, pilot-in-command in which he, seven-year-old Jessica Dubroff and her father were killed. He suffered fatigue from the first day’s flight. On August 18, 1993, a Connie Kalitta DC-8 crashed on a 1/4-mile base leg to final. The flight crew had been on duty for 18 hours and flown nine, thereby experiencing sleep loss and a disruption of their circadian rhythms. ‘On January 2, 1989, the captain of a 707 tried to maneuver his plane to land in Salt Lake City after breaking out of the clouds at 200 feet. He dragged his left, outboard engine on the runway, leaving a 60-foot-long groove. Within the preceding 30 hours, he had been on duty for 19 hours, and flown 13 hours. He had been off duty for almost 12 hours, but was only able to get one hour of sleep in that time’ (Printup, 2000). In August 1985, the crew of a Learjet killed themselves and their passenger in a failed approach to Gulkana, Alaska. One of the contributing factors was that the company would shift the crew’s duty/rest requirements from FAR Part 135 to those of FAR Part 121, thereby disrupting their sleep patterns and inducing fatigue (Printup, 2000). Countermeasures Based on several reports a number of countermeasures have been devised to improve alertness to counter fatigue. Preventive measures like 3-4 hours of sleep can restore alertness for 12-15 hours and 10-30 minutes of sleep can do it for about 3-4 hours. Similarly it is advised to rest for 15-20 minutes after awakening and before flying. Some of other means to restore alertness are:- Consumption of high protein diet and less intake of fat and high carbohydrate food. Consumption of large quantities of fluids. Use of caffeine to work against fatigue symptoms if awake for 18 hours or less. Due rotation of flight tasks and frequent conversation with other crewmembers Maintenance of temperature inside the deck to lower levels. Frequent movement of body parts and a possible walk in the cabin. Gradually shift times for sleep, meals, and exercise to adjust to a new time zone (Strauss, n.d.). Conclusion For the safety of pilots as well as passengers the issue of pilot fatigue is of major concern. Growing number of aircrafts in the sky also means longer durations of flight for the pilots, which is a major cause of this problem. History bears the testimony to the fact that fatigue has resulted in numerous aviation accidents resulting in the loss of thousand of lives. To save more lives from getting lost there is a need to solve this problem. Allowing flexible schedules for the pilots is the only viable solution in sight at the moment. Our lives are getting busier and it would be wonderful if they become safer as well. References Dawson, Drew and Reid, Kathyryn. (August 1997). Fatigue, Alcohol and Performance Impairment.   Retrieved December 1, 2007, from http://www.eurocockpit.be/media/Dawson-Reid-1997.pdf Dr Samuel Strauss. (n.d.). Pilot Fatigue. Retrieved December 1, 2007, from http://aeromedical.org/Articles/Pilot_Fatigue.html Goode, Jeffrey H. (27 March 2003). Are pilots at risk of accidents due to fatigue?. Retrieved December 1, 2007, from http://www.eurocockpit.be/media/Goode-2003.pdf Heath, Brad and Levin, Alan. (Nov. 8, 2007). Fatigue plays role in aviation mistakes. Retrieved December 1, 2007, from http://www.azcentral.com/arizonarepublic/news/articles/1108sleepypilots1108.html Mann, Michael B. (August 3, 1999). Statement of Michael B. Mann Deputy Associate Administrator Office of Aero-Space Technology National Aeronautics and Space Administration. Hearing on Pilot Fatigue Before the Aviation Subcommittee of the Committee on Transportation and Infrastructure United States House of Representatives. Retrieved December 1, 2007, from   http://www.hq.nasa.gov/office/legaff/mann8-3.html Printup, Mark Brandon. (September, 2000). Guest Editorial: The Effects Of Fatigue On Performance And Safety. Retrieved December 1, 2007, from http://www.airlinesafety.com/editorials/PilotFatigue.htm Rosekind, Mark R. (November 1994). Fatigue in Aviation. Retrieved December 1, 2007, from http://cf.alpa.org/internet/projects/ftdt/alpmag/FATIGUE.html Samel, Alexender,   Wegmann, Hans Martin and Vejvoda, Martin. (1997). AIR CREW FATIGUE IN LONG-HAUL OPERATIONS. Retrieved December 1, 2007, from http://www.eurocockpit.be/media/Samel-Wegmann-Veivoda-1997.pdf