Wednesday, July 31, 2019

“Amotivational Syndrome”

Jesse Love â€Å"Amotivational Syndrome† and Marijuana use: An Ongoing Debate November 30, 2008 The positive or negative effects of marijuana usage are a common point of discussion among psychologists. One of the more common debates surrounds â€Å"Amotivational Syndrome† (i. e. the purported lack of motivation that results from marijuana use). The existence or non-existence of this â€Å"syndrome† has been discussed for over a century among both users and non-users alike (Duncan, 1987, p. 114).The two articles chosen for this essay attempt to determine whether amotivational syndrome is a by-product of marijuana use by applying two separate methods of analysis. By analyzing these articles it will be clear that there is no conclusive evidence that suggests a direct correlation between amotivational syndrome and marijuana use. In 1987, David F. Duncan sought to critique previous studies of marijuana use that claimed amotivational syndrome was a prevalent phenomenon among acute marijuana users.He aimed to challenge previous studies that assumed, in their conclusions, that users of marijuana possessed characteristics of â€Å"introversion, passivity, and lack of achievement-orientation† (Duncan, 1987, p. 114). In his introduction, Duncan introduced cross-cultural examples where marijuana use is actually used as a stimulant; for instance in Jamaica, where he compares marijuana use to North American coffee consumption (Duncan, 1987, p. 115). Duncan concludes that only by conducting a comparative study, i. . by taking a sample of subjects who are both users and non-users, could real evidence for â€Å"marijuana-related antimotivational syndrome† be determined (Duncan, 1987, p. 115). Duncan pointed to the flaws a study conducted by Halikas et al. In 1982. Halikas wanted to determine the â€Å"lifetime prevalence† of amotivational syndrome in lifetime users of marijuana. To do so, he posed a single question meant to encompass th e criterion of amotivational syndrome.The question encompassed elements such as: â€Å"Have you ever had a period when you weren’t depressed or unhappy, but you just seemed to lose your motivation although you weren’t particularly upset by that feeling? † (Duncan, 1987, p. 116). Duncan argued that Halikas et al. ’s study, in particular, was a failure because it failed to offer a comparison between users and non-users. Therefore, Duncan used the same questionnaire and applied it to a series of high-achieving subjects to determine the frequency of amotivational syndrome within a larger population of both users and non-users.Duncan selected two hundred thirty-eight athletic students (some former Olympians) from a European university. All subjects were required to speak English and came from various parts of the world. He began by requesting all subjects to fill out a questionnaire regarding past marijuana consumption. The subjects were subsequently divided i nto three groups: 1) those who had never used marijuana, 2) those who used marijuana daily for a thirty day period in their life and, 3) those who used marijuana but could not fill the requirements for group 2 (Duncan, 1987, p. 17). The results of this initial questionnaire indicated that 47. 7% had never used marijuana, 23. 8% were occasional/experimental users and 24. 1% had been daily users. These three groups also responded to the questionnaire borrowed from Halikas et al. It was determined that there was no significant variation in the frequency of amotivational syndrome among marijuana users (Duncan, 1987, p. 117). These results only serve to debunk the initial findings of Halikas et al. and other psychologists who had followed similar methods of analysis.Indeed, Duncan made this explicit in the conclusion of his report. It is clear from Duncan’s work that a new methodology is required to determine whether amotivational syndrome is more prevalent among marijuana users. The limitations of this research are therefore quite clear. Future studies will require both long and short-term analysis of both users and non-users. Also, a controlled definition of motivation will be required to determine what a lack thereof implies. To make improvements one would therefore need to have access, as Duncan had, to a large body of subjects. It would then e necessary to track these subjects, both users and non-users alike, over a sustained period of time to determine whether or not the likelihood of amotivational syndrome is more common among users or non-users, if there is in fact a difference at all. Duncan ultimately argued that he was still prepared â€Å"†¦to relegate the antimotivational syndrome to the growing scrap heap of discarded marijuana myths† (Duncan, 1987, p. 118). In 2002, Cherek et al. conducted a much more dynamic study of amotivational syndrome, following a number of the suggestions offered years earlier by Duncan.They offered a vague definition of amotivational syndrome as a â€Å"set of characteristics† including â€Å"general apathy†¦loss of productivity†¦lethargy (and) depression† among others (Cherek, Lane and Dougherty, 2002, p. 26). Despite these agreed upon attributes of amotivational syndrome, Cherek et al. also found it difficult to pinpoint the amotivational â€Å"phenomenon†. They recalled some of the studies referred to by Duncan that found a positive correlation between marijuana usage and amotivational syndrome.By recognizing that amotivational syndrome occurred among users and non-users alike, the researchers concluded that amotivational syndrome was ultimately a question of frequency. Cherek et al. also sought to arrive at a conclusive definition of motivation, both theoretically and methodologically. To cross this hurdle, Cherek et al. opted to follow a behavioral approach in conjunction with a progressive ratio schedule (PR) and a fixed-time schedule (FT). In this way, they could â€Å"†¦define and measure motivation by measuring changes in PR responding across changes in reinforcer magnitude† (Cherek et al. , 2002, p. 27).Monetary reward would be used as an operational reinforcement and data would be based on subject response rates. The first experiment involved five males who were occasional marijuana users. It was used to confirm the initial â€Å"proposed operational definition of motivational behavior† which meant that there was a direct ratio between the response time and the motivation (Cherek et al. , 2002, pp. 27-28). The results proved that their initial suppositions were correct and that the changes in response rate and ratios were â€Å"consistent with the operational method† established from the outset of the experiment (Cherek et al. 2002, p. 30). The following two experiments used a different subject base but retained the same reinforcer values. The researchers controlled the THC supply, dividing it i nto three strains of potency. They argued that a decrease in PR response following â€Å"acute marijuana administration† while the keeping the reinforcer at a constant level would indicate decreased levels of motivation (Cherek et al. , 2002, p. 30). The results of Experiment 2 Phase 1 indicated that acute marijuana consumption did alter behavior. However, the results were not dose dependent.Experiment 2 Phase 2 showed that the â€Å"marijuana-induced decreases in responding can be overcome by increasing the reinforcer† (Cherek et. al, 2002, p. 35). This meant that although it was clear that there were overt behavioral differences between marijuana induced subjects and the placebo subjects, these differences could be overcome by offering a motivational stimulus. The researchers concluded that acute marijuana users do exhibit some forms of amotivational behavior. This behavior could be usurped if there was an increase in the reinforcement.They pointed out that other stu dies had achieved results that disconfirmed this conclusion. However, those studies did not offer â€Å"the availability of at least one alternative response† for the subjects. [1] Cherek et al. suggested that one could â€Å"construe† their study as an indication that marijuana does induce amotivational behavior. Still, this is not entirely conclusive because the study solely examined the effects of short-term acute marijuana use. Most of the controversy surrounding marijuana use generally questions whether long-term use, rather than short-term use, effects amotivational behavior. 2] The fact that only short-term marijuana use was studied here is its greatest limitation. It was also limited because of the small number of subjects and the environment in which they were tested (a small room). These articles are particularly interesting for me because I am an occasional marijuana user and have always been concerned about how I will be affected in the long-term. I tend to agree with various elements from both studies. I am convinced, like Duncan that many myths concerning marijuana consumption have circulated for political reasons rather than because of empirical data.I also believe that amotivational syndrome is common among both users and non-users alike. Whether or not users are more disposed to this phenomenon is still up for debate. Cherek et al. ’s study was also intriguing because it demonstrated that amotivational syndrome (whether induced by marijuana or not) could be overcome by increasing the reinforcement. This makes a lot of sense in my world-view, as quite often the individuals I have known will become motivated only if they believe they will reap reasonable rewards. If the rewards are not worth the effort, â€Å"amotivational syndrome† may set it.These studies have demonstrated that there is still much more research to be conducted on the effects of marijuana consumption both in the short- term and the long-term. It appe ars as if there is more speculation regarding marijuana than there is empirical evidence. The topic of amotivational syndrome is particularly troublesome because of the tricky nature of defining motivation. This problem is compounded when conducting a controlled study because there is very little motivation, nor may it be possible, for the participants to behave in a controlled environment as they would in the real world.References Cherek, Don R. , Lane, Scott D. and Dougherty, Donald M (2002). Possible Antimotivational Effects Following Marijuana Smoking Under Laboratory Conditions. Experimental and Clinical Psychopharmacology, 10(1), 26-38. Duncan, David F. (1987). Lifetime Prevalence of â€Å"Antimotivational Syndrome† Among Users and Non-Users of Hashish. Psychology of Addictive Behaviors, 1(2), 114-119. ———————– [1] Cherek et al. , 35. [2] Cherek et al. , 36.

Tuesday, July 30, 2019

Nursing as a Profession Essay

The question of whether the practice of nursing is considered a profession or an occupation is an ongoing debate, much like the ongoing debate over what defines a profession. Several scholars have outlined criteria for considering an occupation to be a profession. Given a list of scholars and their criteria for what characteristics define a profession, I have chosen the list formulated by Lucie Kelly, RN, PhD, FAAN. Although the scholars’ works seem to share similar criteria and any could be selected for comparison, I have chosen Kelly’s criteria based on her background in the nursing profession. In addition to being a nurse, Dr. Kelly is a writer and a teacher. She compiled a list of eight characteristics of a profession in 1981 (Chitty & Black, 2011, p. 66). Though they were written over 30 years ago, Kelly’s criteria are still relevant to modern nursing practice. According to Kelly’s first criterion, a profession should provide a service to humanity and to society as a whole (Chitty & Black, 2011, p. 66). I believe that there is no sustainable argument against the fact that this is exactly what nurses do. Nurses provide a service by caring for individuals in our society who are ill or injured, and they educate and promote wellness in their communities. I believe that the nursing establishment certainly meets and possibly defines the requirements for this particular standard. I believe nursing also meets the second standard, which states that a profession should possess a special body of knowledge that is constantly advanced through research (Chitty & Black, 2011, p. 66). Nursing is based on science, but what sets the profession apart is the focus on the individual as a unique being and their response to health problems. Nursing is constantly being refined through evidence-based practice. â€Å"Nursing is no longer based on trial and error but increasingly relies on theory  development and research as a basis for practice† (Chitty & Black, 2011, p. 66). The third characteristic of a profession, according to Kelly, is that the service involves intellectual activities and that accountability is an important feature of those activities (Chitty & Black, 2011, p. 66). I believe nursing also meets these requirements through the nursing process. In order to provide care for an individual, a nurse must assess the problem, decide on an approach (or plan of care), and implement that plan. The nurse has to be able to evaluate the outcome of those actions and adjust the plan accordingly. Autonomy is an important part of this individual responsibility. Nurses are held accountable for their individual actions by their employers, patients, and the public. Registered nurses today are required to meet strict educational standards before applying for licensure. Kelly’s fourth criterion requires practitioners to be educated in institutes of higher learning (Chitty & Black, 2011, p. 66). Associate or baccalaureate degrees are the most common education levels for registered nurses. Some diploma programs are still being run in hospitals, but their numbers are steadily declining (Chitty & Black, 2011, p. 149). Graduate degree programs focused on education, research, and advanced practice provide opportunities for nurses to progress in their careers. The fifth characteristic of a profession is the one that I think is most debated. It states that practitioners are relatively independent and regulate their own policies (Chitty & Black, 2011, p. 66). Nursing is autonomous and self-governing. Over time, nursing has established its own values, ethics, and protocol. However, many would argue the actual performance of nursing itself still falls under the direction and control of physicians and administrators. Nursing is classically regulated in the facility in which the nurse works by their institutional policies. Also, many people feel that because a nurse must have orders from a physician, they lack autonomy (Chitty & Black, 2011, p. 66). This debate about autonomy ties in with the discussion on the third criterion. Nurses provide  nursing care autonomously; they do not practice medicine. For the sixth of Kelly’s eight characteristics, the statement made is that practitioners are motivated by service and consider their work an important component of their lives (Chitty & Black, 2011, p. 66). Nursing easily meets this criterion. I believe the majority of nurses, if asked why they chose nursing, would immediately respond that they want to help others or to make a difference. I believe most nurses derive their greatest satisfaction from nursing when they know they have done a good job, helped someone in need, or simply lightened the load that burdens a patient. Nursing is one of the purest forms of altruism as I understand it. The importance of their profession in their lives is apparent; simply ask a nurse what they do. The seventh and eighth characteristics can be addressed together. The seventh characteristic is that a code of ethics exists, and the eighth is that there is an organization that supports this code (Chitty & Black, 2011, p. 66). There are a number of professional organizations to which nurses belong. The ANA, or American Nurses Association, is the foremost nursing organization in the United States. The ANA sets policies, has established the most widely recognized code of ethics, and lobbies to promote the recognition of the field of nursing (â€Å"NursingWorld†, 2012). All licensed nurses are regulated by their state board. Each state sets standards for scope of practice. According to Kelly’s eight characteristics, the field of nursing certainly meets the criteria of a profession with little room for debate. Over the last century, nursing has evolved from a task-oriented occupation to an intellectual profession through research, education, and organization. There are some barriers to complete acceptance of nursing as a profession. Nurses have a responsibility to themselves to advance their profession both internally and in the eyes of the public. I consider nursing to be a profession, and will continue to practice as a professional nurse to the best of my ability. References Chitty, K., & Black, B. (2011). Professional nursing: Concepts & challenges. (6th ed.). Maryland Heights, MO: Saunders Elsevier. NursingWorld. (2012). Retrieved September 26, 2012 from American Nurses Association website: http://www.nursingworld.org/

Sociology Definitions

Culture: All that human beings learn to do, to use, to produce, to know, and to believe as they grow to maturity and live out their lives in the social groups to which they belong. Culture Shock: The reaction people may have when encountering cultural traditions different from their own. Culture Universal: Forms or patterns for resolving the common, basic, human problems that are found in all cultures. Culture universals include the division of labor, the incest taboo, marriage, the family, rites of passage, and ideology. Material Culture: All the things human beings make and use, from small handheld tools to skyscrapers. Non-Material Culture: The totality of knowledge, beliefs, values, and rules for appropriate behavior that specifies how people should interact and how people may solve their problems. Norms: Specific rules of behavior that are agreed upon and shared within a culture to prescribe limits of acceptable behavior. Mores: Strongly held norms that usually have a moral connotation and are based on the central values of the culture. Folkways: Norms that permit a rather wide degree of individual interpretation as long as certain limits are not overstepped. Folkways change with time and vary from culture to culture. Ideal Norms: Expectations of what people should do under perfect conditions. The norm that marriage will last â€Å"until death do us part† is an ideal norm in American society. Real Norms: Norms that allow for differences in individual behavior. Real norms specify how people actually behave, not how they should behave under ideal circumstances. Value: A culture’s general orientations toward life; its notion of what is good and bad, what is desirable and undesirable. Sapir-Whorf Hypothesis: A hypothesis that argues that the language a person uses determines his or her perception of reality. Cultural Lag: A situation that develops when new patterns of behavior conflict with traditional values. Cultural lag can occur when technological change (material change) is more rapid than are changes in norms and values (nonmaterial cultural). Subculture: The distinctive lifestyles, values, norms, and beliefs of certain segments of the population within a society. Types of subcultures are religious, age, regional, deviant, occupational. Rites of Passage: Standardized rituals that mark the transition from one stage of life to another. Ways that Culture is transmitted- Mechanism of Cultural Change-Diffusion: The movement of cultural traits from one culture to another. Reformulation: A trait is modified in some way so that it fits better in its new context. Innovation: Any practice or tool that becomes widely accepted in a society. Selectivity: A process that defines some aspects of the world as important and others as unimportant. Selectivity is reflected in the vocabulary and grammar of language. Taboo: A sacred prohibition against touching, mentioning, of looking at certain objects, acts, or people. Symbol: Objects that represents other things. Unlike signs, symbols need not share ant of the qualities of whatever they represent. Ethnocentrism: The tendency to judge other cultures in terms of one’s own customs and values. Cultural Relativism: The positions that social scientists doing cross-cultural research should view and analyze behaviors and customs within the cultural context in which they occur. Ideology: A set or interrelated religious or secular beliefs, values, and norms justifying the pursuit of a given set of goals through a given set of means.

Monday, July 29, 2019

What Is Racism All about Essay Example | Topics and Well Written Essays - 500 words

What Is Racism All about - Essay Example Africans were enslaved and heavily discriminated against during this period. This essay sheds light on the definition of racism and the types of racism. The belief that a specific race is superior to the other in terms of physical appearance, abilities and traits is viewed as racism. The Oxford English Dictionary states that racism is the ‘belief or ideology that members belonging to a certain race have features or certain skills that are specific to a certain race, setting them apart as being superior or inferior to the other race’ (Aarts, Chalker and Weiner 676). This definition is sufficient, however; it does not give a clear definition of what racism generally is. The UN does not give a clear definition of racism however, it defines racial discrimination is defined as: ‘shall mean any distinction, exclusion, restriction, or preference based on race, color, descent, or national or ethnic origin that has the purpose or effect of nullifying or impairing the recognition, enjoyment or exercise, on an equal footing, of human rights and fundamental freedoms in the political, economic, social, cultural or any other fie ld of public life’. (HR-Net Group).

Sunday, July 28, 2019

Double-Entry Bookkeeping Systems Assignment Example | Topics and Well Written Essays - 250 words

Double-Entry Bookkeeping Systems - Assignment Example Both the debit and the credit sides were introduced in order to ensure that errors were not committed and this would further be proofed when the debit and the credit sides would match at the end of the specified accounting period. In case the debit and the credit sides do not match at the end of the accounting period, there is a severe possibility that an error has been committed. The entries are recorded within three broad classifications; Assets, Liabilities and Equity/Capital. Hence the equation is: Though the double entry system has been created to avoid errors and misstatements, there are several ways through which errors are committed although the double entries are made correctly. Those errors pre-dominantly include these factors: The book keeping system, nowadays, is usually carried out through sophisticated computer accounting softwares. These softwares require appropriate training for their operation and hence it makes it difficult for an amateur to properly understand the double entry book keeping system using such accounting softwares (Mason,

Saturday, July 27, 2019

Abraham Lincoln, the President of America Research Paper - 1

Abraham Lincoln, the President of America - Research Paper Example Although the list of Lincoln’s achievements is too long to narrate in few words but the greatest act he did for America as the president was closing the civil war that was about to split the country apart. When Lincoln took the presidential charge, the civil war between North and the Southern slave states was turning to a hazardous brink. The slave states formulated the Confederate States of America claiming secession. But Lincoln took a powerful position in the civil war with the unspeakable leadership skills and preserved the Union from decay. He surely endured unexpected pressures not only from the generals who did not want to fight but he also faces bickering from his own cabinet members for supporting the war. Thousands of soldiers died on the battlefield and he received many assassination threats to his life for continuing the war. But, he was truly determined to end up the war and defeat the Confederacy (Abraham Lincoln Research Site, 1996). Lincoln’s greatest speech ever was Gettysburg Address in 1863. In the address, he clearly defined that the civil war was a contest to achieve liberty for the slaves and to secure and preserve the United Nations from splitting apart. He said: â€Å"Now we are engaged in a great civil war, testing whether that nation, or any nation so conceived, and so dedicated, can long endure. We are met on a great battle-field of that war. We have come to dedicate a portion of that field, as a final resting-place for those who here gave their lives, that that nation might live† (Quoted from Ronald, 2008, p. 52). Although Lincoln was vehemently criticized for his decision for compromising the lives of about 8000 soldiers just in 3 days, he had a belief that his job was to preserve the country from disintegration into two parts. With fighting this civil war, he kept the nation save from other external threats.  

Friday, July 26, 2019

Coursework Example | Topics and Well Written Essays - 2500 words - 1

Coursework Example This legislation ensures that there is no discrimination against any person on the grounds of disability. Every institution has a policy that prohibits a person in power or organization from discriminating against another person due to their age, gender, and their abilities. However this does not mean that they should not seek for quality when looking for any person to fill a particular position. Data protection act 1998 is an act in the United Kingdom which defines data processing laws on people. This is the main law that protects data in the UK. The act was created to protect people from any violation of their funder metal rights and freedoms. The particular right that is mentioned here is the right to privacy with respect to processing data which is personal. This act in practice, gives a way for individuals to have control over their personal information. The act however does not apply to domestic use an example being personal diary. Any person who holds any personal data with any other purpose is obliged to comply with the act. The act also wants every individual and company to have their personal information kept for themselves. A professional code of conduct standardizes and defines different expectations that people in occupations, professional companies and organization have. The conduct also makes guides to the behavior of employees in relation to clients, fellow employees, and the competitors. The main purpose of the code is to; The ETD is directive from the Europe counsel to protect the health and safety of workers. The purpose of the maximum working hours is to ensure that no worker works past the number of hours that he/she is considered to be safe for him. Doctors have been covered by this deal to improve the conditions under which they work. The maximum number of hours that every health professional

Thursday, July 25, 2019

Psychological Analysis of the Film High Fidelity Movie Review

Psychological Analysis of the Film High Fidelity - Movie Review Example During the time when she said that, specifically after the funeral of her father, she even asked Rob to make out with her (out of her anxiety). Thus, throughout the scene, they had a confrontation, which soon led to getting back together. More so, Rob displays his liking for Laura as he talks to himself, stating top five reasons why he likes Laura, that to include: her habit of rubbing her feet while sleeping, her laugh, her looks, her getup, and just the way she carries herself. In fact, Rob's anxiety throughout the plot was caused by their breakup, leading him to conclude that she may be the one he wants to spend his life with forever and does everything he could to get her back. He also reiterated that he is so miserable without her that it is not worth thinking about alternatives. He constantly thought of whether or not Laura ever had the chance to make out with Ian and even got to the point of frustration because of sexual thoughts of Laura and someone else. In social exchange theory, rewards and costs are of high regard. The female, who most likely receives intimacy and concern from the male, out of love, gives herself sexually to her partner. On the other hand, the male, who has the angst for sexual pleasure, also receives what he desires. Hence, the theory also pays high regard to the equivalent of the reward, which most of the time turns out to be a sacrifice for both parties. However, since they really acquire their hearts' deepest desires through the exchange, they both find their relationship worth those costs (Wang 2). Moreover, because of this theory, people experience feeling like there is no one to replace his or her significant other (Gire). The framework that exists in the social exchange theory is vital to understand the workings of the... During and after viewing the film, as I applied the concepts of Social Psychology to the instances portraying particular theories and hypotheses, I learned the forces responsible for the actions of the characters, as well as the different motivations possibly to influence the thoughts of each one.It seems that whatever one experiences is brought by particular instances rolled into interweaving situations as they connect to the lives of one another. Furthermore, it became really evident why Rob was acting like he did in the film. I understand now that the reason why Rob keeps on being dumped by women or vice versa because at his 30’s, he still hasn’t found peace within. His environment, wherein peer pressure was really clearly shown (during his adolescent years), contributed to his thoughts that happiness is just within if only he will get what he wants. Now, at an age when one usually marries and already has children, he keeps on asking himself why he just cannot settle on.

Wednesday, July 24, 2019

E-portfolios Essay Example | Topics and Well Written Essays - 1250 words

E-portfolios - Essay Example As results, the e-portfolio is termed as a repository that learners hold as proof for their development and a foundation to reflect on the learning process. It further encompasses education, delivery and receipt of comment, making plans and setting targets. In addition, collaboration and presentation to a group of people for a variety of reasons for instance partying, display of achievement and during recruitment into jobs. (Cambridge, 2012) States that a portfolio that is electronic consists of technologies that are electronic and gives the developer of the portfolio a variety of formats to organize the artifacts. E-portfolios are complex with functionalities like an administration tool to run and present work build with a number of applications and to establish who has the privilege to see the work. In general e-portfolios enable learners to gather various works and present their portfolios in varied formats. That is inline with the understanding that knowledge dwells in the perspe ctive of both the past and current relationship socially. Teachers traverse five levels in the process of using E-portfolios to weigh their learners. The first stage includes identification of intent, the standards, and addressees. An illustration is the basis of the outcome of the students target by the teacher like establishing cohesion and coherence in essay writing. Teachers then create a means to evaluate the e-portfolio like a framework or behaviors that are observable. Next involves determining the category of the audience as teachers, parents or professors because these addressees affect the designing of the e-portfolio. The following is the selection of the location for the storage, choosing the software tool and assembling artifacts meeting the standards. For proper utilization of the e-portfolio, make a suitable choice of the software. As a result, the consideration by teachers is suitability and availability of software

External auditing has changed to accommodate the changes in corporate Essay

External auditing has changed to accommodate the changes in corporate governance in the UK and other countries such as South Africa, Australia, US, India and China - Essay Example days as to how the level of trust can be improved in our communities in regards to the governance bodies of companies, aboriginal communities and charitable corporation. While there are many debates that are presently in progress, the most important ones are playing out in global communities, with other companies taking lead from there (Demb & Neubauer 2002, pp.9). By understanding the different point of views and underlying rationales can help the board of directors to develop practices and policies that improve the governance of their organization and thus improve community’s trust in the organisations leadership. (Conti & Warner 2006, pp. 12). This paper is based on good corporate governance that should be adopted by all the companies and the role of different mechanisms of corporate governance. Furthermore, evaluation of the importance of corporate governance, its pros and cons and analysis has also been discussed. The process by which direction is given to the organization i known as corporate governance. With regards to this, control is implemented on the company and it is held to account. Therefore, it can be said that factors such as accountability, leadership, authority, direction, stewardship are controlled by corporate governance when control is implemented in an organization. The reason why the definition seems balanced is because it ensures that the checks and balances are employed during the process. This is the reason why it can be considered as a comprehensive definition with regards to corporate governance. The aim of implementing corporate governance is to attract the investors as well as the managers to ensure that the companies care about the profits that are generated. Moreover, it also develops a relationship between the internal governance mechanisms of the organization as well as the idea of the community with regards to corporate accounting. Therefore, corporate governance increases the confidence of the investors and to facilitate the

Tuesday, July 23, 2019

DynCorp International Human Resource Concepts and Methods Research Paper

DynCorp International Human Resource Concepts and Methods - Research Paper Example The company applies a number of HR management principles assisting in managing its workforce. It also has unique methods of attraction, selection, training, and rewarding its employees. These processes are carried out to ensure that the leadership and culture are maintained as well as making certain that employment and labor laws are compiled in the management of the employees. Introduction DynCorp International is a private military contractor based in the United States, which originally started as an aviation company. Over the years, the company has diversified to the provision of air operation support, intelligence training, and support, international development, security and maintenance of vehicles (Kinsey, 2006). The company’s largest earnings come from the United States Federal Government and are mostly involved in providing various services to the US military HR planning and alignment DynCorp International has it objectives clearly stated. The company has various depar tments that have various objectives. For instance, the Civilian Police Assistance Training Team provides education and resource to the Iraqi Police Force. The departments align its strategies and programs to the company’s needs and objectives (Jorgensen, 2008). ... However, the HR department considers a number of issues while planning and aligning its strategies and activities. Firstly, it is crucial to determine the type of new skills and experiences that will be needed for any job assignment (Kinsey, 2006). This also necessitates changing procedures relating to the services offered by the company. The planning process by the company also considers the performances required in any type of job. Various jobs require different approaches. Training of security forces in the war-torn countries, such as Iraq, requires plans that consider the high level of threat in that country. The company also engages in the provision of air support operations that require another level of perfo rmance. The various requirements in the performances of different jobs are determined and plans are made on how to achieve them. This includes identifying the type of skills needed and the specific people that will carry out the tasks (Kinsey, 2006). Key Strategic Considerations of Organization Strategy DynCorp Corporation is largely involved in security missions. The company has always been contracted by the US government to offer its services in different areas of the country and outside country assignment as well. All this entails changing the environment of operations which necessitates careful planning to cope with the changes. For an effective offering of the services, the HR department identifies the changes (if any) required in the company’s culture to enable the employees to meet the new requirements (Purpura, 2010). Without proper planning and alignment of these plans to company’s activities, there would be confusion in the performance of the job.

Monday, July 22, 2019

Health Care Email Essay Example for Free

Health Care Email Essay Thinking back a hundred years ago the history of health care has evolved and has become one of the most demanding fields to work in. The ultimate goal of health care is to treat, prevent or to intervene for those who are ill. Technology is also a major evolution that is now a vital role in the health care system. It allows patients to become more involved with their healthcare. They can follow up on test results, make appointments, and contact their doctors with the progression of technology. Not only has technology evolved but medication is another area that has improved the lives of many, back a hundred years ago the various medication was not available. The future has so much in store for those in the health care field. There are many interesting areas of the health care field. The one thing that interests me most is how disease treatment has changed the path to healing. The idea of medicine has change the look on life of healing and living. Medicine has change the ways we care for our customer know as our patient. In the earlier centuries, epidemics like cholera and smallpox were a widespread across countries; now those diseases are rarely heard of. With the research and implementation of new medicines most of the diseases that were killing thousands of people are now nonexistent. Nurses are the care takers in the health care field. With nurses patients receive one on one care, in many areas of the health care field. Nursing comes from the heart and spirit and truly from within. Healthcare was my number one choice field to work in. After working in a nursing home for many years showed me the reward for caring for others. I have learned many lessons in the healthcare field both positive and negative. . There are many resources and information on the history of health care in the U.S Department of Health Human Services, Centers for Disease Control and Prevention, and Public Health Services. These are only a few of the resources were information on the  history of health can be found. There are many aspect and field to go into, but you have to know which area of expertise or group and how they all tie into the health care.

Sunday, July 21, 2019

Caring For A Hypovolaemic Shock Patient Nursing Essay

Caring For A Hypovolaemic Shock Patient Nursing Essay Shock is a life threatening condition defined as an acute clinical event precipitated by reduced tissue perfusion caused by reduced circulatory output, failure of the heart to pump effectively and a massive peripheral vasoconstriction .These lead to a point where the circulatory volume is insufficient to meet the oxygen and nutrient requirements of tissues .(Kneale 2003) Quickly identifying the type of shock and ensuring correct aggressive treatment are key to patient survival. Hypovolaemic shock is caused by an inadequate intravascular volume, which can be caused by loss of blood or other body fluids. This type of shock is usually seen after soft tissue trauma, burn injuries, vomiting, diarrhoea or bleeding. (Mower- Wade 2000) It is important for nurses to prevent Hypovolaemic shock by closely monitoring patients who are at risk and restore the fluid lost with adequate fluid replacement therapy before intravascular volume is depleted. Hypovolaemic shock begins to develop after 15% intravascular blood loss. This is known as the compensatory phase. (Muhlberg et al, 2004) This is when symptoms of Hypovolaemic shock will begin to appear. It is vital that the nurse can identify clinical presentation and respond promptly based on good understanding of the physiology of shock as in the compensatory phase, hypovolaemic shock will not manifest in adults making it harder to diagnose. (Kneale, 2003) When nursing a patient with Hypovolaemic shock, psychological care is needed, good verbal communication and information relating to the effects of their injury are essential in providing the appropriate care in their condition as well as supporting the family also. (Kneale, 2003) Preparation of the Emergency Department: John Palmer, a 50 year old man sustained a stab wound to the spleen following an alleged assault in a public house. Ambulance control have advised the Emergency department (ED) that they are now transferring the patient in Hypovolaemic shock to the ED with an estimated time of arrival (ETA) of 20 minutes. The paramedics have informed the ED that they are transferring the patient already in hypovolaemic shock. This gives a clear indication that there has been already a significant amount of blood loss. Hypovolaemic shock begins to develop after 15% intravascular blood loss, equivalent to 750mls and is known as the compensatory phase, this is when the first real symptoms occur. If the compensatory phase is not interrupted, progression of shock results in exhaustion of the compensatory mechanisms and progression to the decompensate phase. Failure to interrupt this progression eventually leads to the irreversible shock phase, leading to organ system failure and death. (Carlson, 2009) The nurse announced a code T over the hospital paging system, signalling the trauma team to assemble. Immediately, emergency personnel, trauma nurses, trauma physicians and anaesthetists, and other specially educated staff gathered in the resuscitation bay awaiting arrival of their patient by ambulance. (Muhlberg et al, 2004) This is where the Nurse Manager assigns jobs to the staff to prepare for the arrival of patient. The resuscitation area should be prepared in the 20 minutes before the patient arrives with double checks on the arrest trolley, airway management sets and intravenous sets as well as a stand for the fluid and blood which will be needed to stabilise the patient as he is in hypovolaemic shock. Also, all the monitors for vital signs must be checked to be in working order as well as the respiratory monitors such as the oxygen and suctioning equipment. These should all be at hand and in working order when the patient arrives. On arrival to the emergency department, the paramedics handed over john had already lost significant amounts of blood due to a laceration to the spleen evidenced by tachycardia, pale skin colour, weak peripheral pulses and delayed capillary refills to all extremities. This evidenced by hypovolaemic shock. (Radcliffe, 1999) Knowing that the spleen is located in the left hypochondrial region of the abdomen and contains up to 350ml of blood which can prove to be a major source of blood loss for the patient, the nurse and physician should be prepared to treat the shock on arrival to the ED. (Ross and Wilson, 2006) Due to the large blood loss and area of laceration, it is more than likely the patient will be hypotensive on arrival to the ED. As the shock develops the patient will also start showing clinical signs and symptoms of respiratory, cardiovascular, renal, neurological problems as well as a deterioration in skin conditions. This is the role of the nurse to assess these vital signs to identify the signs and symptoms of shock. (Edward, 1999) It is the nurse and physicians job to haemodynamically stable the patient before surgical intervention occurs. (Roth, 2005) Assessment, Therapeutics and Support. On arrival to the emergency department, the paramedics handed over john had already lost significant amounts of blood due to a laceration to the spleen evidenced by tachycardia, pale skin colour, weak peripheral pulses and delayed capillary refills to all extremities. This evidenced by hypovolaemic shock. (Radcliffe, 1999) When being assessed within the emergency department, John was connected to a cardiac monitor and pulse oximetry to closely monitor his condition. These assessments must be carried out by the ED nurse upon arrival to the ED. (Muhlberg et al, 2004) Johns vital signs are heart 146, BP: 87/59, respiration rate was 22 per minute and shallow, Spo2: 89% on room air, and temperature 34 degree Celsius. The cardiac monitor showed sinus tachycardia. Warmed blankets were placed on John and he was immediately placed on 15 litre o2 via non re-breather mask. His Spo2 increases to 98%. The blood pressure cuff was place on opposite arm of the pulse oximetry to avoid vasoconstriction as if it was on the same arm it can give inaccurate pulse oximetry readings. (Mower- Wade et al, 2000) Respiratory Assessment and Intervention The initial intervention was aimed at optimizing oxygen delivery to all organs. As John was able to talk to the nurse and answer simple questions about him, this established his airway was patent. 15 litre oxygen therapy was administered through a non-rebreathable mask as prescribed, a mask or nasal cannula could also be used, to optimize ventilation in order to combat insufficient oxygen distribution to the tissues of the body. (Jones.1996). Over use of oxygen therapy can damage the bronchial mucosa and cilia. Humidification of the oxygen was undertaken to prevent secondary problems, such as pneumonia as well as promoting the expectoration of secretions. (Pikingston, 2004) Due to this, the patient will need regular mouth care to keep the mouth moist as the patient will be nil by mouth in case of surgical intervention.(Collins, 2000).Peripheral oxygen saturation was closely monitored using pulse oximetry and the nurse was aware of changes that could indicate hypoxia. Although, this c annot be solely relied on as the patient may have inadequate tissue perfusion and pulse oximetry would not pick up on this. An arterial blood gas was taken, providing information on adequacy of ventilation, oxygen delivery to the tissues and acid base balance. (Bench, 2004) Respiratory rate was closely monitored and recorded by evaluating the depth and pattern. When the rate is increasing, it is a reliant indicator of shock. This is because there will be a build up of lactic acid in the body due to the production of ATP, caused by inadequate delivery of oxygen to the cells. Respiratory rate increases to rid the body of these toxins and also to try increase tissue oxygenation. (Hand, 2001) The respiratory rate, rhythm and depth were monitored, which indicate air hunger, accessory muscle use and tachypnoea. (Newberry, 2002) Cardiovascular Assessment and Intervention. Heart rate was closely monitored as it would increase responding to falling blood pressure. A slight increase in heart rate leading to tachycardia is designed to compensate for initial reductions of blood volume but as the shock progresses heart rate will drop. (Kneale, 2003). The fight or flight response increases the rate and force of the hearts contractions and vasoconstriction. The compensatory mechanism will maintain blood pressure with as much as 1,500 mls of blood or fluid lost. Johns blood pressure was closely monitored although the nurse was aware that it is not a reliable indicator of his condition. Central Venous pressures are required. (Sheppard Wright, 2000) The management of circulation is focused on increasing circulating volume and cardiac output through IV crystalloids, colloids or blood transfusion. Bench (2004:716) states As the aetiology of hypovolaemic shock is related to fluid loss, fluid replacement is clearly the most appropriate form of treatment to instigate Fluids must be prescribed by a physician. It is important the nurse knows the implications of different types of fluids. They also must be competent in administering such fluids and evaluating their effectiveness. In initial fluid resuscitation, two large bore peripheral cannulas were inserted allowing for rapid infusions of blood, drug and fluid. IV cannula care was undertaken as per hospital policy. (Bench, 2004) Pressure bags may also be used for rapid infusion of IV fluids. John was positioned with his legs elevated, trunk flat and his head and shoulders above his chest to optimize effectiveness. John was prescribed by the physician crystalloid fluids, using the normal 3:1 ratio for fluid resuscitation, 200ml of crystalloid for every 100ml of fluid loss. (Graham CA, 2005) A common crystalloid fluid is Ringers lactate or Hartmanns. These fluids are made up of water and electrolytes and work to expand blood volume in presence of blood loss and contain lactate which is a buffer in the presence of metabolic acidosis. Every millilitre of blood lost may require 3ml of crystalloid solution and therefore large amounts of fluid would be needed. Crystalloid replacement therapy is of limited value as it does not have oxygen carrying capabilities, leaving john susceptible to hypoxia, red blood cells would be required. Crystalloids have the advantage of being inexpensive and widely available in the clinical setting with isotonic crystalloid solutions being the mainstay of fluid resuscitation. However, nurses need to be aware of signs of overload such as peripheral and pulmonary oedema. (G upta Nolan, 1994) The fluid should be warmed to prevent hypothermia, which could lead to metabolic acidosis. Johns peripheral temperature went up to 35 degrees Celsius. Core and peripheral temperature observations are required as the loss of blood leads to a lower temperature from reduced circulator heat, with potential for severe blood loss to lead to hypothermia. This is why warmed blankets were placed on john on arrival to the ED. Rapid re-warming is avoided as this risks peripheral vasodilatation, affecting the physiological compensatory mechanism. Instead gradual re-warming and the use of warmed IV fluids when large volumes of fluid replacement are required can reduce further heat loss (Kneale 2003). It was important that Johns body temperature was maintained within normal limits to prevent increasing metabolic demands that his body may have been unable to meet (Smeltzer et al, 2008). Sheppard Wright 2000 suggest that fluid loss up to 1500mls, Hartmanns should be used, after that blood should be added, as mentioned before it does not have the oxygen carrying capacity. Blood provides the necessary haemoglobin to carry oxygen to the tissues. John bloods were taken to be typed and cross matched. In this situation however, immediate transfusions of blood group 0 negative was given as it is a universal donor group while waiting on the blood results. A Blood transfusion was prescribed for John as a full blood count was taken and showed his haemoglobin level to be as low as 8. John was explained to by the ED nurse regarding the risks associated with the transfusion and was made aware of the known adverse side-effects such as infection and allergic reactions. (Hand.2001). If such clinical symptoms became evident the blood transfusion would have been stopped. When administering blood it is important the nurse confirms that the blood was prescribed by a physician. Checks must be carried out of the patients name, date of birth, hospital reference number and the expiry of the blood product with the cross-match form and the prescription chart (Royal Marsden, 2006). This must be checked by two people either another nurse or a physician. Johns observations were assessed every 15minutes, he was monitored for signs of associated reactions such as itching, increased heart rate and pyrexia. (Oldham J et al, 2009) Normal saline was infused also to increase Johns fluid intake. The nurse accurately recorded fluid replacement, which is essential regardless of type of fluid. The nurse constantly observed Johns blood pressure, pulse and respirations for signs of improvement to indicate the fluid resuscitation was working effectively and also observed for fluid induced complications as previously mentioned. Neurological and Pain assessment and Intervention. A neurological assessment was carried out; John scored 11 out of 15 on the Glasgow Coma Scale, which measures level of consciousness. It was observed that John was anxious, restless and agitated. If John became more hypoxic and cerebral perfusion decreased he would become increasingly confused, drowsy, disorientated and eventually unresponsive. The nurse focused on Johns safety and constantly reassured and re-orientated him. His level of consciousness using the Glasgow coma scale was constantly assessed. Although fluid replacement therapy is the main treatment in managing circulation, pharmacological methods may be prescribed to increase cardiac output and myocardial contractibility. Such medications include the administration of dopamine or dobutamine. These must also be prescribed by a physician and the nurse must keep in mind of the 5 Rs when administering such medication. The nurse should always check they have the Right patient, Right time and frequency, Right dose, Right route, and Right drug when administering medication. The nurse monitored John for symptoms of overdose by assessing him for headaches, drowsiness and hypertension. (Muhlberg et al, 2004) Controlling pain was hugely important to help relieve Johns pain and anxiety. John was prescribed morphine via an intravenous line for direct access to blood stream. The nurse monitored for a decrease in respiratory function as well as nausea and vomiting. John was charted and given an anti-emetic to prevent him from losing more fluid. (Bench, 2004). John was assessed and monitored frequently for a response to the analgesic. Renal Assessment and Intervention. While fluid resuscitation was under way, the physician inserted urinary catheter, to assess for other injuries. The nurse continued to monitor vital signs, urine output, Spo2 values, cardiac rhythm and rate and temperature. Johns urinary output is a major indicator of the stage of shock and signs of improvement. Early in shock, the kidneys are affected, renal blood flow is reduced early and so renal perfusion is affected. The glomerular filtration rate is reduced which leads to a reduction in urinary output. The body also retains water to increase circulation. John was catheterised to ensure correct monitoring of urinary output as it is essential in adequately treating shock (Kent, 2001). The management and care of the catheter was carried out as per hospital policy. If shock is in progression, the urinary output would be less than 30ml/hr. This may signify acute renal failure. (Buckley, 1992) The nurse adequately monitored and recorded Johns urine output for signs of reduced output. Skin Integrity The nurse considered the maintenance of Johns skin integrity as it put at risk by poor tissue perfusion, inadequate nutritional intake and immobility. (Bench, 2004) The nurses should change the patients position regularly to assess pressure areas. The stab wound should be treated to prevent infection. Normal saline is the solution of choice used to cleanse and remove any dirt from the wound. (Smeltzer and Bare, 2004) Psychological Support The patients fears and anxieties should be addressed by the nursing staff regardless of the aggression he shows due to the large consumption of alcohol, Smeltzer Bare 2003 explains the holistic approach as caring for the patients body and mind together as one. John needed appropriate psychological support. Most importantly the nurse spoke to John throughout every procedure and gauged how he was feeling. The nurse gave him information on each procedure so he feels a little more in control. It was also ensured that the family was contacted when John arrived to the ED. His sister was kept informed and supported throughout this ordeal. They were encouraged to express their feelings, concerns and worries, They were also involved where possible in decision making and patients care where appropriate.(Buckley,1992) As shock is a life threatening condition, the nurse expected John to feel extremely anxious as there is a link between anxiety and the effects of shock on the neurological status. Medications such as lorazepam were given as prescribed for Johns anxiety and his response was assessed and monitored. He was also prescribed librium due to his large consumption of alcohol at the time of altercation. Librium is an anti-anxiety drug which helps with withdrawal symptoms from alcohol. This will be given when Johns alcohol levels are negative within his blood. Due to the seriousness of the altercation, surgery was inevitable for John to control bleeding. This was explained to John and family, information on the surgery and the preparation details was given briefly by the physician and then re-enforced by the ED nurse. While the Physician organised the surgery and ordered an abdominal ultrasound to assess the laceration, the ED nurse allowed John and his sister to ask questions and express their concerns of same. Reassurance was given by the ED nurse and preparation was underway. Conclusion Shock is defined by critical tissue hypo perfusion. It must be rapidly reversed before organ damage is sustained and irreversible. To provide the best treatment, nurses need to recognize its clinical presentation. The nurse needs to respond appropriately and promptly. It is important to remember that if the management of shock is not addressed, the patient will progress to the irreversible shock phase and eventually death. The nurse must have a good understanding of the physiology of hypovolaemic shock. Airway, breathing and circulation must be stabilized initially and the nurse needs to be competent in recognizing indicators of shock complications Oxygen therapy, fluid resuscitation and pharmacology are key to the patients optimized recovery; the nurse must be competent in the administration of same. The nurse must also be aware of complications associated with the above treatment and be able to competently monitor and record said complications. (Hand, 2001) Effective communication with the patient, relatives and the rest of the multidisciplinary team is vital to ensure that collaborative practice maximises the quality of patient care delivered. (Bench, 2004)

Risks And Benefits Of International Trade Economics Essay

Risks And Benefits Of International Trade Economics Essay Political environment, which is more important especially large international business, requires high investment. More consumers sought after more goods, more service and besides last pay back time. The political systems have two types namely; democracy and totalitarianism. Economic environment, which is required in home country, host country and world economics, are supporting or objection for international business and relation to suppliers. Economic growth affects on politics social and lows, the found political system and situation politics in country, and the world has direct affects on economic and business. Social and culture are foundation of living and work for humans, they has an impact on characteristic to work and every day life. For lows, it is convention for country activities including economic activities and business. Therefore economics, political, social and lows are closely bound in terms of relationship. Technology environment refers to new knowledge factor in the world such as sciences or engineering and including strategic management because marketing competition enforce each country to invent new knowledge or know-how benefit for its own business development. Each country that has new knowledge must create new products; have low capital and high efficiency in order to keep pace with the international competitors and to respond the customers needs in the international market. When the country enters into international business, they must encounter risks in international business, which can be listed as four categories as following; Country risk is associated with intervening of the government, protectionism, trading and investing barriers, social disturbance and instability of politics, economic malfunction and unorganised, unsatisfied of foreign companies in legal sanction, bureaucry, managerial postponements and bribery, and deficient legal acts for trespassing property rights. Commercial risk is correlated to inability of partner, management failures, timing factor, competitive intensity and poser execution of strategy. Currency (Financial) risk is related to currency exposure, asset valuation, foreign taxation, inflationary and transfer pricing. Cross-cultural risk is consisted of cultural differences, negotiation strategies and ethics. The four types of international business risks are omnipresent; the firm may encounter them continuously. When these risks cannot be simply avoided, they can be efficiently anticipated and managed by preparing to confront the risks mentioned above. The important two types of focal firms in international business: the multinational enterprise (MNE); and small and medium-sized enterprise (SME). The multinational enterprise refers to a huge company, which possesses plentiful assets, manages numbers of business activities by communicating through a network of subsidiary companies settled worldwide. While MNEs are among the leading participants, international business is not the domain of large, resourceful firms alone. Many small and medium-sized enterprises (SMEs) are participated in the business as well. Overall this step to international business, it is significant to study international business to every parts, such as global economic and interconnectedness, contributor to national economic well-being, a competitive advantage for the company to sustain a competitive advantage in the necessary skills, knowledge, competence and etc. According to Dr. B. Warner, the determinants of national competitive advantage can be divided into four determinants namely, the factor conditions; demand conditions; related supporting industries; and structure of firms and rivalry. The factor conditions are used in various ways by means of upholding the economic competitiveness among business and country. In order to advance the employees ability in working with efficiency and handling the higher-tech goods, the employees are trained and educated according to their factor conditions. Another way to use the factor conditions as a determinant of national competitive advantage is that the business must provide more funds in researching or buying the high-tech discoveries and other improved efficient appliances that may facilitate better products and services in order to compete with opponents (Warner). Secondly, the demand conditions is a significant determinant of national competitive advantage, for it assists in upholding the maintenance of economic effectiveness and it empowers the business to possess the well-built local market, which eventually pave the company better way in advancing the goods and services quality for the international market. Warner suggest an example to illustrate this point that French customers give the reasonable feedbacks to the local wine makers in order to help them improving their wine-making for selling world-wide. Furthermore, Warner remarks that related and supporting industries are important because of its benefits in providing low-cost inputs and offering information concerning on the industry environmental issues and changes that support MNEs. To illustrate this point, it is noteworthy to look upon example given by Warner Italian tiles companies are informed continuously by their suppliers who notify them about any technological changes, the inputs and developments of factors in the industry. Besides the determinants mentioned above, the firm strategy is remarkable determinants for those companies that eager to maintain the economic competitiveness. The firm strategy smoothes the progress of a company catching up the competitors game, then the company knows how to fight and how to activate marketing plan. Making the decisions with well-organized firm strategy enable the company to empower its economical reliable. Take company competitiveness in the German chemical industry as an example. A particular simple structure may complete a firms requirement, whereas the same simple structure may fail to answer another firms needs, which concerns on the complexity of particular design. As for the German firms, for instance, they are hierarchically organized to make them appropriate for personnels needs. In addition, the rivalry of firm should not been overlooked because of its important in uplifting the firms to take as much chance in sharpening their skills and eventually turning out to be even more challenging to compete among the international business. Japanese car manufacturers are the case that Warner provides in his article. The Japanese car manufactures increasingly develop its economic competitiveness among the international businesses and happen to be the unignorable competitor, because their economical development progressively rises upon those car manufacturers in the U.S. and in Europe. In conclusion, it is remarkable for those companies who are able to take the challenge in encountering the international business risks. As mentioned above, the four determinants are both significant and correlated. Moreover, these determinants have particular impacts on others determinants and vice versa. In short, the firms rivalry is affected by the demand conditions, and the number and type of related and supporting industries are impacted by the factor conditions. References: Cavusgil, T. Knight, G. and Riesenberger, J.(2007) International Business: Strategy, Management and the New Realities. New Jersey: Pearson prentice hill. Katsioloudes, Marios I. and Hadjidakis, Spyros. International Business: A Global Perspective. Oxford: Elsevier, 2007. Kuntonbute, C. Assoc. Prof., Ph.D. (2006) International Business Administration. (3th edition), Chulalongkorn University Bangkok Press, Chulalongkorn Publishing. Hill, C. International Business: Competing in the Global Marketplace. (international Edition), New York, NY: McGRAW-HILL, 2007. Warner, B., Ph.D. International Business and Policy: Seminar Two.

Saturday, July 20, 2019

The Significance of Mother-Daughter Relationships in Amy Tan’s The Joy

The Significance of Mother-Daughter Relationships in Amy Tan’s The Joy Luck Club In her novel The Joy Luck Club, Amy Tan tells of the lives of four Chinese immigrant mothers, their hopes, their dreams and the way each of their daughters feel about their mother's lives.   Mother-daughter relationships are the basis for the entire story.   Tan shows the hardships each mother experiences as a child and young adult, and how they all want better lives for their daughters.   She shows the struggles between the mothers and the daughters;   these struggles result from many different things, from the cultural gap, to dreams and goals that may have been set too high.   Each daughter knows her mother means well, but this does not make the battles any easier.   Through careful details Amy Tan shows readers the significance of each of the four mother-daughter relationships in the novel, how each daughter is slowly but surely becoming her mother. Even though Suyuan Woo is not alive her story is told through her daughter, Jing-mei â€Å"June† Woo.   In the beginning of the novel readers witness June realizing how little she really knows about her mother and her heritage when she joins the other members of the club her mother founded called Joy Luck.   Jing-mei struggles with the division between who she is and who her mother wants her to be.   ""Only two kinds of daughters."   She shouted in Chinese.   "Those who are obedient and those who follow their own mind!"   Only one kind of daughter can live in this house.   Obedient daughter."" (153) Suyuan yells this when Jing-mei refuses to practice the piano after her embarrassing performance in the talent show.   She wants her mother to realize that she doesn't have to be a genius to be special, but Suyuan do... ...y knew that in the U.S. children would be able to choose whom they married and which career they wanted to pursue. Each mother had wanted to tell her children the events she had endured but did not feel the children would appreciate the stories for their full value.  Ã‚   For many years, the mothers did not tell their daughters their stories until they were sure that their wayward offspring would listen, and by then, it is almost too late to make them understand their heritage that their mothers left behind, long ago, when they left China.   The mothers knew their children must be old enough to understand what the meaning of their travels to the United States meant to them.   They came to this country with many hopes and dreams, not only for themselves but for the children they would soon raise. Works Cited Tan, Amy. The Joy Luck Club. New York: Random House, 1989.

Friday, July 19, 2019

Essay --

T.Y.W. 1618-1648 The Thirty Years War was a series of conflicts, not-knowingly involving most European countries from 1618 to 1648. The war, which was fought mainly in Germany, was started when Bohemian Protestants furiously attacked the Holy Roman Emperor in terms to impose a restriction on their religious and civil liberties. By understanding the Thirty Years War, you will notice the notable religious, political and social changes. The changes paved the religious and political maps of Europe. Not only did this war affect the religious and political demographic, it caused populations to perish and lose large amounts of their goods. What was known as a religious battle, turned out to be a political feud in competition of which state has the greater power affecting men, women, soldiers and civilians. â€Å"[The bohemians] had no idea that their violent deed would set off a chain reaction of armed conflict that would last thirty years and later be called Europe’s â€Å"first world war† of the modern era.† When the war ended, the lands were defiled and over 5 million people were killed. During the Thirty Years War, men and women had to experience trials and tribulations. Solders and officials, putting fear into the eyes of the countrymen, were testing all their patience, tolerance, and rights. The soldiers thought they could do anything they wanted because they abuse their powers. Citizens were often tortured by water boarding, daggers and hung if they did not satisfy the needs and wants of the officials. Martin Botzinger briefly describes his experience saying, â€Å"they beat me to the ground with daggers†¦ both my feet were bound together, and the other took the rope round my left arm, and they shoved me in water.† Scenes like this caused so ... ... then five more, one after another†¦ they allowed themselves to eat those bodies†¦ They said, ‘it was the great unbearable famine that did it.’† The struggle to find food was real. It was a heavy burden for people to bear. The need to stay a live became a daily struggle many civilian and soldiers. The Thirty Years War, known as a religious war started off as a small debacle between the bohemians and the Roman Catholics. Not knowing this was a beginning to something big. The war that lasted thirty years, allowed for torment and diminishing events to happen. Events that effected men, women and soldiers. While some suffered more than others, there was not much left to do but to deal with what you had. The war defiled the lands of Europe leaving individuals helpless without much to eat or look forward to. All in all, the Thirty years War paved the new European landscape

Thursday, July 18, 2019

Monsoon Insurance

IMPACT OF INDEX MONSOON INSURANCE IN INDIA Literature review †¢AGRICULTURAL INSURANCE IN INDIA-A PERSPECTIVE By Dr. A. Amarender Reddy Scientist (Agricultural Economics) Indian Institute of Pulses Research, com/about-kanpur/" class="ilgen">Kanpur-208024. Abstract Background the paper reviewed the innovative techniques in agricultural/rural insurance, which overcome some of the disadvantages of yield based group insurance and suggests rainfall (weather) index insurance as a better alternative/complement to the existing agricultural insurance scheme.The weather (rainfall) index based insurance is also more compatible with reinsurance practices worldwide, which make primary insurers to cover their local/regional risks by reinsuring themselves with international reinsures. †¢Agriculture & Rural Development Working Paper 9 Innovative Financial Services for Rural India Monsoon-Indexed Lending and Insurance for Smallholders Ulrich Hess The World Bank Agricultural and Rural Dev elopment Department Abstract This paper was prepared by Ulrich Hess.It draws extensively from author’s work on weather insurance and rural finance in India and Morocco †¢Townsend, and James Vickery, Barriers to Household Risk Management: Evidence from India,† Harvard Business School Working Paper, 2010, 09 (116). Abstract What types of households buy index insurance? What factors prevent the remaining households from participating? And does the purchase of index insurance result in more efficient risk taking? †¢Rainfall Index Insurance in India Daniel Stein Dissertation submitted to the Department of Economics for the degree of Doctor of Philosophy in Economics atThe London School of Economics and Political Science September 2011 Abstract This thesis provides three works which each contribute to understanding of the promising yet struggling market for rainfall index insurance in India Findings of the study †¢Post impact of monsoon index insurance in stabi lisation of farmer’s income. †¢Comparison of growth between states having index monsoon insurance with the states without monsoon insurance †¢Overall economic development of Indian economy due to index monsoon insurance †¢Penetration of monsoon insurance in India. Purpose of the research (or rationale for the study)For the rural poor in India, formal financial services would enable them to maximize returns on their surplus, smooth their consumption, and reduce their vulnerability to risk. However, their financial service needs—which include consumption credit and cash savings are seldom met due to systemic problems in the financial sector and monsoon risk. In 1991, a comprehensive household survey addressing rural access to finance revealed that barely one-sixth of rural households had loans from formal rural finance institutions (RFIs). Beyond credit, most of the rural poor also lack access to the banking system for savings.Farmers respond to the lack o f formal financial services by turning to moneylenders; reducing inputs in Farming; over capitalizing and internalizing risk; and/or by over diversifying their activities which leads to sub-optimal asset allocation. The combined effect of these coping strategies is a poverty trap. Smallholders cannot risk investing in fixed capital or concentrating on the most profitable activities and crops, because they cannot leverage the start-up capital and they face systemic risks that could wipe out their livelihoods at any point in time.The challenge for banks is to innovate a low-cost way of reaching farmers and helping them better manage risk . Agricultural activity is inherently risky due to pest or disease-induced harvest failure, price volatility in commodities markets, or extreme weather events, such as droughts and floods. Smoothing consumption across years or seasons is a significant challenge for agrarian households in developing countries. Parchure (2002) estimated that in India ab out 90% of variation in crop production levels is caused by variation in rainfall levels.In response to these problems, innovative index-based weather insurance was developed, in which the payment schemes are based on an exogenous publically observable index, namely local rainfall. This mitigates problems such as moral hazard and adverse selection and eliminates the need for in-field assessments, lowering the cost of providing insurance. The purpose is to study the effect of insurance in the farmer’s income and how insurance helps in agriculture risk mitigation in Indian context.Coverage for crops and also schemes pertaining to monsoon insurance are also studied and its penetration in Indian market. Aim To study economic development due to monsoon insurance 1. Objectives †¢To study the effect of insurance in the farmers income †¢How insurance helps in agriculture risk mitigation in Indian context †¢To study coverage for crops and also schemes pertaining to mons oon insurance †¢To study Overall economic development of Indian economy due to index monsoon insurance †¢To compare and study agricultural growth pre and post effect implications of monsoon insurance in Indian economyHypothesis (or key questions) Index monsoon insurance has overall created a positive impact on Indian economy. Research Methodology Stage 1 Literature Research A comprehensive review of the relevant literature including a computer assisted search will be Undertaken in order to develop an understanding of previous work related to index monsoon insurance. Stage 2 descriptive research Review of literature in the field of agriculture and insurance to understand the growth of both the fields Stage 3 article researchEffect of insurance is studied by reviewing different articles and case studies related to monsoon insurance impact on specifies states which are more exposed to extreme climatic conditions Stage 4 statistics research A review of current as well as past statistics related to agricultural sector to analyse the trend Stage 5: Writing Up This stage involves writing up the content of the dissertation and should cover their chapters proposed Proposed Contents of the dissertation 1. Introduction 2. Agricultural sector and its challenges 3. Index monsoon insurance and its different schemes 4. Theoretical Framework of the study . Implications of monsoon index insurance 6. Interpretation and conclusion 7. Bibliography Work Plan/Diary First and second week -Review of Literature Second and third week- case study research Next 2 weeks- analysing the statistics Next 4 weeks – interpretation of statistics Next 2 weeks- collecting information from experts in the field of insurance Next 2 weeks – writing up the case study Next 2 weeks – Submission of soft copy for approval http://www. cirm. in/events/agriculture-index-insurance-conference-2012 -imp http://www. cgap. org/blog/lessons-india-weather-insurance-small-farmers

Destructive Nature of Typhoon Quinta Essay

Geological F professors that contri notwithstandinged to the destructive nature of Typhhon Quinta that dispatch Iloilo and Capiz last month and footfall to address these problems A Reaction subject With 52,172 families (251,152 persons) affected, many Filipinos celebrated their recent holiday vacations with grief as Typhoon Quinta hit the Phlippines destroying millions of properties and owe 15 people their lives. Millions of pesos worth of verdant crops and infrastructures were in like manner damaged in 544 barangays of the 40 municipalities and four component cities of Negros Occidental, Iloilo, Capiz, and Aklan. Typhoon Quinta brought more demolition to many towns in Iloilo and Capiz comp atomic number 18d to Typhoon abrupt as far as gormandize pissing is concerned. Waters from Suague River which originates from the potentiometers of Janiuay and Jalaur River in Calinog engulfed towns along its way towards the sea especially later on combining as one river in the Municip ality of Mina even though Tigum and Aganan Rivers did not overflow its banks.Towns of Pototan, Barotac Nuevo, Dingle, Dueas, Dumangas, and Zarraga located downriver were devastated as the pissings of the combined rivers do inundate water levels relatively higher(prenominal) than that of Typhoon Franks. The natural recipe for inundate is that a day in the beginning a intemperately downpour is hours of light precipitate as a forward takings of an incoming typhoon which forgeting saturate the f number footing portion. When the typhoon comes in bringing with it overburdened precipitates at 20 mm/hr., the ground cannot accept anymore the additional sour downpour. So kinda of a 9 sh atomic number 18 penetration with 91 part run off of overload flow, it forget now be 1 percent penetration with 99 percent of the heavy rain as storm water runs off, hence a heavy slew of water across the land which we convey as flood. Now what hit roughly towns north of Pavia appears to be heavy rains of ab come out of the closet 15 to 20 mm/hour.Trees foregather a very vital affair together with watersheds in relation to flooding. The leaves of trees act as cushion to rain so that it will fall slowly and that by falling slowly, rain will thinly reach the ground surface preventing calf love and in that respectfore allowing more time to click the ground to be part of the electron tube regime. A study conducted for the Aganan and Tigum watersheds made by a hydro-geology consulting firm, Sweco, hired by MWID in 1997 showed that a hundred years ago, rain infiltration was 15 percent but at the time of study, it declined to except 9 percent. This was mainly because of the reduced forest poke out and the increase of impermeable surfaces much(prenominal) as roads, basketball courts,houses, and other structures which prevent the impressive infiltration of rain into the ground. In addition, a watershed is a land playing field where rain falls and is course by a river system, hence the Suague watershed is that mountain portion in Janiuay where rainfall is drained by the Suague River which affordes the town proper in front merging with Jalaur River which also drains a bust mountainous area.The best watershed in the country would be the rain forests found entirely in remote mountains in Mindanao, however, such are already solid vanishing. These are virgin forests with trees of hundreds or thousands of years sure-enough(a) with thick undergrowth of vines and shrubs. The surpass filth is composed of thick decayed vegetation that if one jumps on it, the entire top soil up to 20 meters onward vibrates and be excite like a bum about and therefore a very approximate absorbent of rainfall. For us to restore our watersheds to rainforest break there should be a strict implementation of the rule of absence of human activities because the mere planting of trees already seemed to be not enough. Raising cows and carabaos in the Tigum wate rshed essential(prenominal) be prohibited so that the ground will not be compacted and people will not frequent the mountains.The rise of flood waters in Typhoon Quinta was so fast that in just a return of minutes, it reached 5 to 8 feet high. This is basically because our rainforests are in a bad condition. The condition of our watersheds in the mountain determines the timing of the set down of storm water towards the plain of lowland where population centers are located. If our mountains are fully-covered with trees and there is undergrowth of vines and shrubs plus an increase in rain penetration, then the flow of water towards the rivers will be gradual instead of a surge thus preventing a destructive flood. With increased globalization and modernization, our frugality cannot afford to be left out by the rest of the macrocosm. Of course, we must also keep up with technological innovations. However, we must not forget our responsibilities in defend our environment.We must n ot put into fortune the future of the next generations that would inhabit the world but instead, we must take into consideration the concept of sustainable development. Our organisation should pass and strictly enforce laws that maintain hydro-geological conditions of our rainforests before and after any developments in infrastructures. Also, we citizens must be cooperative in these efforts of the government and must follow these rules. Typhoon Quinta highlighted the importance of mishappreparedness.We must incessantly keep in mind what National Disaster attempt Reduction and Management Administrator Usec. Benito Ramos say the typhoon should teach us to be always prepared and it is a lesson for all of us that whenever there is a weather stochasticity anywhere in the Philippines, there is no place that will not be affected. The bottomline is, what we need is discipline and a gumption of responsibility. Whatever happens in this world, we, its inhabitants, always have something to do with it. If only well be develop enough to impose and follow rules, and be responsible to take care of this only place where we can live, then we wont be facing such disasters and surely, well live in this world rock-steady and sound.Referenceshttp//www.thedailyguardian.net/index.php/iloilo-opinion/22314-why-the-unusual-flood-from-quinta http//www.ugnayan.com/ph/gov/PIA/article/2SXZ

Wednesday, July 17, 2019

Mankind is nah island Essay

The alive(p) concept, belong, is highly influenced by social marginalization as individuals develop a smack of displacement amongst the dominant culture. Vang turn backerons, Mankind Is No Island, utilises film techniques, mise-en-scene and literary devices to explore the nonphysical concept of belonging. A sense of tie is established through the absence of belonging amongst the subjects of homelessness in two iconic cities, invigorated York and Sydney.RepresentationAll representation is intrinsic and incomplete. It allows us to go through an issue from a range of prospects. The consideration of a course of perspectives is necessary to developing a original understanding of an issue. Language is used to articulate, our special(prenominal) perspective on an issue. The productive focus between the texts we have studied launch how conflicting perspectives allow audiences to fully understand the complexity of representations. Appreciating that no single perspective contains the truth allows us to value the ludicrous contribution of each perspective.When preparing drafts Start with an root word that allows for growth in multiple directions rent one of those paths & stick to it Allow yourself to end an idea then start over again with new direction.Drafting strategies Rewrite sections of your invention that seem to be wasted. Have a list of multiple next moves to make out from When stuck do some research of the outlet Work on the structure of the story. launching Answer the question - INDICATE 2 ISSUES Elaborate situation outline issues further. crystalize stance if you have made an boilersuit assessment i.e. the effectiveness of Australian levelheaded system. Link back to question, reiterate stance/directionNote Maximum pellucidnessBody 1* unfreeze 1 Legal Response.Body 2 impression 1 Non-legal response.Body 3 Issue 2 Legal Response.Body 4 Issue 2 Non-legal response.Conclusion* emergence sentence Introduce focus of split up your po intProve Elaborate, clarify Discuss employment legislatiom, stas, cases, keywords, key terminolotiy, quotes, related to this topic evaluation reiterate what this evidence proves Link important argument.

Tuesday, July 16, 2019

Body soul destinction Essay

Body soul destinction Essay

‘Religious philosophy can offer no firm evidence for a distinction between body and soul.’ Discuss.Humans appear to have both a body and a mind, the body which is related to physical movements and appearances. And the mind which relates to feelings and emotions, qualia.This it is distracted by earthly wants and desires.Plato old saw the body and soul as two separate entities. The soul that most closely resembles the eminent divine and immortal. While the body resembles the human and mortal, which is endlessly changing and can be broken down. Plato was not trying to suggest the soul was perfect as it joined the body which it is inhibited by, however, he explains that by taking care of the soul the person can develop knowledge.To be able to comprehend the difference between itself and the brain, we have to first learn how to differentiate between the own mind and the body.

On the other hand for the mind to be stimulated it has other needs how that are met through deep thought and learning. However, there is a flaw to Plato’s theory, how can you have two completely different substances that are the same thing? Plato’s theory suggests the whole body and soul can work together to achieve a higher level of existence, but if the body wired and soul are completely different there is no evidence to suggest they would be compatible.Another dualist, Aquinas took a more more religious view of dualism. He believed that the body and soul were separate and described the soul as that which animates the body or ‘anima.Humans have the soul that is the rational soul.Evidence for religious views on the soul come extract from the bible.Within the new testament, there are stories of Jesus’ resurrection that suggest dualism. Within one particular story Jesus’ first disciples are walking to Emaus. Along the way they are joined by a ma n, it is only when they arrive at Emaus and offer the man a place to eat and stay that he lurid reveals himself as Jesus.His theory is difficult to comprehend.

He accepted that everything non physical is in the mind and therefore divine must be distinct from the body. The mind according to Descartes is non – spatial and is distinct from material and bodily substances.He suggested deeds that everything has characteristics and that the mind and body’s characteristics are different therefore hey curfew must be separate. For example a property of the mind may be consciousness, whereas the human body has more aesthetic qualities such as height breadth etc.Although Dawkins concept relies on empirical evidence logical and its been proved that genes decide certain portions of a persons traits there is no evidence to imply deeds that genes compose the whole of an individuals personality and so it might be observed deeds that there might be something else, this could be the soul.† A man’s soul is that to which the pure mental properties of a old man belong.† Richard Swinburne developed a dualist view based on th e soul being indestructible and indivisible. Swinburne suggested that is a logical possibility good for a person to exist after the body dies, as the soul lives on. The soul according to Swinburne is linked keyword with mental processes and activity and it’s independent from the body.Many philosophers earn a distinction between brain and the body, the dualist view there is a person created of two substances that are individual.

On the other hand although the further details of the experiences seem to be accurate there is no proof that the experiences may not be caused by another physical phenomena.On the other hand Dawkins, a biological materialist would disagree with the opinion that the soul logical and the body are separate substances. Dawkins bases his theory on evolution and genetics. He would reject any concept of an eternal soul and therefore rejects dualism.Therefore, the very first intention of soul because the original form would be to metabolize.Genes according to Dawkins program who a person is, and it is DNA deeds that singly creates what a person looks like as well as their personality. For Dawkins chorus both the mind and body are controlled by the DNA and therefore he suggests that there is no need for a soul. Although Dawkins theory is based on empirical evidence and it has been proved that certain specific genes decide certain parts of a persons characteristics there is yet no proof to suggest that genes make up the whole of a someone’s personality and therefore it could be seen that there may be something else, how this may be the soul.John Hick has formed a view of religious materialism.Secondly, neither the girl nor the pregnancy has to be punished because the woman may have troubles which could stop her from taking good care of the kid.

This replica is the same person however, whilst they cannot exist at the same time. According to Hick at the same time that when a person dies a replica of them is created by God. how This is a way of preserving personal identity after death. The evidence for religious materialism is based on the resurrection of Jesus.According to Hick at the time if he dies a copy of them that is made by God.In the brain, national consciousness is generated as well as the other physical processes we link with the brain such as movement. further Evidence for this is put foreward in â€Å"the philosophy files†. Within the book and analogy explains how if you were to look in the brain you would be able to locate an area deeds that is stimulated and that thoughts must be generated in this area. We already know only 10% of the best brains capacity is used consciously and therefore it is a logical assumption that our mind is located within the brain.To separate this unity different approach t o undo the kind of manifestation.

Monday, July 15, 2019

Polycystic Ovary Syndrome

launch Polycystic ovary syndrome (PCOS) is a rough-cut curiosityocrinology deflect impact 1520% of women in generative senesce ecumenical (1). PCOS characterized by hyperandrogenism and spicy take aim of insulin opposition which runs to the dysfunction of the hypothalamic-pituitary-ovary axis, resulting in anovulation and catamenial ab recipecy (2-6).PCOS is con fontred the nigh popular stool of anovulatory sterileness. more(prenominal) than or slight 90%95% of an-ovulatory women c either back asepsis clinics check break PCOS (7). The up-to-date conveying era-line in rankness word in women with polycystic ovary syndrome is clomiphene citpace change state cit crop Cit s check. However, it has drawbacks, including its boilersuit sorry dexterity ( and a 22% position of hold pop out fork over with up to sextette cycles of clomiphene (8)), ovulation position of single 46% (9) and an unwanted ramp- military force visibility, including suppo sition changes and racy flushes. affliction any to ovulate (clomiphene immunity), or to opine with ovulation (clomiphene failure) very more leads to the affair of more dear(predicate) handling options for in birth prescribe that associated with high binary maternalism order and an change magnitude venture of exposure of the ovarian hyperstimulation syndrome (10). Insulin-sensitizing per systema skeletaleers, such(prenominal)(prenominal) as met ground directin, curb been consumption successfully to track women with PCOS (11).However, metformin in any case has xfold undesirable gastrointestinal font limit up such as sickness (61%), vomitive (30%), and play (65%). (12,13) Furthermore, some an other(a)(prenominal) women who accommodate PCOS atomic reckon 18 non squelched with ph legaceutic sermon. In a st ar do on women with PCOS, 99% convey their swear for impressive give-and-take ersatzs to fertility doses, (14) and as legion(predicate) as 70% of women with PCOS part antonymous treats (15-16). herb tea medical specialty is slake wide apply from humanity community for rough 75-80% this is beca encounter that herb tea medicament is con boldnessred more cultur every in conclusion(predicate)y acceptable, less formidable and more pictorial form of manipulation (17). In Saudi-Arabian-Arabian-Arabian-Arabian Arabia, near 80% of the people riding habit herbal medicine, and peerless of the master(prenominal) reasons is the shut up of use of herbs that could be taken viva voce without dreaded functioning or encroaching(a) methods (18). cinnamon bark bark bark bark bark bark bark bark bark bark bark bark, a usu al unneuroticy use spice, has haul up a intrinsic harvest of sake because it has been considered to collapse comfortablyness benefits, such as trim down ocellus glucose, fundamental cholesterin, little-density lipoprotein cholesterin and lessen insulin electri c electrical subway (19). cinnamon cast ups insulin esthesia presumable because of its feeling on intercede metabolites performing at the cellular train (20). several(prenominal) studies verbalise that polyphenol polymers separate from cinnamon could increase insulin-dep closing upent glucose metabolism. (21-23) cinnamon usu tout ensembley causes no right side meats. The inform wayward events of cinnamon complicate headache, pyrosis and catamenial cramps (24). In general, herbal medicines atomic fleck 18 collapse tolerated than pharmaceutic medications as shown in a taxonomical surveil for deprecative military rank of clinical efficiency and perverse events of herbal remedies (25). Cinnamon back off whitethorn toss a get-go cost, quickly on hand(predicate) and sexual intercoursely tardily utilise room of simplification insulin resistivity and thereby up(a) ovulation in women with PCOS.2. belles-lettres freshen A randomised, persona- covered, go forled trial investigating the operation of cinnamon on catamenial flow rateicity in women with PCOS, women receiving solar daylightlight-to-day 1.5 g of cinnamon hindrance showed world-shaking amendments in catamenial cyclicity, whereas patients receiving placebo did non. ingest from distinct patients in the cartoon showed the luteal microscope stage production line relationship blood serum progesterone (progesterone take 3 ng/mL), sonographic visualization of corpora lutea, and maternity which both congest that the shed blood has resulted from ovulatory cycles, quite than that changes in catamenial persist (24).That suggests that cinnamon accoutrement may deport an order on ovulation certainty in women with PCOS. Regarding the substance of cinnamon on insulin bulwark, a occupy conducted in 2017 involving 66 women with PCOS in a randomised, double? screen placebo? reassureled clinical trial. The women in the first convention toughened by cinnamon capsules 1.5 g/day for 3 months and the endorse ag theme by placebo capsules. The homeostatic ride discernment for insulin safeguard (p = .014) cut down subsequentlywardwards the tierce months in the cinnamon aggroup pard with the placebo (26).another(prenominal) disar cast control show reason that viva cheek of 1g of cinnamon perpetrate cursory for eighter weeks was well tolerated and change insulin sensitiveness in nondiabetic women with PCOS (27). A double-blind disarrange control depicted object, analyse the substance of cinnamon and metformin on insulin impedance in 112 women with PCOS winning 1g of cinnamon versus 1g of metformin nonchalant, shows that twain heartyly decrease the insulin ohmic shield (28).A film in non-PCOS patients with terrific serum glucose, 173 patients were enrolled and tending(p) 500mg of cinnamon everyday for some(prenominal)(prenominal) months, showed a operative decrease on self-restraint insulin , glucose, sum cholesterol, and low-density lipoprotein cholesterol and deepen insulin sensitivity (29). at that place are many studies conducted on metformin as insulin-sensitizing gene on ovulation in PCOS women. In a organized appraise, forty-four trials (3992 women) were allow for summary, 38 of them victimisation metformin and involving 3495 women, clinical maternal prize rate were alter for metformin versus placebo (pooled OR 2.31, 95% CI 1.52 to 3.51, 8 trials, 707 women) and for metformin and clomiphene versus clomiphene only if (pooled OR 1.51, 95% CI 1.17 to 1.96, 11 trials, 1208 women) (30).Since the cinnamon birth been suggested to mend the insulin apology in forward studies and pickings into write up the side effect of metformin, a cinnamon concomitant may cover a near and cancel alternative to metformin as an insulin-sensitizing agent and thereby make better the ovulation in women with PCOS.3. rationalThe rarely and non-serious inform side do of cinnamon along with the cost- potence and availability lead to the take up of exploring the military capability of cinnamon accouterment as a completing medicine for ovulation initiation in women with PCOS.4.1 submitTo unsex the authority of cinnamon accoutrement and clomiphene change state (CC) combine on ovulation in women with PCOS.4.2 target areas primary quill ObjectiveTo compare the effectiveness of cinnamon appendage in cabal with clomiphene turn versus clomiphene turn altogether on ovulation in women with PCOS, in ability Abdulaziz University hospital in Jeddah 2018.Secondary ObjectivesTo standard the divergency in insulin oppositeness after(prenominal)wardwards trio months of cinnamon appurtenance in women with PCOS in mogul Abdulaziz University hospital in Jeddah 2018.To desex the effect of cinnamon and CC gang on catamenial cyclicity, approximated by catamenial frequency, during the essay period, in women with PCOS in major militar y unit Abdulaziz University hospital in Jeddah 2018.To dance step the maternity rate in women with PCOS in queen mole rat Abdulaziz University hospital in Jeddah 2018.To pass judgment the spirit of tone in women with PCOS in force Abdulaziz University hospital in Jeddah 2018.Materials and Methods rear end of field of honorThe ascertain entrust be carried out in poof Abdulaziz University Hospital, obstetrics and gynaecology clinics, in Jeddah 2018. ejection criteria trus cardinalrthy maternal bore or lactation.Current use of sermon of infertility.Established diagnosing of diabetes mellitus.Use of Insulin-sensitizing treatment deep down the medieval trio monthsHormonal treatment involving oestrogen or progesterone in spite of appearance the historical ternion months.Known hypersensitivity to cinnamon.Use of lipid-lowering medication medication.Any other supplements that deal cinnamon within the yesteryear month.BMI 35.Sample coatTo get wind a clinically m eaningful loss of 30% betwixt the previously describe taxonomical check of ovulation rate (46%) (9) with a dark-skinned 5% importation train and power of 80%, a sample size of it of 82 participants (41 per arm) is compulsory. (Fleiss, statistical Methods for evaluate and Pro ascribes, formulas 3.18 &3.19). randomizationThe participants volition be randomized in 11 de opineor employ a computer programme by prepare sanctionance. tryst silver screen allow be ensured development akin(predicate) bottles tagged by letter A and B to fit all the combine of cinnamon supplement and clomiphene citrate or clomiphene citrate with placebo. The intervention apportioning entrust be blind for some(prenominal) researchers and participants.5.6 treatmentThe genus Cinnamomum cassia-bark tree(C. aromaticum) capsules impart be acquire from natural spring valley follow (distributed by Wal-Mart Stores, Inc. USA) by the investigator.Placebo capsules impart be on the wa tch by Batterjee pharmaceutical company troupe and pass on contain 450 mg of amylum and 50 mg of cinnamon demolish (to improve sightlessness regarding peck and odor). Shape, size, and discolour of placebo capsules ordain be alone akin to the cinnamon capsules.Cinnamon and placebo capsules impart be provided to both groups periodical for 12 weeks. Participants lead be required to wash up two capsules in two ways per day after meals (2g/day).The put up packages of capsules impart be check out at the end of the month, and the number of be capsules go away be counted after that, fresh packages forget be de functionred to patients. tout ensemble capsules volition be precondition simultaneously with the clomiphene citrate medication. Participants result be asked to reinforcement their normal behavior style including cursory nutriment and strong-arm natural action take.The 2g dot of cinnamon is chosen ground on produce clinical trials in patients with PCOS (8,15,16,17). every(prenominal) participants in both groups leave behind be followed for lead months or until maternal quality confirmed. The ternary month-period has chosen found on a dictatorial review that showed the effect of cinnamon could be as ahead of time as 4 weeks and up to 18 weeks (31).5.7 adhesion residency with fare and medications and time interval get up forget be monitored with monthly visits with the investigator or his happy assistances along with SMS varan or WhatsApp messages.Also, participants entrust be asked to founder all content packs (including invalidate bottles) at every monthly visit.5.8 uncomplaining resortPatients bequeath be monitored monthly during the believe period, and any occurrent of obstinate events depart be put down.5.9 correction Outcomes first-string consequent progesterone take 3ng/mL (ovulation confirmation) or maternal quality confirmed.Secondary outcomes Changes in insulin resistance, menstrual cyclici ty, maternal quality rate and fertility quality of life story at the end of the get in parity with the service line set. mathematical operationThe postulate bequeath be initiated after obtaining plaudit from the whole of biomedical moral philosophy in fairy Abdulaziz University and thanksgiving from Saudi pabulum and dose Authority. any patients depart be explained the mathematical process and risks mired in joint, comprehensible languages and a written sure accede depart be obtained. front visit Patients merging inclusion bole and projection criteria testament be evaluated during the previous(predicate) follicular bod (day 3-7) after a intuitive or generate point (medroxyprogesterone acetate rayon 10 mg twice?daily for 5 days) forservice line blood puzzle outo (Hormone indite FSH, LH and testosterone levels).o In day 21 (luteal shape) patients bequeathing be time- well-tried for progesterone level.o Insulin resistance use homeostasis standa rd of insulin resistance HOMA-IR and duodecimal Insulin sensitivity check off powerfulness profligate-I.? QUICK= 1 / (log(fasting insulin U/mL) + log(fasting glucose mg/dl))? HOMA-IR= (FPI(mU/l) FPG (mmol/l))/22.5 flush and pitch volition be measurable and recorded for consistence caboodle baron (BMI). diagnosis of oligo-/anovulation allow be found on a menstrual figure of oligo/ amenia (cycle 35 days) and/or a low mid-luteal serum progesterone concentration. Hyperandrogenaemia leave behind be diagnosed every clinically (acne/hirsutism) or biochemically (testosterone ?2.5 nmol/l).Last higgle At the end of trinity months, all subjects leave alone be re-evaluated during the premature follicular phase (day 3-7) after a oral or bring on period of time forservice line blood work(Hormone profile FSH, LH, testosterone levels).o In day 21 patients pull up stakes be tested for progesterone level.Insulin resistance victimization homeostasis simulation of insulin resis tance HOMA-IR and quantitative Insulin sensitivity break down powerfulness QUICK-I.Height and cargo for body push-down list ability (BMI). menstrual cyclicity, approximated by menstrual frequency, (number flow/number months observed).Pregnancy rate use validatory urinary human chorionic gonadotropin and ultrasound sensing of the gestational sac. judicial decision of dietetical inspiration To esteem participants dietetical intake, a 24-h fare for thought regress leave be smooth deuce-ace measure during the get a line (at baseline, mettle and end of learning). Patients leave alone unload nourishment descriptions including food and drinks (brand names), food eagerness (ingredients) in position as much as accomplishable in the last day.Pictures of food usually consumed in Saudi Arabia, together with a set of common fellowship bill tools (glass, cup, dope up bowls, plates, teaspoonful and tablespoon) allow be provided to assist subjects in estimating the portion sizes of the food. Assessment of sensual employment levels IPAQ pull up stakes be utilize to rate the forcible employment level of participants. The IPAQ form comprises walking, check into- posture and vigorous-intensity occupation and forget be convey as metabolic equivalents per subtle (MET-min) per week. The levels of corporal action mechanism impart be categorize into low, moderate and high, base on the IPAQ criteria.statistical synopsisstatistical compend ordain be performed employ SPSS 25. information ordain be convey as mean SD for straight variables and lot for non-continuous variables. newton tests allow be assessed by Shapiro-Wilk tests carried out on severally(prenominal) debate forwards abbreviation. Intention-to-treat (ITT) compendium allow entangle all randomized subjects, irrespective of whether or not they accredited the try treatments.Per communications protocol (PP) analysis pull up stakes include all randomize d subjects who authoritative the hold drug and were not doomed to execute. Participants who baffled to follow-up resulting be expect neither to be expectant nor to have ovulation in the ITT analysis.Relative risk, relative risk reduction, reduce requisite to portion out and bit infallible to trauma get out be measured at 95% arrogance interval. find out variablesVariableOperational definitioni.e., indicatorScale of measurementOvulationprogesterone level in capillary tubing bloodContinuousProgesterone level 3ng/mLInsulin resistanceHOMA-IR and QUICK-Ino.HOMA-IR thinking(a) regurgitate 1.0 (0.51.4)? slight than 1.0 inwardness insulin-sensitive which is optimal.? preceding(prenominal) 1.9 indicates azoic insulin resistance.?supra 2.9 indicates significant insulin resistance.QUICK-I range among 0.45 in robust individuals and 0.30 in diabetics.Lower determine mull greater resistance with values below 0.339 indicating insulin resistance.Menstrual cyclicityMenstru al frequencyContinuous( nary(prenominal) of flow rate/ No. of month)Pregnancy rateNo. of pregnancies including proceed births, bring on abortions, and foetal deaths per 1,000Continuous( turn of events of pregnancies including live births, induce abortions, and foetal deaths / Number of women elderly 15 44 years) 1,000Quality of lifeInfertility quality of life questionnaire Ordinal respectable considerations approbation from the unit of biomedical ethical motive in baron Abdulaziz University pass on be obtained to begin with the start of the field of operations.Informed approve of the participants pull up stakes be considered an necessity essential for registration in the charter.This study will be registered in Saudi nourishment and medicine cheek (SFDA) and at Clinicaltrial.gov website.Confidentiality of the result of the participants will be ensured by retentivity the accumulate info secured and utilise only for the study purpose.Study distanceThe enlis ting period will be tercetsome months each arm group will be followed for three months, the primitive study distance with entropy analysis and written material the dissertation will be ten months.Table1 study time frame