Reflective analysis of my leadership approach Essay

â€Å"†¦..beyond the horizon of time is a changed world, very different from today’s world. Some people see beyond that horizon and into the future. They believe that dreams can become reality. They open our eyes and lift our spirits. They build trust and strengthen our relationships. They stand firm against the wind of resistance and give us the courage to continue the quest; we call these people leaders† (Kouzes and Posner, 1995). For a number of us leadership can be described as quality – even though we know it when we see it but it is quiet difficult to define or describe. In this respect, Kouzes and Posner (1995) aptly capture what I think about when I was asked to describe a leader and leadership. In the course of my education and career, I have come across some touch points that shaped my opinions and influenced my general perspectives regarding the roles of leaders and leadership. Fundamentally, I have been able to experience my various roles as a le ader who articulates and puts into words into action to develop vision for a future that inspires others to join. It is within this context that my perspectives on leadership have been developed. My thoughts on concepts of leadership are an amalgam of what I have was taught in Leadership in Healthcare Module, what I have read, what I have experienced as an individual, and the lessons that I have picked up along the way. Due to complex nature of leadership especially regarding the number of theories that have been suggested by scholars, it is important that not only leaders, but also people who aspire be leaders develop their own personal philosophy leadership. This could be achievable by engaging in reflective exercise. I have come to realise that some fundamental principles have sharpened my opinions and also driven my beliefs and perception about leadership as an ongoing process, rather than a destination or an achievement. Frequently, I also know that additional learning, unlearning and relearning (through books read on the subject of inquiry, or book read out of mere curiosity) have supplemented the theorizing process of leadership, and fall short of being consistent with grounded theory methodology in which a review of academic literature often occurs following initial data and prior to formation of theory (McGhee et al., 2007). Therefore, this essay will adopt the model of ground theory, starting from the scratch, a collection of my personal  observations, beliefs and experience regarding the concept of leadership approach. Reflective analysis of my leadership approach is based on three principles: (1) Maintaining a steady focus on mission and vision; (2) risk taking and (3) empowering peopl e. Starting with maintaining a steady focus on mission and vision, I have been able to learn that one of the greatest challenges that a leader can face is staying on mission of the organization. People, the led, need to know the direction they are heading to, and to know the expectation of the leader regarding the organizational vision and mission. Maintaining a consistent focus on the organization’s vision and mission is a key attribute required for leadership and it is a critical task for a leader. The leader starts its task by clearly defining the vision of the organization then keeping it alive. The leader is also responsible for achieving such vision; the buck stops at his table and must therefore communicate such both within and outside of the organization. In this regard, the leader serves as a bridge between the organization and its environment. Beyond just communicating the organization’s vision, the leader must be a source of inspiration in order to the vision and to develop a positive mental attitude and belief that it can be achieved. Covey (2012) refers to this attitude as principle-centred leadership. This is a key attribute, especially, in light of the dynamic environment in operation today. This is an attitude I have adopted over and over again in the course of my leadership role. Risk taking; this is an embodiment of 2nd principle of my personal philosophy of leadership. Like my first principle of maintenance focus on vision and mission of the organization, I consider this as another critical factor that distinguishes leaders from their followers. The rar e courage of risk-taking, to step out in front, to test water, to be a pathfinder has been long considered as an attribute that sets the leader apart from the followers and rest of the organization. According to Kouzes and Posner (1995), leaders must take a role of â€Å"pioneers.† They should develop courage to venture the horizon’s edge and report back about what is seen. Leaders take calculated risks for the sake of the vision and mission of the organization. I have done this in a couple of times and I have succeeded. I agree that some leaders are more comfortable in taking risk than others; and it is noteworthy to realise that there are different degrees of risk associated with the decisions to be taken by leaders. Over  the years, I have learnt that it is better to take a calculated risk. And I agree with school of thoughts that believe that people who are â€Å"risk averse† are not fit to be leaders. Empowerment of others: The third principle of my leadership philosophy, the final portion of my analysis, relates to the role of leaders in empowering others. Empowerment entails conveying the mission and vision in such a way that other people in the organization can make use of their initiative to make decisions on their own. This also involves some amount of boldness, confidence and risk-taking. While I was Senior Carer in a Care Home, I always encourage my colleagues to come up with, at least, two initiatives to move the association forward at each meeting day. According to Senge (2012), a certain limit of error in an organization is acceptable as long as such error provides an opportunity for people to learn and also lends credence to empowering others while carrying out the organiza tion’s mission and goals. I agree with Senge, 110%. In conclusion, I have been able to present reflective analysis of my role as a leader in various capacities I have served before. I draw my experience from past and ongoing learning processes and experience, and I have developed a set of personal leadership philosophy which are maintaining a steady focus on mission and vision, risk-taking and empowering people. I hope I will be able to develop myself further in preparation of leadership role I will engage in the future. References Covey, S. (2012). Principle-centered leadership. New York, NY: Simon and Schuster Kouzes, J. M. and Posner, B. Z. (1995). The Leadership Challenge: How to Keep Getting Extraordinary Things Done in Organizations. San Francisco, CA: Jossey-Bass Publishers. Senge, P. M. (2012). The Fifth Discipline: The Art and Practice of the Learning Organization. New York, NY: Doubleday/Currency

Why Teens Make Bad Decisions

Topic : Why do teens make bad decisions ? Don't be afraid to go after what you want to do, and what you want to be. But don't be afraid to be willing to pay the price. In the last 20 years, the earnings level of dropouts doubled, while it nearly tripled for college graduates. Approximately 4 in 10 young women in the U. S. become pregnant at least once before turning 20 years old. These are perfect examples of bad decisions teens make in life . Teenagers can’t be considered as adults because their lack of maturity and their brain aren’t developed yet .Teens lack their maturity to care of the consequences of there actions . They can get into it from fun , pressure , and being curious/experiment . A part of a teens brain isn’t developed fully so that’s what makes them stupid . The human brain for females fully develops by the age 19 – 21 and for guys it’s 25 . Teenagers usually are not willing to get something from hard work so they find an easy way out of it . Things like smoking , doing drugs , and drinking .Many kids get peer pressure either because that’s the only choice they have , like in a party they don’t want to feel like a loser or a outcast or because they started hanging out with different people and they happened to do drugs . People are influenced by peers because they want to fit in, be like peers they admire, do what others are doing, or have what others have. Also influence by the way they dress and act, things they're involved in, and the attitudes they show. Not all peer pressure is bad , peers can set good examples for each other .Having peers who are committed to school or doing good in a sport will most likely influence you to do the same . Your peers encourage you to work hard for something you really want . Your friends will be their to listen and support you when your down and upset . Your friends listen and give you their opinion on things . They can also help you make decisions , fr iends often give each other good advice and will be quick to tell you when you might be doing the wrong thing or maybe something risky .Many kids are raised right and taught well but they still do bad decisions due to lack of parenting . When a kid and parents fight that kid has more than enough â€Å"emotional support† from the wrong people, who agree with his side of things, outside his family. Bad parenting never helps a child grow into a solid, sensible, teen; but I'm convinced that many, if not most, bad choices teens make are not the result of bad parenting. The goal for parents is to create an environment where teens can trust and learn from .It’s very important that parents be aware about how they act and feel so that they can talk about the situation appropriately when there dealing with a teenager whose doing bad decisions . Approximately 80% of adult smokers started smoking before the age of 18. Every day, nearly 3,000 young people under the age of 18 become regular smokers. One reason often heard from people using drugs is that they do it to make them feel good .Some might light up a cigarette at a party . They might not consider themselves a † smoker † but they do it to feel good or to † look cool † . Some teens might smoke pot in a friends house because they would think its fun . Little did they know that the same effects can occur whether you’re drinking to have fun or drinking to forget a problem whether you're doing drugs to see how they feel or doing them to be one of the crowd . No one wants to be left out.So sometimes they make bad decisions , like taking drugs , to cover up their insecurities. They don't think about how drugs can isolate you from your friends and family. Lots of people turn to drugs for a little excitement because they say there’s nothing else to do . But people who make these kinds of decisions usually find out that drugs are a waste . Drugs don’t change the situa tion they might make it worse . In addition another reason why teenagers take drugs is because they want to escape and relax .The thing is , the problems are still there and not only do they still have to deal with it , they have to deal with it when they’re not thinking straight . The number one drug that teens use is marijuana . Anyway it goes in your body will mess up the way your brain works and ability to do good decisions . These bad decisions can involve making sexual choices that are unsafe , saying things your going to regret later . Whats more negative then all of those is that it can effect your memory and your ability to learn .Marijuana affects different people in different ways , but the following short-term effects are common : problems with thinking and solving problems difficulty remembering and learning things altered perception of light, sound and touch clumsiness increased appetite increased heart rate No matter why other people are using it , you don†™t have to join them . You’re the one that needs to speak up and make smart choices . Many teens make the mistake of giving into their urgues without thinking things through . Sex is more then just a pleasurable act , it’s a risk .Most teens don’t stop to think about having sex . Deciding whether it’s right for you to have sex is one of the most important decisions teens ever have to make . In fact considering some factors both physical ones , like a possibility of becoming pregnant or getting a sexually transmitted disease (STD) . On the other hand some teens who are going out don’t pressure each other about sex , truth is that in many relationships one person wants to have sex but the other one doesn’t .One person in a relationship is more curious and has stronger sexual feelings than the other . As with almost every other major decision in life , teenagers ned to do what is right for them and no one else . Sex should be an expression of love not something a person feels that they must do . If a boyfriend or girlfriend truly love you they wouldn’t pressure you to do something you aren’t ready for yet . Each person must use his or her judgment and decide if it’s the right time and the right person .Alcohol use is very common among teens , especially drinking five or more alcholic beverages over the course of a few hours , it’s dangerous for a teen because it puts them at risk of health problems now and the future . Everyone knows that the legal drinking age throughout the United States is 21. But according to the National Center on Addiction and Substance Abuse , almost 80% of high school students have tried alcohol. When large amounts of alcohol are consumed in a short period of time , alcohol poisoning can result .Some reasons that teens use alcohol and other drugs are : curiosity to feel good , reduce stress , and relax to fit in to feel older Although it’s illegal to buy alcoho l in the united states until 21 , many teens can get access to it . Therefore it’s up to the teen to make the decision about drinking . Teens who drink are likely to get into fights and commit crimes . Teens who drink are more likely to be sexually active and have unprotected sex . Use of alcohol causes the chance that a teen will be involved in a car crash , homicide , or suicide .One thing leads to another and then another and then another. Before you know it , you've made a bad decision based on the bad decision you made before that one . As a teen your trying to find your own place in the world . Making decisions for yourself , those decisions can be good ones or bad . parents can’t sit back and watch you make mistakes to learn from . If your parents think that you are hiding things from them in order to do things they wouldn’t approve .You must behave in an open and honest manner with your parents at all times . You need to give them an idea of how you thin k and behave when there not around . Many teens take their relationships every bit as seriously as adults . Parents need to be positive about the teens friends and get to know them . Like it or not , the teenager friends will be most likely be their strongest influence and support when it comes to dating . Dating helps teenagers to get along with others , communicate , and make decisions .It is an important part of growing up . Here are some teenagers' statistics and facts about sexuality in the United States : Parents rate high among teens as trustworthy and preferred information sources on birth control. Half of teens say they trust their parents for reliable and complete information on birth control. Teens say that parents most influence their decisions about dating and relationships. 89 percent of parents think they've had helpful conversations with their teens about sex.Only 71 percent of teens agree. Body image can be a real problem for every teenager . Body image is a personà ¢â‚¬â„¢s opinion , thoughts , and feelings about their body and physical appearance . Body image means feeling satisfied with the way you look , appreciating your body , and accepting it’s imperfections . So how a teen feels about their body will affect on how they feel about themselves . If the teen gets to focused on not liking the way they look , their self esteem can go down .While it's important to have a positive body image , getting too focused on body image and appearance can cause a teen to overlook the other positive parts of themselves . Teenagers are more worried about body image than the environment , school and peer pressure. Self esteem is all about how much people value themselves , the pride they feel In themselves , and how they feel . It’s important because feeling good about yourself will affect you on the way that you act . Some people think they need to change how they look or act to feel good about themselves.That’s not the right way to so lve your insecuritys about yourself , all you need to do is change the way you see your body and what you think about yourself . Sexually transmitted diseases ( STD ) are infections diseases that spread from person to person . STD can affect guys and girls from all ages who are having sex . If you untreat some STD’s can cause permanent damage like not having a baby or even death . STD’s spread easily because you can’t tell whether someone has it or not .In fact some teens have STD’s and don’t even know it . These teens are in danger of passing the infection to their sex partner without realizing it . Two of the main reasons people are bullied are because of appearance and social status . Bullies pick on people they don’t fit in , maybe because of how they look , how they act , or their race or religion . Teens in a popular group often bully people they think is different by excluding them and talk about them . A lot of bullies have things in common .They like to take over and focus on themselves . They sometimes have no feelings or caring to other people . Bullies put other people down to make themselves feel more powerful . And some bullies act the way they do because they’ve been hurt by bullies in the past or maybe the bully was in there family like their parents or even another adult . Bullying backfires and makes everyone feel bad and miserable even the bullies themselves . People might feel intimidated by bullies , but they don't respect them.

10 Ways How Photoshop Changed History of Photography

10 Ways How Photoshop Changed the History Of Photography by Steven Campbell on Apr. 2nd, 2010 In the past, you had to be very patient as a digital photographer. If you wanted to catch something spectacular you had to carry your camera with you everywhere until you saw something special. To capture a sunrise you had to get up at the crack of dawn. Models had to spend hours in the makeup room and studios had to be well lit. Everything I just mentioned changed instantly with the invention of Photoshop.Photoshop has changed the history of digital photography. Nowadays, when you look at an amazing photo or image your first impression is still â€Å"wow† but your immediate second thought is â€Å"that has to be photoshopped†. When you think of the history of Photoshop and everything Photoshop did to change the game, it’s pretty insane. In this article, I’m going to cover some of the ways how Photoshop has changed digital photography forever. How We See the World [pic] The most significant effect Photoshop has had on us is how we see our world.Digital artists and manipulators know how to take an ordinary photograph and turn it into something completely different and extraordinary. [pic] Images that are photoshopped really have me doubting reality sometimes. Whether they have to do with people, places, or things, you can’t argue with the creativity and time that goes into some of these images. They give you a new perspective on the world. How We View History [pic] Aside from the historical significance of digital photography, Photoshop has changed the way we view history in general.Historical photographs can be photo shopped just as easily as any other image, which leaves you wondering if you are viewing a historical painting or a modern piece of Photoshop art. How We Advertise I bet you were wondering when I was going to get to this part. Advertising has changed forever due to image manipulation. You can’t look through a magaz ine without seeing dozens of photo shopped ads (I dare you to try). [pic] Think about what this means. To me, this says that companies that used to run text ads or had to hire a photographer to take their photos can now just pay someone to make their ad on a Mac or PC.Photoshop has changed advertising and business as a whole. How We View the Human Form [pic]Photoshop has also changed our image of what the perfect person looks like. With models and celebrities – most notably – we have seen Photoshop go into every magazine cover and spread in modern existence. Allow me to touch on a few examples of this. Erasing Blemishes Ever wonder how your favorite actor looks so perfect all the time? Well, they don’t. Image editing has led us to believe that some people are actually perfect in appearance, when in reality these photos have been doctored.You want to look perfect in all of your photos? Start learning Photoshop. Adding Style [pic]You can do anything you want to a person on Photoshop. Hair color, eye color, fashion, you name it – you can change everything. Age Progression Want to see what Katie Holmes might look like in a few dozen years? Someone’s already thought of that. Thought of that. [pic] You can use Photoshop for practical means like predicting age progression. It takes a bit of talent, but nonetheless it’s a possibility.How We Witness Nature [pic] If you’ve ever seen Planet Earth on the Discovery Channel you know that there are some beautiful places on this planet with some crazy looking creatures living there. Photoshop has allowed artists to get even more creative with nature and create their own species and landscapes. See the skull in that tree? What We Find Humorous [pic]A lot of photo shopped images are meant to be funny. Creators use irony and humor to adapt digital photos to make us laugh. To Make Fantasy Reality pic]Aside from all the real world examples of Photoshop history, images are constantly created to invoke our imagination. When you look at one of these pieces of art you are able to visualize the artist’s dreams and fantasies. What did we do before this? Conclusion These are the 10 ways I’ve noticed that Photoshop has changed the history of the digital photograph. There’s got to be more but these things just don’t jump out at me anymore due to the norms I’m accustomed to in the Photoshop era. What do you think about Photoshop? Has it affected your life in some way?

Discuss the letter Essay Example | Topics and Well Written Essays - 500 words

Discuss the letter - Essay Example However reading the opening part of the letter, the author seems to be rational in his ideas as he quotes concrete evidence of whatever that he perceives. The author has based his understanding of the situation upon hardcore facts and not mere assumptions. In this case it can be said that the argument presented by the author is rationally strong as it provides the readers with a reason to believe. However as we move to the next passage of the letter, it can be observed that though the author has build up his argument in a rational manner once again, but this argument contradicts the preceding one. In this case, though, the readers have strong evidence and reasons to believe in what is being communicated, but the contradiction in the overlapping passages may go on to bewilder the readers and lead to a state of irresolution (Sellnow 185). The penultimate passage is followed by a conclusive one. Ironically, the conclusive part of the letter leaves the readers with a question, unanswered. In this paragraph, the author has used his rhetorical power to get his message across to the audience. The author incorporates a personalized tone to the message and indicates the inception of personal influence in the conclusion that the author has drawn himself, inspired by his personal experiences and perceptions to various stimuli in the world. The final lines of the letter are analyzed to be rhetoric because the author does not provide solid evidence or basis to the reader to believe in what is being said. The reader is left with the freedom to either believe in what is being said or simply leave it. This is the specified characteristic of rhetorical arguments; they leave the reader in an indecisive state and let them make their own opinions. However there is a strong likelihood of readers agreeing to what is being communicated and base their opinions as per those of the author, but this depends upon

Negotiation skill Essay Example | Topics and Well Written Essays - 3000 words

Negotiation skill - Essay Example The events that unfold in the incident begins in 1976 when Thomas K Seligman, the then curator-in-charge of Africa, Oceania, and the Americas for the museum, is informed about the bequeathing. He is shown Mr Wagner’s handwritten will stated that the deceased ‘hoped’ that the museum would pay all costs for settling his estate in return for the priceless murals. Mr Seligman is informed the museum’s lawyer said that this would give rise to certain ethical and legal problems with Mexico, the original source of the murals. A temporary solution was arrived at when Crocker Bank who was in charge of the assets of Mr Wagner and the other legatees agreed that the murals may be kept in the museum until a more permanent solution was arrived at. What follows next is an example of successful international negotiation that was to last for the next ten years. The problem referred to by the lawyer came about because in 1972, four years before the incident, the UNESCO had passed the â€Å"Convention on the. Means of Prohibiting and Preventing the Illicit Import, Export, and Transfer of Ownership of Cultural Property." Its implications were relevant here because it was not sure whether the murals had been on American soil with the permission of the Mexican Government. This was further complicated by a treaty between the Mexican and US Governments called the â€Å"Treaty of Cooperation Providing for the Recovery and Return of Stolen Archaeological, Historical and Cultural Properties between the United States of America and the United Mexican States." The treaty gives special mention to wall art and there is no doubt as to the fact that murals are classified as wall art. Lengthy discussions were done with historians, other museum s and lawyers followed and what ultimately became clear was that no relevant precedents existed. One related incident involved a bronze of Nataraja that once belonged to a temple in South India

Pick one all info is there Essay Example | Topics and Well Written Essays - 1000 words

Pick one all info is there - Essay Example They feel oppressed, disconnected, machine-like, and very much out of control with being forced to perform in some manner in order to regain those freedoms. How can this be? First of all, in order to determine what freedom is and what it isn't, we must clarify and accept the definition of the word freedom. The Free Dictionary defines freedom as the condition of being free from restraints. It also includes political independence, lack of slavery, detention or oppression, exemption from authority in performing a certain task or action, liberty, exemption from an onerous or unpleasant condition, the ability to choose for oneself, and move about without restriction, lack of reserve or modesty, full access, all the rights of citizenship or membership, and the power to perform certain actions without interference or control. This is a very broad definition containing many implications and directions for freedom to go. II. Point One By considering freedom in the broadest of terms, it's easy to see how one may think it would be the most wonderful concept on the planet; everyone should be free. Life would have the greatest meaning for the largest number of people if only there was more freedom. The suffering and oppression of Third World countries would be alleviated and more people would rise from the ashes to take their places if only there was more freedom in the world. All people would be free to live a life of their own choosing; finding success and peace within themselves, lacking nothing of comfort and convenience necessary for daily living. While this may be a very broad goal, not easily attainable; it is neither logical nor practical. The systems created to serve life on planet Earth cannot operate within this framework. Most economic systems require there to be supply and demand; which also requires there to be people who consume as well as those who produce. This, in turn, requires there to be managers, as well as workers have no ability to move around withou t restrictions or to perform certain actions without interference or control; the haves and the have nots. III. Point Two Perhaps freedom just means freedom from an onerous and unpleasant condition. Well, if that were the case, then freedom from hunger, pain, illness, or even a bad relationship or boring career would bring immediate relief for millions of people across the globe. Yet, the systems they were born into dictate for them what they’re entitled to for daily living; including the choice to marry and with whom they will marry, what career they will have, if they will work, and who they will work for. Maybe political independence is necessary in order to remove the suffering from the world. By gaining full access to all the rights of citizenship within a geographical area, having the power to move around with exemption of authority as well as the ability to make decisions without interference or control would create a world where all the needs of the people are met and the human family is happy and satisfied. As long as there is only one person in this utopian society, things would be fine. The problem exists when people, who are uniquely different in their growth and development, as well as in their needs, beyond the basics, try to live together in small spaces, called communities. Then, the concept of freedom becomes moderately distorted. My freedom

Nonhuman Primate Sign Language Essay Example | Topics and Well Written Essays - 1250 words

Nonhuman Primate Sign Language - Essay Example The present research has identified that human and nonhuman primates such as chimpanzees have commonalities in brain features in high-level communicative and cognitive functions. Brains of both human and nonhuman primate show some degree of asymmetry. Both halves of the human brain are not symmetrical they are lopsidedness that arise at the development stage of brain. Brains of humans show a greater variance of asymmetry than that of chimpanzees, but brains of both species are asymmetrical in structures. Brain asymmetry gives a room for flexibility and enables the brain to adapt easily to different conditions and situations. Human and primates share 99% of their genetic makeup. However, their main difference between the two is the capability of communicating in a language that is defined. Chimps do not can speak human language, but they have a way of communicating to each other. One of the ways they communicate to each other is through different types of vocal calls. If the chimps fi nd food, they start making different types of grunts, pant hoots and barks to let others know the source of food. Chimpanzees have different pant hoots that distinguish each from one another. It helps others to identify individuals who are making the call. When chimps get back from a successful hunt, they make calls in an exciting way to alert others about a successful mission. When they come across a dangerous situation, they produce a savage-sounding to alert others on the potential danger. Chimps also communicate with each other by making use of bodily gestures and postures. Some communities such as that of a monkey make use of physical contact to express anger, happiness, fear and aggressiveness. When chimps get angry, they express anger by standing upright using their hind legs, wave their arms and sometimes they can throw rocks and branches. The behavior alerts other chimps that are near and steer clear of this particular monkey.

Photo51 Essay Example | Topics and Well Written Essays - 250 words

Photo51 - Essay Example The Watson and Click models showed the backbone of a molecule to be located at the center and the bases diffusing outward. Watson and Crick recognized that if the bases were organized to point inward, then the DNA width can move toward 2.0-nm like illustrated in Photo51 (Fitzgerald-Hayes & Reichsman 22). Rosalind Franklin discovered a specific well-determined X-ray diffraction pattern of a DNA fiber in Photo51. The DNA fiber was utilized to explain the 3.4á ¾ ¹ distance between the 34á ¾ ¹ periodicity of the helix and base pairs. In addition, the photo51 revealed the actual dimensions of DNA diameter and molecule (Anholt & Mackay 51). The photograph assisted Watson and Crick to conclude that the DNA molecules constitutes of two strands. The two strands are double helix that runs in opposite directions. The information was employed to construct a three-dimensional structure of DNA that demonstrated to be accurate (Anholt & Mackay 51). In conclusion, the Photo51 opened a new window in scientific history by discovering the formation of DNA. The dimensions revealed in the photograph assisted in the accurate development of a DNA structure. The information disclosed the composition of the genetic

Diamonds Research Paper Example | Topics and Well Written Essays - 1000 words

Diamonds - Research Paper Example According to the research paper "Diamonds" findings, diamonds are considered to have been originally discovered and mined in India. Over 6,000 years ago, substantial alluvial deposits of the stone were traced along Godavari, Krishna, and Penner Rivers in India (Koizumi, Nebel and Nesladek 4). Today, it is approximated that close to 130,000,000 karats of diamond are mined every year. This translates to about 26,000 kilograms of diamond being mined annually. Apart from this, it is also estimated that close to 100,000 kilograms of diamonds are synthesized every year (Pagel-Theisen 9). The exact amount of diamonds that exist in the world cannot be accurately established. However, at this current rate of mining and synthesis, a number of diamonds that exist can be estimated (Zaitsev 10). India has been leading the world in the production of diamond from the time they were discovered there around 9th century BC until mid 18th century AD. This led to the exhaustion of these sources. Diamond began being extracted from primary deposits of lamproites and kimberlites in the 1870s after being discovered in fields, in South Africa. Since then, its production is estimated to have reached 4,500,000,000 karats to date. This is approximately 900,000 kilograms of diamond (Koizumi, Nebel and Nesladek 33). Much of the diamond produced in the world is used for various purposes. A significant amount of diamond is used for industrial applications because of its characteristic high dispersion of light, and its hardness. Another common use of diamond is to make jewelry. Due to its electrical conductivity, diamond is also used as a semiconductor. Most of the diamond produced all over the world is used for these common purposes (Zaitsev 12). It is usually assumed that diamonds are solely fashion accessories. However, they have other numerous applications as stated (Pagel-Theisen 16). It is important to point out that most diamonds can be recycled. Sometimes, when diamonds are mined, not all of them are appropriate for use in making jewelry. This may be because of their size or quality. Such diamonds can be used to coat different cutting tools (Pagel-Theisen 44). This will make those cutting tools more effective because of the hardness of diamond. Tiny flawed diamonds may be used in other areas such as computing and optics. This shows that diamonds can be safely recycled by themselves. When glued to other parts for various uses, diamonds must be separated from these toxic parts before being recycled (Zaitsev 15). There are some cases whereby diamond cannot be recycled. These include instances where diamond was used in industries to grind other things, and it eventually turns into dust. According to the United States Geological Survey (USGS), in 2003, 4.9 million carats of industrially used diamond was recycled (Koizumi, Nebel and Nesladek 30). Diamonds are also being recycled through recutting and resetting. It is estimated that 49% of diamonds in the world come fro m Southern

Is There Really a Heaven Research Paper Example | Topics and Well Written Essays - 1000 words

Is There Really a Heaven - Research Paper Example Christians believe that Heaven is the place where God and his angels reside (Bunyan 56). The life in this world is temporary and human beings will be able to continue their eternal life only after leaving this world. Heaven was taken from human beings because of disobedience of Adam and Eve and human beings will be able to be a part of Heaven after they spend a life on this earth by doing good deeds. Bible gives a detailed account of the presence of Heaven and Hell and as per the book, both Heaven and Hell exist and human beings will be placed in both as per their deeds in this world. Overall, it is stated that God keeps the whole right as to decide who is to go to Heaven and who to Hell. The decision depends on His mercy on humankind (Bunyan 68). Therefore, Christianity speaks of existence of Heaven. Like Christian religion, Islam also speaks about the existence of Heaven. There are a number of instances in Quran, where the readers can find mentioning of ‘Jannah’, the A rabic word for Heaven, which is indicative of the fact that Heaven exists as per Islamic religion (Masumian 129). Muslims believe that Heaven will be rewarded to those Muslims who will do good deeds and they will be able to enjoy the bounties of the Garden of Heaven while unbelievers will be thrown in the fire of Hell as a punishment for their ill doings. As per Islamic religion, human beings will be allowed to enter Heaven based on the comparison between good and ill deeds, if good deeds are more, the Muslim will be able to enter Heaven while if bad deeds are more, the Muslim will be sent to Hell. There are detailed physical representations of Heaven in Quran as a happy place, where there will be no sorrows (Masumian 134). Jewish religion gives a little account about Heaven and this information is not as elaborative as in Islam and Christianity. The readers can find the mentioning of an immortal soul that will be able go back to its Creator after leaving this earth (Moody 114). Tor ah, the Jewish book talks about resurrection and immortality but in actuality, there are no straightforward descriptions about the fate of people after vanishing from earth. There is no apparent or comprehensible assistance to the followers as what is the coming destiny as an afterlife (De Lange 85). However, the belief in the afterlife exists as well as in Heaven. Therefore, there is no negation of the concept of Heaven in Judaism as well. So, as per Jewish religion, Heaven exists. Human beings can never be perfect but God being forgiving and gracious allows them to enter Heaven forgiving their wrong deeds to some extent. Kvanvig (2008) says, â€Å"human beings are sinners, and that God justifies such human beings, i.e., grants them heaven in spite of their not deserving it.† A Heaven exists where human beings will be assessed in terms of their performed deeds and God will decide for their destiny in Heaven or Hell. According to Kvanvig (2008), Heaven is a place of reward wh ile Hell is a place for punishment. The existence of Heaven as well as Hell cannot be negated. People if asked about their belief in Heaven give mixed opinions and it can be seen that those who prioritize religion mostly believe in existence of Heaven (Moody 64). However, those having shaking belief in religion or having no belief at all, think that Heaven is an imaginary place, which cannot exist in reality. Even critics have mixed

Benefits and risks of migrating physical servers into a virtual Essay

Benefits and risks of migrating physical servers into a virtual environment - Essay Example (VMware) The main advantages of server virtualization Server Virtualization technology provides a number of advantages that can be very useful to an IT department and to an organization as a whole. Following, we provide a list of representative IT issues that can take advantage of the benefits of Server Virtualization. Virtual machines can be utilized for consolidating the workload of multiple under-utilized servers into a smaller number of server machines, possibly to only one machine. The associated benefits of this are the economy in hardware infrastructure, environmental cost, in administration and maintenance costs. The need for executing old legacy applications that used to work in server machines with operating systems that have become outdated is absolutely fulfilled by the use of virtual servers. An old application might not be able to execute in a new environment that is running a new operating system. Even if it is possible to run in that server environment, it might under -utilize the server machine, in a way that the consolidation of this server together with others into a virtual server - as already mentioned in the previous paragraph- does make sense. This might not be feasible without the use of virtualization as this kind of applications usually have not been developed in a way that they can co-exist with others in an execution environment. Virtual severs can be used for the creation of operating systems or execution environments with limitations to the usage of physical resources, provided that there exist the suitable routers with guaranteed resource access. Virtual servers can be used for the execution of multiple operating systems simultaneously: different versions or even absolutely different operating systems. Virtual servers... It is evident from the study that Server Virtualization is a framework, methodology and technique that achieves the segmentation of the computer machine’s physical resources into multiple execution environments (which are called virtual private servers), by applying one or more technologies. It is the method of executing multiple independent virtual operating systems in a physical computer machine. It is a way of â€Å"disguising† the physical computer resources, including their number and the identity of the isolated physical servers, processors and operations systems, hiding them from the end users of the â€Å"virtual† server. Server Virtualization technology provides a number of advantages that can be very useful to an IT department and to an organization as a whole. Following, we provide a list of representative IT issues that can take advantage of the benefits of Server Virtualization. Virtual machines can be utilized for consolidating the workload of multi ple under-utilized servers into a smaller number of server machines, possibly to only one machine. The associated benefits of this are the economy in hardware infrastructure, environmental cost, in administration and maintenance costs. The migration of the physical servers of an organization to a virtual environment has a lot of benefits. However, server virtualization also generates a number of risks that the organizations have to take seriously into account. Those risks are analyzed in the paragraphs that follow.

Automobile and Bumper Sticker Essay Example for Free

Automobile and Bumper Sticker Essay Copy and paste the questions into the student comments section. Read the questions thoroughly. Answer the questions in a full and complete manner. Use complete sentences, including proper spelling and grammar. When you are ready to turn in your assignment, add a check mark to the Submit for Grading box and then select Submit. Module 5: Laws and Rules of the Road Create a car saying (Bumper Sticker) or a Road Sign (Billboard) that would describe one main point you learned in Module 5. This is an example of a bumper sticker from a former student: â€Å"â€Å"Driving the right speed is always a good deed. Enjoy your ride and don’t collide! † 1. What would yours say? â€Å"SPEED. Do It Right Save A Life 2. How would it look? It would have a black background, the saying would have red letters, and there would be speed limits signs around the words. 3. Now, write at least one paragraph (5 sentences or more) which explains why you thought this would make a great bumper sticker or billboard, and how it summarizes the information you learned in Module Five. Remember to use complete sentence answers and proper spelling and grammar. My billboard would be great because so many drives, whether they are young or old, are speeding causing unnecessary accidents, killing or injuring innocent people. More and more drivers are becoming reckless. To either just show-off or from being impatient.. 3. Now, write at least one paragraph (5 sentences or more) which explains why you thought this would make a great bumper sticker or billboard, and how it summarizes the information you learned in Module Five. Module 6: Effects of Alcohol and Drugs Some day you might find yourself in a dangerous driving situation because of drugs, alcohol, or extreme drowsiness due to medication. Talk to a parent or guardian about what they would like for you to do if you find yourself in this situation. Answer the following questions in one or more complete sentences. 1. Explain three ways you can get home safely, without getting behind the wheel, if there are drugs or alcohol in your system. A. I would see how well I was feeling that day. B. I would see how any medication affected me before getting behind the wheel. C. Call your parents, call a cab, take a bus 2. Explain three ways you can get home safely if the friend you rode with has drugs or alcohol in his system and you prevent him from getting behind the wheel. A. Drive yourself. Call another friend to pick you up. Call your parents to pick you up. B. Get a taxi, get a bus. Try walking it C. I would take the wheel and drive him home 3. What would your parent/guardian want you to do? My parent would want me to take responsiblity and drive my friend home safely. 4. Look up and list the number of a local taxi or car service in your community. Include the company name and telephone numbe 24/7 Yellow Cab Serving the 33157 Area. (305) 244-4444 A A A Taxi Inc Serving the 33157 Area. (305) 999-9990

Small Company Financial Statement Example

Small Company Financial Statement Example Management System DJs Ltd is a private limited company that is run in the style of a regular partnership firm. The two directors David Golding and John Selwood have divided the operating responsibilities of the company into two distinct areas and take care of their individual functions, while doubling up for each other if the need arises. While functional responsibilities are clearly defined, the organisation is otherwise loosely managed with four employees, two managers, (one for sales and front ending responsibilities, and the other for operational management), the chef, and a part time bookkeeper being the key operating persons. Operating systems, rules and procedures lack clarity and are, on occasion, ignored. Recording, accounting, and custodial functions are weak, possibly because of the small size of the business, its single location, and the presence of two hands on owners who exercise their own informal controls and checks to ensure the smooth functioning of the business. Risk of Fraud The risks of fraud, as in any business without structured control and checking systems, are significant. Fraud deterrence and control occurs mainly because of the presence of the two owners of the business, its small size and its compact single locational operations. Frauds can occur, and that too very easily in purchasing, inventory operations, cash management, payment of wages, cash sales and through tampering with the accounting system. Detection of Fraud While the current recording and accounting system is too loose to be of much help in immediately spotting frauds and throwing up alerts, the presence of irregularities and potential fraud can be detected through a number of overall checks in different operational areas. Tracking of movement of goods from the placing of purchase orders through inventory receipts, issues for consumption, and closing stock balances followed by reconciliation of opening and closing inventories with purchases and consumption, will reveal buying, consumption, and pilferage irregularities. Similarly tallying of total sales with cash, credit card and cheque payments, as well as of cash sales with money receipts will give an indication of the accuracy if records and the presence of dishonesty in the sales and collection function. Daily checks may well be unhelpful in this area as the guilty employees may become alert and become careful. It is best to do such checks for fairly long past periods to get accurate results. Overpayment of wages can again come to light if attendance records are tallied with actual wages paid for a specific number of months. Small companies in the UK, while they are mandated to prepare and file annual accounts that represent a true and fair picture of the operations and financial condition of the company, are exempted from statutory audit if their turnover does not exceed 5.6 million GBP or their balance sheet total remains at less than 2.8 million GBP. Considering the size of DJs Ltd and the nature of its business, the company will, in all probability, not be required to face statutory audit. The audit plan should commence with a detailed understanding of the operations of the company and progress to laying out the audit objectives. The audit objectives should include the ascertainment of the reliability of accounts, the legality and validity of company transactions and the adequacy of financial management under practice. The scope of the audit should thus incorporate two separate issues, the assessment of the financial accounting status, as evidenced by (a) the correct recording of assets and liabilities, including off balance sheet items, (b) the existence, ownership, valuation, description, classification and disclosure of assets (c) the legality and correctness of transactions, (d) the completeness and accuracy of recording entries pertaining to the period, as well as their description, classification and disclosure, and the financial management procedures, which need to ascertain economy, efficiency and effectiveness through an analysis of input/output ratios, cash m anagement practices, financial ratio analysis, and the availability of resources in time, as well as their effective utilisation. Apart from laying down the objectives and scope of the audit the audit plan will need to provide for time planning, (based upon a quantification of necessary audit tasks), the criteria for choosing transactions and items for audit scrutiny, the audit methodology to be followed, (involving procedures for checking of vouchers and postings, carrying out reconciliations of bank and supplier accounts, taking physical stock of inventory items, and checking accounts receivables and payable balances with the external parties), the required audit tests, and the allocation of manpower resources. The establishment of materiality is significant in the formulation of a plan. A proper understanding of the business will help in identifying matters of significance and will enable the plan to incorporate materiality factors vis-a-vis nature, amount and significance of transactions. Identification of areas where controls and checks are loose, as elaborated in task 1, will throw up the possibility of r isks and frauds. These areas will warrant more detailed and intensive scrutiny, as well as the need for overall and input/output checks. Formulation and execution of appropriate audit tests are integral to the successful execution of an audit. While audit tests are mainly framed in accordance with established accounting and auditing procedures they need to be adapted to the nature of the industry and provide for the peculiarities of the business. In the subject case the company uses standard SAGE accounting software, which eliminates to a great degree the need to check for manual accuracy and the correctness of posting entries and arithmetical accuracy of generated accounts. However, errors and irregularities can arise in many other areas and a number of audit tests will need to be included in the required audit methodology. Audit tests should start with a sample checking of the accounting correctness of vouchers to ensure that correct accounts have been debited and credited for both revenue and capital transactions. A sample testing procedure involving complete checking of three months vouchers and varying percentage checks for the other nine months should serve the purpose adequately. Journal vouchers need to be checked to test whether proper accounting procedures have been followed for incorporating extraordinary entries or corrections. Audit tests should include checking of purchases for rates accepted, with those available in the market, tallying of purchase orders, goods inward notes and bills, both for value and quantity, as well as reconciliation of inventory, checking of book and actual balances, sales bills for billing accuracy, both for rates and quantities, sales and collection totals. Apart from these tests, bank and supplier reconciliations, and carrying out of ratio analyses for operating and profit margins, debt and liquidity, will help in providing the auditors with an idea of the financial condition of the company. The following statement outlines the details of work to be carried out and its manner of recording for incorporation in the audit report. The scope of the audit will cover work involved in ascertaining whether the prepared accounts reveal a true and fair picture of the operations of the company for the specified period, the financial condition of the company at the end of the period, and whether financial management practices are appropriate for the efficient and effective running of the company’s operations. Audit activity will include assessing the scope of audit, checking of accounts for accuracy and adherence to stipulated accounting requirements and the appropriate financial framework, through standard auditing procedures involving sample and complete checking, carrying out of audit tests, interviewing and questioning required company officials, use of reconciliations, and other analytical tools like input/output studies, ratios and trends. The results of the audit will be recorded in different sections of the audit report, namely in (a) an introduction identifying the accounts that were the subject of the exercise and the relevant financial framework, (b) an explanation of the scope of the audit, (c) an assessment of the preparation of the accounts in accordance with the Companies Act, (d) a section on inconsistencies, if any between the directors report and the actual position, and (e) a description of irregularities, which, if material will find place in qualifications to the report. Companies registered in the UK companies with turnover exceeding 5.6 million GBP or with net assets more than 2.8 million GBP need to undergo statutory audits conducted by registered auditors. Statutory audit reports are part of the annual financial statements prepared by the company for the use of people who wish to obtain reliable information about the operations and financial condition of companies. They are as such used by all stakeholders, namely investors, banks, lenders, buyers, customers and employees for information checked, verified, and certified by independent, external, registered professionals with domain knowledge about their subject. A statutory audit report must begin with an introduction describing the accounts that were the focus of the audit and the financial structure that has been applied in their preparation (i.e. either UK GAPP or IAS) and further contain (a) a clarification on the audit scope along with the accounting standards used in the audit, (b) the opinion of the auditors on whether the accounts have been prepared in accordance with the Companies Act (and, if appropriate, Article 4 of the IAS Regulation), and whether they give a true and fair view of the company’s financial affairs. The auditors must also include their opinion on whether the directors’ report is inconsistent with the accounts, and can, if so warranted, contain qualifications to the prepared accounts. Irrespective of the qualifications the report must include references to matters to which attention needs to be drawn without qualifying the report. Quoted companies also need the statutory report to contain details on di rectors’ remuneration and the consistency of the operational and financial review with the prepared accounts. Provided below is the draft of a suitable letter to the management in relation to the audit of the business under discussion. DJs Limited, Address Dear Sirs, We are glad to inform you that the financial audit of your company has commenced and is proceeding as planned. The scope of the audit has been defined and agreed between the undersigned and your directors, Mr. Golding and Selwood. Our staff will visit your offices on Monday, July 30 to begin the audit work and convey to your officials the details of documents required. We shall be obliged if the required documents are provided and they are given the cooperation required. Yours truly XYZ and Associates Signature Name of Signatory Partner Reference ICAEW, 2007, Institute of Chartered Accountants of England and Wales, Retrieved July 25, 2007 from www.icaew.co.uk

Management of Diabetic Foot Ulcers

Management of Diabetic Foot Ulcers Diabetic foot disorders are the rated as the number one cause of hospitalisation for diabetic mellitus patients in the United States and abroad. Among these disorders are, foot infection, ulcerations, cellulitis and gangrene. It is estimated that a 100 people per week lose a digit, foot or a lower limb due to diabetes mellitus8. Diabetic foot disorders and its long term complications account for direct medical budget of hundreds of millions of dollars annually, including lengthy hospital stay of patients and lengthened periods of disability. In the UK, diabetes cost the NHS over  £5 million pounds per annum and the cost of diabetic foot complications including amputations was  £252 million in 2003. Figures show that 1 in 10 foot ulcers result in the amputation of a foot or a leg. The most distinguishing foot complication of diabetes is the ulcer, which is of course a major risk factor for amputation. Mortality rates after amputation are as high as 50 percent in diabetic patients. Although the primary pathogenesis is neuropathy, immunopathy and vasculopathy (ischemia), diabetic foot ulcer is attributed to a number of other risk factors. Early detection of these risk factors as well as the foot ulcers themselves is crucial in the general management of diabetic foot ulcers and amputation prevention. Therefore, immediate and aggressive treatment of all diabetic foot ulcers can prevent worsening of the complication and the need for amputation. The objective of treatment as a result should be prompt intervention to allow good healing of the ulcer and once healed, to prevent its recurrence. However, the optimum care for foot ulcers rest upon the treatment teams understanding of the pathophysiology associated with diabetic foot ulcers, familiarity with current methods of treatment and the concept that the multidisciplinary team approach is the gold standard in preventing limb amputation. And above all, prevention of foot lesions should be ranked highest amongst all priorities. EPIDERMIOLOGY There is no concrete data illustrating the true picture of the incidence and prevalence of diabetic foot ulcers. However, majority of the information gathered about its aetiology is based upon national hospital discharge survey (NHDS) data, which does not include a vast number of patients with ulcerations treated on the outpatient basis. Cross-sectional and population-based studies help to approximate the distribution and frequency of diabetic foot ulcers, while prospective cohort studies and retrospective case-control studies are instrumental in detecting associated risk factors for the foot lesions. According to Reiber et als epidemiological review, chronic ulcers represented 2.7% of all diabetes related admissions and 46% of all admissions due to any ulcer condition. The 1983-1990 NHDS survey also revealed that the highest ulcer rates were found in individuals aged 45-64 years, with male preponderance over the female. The average length of stay (LOS) for diabetes pat ients discharged with ulcers was 59% more than in patients without ulcers, around 14 and 8 days, respectively. Numerous population-based studies record a yearly incidence of diabetic foot ulcers in the magnitude of 2% 3% in both type 1 diabetes mellitus (IDDM) and type 2 diabetes mellitus (NIDDM) patients, while the prevalence ranges between 4% and 10%. These studies also suggest a widespread trend for higher prevalence of ulcerations with increasing age and duration of diabetes. Once ulcerations have occurred, recurrence rate can get to 50% in 2 years and 70% in 5 years. Despite the fact that mortality linked with diabetic foot ulcerations has not been recorded, 70% to 80% of amputations of the lower extremity can be lead by foot ulcers. Amputation is one of the most common sequels in persons with diabetes mellitus now exceeds 100,000 per year in the United States and amputations involving the leg, foot or toe(s) are not uncommon. Approximately 15% of patients with diabetic foot u lceration will require amputations due to uncontrolled infection, gangrene or failure of the ulcers to heal. Unfortunately, there is a 3-year survival rate of 50% after the amputation of a lower limb, while the 5-year survival rate is approximately 40%. Subsequently, less than half of the patients who end up with lower extremity amputation (LEA) of one limb go on to develop a severe contralateral ulcer within a space of 2 years, thereby putting the future of the other limb at risk as well. AETIOLOGY/PATHOPHYSIOLOGY Several factors have been implicated in association with diabetic foot ulcers. These factors include the intrinsic complications of diabetes mellitus in affiliation with some extrinsic factors and together predispose the diabetic patient to the risk of developing foot lesions. The trilogy of peripheral neuropathy, peripheral arterial disease (ischemia) and susceptibility to infection (immunopathy) are the main predisposing factors for lesions on the foot. The impact of peripheral neuropathy may not be easily detectable, with little or no signs and symptoms. Notwithstanding, its pathology advances fast and the end stage of tissue necrosis quickly reached. Distal sensory neuropathy can be seen in 20% to 50% of patients with type 2 diabetes. This decreases the protective sensation in the feet, leading to abnormal spreading of foot pressure and shear stresses with subsequent callus formation. This in turn diminishes the patients ability to perceive minor trauma to the foot and this is de monstrable by vibration perception threshold (VPT) and insensitivity to a 10g monofilament, which conveys a 7-fold and 18-fold risk of foot ulceration respectively. Distal motor neuropathy precedes atrophy of the intrinsic and extrinsic musculature of the foot, with accompanying deformities of the toes and metatarsals heads on the plantar aspects of both feet and consequent bunions on the 1st and 5th metatarsal-phalangeal joints. However, these irregularities of the feet cause an increase in the foot pressures, particularly around the bony prominences, thus resulting in more calluses forming. These calluses then go on to further increase the local subcutaneous pressure, ultimately resulting into haemorrhage beneath the callus, a lesion known as the pre-ulcer is then formed. With progressive pressure mounting on the pre-ulcer, the overriding skin breaks down to produce an ulcer. In addition, distal autonomic neuropathy could as well spark a plantar ulcer directly by reducing sweating in the feet with consequent drying and cracking of the skin28.Peripheral arterial disease and impaired cutaneous circulation are also important risk factors for both ulcerations and LEA. Peripheral arterial ischemia sometimes produces ischemic ulcers, but these are rare occurrences i.e. (1% 2% incidence) than neuropathic ulcers (65%) or combined neuroischaemic ulcers (25%) 28. Transcutaneous oxygen tension (Tc pO2) levels less than 30mmHg and absence of peripheral pulses or past history of vascular surgery are strong separate predictors of ulceration. Diabetic foot infections often set in and complicate already settled foot ulcers. Although, infections play an integral part in the pathway to lower limb amputation, there is inconclusive data with regards to the position of susceptibility to infection in causing ulceration. Even though, most ulcers are caused by minor foot trauma, and in some cases the patient takes no notice of because of the sensory neuropathy. These minor injuries (i.e. extrinsic factors which include; wearing ill-fitting/brand new shoes, hot soaks occupational hazards and to a lesser extent self-induced trauma by cutting toe nails or calluses) constitute the leading cause of acute precipitant of diabetic foot ulcers. In addition, there are also a number of intrinsic factors which could predispose diabetics to developing foot ulcers and they include; longstanding diabetes, past history of ulcers or amputation, age, weight, retinopathy, nephropathy and structural deformities of the foot (i.e. Charcot foot) have al l been associated as risk factors for ulcerations. However, bad biomechanical function arising from the complications of diabetes generally leads to foot injuries in most diabetic patient. ASSESSMENT OF DIABETIC FOOT ULCERS A detailed and well organised evaluation of the lower extremities is crucial when commencing the treatment of a diabetic foot ulcer. Before carrying out the physical examination of the limbs, it is noteworthy to perform a quick inspection of the patients shoes for good fit, foreign objects and the wear and tear patterns. The clinical evaluation must include an appropriate assessment of the ulcers aetiology, its extent and depth, presence and severity of both local and systemic infection and peripheral vascular status. A comprehensive assessment of the patients general health and glycaemic control, extent of peripheral neuropathy, a careful, yet detailed dermatologic and musculoskeletal examination should also be included in the evaluation. These assessments determine the ulcers healing rate, potential progression to LEA, and the likelihood of reoccurrence. Therefore, they should be accomplished urgently in the ambulatory or hospital setting and require a multidisciplinary team approach, with possible consults to the infectious disease specialist, podiatry, vascular and orthopaedic surgeons. Bilateral lower limb pulses must be examined. When pulses are diminished or not palpable, Doppler segmental pressures to the toes or TcpO2 measurement are indicated and the vascular experts should be brought on broad. The neurological evaluation should assess the patients sensorium and deep tendon reflexes. The ankle and knee reflexes are tested with the aid of a simple neurological hammer, while the important aspects in the evaluation of the sensorium are: reduced sensation to pain, light touch, hot/cold and vibratory sensation. Pain sensation is easily assessed with a disposable needle. A piece of cotton ball, lambs wool or 10-g monofilament can be used to evaluate the light touch and a 128-Hz or 512-Hz tuning fork or biothesiometer are approved for vibratory evaluation. Cold perception is also assessed by submerging the metal arm of a neurological hammer into cold water and then placing it against the patients skin. Anatomical deformities such as hammertoes, previous foot amputation, or Charcot joints often produce high pressure areas which result in ulceration. The musculoskeletal evaluation cannot be done by visual inspection of structural findings alone, it must also include testing for muscle strength, weakness, atrophy and contracture. Assessment of joint range of movement and gait evaluation with computerised plantar pressure analysis will also be of great value in appreciating the abnormal dysfunction contributing to ulceration. Examination of the skin of both feet is also carried out with detailed attention to the quality and integrity of the skin around the interdigital areas. Changes in the colour of the skin often associated with spotted rashes and heel fissures are suggestive of a significant level of ischemia. Toenail changes and presence of subungual drainage are pointers to a proximal source of infection. Clinical assessment of the ulcer should include a detailed description of its appearance as well as the measurement of the ulcers diameter with a wound measuring guide. Outlines of the ulcer on a translucent film or plastic sheet can also promote this process. This must be documented and retraced at subsequent visits to assess the treatment process. The depth and extent of the wound should be carefully explored with a blunt sterile probe. Special care must be taken to probe for hidden sinus tracts and subcutaneous abscesses or to identify tendon, bone or muscle or joint involvement. Ulcer depth is a significant predictor of healing rate, possibility of concurrent osteomyelitis and the chances for amputation. The presence of infection is a huge cause of the need for hospitalization. Therefore, a general assessment with physical examination, laboratory investigations and radiographic studies is important in classifying infection as absent, mild, moderate or severe. This classification acts as a guide to determine or select the initial antibiotic therapy and to decide when to hospitalise the patient. Clinical signs of infection such as purulent discharge, odour, cellulitis, fever and leucocytosis must be documented. However, Leucocytosis and fever might not always be noticeable even in the presence of acute osteomyelitis. Approximately 54% of patients with diabetic foot infections had normal white blood cell count and no fever44. Bacteria cultures of anaerobes and aerobes (both gram positive and gram negative) should be obtained from the base of the ulcer, bone or blood or from all three depending on the clinical setting. This helps in clarifying the true hidden pathogens and may facilitate the decision to adjust initial antibiotic therapy. Physical examination of signs of infection in the patient centers on the presence or absence of systemic responses such as fever, tachycardia, sweats or hypotension and the appearance of the wound and adjacent tissues. Early signs of infection are evident by increased amount of exudates from the wound, base of the ulcer changes from pink granulation to yellowish- grey tissue, tenderness and induration around the ulcer. Infection should be considered severe when the patient present with systemic toxicity, signs of fascilitis or a rim of erythema around the ulcer greater than 2cm in diameter. Laboratory investigation to confirm the presence of infection should include white blood cell count and differential which could show leucocytosis or a shift to the left or both, erythrocyte sedimentation rate (ESR) which when elevated above 40mm/hr is a strong indicator of osteomyelitis28. In addition, glucose, bicarbonates and creatinine levels are tested to rule out possible hyperglycaemia, metabolic acidosis or azotemia from dehydration which strongly suggest the presence of a severe infection. Radiological evaluation should be obtained promptly to ascertain the presence of fractures, foreign objects or signs of osteomyelitis. Plain x-rays have a low sensitivity, thus they should be interpreted with caution as changes in the foot caused by Charcot foot could mirror those osteomyelitis when seen on a plain x-ray. However, a normal plain x-ray of the foot does not rule out osteomyelitis, a repeat should be requested 2 weeks later to exclude occult osteomyelitis. As indicated, other imaging modalities can aid in the diagnosis of osteomyelitis such as CT scans, magnetic resonance scan (MRI) or leukocyte scans and each having their own strengths and limitations. TREATMENT Management of the foot ulcer is mostly determined by its severity, vascularity and the presence of infection1. Recognition of its root cause will serve as a guide during the course of treatment. However, a multidisciplinary team consisting of specialist from podiatry, orthopaedic surgery, vascular surgery, the infectious disease service and diabetic education service should be involved in the management. The multidisciplinary team approach is due to the complicated nature of the disease itself as well as managing the various comorbidities associated with foot ulcers. In addition, the approach has been demonstrated in clinical trials to produce significant outcomes in terms of improvement and reduce the incidence of major amputations. The wound should be immediately relieved of all pressures, elevated and rested at first presentation. Effective local wound care must be carried out and ill- fitting footwear should be discarded and replaced with appropriate surgical or relief shoes for protection. And in cases where total nonweightbearing with crutches is impossible, a pressure felt padding or foam can be used in the surgical shoes. However, the total contact cast (TCC) is considered gold standard to protect neuropathic ulceration during ambulation due to its ability to eliminate high pressure areas under the foot. Adequate alternatives to the TCC are the Scotchcast Boot or removable walking braces. Treatment of hyperglycaemia, ketoacidosis, renal insufficiency and other comorbidities that may coincide in the ulcerated patient should be treated simultaneously with the foot lesion. Consultations to internal medicine, endocrinology and cardiology are generally frequent when managing acutely infected patient who need to be hospitalised. Such consultations are usually sought early in course of treatment to ensure good metabolic control. Diabetic foot infections are usually polymicrobial and as such initial antibiotic therapy should be broad-spectrum after obtaining good aerobics and anaerobic culture samples. Antibiotic therapy should be later modified according to the culture and sensitivity test and the patients clinical response to the initial therapy. Surgical debridement and drainage or local partial amputations are crucial adjuncts to antibiotic therapy. Underlying osteomyelitis usually present in moderate to severe infections and often requires aggressive bony resection of infected bone and joints accompanied by cultured -directed antibiotics for 4 6 weeks. Foot ulcer patients with underlying ischemia should undergo revascularization with angioplasty or vascular bypass procedure if its anatomically possible. Even with severe distal arterial obstruction, revascularization to return pulsation to the foot is a major part of the limb-salvage strategy and may be accomplished in such patients. However, where revascularization is not feasible or in cases of advanced infection or extensive necrosis, amputation at some level may be required. Wound care is also necessary after surgical or sharp debridement of all callus and necrotic tissue58. Practically, a warm, moist environment conducive for wound healing should be maintained.This can be arranged using saline wet/dry dressings or special dressings such as semipermeable films, hydrogels, calcium alginates and hydrocolloids. Tissue-engineering dermis is a more recent class of biologic dressing and has been tested to be more effective than saline dressings. There is little evidence to support the role of topical enzymes and should be avoided. Although the role of topical growth factors in the healing rate of ulcers is beneficial, however, they are expensive and should be limited to patients whose ulcers cease to improve after 4-6 weeks of adequate therapy. PREVENTION OF RECURRENCE AND AMPUTATION Prevention is regarded as a major aspect in avoiding ulcer relapse and diabetic lower limb amputation. Recurrence rate with diabetic foot ulcers and LEA are as high as 50% -70% over three years. Comprehensive intervention programs tailored to individual patients can lower these rates and can be accomplished with a multidisciplinary team approach. Control of both macrovascular and microvascular risk factors is also of great importance. Patient education and re-education plays a primary, yet active role in this program and involves instruction in foot hygiene, the need for daily inspection, proper footwear and the necessity of prompt treatment of new lesions. In addition, regular and frequent visit to a diabetic foot care program is crucial. The feet must be thoroughly inspected at every visit and should include debridement of calluses and ingrown toenails. This provides an excellent opportunity to back up self care behaviour as well as allowing early detection of new or imminent foot problems. Appropriate therapeutic footwear with pressure-relieving insoles and high toe box which protect the high risk foot are an essential element of the prevention program and have been associated with significant reductions in ulcer development. Subsequently, patients with major structural deformities may benefit from reconstructive surgery to prevent recurrent foot ulcers. Surgery may be especially suitable in patients who cannot be accommodated in therapeutic footwear. And because patients with healed ulcers are at risk for future ulceration, these preventive measures must be integrated into a long life strategy and treatment program. CONCLUSION Diabetic foot ulcerations, infections, gangrene and lower extremity amputations (LEA) are major causes of disability to patients with diabetes mellitus. And these often results in extensive periods of hospitalisation, substantial morbidity and mortality. Although not all such lesions can be prevented, it is certainly possible to reduce their incidence by proper management and prevention programs. A multidisciplinary team approach to diabetic foot disorders has been regularly proven to be the best method in achieving favorable rates of limb salvage in this high risk population. Foot care programs accentuating preventive management can reduce the incidence of foot ulceration through modification of self care practices, appropriate evaluation of risk factors and formulation of treatment protocols directed at patient education/re-education, early intervention, limb preservation and prevention of new lesions. The joint team of medical, surgical, rehabilitative and footwear specialist shou ld impart effective and coordinated services for acutely infected or ischemic inpatients as well as management for the outgoing patients. In general, the incidence and morbidity of diabetic limb amputations can be reduced if the above principles are embraced and integrated into everyday patient management protocol.

Destined to Fail :: Free Essays Online

Destined to Fail Imagine having to wake up every morning and going to a broken down old building for seven hours a day. In the building you are forced to complete tasks which are easier in other buildings five minutes away, but since yours is poor you can not, if at all, complete these tasks. The outlook is so bleak that it almost seems as if you are destined to fail. For children in Camden, New Jersey this is school. Students in Camden are faced with an obvious, apalling educational disadvantage when viewed against the suburban Cherry Hill schools which are five minutes away. The crux of the problem with the Camden public schools is the impovershed state in which it attempts to educate its children. The main cause for the destitution in the Camden public schools is the serious lack of funds for educational materials including those for school facilities. The schools are in such dire straits that most do not have the necessary materials with which to teach. Students at times do not even have their own textbooks and science labs lack the necessary equipment to teach lessons properly. If a student is lucky enough to receive a textbook it is either outdated or falling apart. School facilities are also in a state of trouble, many are falling apart or have serious problems which inhibit learning. In Savage Inequalities, by Jonathan Kozol, the malfunctioning heating system not only makes the building extremely hot all year round, but also melted approximately forty of the fifty computers in a lab. Is this the proper environment for education? Would you want to go to a school like this? Disadvantages such as these cause greater problems as students progress in their education. The lack of proper educational materials prevents students from learning. Since it prevents students from passing state mandated tests, they have to spend approximately eight months of the year school year, usually in high school, preparing for these exams. In the long run students only learn how to take the test and spend only two months on material which may spark some intellectual interest. Students do not gain any kind of critical thinking or conceptual framework; they are simply robots which know how to pass a certain test. When viewed against students with whom they will be competiting for scholarships, college acceptance, and future employment, Camden public school students have obviously no chance.

Smoking Risks Essay -- essays research papers

  Ã‚  Ã‚  Ã‚  Ã‚  One of the most popular habits in today’s society is smoking. Yet each year, cigarette smoking kills more Americans than AIDS, alcohol, car accidents, homicides, suicides, illegal drugs and fires combined. Smoking is an extremely bad pastime, practiced for centuries, for an individual’s health and those surrounding him/her. People start for many different reasons and get addicted to the nicotine in cigarettes. Smoking cause many fatal diseases, but help is available to those who seek it. Cigarette smoking is a disgusting and unhealthy habit. History of Smoking   Ã‚  Ã‚  Ã‚  Ã‚  Smoking is defined as the action of inhaling tobacco from a pipe, cigar or cigarette. It has been practiced for 100’s of years, including by early North-American natives. Europeans had introduced it into the Old World by the early 16th century (Petrakis). It was continually practiced since then throughout the world, with tobacco companies arising and packaged cigarettes soon available. Smokers would praise it for medicinal reasons and also claimed smoking to be pleasurable.   Ã‚  Ã‚  Ã‚  Ã‚  Smokers had no knowledge of cigarette smoke’s harm to their health until 1964, when the surgeon general of the U.S Public Health Service concluded that smoking was hazardous to an individual’s health, and soon after it was discovered that second-hand smoke was also hazardous to the health of surrounding non-smokers inhaling it. Reasons Why People Smoke   Ã‚  Ã‚  Ã‚  Ã‚  There are many reasons why people begin smoking. One of which is insecurity. In an uncertain situation in which a person is not comfortable with their individuality and not confident with themselves, if there are smokers around then that person may be tempted to take up smoking. It might be because they would like to â€Å"fit in† with an unknown group of people, or someone may take it up based on a new friend’s or girl/boyfriend’s influences. Another reason why people take up smoking is because of peer pressure leading to a quick physical addiction. One ingredient in cigarettes is nicotine, and it is extremely addictive. And yet nicotine is not the only physical reason people smoke, they are also get hooked on the taste, smell and the feel of cigarettes. Health Risks of Smoking   Ã‚  Ã‚  Ã‚  Ã‚  According to the American Heart Association there are an est... ... would distract someone from smoking.   Ã‚  Ã‚  Ã‚  Ã‚  The government also encourages people to quit smoking. Cigarette smokers are warned each time they smoke a cigarette of the deadly diseases that could effect their health. By law a warning label must appear on each pack and carton of cigarettes warning buyers of the hazards. There is also a ban on television and radio ads for cigarettes in the United States, and in Canada there is a ban on all advertisements for tobacco companies. It is also illegal to smoke in most public places now, including some restaurants, elevators, the workplace, schools, airlines, public transportation machines and most stores. Also, the Canadian and American governments prohibit the selling of cigarettes to anyone younger than 19 years of age.   Ã‚  Ã‚  Ã‚  Ã‚  Although there are still many individuals who smoke worldwide, one can hope that sometime in the future there will only be non-smokers. Smoking only proves to lead to an early grave for smokers and non-smokers alike. With medicines, support groups and will power, the world could easily become a cleaner, non-smoking place, because a smoker’s death is an unneeded death.

Effects of Safety Negligence

The Importance of Aviation Safety and The Effects of Safety Negligence Michael A. Maze Colorado Technical university Online Why Is safety of such importance throughout the aviation Industry? Throughout this discussion I will Interpret the significance safety Imposes on not only the lives of maintenance personnel but also the lives of many others, which may even include you. Air travel has been a high demand for many years now and everyone should understand how critical it is maintaining these aircraft safely really is.Everyone has eared of a helicopter or airplane crashing here and there. How many have actually sat back and thought whether these accidents could have been avoided? Truthfully some of those accidents could have been. There's not a lot we can do to prevent an aircraft from going down due to a natural occurrence, however with properly trained maintainers the event of a maintenance related failure can be greatly reduced. I will explain the roles of the Quality Assurance (Q UA) and Production Control (PC) sections of maintenance.I will further explain what needs to be required for a shop to run feely and introduce you to examples of FOOD (Foreign Objects of Debris/Damage) and the threat they pose to aircraft as well as many lives that encounter them. Shop safety plays an Important role In succeeding the goals of aviation safety. The work that any individual shop performs can turn catastrophic In the air due to safety negligence. It is imperative that all shop personnel are properly trained and certified in their areas of expertise.Ensuring that employees are familiar with the operation of their tools and using the proper PEP (Personal Protective Equipment) can erroneously reduce the risk of injury within the shop. In many areas of the aviation maintenance industry there is also exposure to hazardous chemicals and materials. Requiring employees to use all PEP In accordance with each chemical/ material's MESS (Material safety Data sheet) will reduce the risk of getting cancer and having other serious health problems throughout time. One of the biggest threats to aircraft today is the presence of FOOD (Foreign Objects of Debris/Damage).One of the most widely known cases of FOOD-related accidents that have taken place In the recent year Is jetliners flying into a flock of birds. There have been many Instances In which these large planes have struck birds therefore causing one or more of their engines to go out or malfunction. Although natural threats of FOOD cannot always be prevented, there are many things that can be done as an aircraft maintainer to prevent an accident due to negligence. Maintaining accountability of the tools you take on and off the aircraft and practicing clean work play a huge role in the prevention of FOOD-related accidents.It is always good to keep In your mind the burden you will face due to your act of negligence and that any debris left behind could cause a catastrophic failure. N any company there can be a vast number to aircraft in their delete. T Production Control office is responsible for the scheduling of phases. A phase is a period where an individual aircraft is due in for maintenance. Each aircraft has its own specified periods for phase and is scheduled in accordance to that aircraft's technical manual, based on the number of flight hours.It is important to have an updated schedule as things change and to avoid having too many aircraft in maintenance than the company can handle at once. With an overload of work you face the increased risk of safety concerns. The personnel that comprise the Production Control office play a key role in maintaining a safe working pace for the maintainers and understand the elevated risk when things fall out of schedule. Although every component of a company in the aviation maintenance industry is important, the most important is the technical inspectors who make up the Quality Assurance section of the company.These inspectors have to have a va st knowledge of the work that is performed on each aircraft. After a maintainer completes their task, the inspector must follow behind ensuring that everything was done in accordance to that aircraft's technical manual. They must then verify that the quality of the work performed meets all specifications. Finally, they must verify that there is not any FOOD left on the aircraft before the task can be signed off as good. The Quality Assurance office is ultimately responsible for every repair done to the aircraft as they sign each individual task off.However in all reality every person involved, from the maintainer to the technical inspector, is responsible for enforcing safety procedures. They are responsible for making sure that the aircraft we fly in everyday are safely maintained and safe to fly. After reading this essay I hope that you have a better understanding of the importance of safety in the aviation industry. The effects of negligence can be vastly reduced when people are more knowledgeable in the subject, therefore reducing the amount of accidents caused by gelignite.

Ekpeye People of Nigeria Essay

It became a serious problem that the elderly indigenes of the town had to cry out for help so that their innocent youths would not be taught this new way of life. It is true that there are many tribes in Nigeria that are still holding to the moral standard of their culture. But in a country where a lot of people migrate everyday away from their tribe and culture to other people’s culture for reasons like admission into higher institutions of learning, youth service, employment, etc; it becomes imperative to consider and treat cohabitation as a very serious anomaly. The Ekpeye tribe, one of the numerous tribes in Rivers state of Nigeria is a very good example of the tribes that are now involved in cohabitation. Working among the Ekpeye youths, one will discover a high rate of premarital sexual relationship among the youths. Many of these youths cohabiting with one another are not unbelievers; many couples in the local churches are not married, at least according to the customary law. Majority of these young people came together as a result of premarital sexual relationships which resulted in unwanted pregnancy. Sad enough, many of these people are church members serving in one capacity or another; in fact, there are pastors among them. It has become the order of the day, a common thing that goes on from one town to the other. Majority of these youths, including Christians go into it with the knowledge of their parents and community leaders. This is gradually becoming a serious temptation to many Christian youths who want to uphold the standard of God for marriage and stay faithful to marriage vows. It  Ã‚   is also standing as a barrier to evangelize those outside the church. This research paper is focused on this people group with the intention of knowing their marriage custom, how cohabitation gained access into the culture, the way cohabitation is practiced and the effects that cohabitation has on the cohabiting families and the church. Ekpeye Tribe and Its Marriage Custom Ekpeye tribe is one of the local tribes in Rivers state. Ekpeye tribe as seen in the map is in Ahoada East and Ahoada West local government areas in Rivers state. There are four traditional groups in Ekpeye kingdom. They are Akoh, Ubie, Upata and Igbuduya. 8 The main occupations of Ekpeye traditional society are farming, hunting and fishing.

Alchemy vs Chemistry Essay

Some people think that chemistry is just about mixing things up and experimenting in test tubes and explosions. Actually chemistry studies everything around us and how they change, for example it tells what your body is made out of. We study chemistry in biology, geology, engineering, and even physics. Chemistry is the science of matter, and how it changes and its chemical reactions, it’s also called as the central science ( the main one) because it connects physics with other sciences. Chemistry is important because it explains the world around you, it explains how food changes when you cook it and how it rots. Chemical reactions occur when you breathe, eat, or even setting down watching the T.V. Chemistry was discovered by a Greek man called Leucippus in the fifth century BC. He came up with the idea that the world was made up of atoms or voids. His student Democritus further refined this idea of the atom and improver the theory so it can make more sense. On the other hand m any people did not believe in chemistry and Democritus’ theory. Alchemy, it’s a form of chemistry that was studied in the middle ages, which was concentrating about trying to change a normal metal into gold. It’s the power to change or create things in a way which seems mysterious and magical. It also involves the discovery of panacea, and the proportions of the elixir of immortality and living forever. Aristotle was another Greek philosopher who had a completely different theory than the one with the atoms. He though that all matters are made up of four elements and they are: Air, Fire, Water and Earth. By physically manipulating the proportions of the elements, matter can be changed from one to another. This idea was known as transmutation, and the main goal of it is to transfer ordinary metal into gold. Aristotle did not have a proof for his theory However, because he was trusted and respected this idea has been for 2000 years even though they were wrong, and still until now there are some people who believe in alchemy and alchemists still exist. Some people think that chemistry and alchemy are the same, but they are different in many ways. First of all, alchemy rely a lot on the spiritual connections to the four elements and they are fire, water, earth and air while chemistry is a lot more logical, factual and scientific based. Second of all, chemistry is considered as science, while alchemy is not. Third of all, chemistry is more famous than alchemy and it’s a part of our modern society and we are used to it. Finally, chemistry makes more sense than alchemy and it does not risk our lives looking for the elixir like alchemy. Chemistry and alchemy does not only have differen ces, they also have some similarities. First of all, they all began as alchemy in the seventeenth century in the medieval Europe. Second of all, the both involve the natural elements which are now arranged on a periodic table. Third of all, they were both considered as science back then because people didn’t know who is right and who is wrong so they used them both as science. Finally, back in time the churches were against both of them because they thought that they used magic and proportions which what they are totally against.

Change and Culture Case Study Essay

In tough economic times, companies are looking for ways to continue to provide services and products to the public without compromising quality and efficiency. When it comes to smaller businesses, or businesses that provide the same product or service, it is often wise to merge the companies together to form a stronger, more stable structure. This will take place when Frithsen Physical Therapy merges with Select Physical Therapy. Select Physical Therapy is a national corporation that provides physical therapy as well as aquatic therapy, occupational therapy, athletic training outreach and long-term care services. For the past decade Frithsen Physical Therapy has seen Select Physical Therapy as a fierce competitor that provides less than quality care to its patients. Frithsen Physical Therapy has been well known in the community for providing care in a professional and personal way. Many employees are afraid that merging with a large corporation will change the way they work, causing the quality of patient care to decrease. Middle managers will become essential before, during, and after the merge to ensure that every employee from each company understands the vision for the new corporation and is willing to compromise to make it a reality. The combining of two companies is no easy task and will change the shape and culture of both companies, until a new one is born. Processes such as communication, hiring, patient care and record keeping will change to accommodate the growing corporation, in hopes it will become more effective than either company was on its own. Merging two companies is a delicate procedure, requiring compromise and patience. Each company has built a certain culture over its existence, and each one believes that their culture is best. In reality, each company has certain services or tasks that they perform better than the other. In the instance of Select Physical Therapy merging with Frithsen Physical Therapy, the culture of the new, combined company will be similar to the cultures put in place by each company separately. However, it is important to create a new culture, differing from the previous ones, to promote a sense of teamwork and camaraderie. If this step does not occur, everyone will continue to work in his or her own culture, which becomes divisive, causing the company to be pulled in different directions (Sherrill, 2001). In the first phases of combining the companies, the culture may be fragmented, with each company holding on to what they know. Many of the employees will be wary of the changes occurring around them on a daily basis and may resist certain adjustments (Stanwick, 2000). A new atmosphere of open-mindedness and compromise needs to emerge for the blended company to be successful. When two companies are combined, there are bound to be differences of opinions between practitioners and administrators regarding polices and procedures. It is important to understand that each company brings something valuable to the table, and all ideas and opinions should be considered and discussed Avoiding a competitive stance will help employees from both sides see the positives of blending ideals and values, and ultimately encourage the birth of a stronger, more successful new culture (Stanwick, 2000). To successfully combine two companies involves cooperation from all levels of management. As a middle manager in a merging corporation, there are different strategies and skills that will be necessary to ensure a smooth transition. The most important strategy will be communication. Before the merger occurs, it is important for middle managers to understand the new beliefs and values that upper management desires (Bolton & Lewis, 1998). Once middle managers understand the vision for the new company, they must pass it down to their employees. It is not enough to simply communicate the new vision; middle managers must begin practicing these changes immediately. Leading by example is the most effective way to produce results. The middle managers in most companies are more approachable than top management; therefore it is imperative that middle managers are on board with the new vision of the company and display this in a positive way. While the merger is occurring it is essential to build a team atmosphere, full of open communication, honesty, and teamwork. Each employee from both companies should feel as though their positions is important, and their cooperation is essential to the success of the forming company. Once the merger is complete, it is all about the new culture, staying visible, approachable, and communicating information early and often (Bolton & Lewis, 1998). Aside from ensuring employees are blending well, it is important to focus on patient care. There will be changes implemented at every phase of the merger, but it is important not let misunderstandings, or issues within the staff affect the quality of care given to the patients. Once the merger has been finalized and integration is complete, middle managers need to assess their staff to be sure that each employee is doing his or her part to make the merge as successful as possible. If there are employees who are resisting the changes being made within the company, or not buying into the new culture and vision, it is necessary to evaluate the situation and decide what is best for the team and the company as a whole. Middle managers must not forget to consider the employees feelings when situation such as this arise. Often times, employees resist mergers because their identities are closely tied to their jobs, and they like to experience continuity of their identities. Giessner (as cited by Sidle, 2006) noted that mergers would challenge this continuity, leading to distress and anxiety from employees. When middle management can understand the feelings of their employees, they can be better equipped to handle issues that may arise by allaying fears or implementing strategies to make employees comfortable with their new roles. Even if all employees from both companies are comfortable with the combining of their two organizations, upper management has the daunting task of reworking its current systems and procedures to include the best strategies from each company. In the case of Frithsen Physical Therapy and Select Physical Therapy, the former’s employees will see the most changes. Frithsen Physical Therapy is a small corporation, covering New England, while Select Physical Therapy is a national corporation, encompassing more services and a variety of clinicians. Along with physical therapy services Select Physical Therapy offers occupational therapy, aquatic therapy, long-term care facilities, and a large athletic training outreach program. This will require managers from Frithsen Physical Therapy to be in charge of more people, and perhaps different clinicians than they are accustomed to working with. The shape and systems currently used in the company will have to shift in order to fit a larger scale of business and a more complicated hierarchy. The regional managers from Frithsen Physical Therapy reported directly to the President of the company, whereas the regional managers of Select Physical Therapy report to one of ten executive managers, who then report to the CEO of the company. The clinic managers of Frithsen Physical Therapy were able to see all of the employees they supervise on a daily basis, working side by side. With the inclusion of the vast athletic training program, they will now be responsible for knowing which athletic trainers report to their clinics, and what schools they are assigned to. There will also be a manager of athletic training services that they will need to communicate with about referrals and business relating to the relationship between the schools covered and the clinics in the area. Due to this more intricate hierarchy, the employees of Frithsen Physical Therapy will see a dramatic change in how they communicate with upper management. Under their old organization, there was a relatively straight path to the top, with only a few levels of management until they reached the President. Communication could be done easily by telephone or in person, and most employees had met each other face to face at one time or another. In the new organization, there will be a need for a more formal kind of communication. In organizations communication tends to be directional, moving upward, downward, diagonal or lateral (Leibler & McConnell, 2008). Frithsen Physical Therapy was used to mostly lateral communication, discussing issues with other managers or sharing notes about a particular patient’s care. With the merger, the managers and employees will mostly be communicating upward, providing detailed reports to their supervisors, who will then provide reports to a higher supervisor, and so on. This will require attention to detail and more paperwork for the managers at every level, which will change the way the managers handle issues that arise within their department. With the inclusion of new services and a goal for comprehensive care, comes the call for new positions and alterations to old ones. A need for more middle management will arise, and more staff will be added to accommodate the growth of services while still maintaining exceptional patient care. In conclusion, there are many factors to consider when combining two organizations. It may make sense financially and logically to combine two entities that provide similar services. However, it is important to understand that not only will it be difficult to combine two cultures; it will also take time for employees to adjust to a new chain of command and new policies and procedures. Middle managers will play an important role in the blending of two corporations. They need to remain positive, lead by example, and possibly sever ties with employees who do not fall into line with new visions and ideas. An increase in communication will help make the transition successful, and ultimately all employees will reap the benefits from such a merger. References Bolton, J.M., & Lewis, B. (1998, Jan/Feb). The challenge of merging and consolidating organizations. Journal of Management in Engineering, 14(1), 9-10. Academic Search Complete. Leibler, J.G., & McConnell, C.R. (2008). Management principles for health professionals (5th ed.). Retrieved from The University of Phoenix eBook Collection database. Sherrill, T. (2001, May). Creating a can-do culture. New Zealand Management, 48(4), 17-21. MasterFILE Premier. Sidle, S.D. (2006, August). Resisting the urge to merge. Academy of Management Perspectives, 20(3), 115-118. Business Source Complete. Stanwick, P.A. (2000, Jan/Feb). How to successfully merge two corporate cultures. Journal of Corporate Accounting & Finance, 11(2), 7-11. Business Source Complete.