Mark Twain Advice to Youth Summary - 5237 Words

The Origins of the Constitution Gordon S. Wood, Brown University When did the story of the Constitution begin? Some might say it ABOUT THE began over 2500 years ago in the city-states of ancient Greece. AUTHOR Others might place its beginnings nearly three-quarters of a millennium back in the fields of Runnymede. Still others might say Gordon S. Wood, is professor of history at the Constitution had its origins three centuries or so ago during Brown University, and the the tumultuous years of the seventeenth-century English author of The Creation of revolutions. Or others, more patriotic perhaps, might date the the American Republic, beginnings of the Constitution from events in the Western 1776-1787 (University of Hemisphere, from the†¦show more content†¦Despite the notable strength of this Confederation, however, it was clear that it was something less than a unitary national government. Under the Articles the crucial powers of commercial regulation and taxation--indeed, all final lawmaking authority--remained with the states. Congressi onal resolutions were only recommendations to be left to the states to enforce. And should there be any doubts of the decentralized nature of the Confederation, Article 2 stated bluntly that each State retains its sovereignty, freedom and independence, and every power, jurisdiction, and right, which is not by this confederation expressly delegated to the United States, in Congress assembled. The United States of America had a literal meaning that is unfamiliar to us today. The Confederation was based on the equal representation of each state in the Congress. It was less a single government than it was a treaty among sovereign states. It was intended to be and remained, as Article 3 declared, a firm league of friendship among states jealous of their individuality. Not only ratification of the Articles of Confederation but any subsequent amendment of them required the consent of all the states. As a confederation the United States achieved a good deal, including the winning of the war and independence from Great Britain. But scarcely a half dozen years after the final ratification of the Articles in 1781, theShow MoreRelatedThe Discourse Community Of The English Subject2328 Words   |  10 Pages and the Elizabethan Period. Of course with every discourse community there are a vast number of people who help to make it up. In the discourse community of English some of these people include author and playwright William Shakespeare, author Mark Twain, author and poet Jane Austen , and a slew of famous African-American authors some including Toni Morrison, Alice Walker, Lorraine Hansberry, and poet Maya Angelou. African American Literature: Urban Fiction The aspect of the English discourseRead Morewisdom,humor and faith19596 Words   |  79 PagesRenaissance Humor: Erasmus, Rabelais, Cervantes, Shakespeare 5 Two European Russians: Anton Chekhov and Vladimir Soloviev 9 Reflections on Humor from Nietzsche to the Theatre of the Absurd 12 Humor and Wisdom in the United States: Lincoln, Beecher, Twain, Sandburg, and Buchwald 17 From The Times (of London) obituary on him (January 19, 2007) that mentioned his â€Å"wit and wisdom† in its title, available at http://www.timesonline.co.uk/tol/comment/obituaries/article1294342.ece. 24 Humor, Wisdom, andRead MoreSda Manual Essay101191 Words   |  405 Pages........... Church Treasurer the Custodian of All Church Funds ............ Conference/Mission/Field Funds ............................................. Sabbath School Funds .............................................................. Adventist Youth Society Funds ................................................. Local Church Funds ................................................................ Funds of Auxiliary Organizations ............................................. Safeguarding the PurposeRead MoreMODR 17608087 Words   |  33 Pagesof a good name: for this shall continue with thee, more than a thousand treasures precious and great. (Ecclesiasticus 41:15) = ought imperative 11- You want to be very careful about lying; otherwise you are nearly sure to get caught. (Mark Twain, â€Å"Advice to Youth†)= ought imperative 12- Democracy has at least one merit, namely, that a member of Parliament cannot be stupider than his constituents, for the more stupid he is, the more stupid they were to elect him. (Bertrand Russell, AutobiographyRead MoreLogical Reasoning189930 Words   |  760 Pageskeeping an eye on the sorts of arguments found in books on formal logic – forget, or underplay, how much of our daily reasoning is concerned not with arguments leading to truth-valued conclusions but with making choices, assessing reasons, seeking advice, etc. Dowden gets the balance and the emphasis right. Norman Swartz, Simon Fraser University v Acknowledgments For the 1993 edition: The following friends and colleagues deserve thanks for their help and encouragement with this project:Read MoreFundamentals of Hrm263904 Words   |  1056 PagesDecentralized Work Sites 8 Skill Levels 8 A Legal Concern 8 Employee Involvement 20 How Organizations Involve Employees 20 Employee Involvement Implications for HRM 20 Other HRM Challenges 21 Recession 21 Off Shoring 21 Mergers 22 A Look at Ethics 22 Summary 23 Demonstrating Comprehension: Questions for Review 24 Key Terms 24 HRM Workshop 25 Linking Concepts to Practice: Discussion Questions 25 Developing Diagnostic and Analytical Skills 25 Case 1: Work/Life Balance at Baxter 25 Working with a Team:Read MoreStephen P. Robbins Timothy A. Judge (2011) Organizational Behaviour 15th Edition New Jersey: Prentice Hall393164 Words   |  1573 PagesNetworked Organizations 20 †¢ Helping Employees Balance Work–Life Conflicts 21 †¢ Creating a Positive Work Environment 22 †¢ Improving Ethical Behavior 22 Coming Attractions: Developing an OB Model 23 An Overview 23 †¢ Inputs 24 †¢ Processes 25 †¢ Outcomes 25 Summary and Implications for Managers 30 S A L Self-Assessment Library How Much Do I Know About Organizational Behavior? 4 Myth or Science? â€Å"Most Acts of Workplace Bullying Are Men Attacking Women† 12 An Ethical Choice Can You Learn from Failure

A Study On Lyme Disease - 1118 Words

Lyme disease is most commonly transmitted to humans by black legged deer ticks that carry a spirochete called Borrelia burgdorferi (Kruger, p. 23, 2010). Spirochete are a type of bacteria which have surrounding filaments attached to their cell walls that help propel it through aqueous environments (Porth, p.302, 2015). Deer ticks can only pass it on if they have fed from an infected host such as small mammals, like mice and squirrels, however, when the tick matures into adult, it prefers the white tailed deer as a host (Kruger, p.23, 2010). The deer themselves do not carry the disease, however they play an important role in the spread of this spirochete. The deer tick only infects it’s host with the Borrelia burgdorferi at the end of a†¦show more content†¦(Moore, p.65, 2015). There is variability in the course of the disease in this stage. Approximately 50% of infected patients will also develop flu-like symptoms (Nichols Windermuth, 2013). Twenty percent of infecte d patients will present with repeated erythema migrans, forty percent will present with multiple rashes and in one-third of fortunate patients, the disease will not continue to progress (Kruger, p.24, 2010). The early disseminated stage marks when Lyme disease becomes systemic and effects the musculoskeletal, cardiac and neurological systems. It can occur weeks to months after the bite when the spirochete travels to organs via hematologic or lymphatic channels (Nichols Windermuth p.363, 2013). Infected patients may present with a long list of secondary diagnoses such as lymphadenopathy, meningtitis, Bell’s palsy, cranial neuritis, radiculoneuritis, arterioventricular block as well as joint and muscle pain. (Nichols Windemuth, p363, 2013). The late disseminated stage occurs with patients who did not receive adequate treatment during earlier stages and occurs months to years following the initial infection (Moore, p66, 2015). These individuals often present with rheumatoid ar thritis and neuropathies. Approximately 60% will have arthritis in their knees, and 5% will develop paresthesia, and cognitive issues such as short term memory loss (Moore, p66, 2015). The literature is controversial

Robotics in Healthcare Personalizing care and boosting Free Essays

Robotics in Healthcare: Personalizing care and boosting the quality, access and efficiency of healthcare (Miss Madhu Hiremath) **Student, Department of Hospital Management, IIHMR, Bangalore Abstracts: Human life is evolving and so is technology. Healthcare, which is one of the major concerns in the 21stCentury, is entering a phase where technology Is becoming an enabler. In the near future, say technologists and doctors, robots will help us a great deal In bringing down the northbound costs of healthcare and Improving operational efficiency and quality of care. We will write a custom essay sample on Robotics in Healthcare: Personalizing care and boosting or any similar topic only for you Order Now Robotics for Healthcare caters mainly six representative areas like Smart medical capsules, Robotized surgery, Intelligent prosthetics, Robotized motor coordination analysis and therapy, Robot-assisted mental, cognitive and social therapy, Robotized patient monitoring systems and many more innovations are expected by around the year 2025. Ethical and legal aspects are also likely to pose obstacles to the developments at some point. It is a field of innovation that encompasses many Interesting leads, problems to be solved and challenges to e met. Robotic surgery is one of the most significant advances in healthcare in recent years. However like any other technological advance, It too comes with a heavy price tag. Aggressive marketing by the manufacturers and surgeons may lead to unethical practices. This article analyses the applicability of robotics to healthcare In India and as compare to North America and European countries. India too is not left behind In acquiring robots In their surgical departments like Nova spine care, Apollo, AllMS, KIMS, Medanta Hospitals etc. At present, the scope for robotics in India is limited because of cost considerations. However Robots aren’t being designed to eliminate people. Instead, they can help reduce physical demands and workloads. Key Words: Robotics for Healthcare, Intelligent prosthetics, Robotized motor coordination analysis, Robotic surgery Reference: http://vwvw_Informationweek_corn/healthcare/clinlcal-informatlon-systems/ vmw. roboucsbuslnessrevlew. com/research/report/ outlook_for_health_care_robotics_for_2013 http://www. kineticconsulting. co. uk/ robots. html 1 OF2 How to cite Robotics in Healthcare: Personalizing care and boosting, Papers

Esri Essay Example For Students

Esri Essay ESRI CASE STUDY 1. Of the three types of uncertainty that characterize high-tech markets, which type is ESRI experiencing most acutely? Elaborate and provide strategic implications for ESRI. a) In this case, I think the ESRI suffer the most in the technology uncertainty. i. Concerns over obsolescence. Technology is evolved extremely rapidly with the relevant elements develop simultaneously and interactively. Microsoft and Google integrate PC, Broadband Internet connection and powerful search engines together to offer virtual globes service which challenge the traditional industry model of market segmentation. As the world’s leading vendor of DIS system software, ESPI faced severe challenge of new innovation and products. The key of high-tech companies’ survival is keeping innovation and advancing own technology before its obsolescence. ii. Initially, the core competitiveness of ESRI software products is its unique geographic database designed for target customers, which provide diverse information to support various customers’ work. As the new high-tech product (Google earth) came out, the classic database had been challenged by new information collection model which construct by mass internet users upload and share information. The uncertainty of technology evolution brings risk to further development of existing technology. ) Currently, the new product may not be professional and target-oriented enough to compete with ESRI’s GIS professional product, but from the strategic angle, new innovation which has been regarded as disruptive technology/product has great potential to compete with existing ones, in addition, that’s the development trend of GIS system and will build new industry standard after widely-dispensed.. ESRI should handle it seriously, interact with the development trend and enhance own strength as well as integrate new advanced technology with own products. . What are the characteristics of the newest competitors that have allowed them to gain traction I n the GIS industry? a) There are several aspects enhance the new products’ competitiveness. i. Strong combination with advanced technology and service. Rather than traditional GIS system provided by ESRI, new product, such as Google earth, is based on innovation of PC, world-wide internet and strong search engine, therefore, Google earth combine new advanced technologies together to create a modern software . ii. Ample and various information. Google earth allow users interact and share own information onto the software, which considered as UCC (user-contributed content). Therefore, these user-driven efforts serve as a model for the GIS community to publish and share more sophisticated and useful services in this dynamic, new online environment, as a result, this architecture for participation abstracted a lot of users. iii. Correct market segmentation. These new products are aimed on the mass market, which refer to the ordinary internet users who need some information in geography and direction. Initially, this segmentation had not been regarded as target customers, while as the popularity of PC and internet, large demand occurred in this segment. These new products just enter the blank market and fulfilled the need, then get a rapid increase in customer amount. iv. New business model and 3. To what extend does ESRI face â€Å"disruption†, in the classic sense of the word? a) Disruptive technology/innovation describe innovations that improve a product or service in ways that the market does not expect, typically by being lower priced or designed for a different set of consumers. Disruptive technologies are particularly threatening to the leaders of an existing market, because they are competition coming from an unexpected direction. A disruptive technology can come to dominate an existing market by either filling a role in a new market that the older technology could not fill (as cheaper, lower capacity but smaller-sized flash memory is doing for personal data storage in the 2000s) or by successively moving up-market through performance improvements until finally displacing the market incumbents (as digital photography has largely replaced film photography). ) In my opinion, ESRI face very severe challenges bring by the disruptive technologies. i. New innovation came out with bulk of relevant advanced technologies, and gradually absorbed considerable customers and occupied a big market. That what Google earth did and had already put a great threat to existing GIS. The new virtual globe has leaded the GIS industry into a new ear and changes the situation of G IS from professional use to mass entertainment. 4. Should ESRI explicitly target the new GIS customer (mainstream, onprofessional, low-end)? If so, what organizational changes might this require? a) Personally, I think due to the great market potential, ESRI should target this group of internet users as further customer. The internet users among the world increase sharply as the rapid popularity of PC and internet, thus, the great potential of the mass market can not been ignored, otherwise, the market share of professional software will be reduced as the development of competitors. b) Organization Changes. anne frank EssayCompanies have to devote money and energy to improve this part to be a recognized characteristic among market and customers. ii. Integrate new customer needs and product development trends into own product. Companies should change themselves to suit the changed market, with the PC and internet market increasing shapely, individuals have been recognized a tremendous market in all the segments of IT industry, GIs companies should change own product to meet new customers’ need as well as to utilize the great information contributed by mass internet users iii. Segment mass market and develop new product to fulfill their particular needs. There is no doubt mass market has great potential for GIS, among these numerous users, segmentation is still necessary for companies to research particular needs and launch products to solve it. In short, companies should always follow the instruction of customers and market , adjust own product into suitable ones, continue to work on RD and keep eyes on competitors

Compare and Evaluate Reform in One Policy Sector in Two Countries

A protest song We Shall Overcome as an Expression of the Peoples Resentment and Hopes

A protest song We Shall Overcome as an Expression of the Peoples Resentment and Hopes In the middle of the past century, in the United States arose the African-American Civil Rights Movement. A protest song We Shall Overcome became an anthem of this movement. Analyzing a book of T. V. Reed, we can notice that the possible criteria for what makes the protest music powerful are its not profitable nature and interest of the common goods.Advertising We will write a custom essay sample on A protest song We Shall Overcome as an Expression of the People’s Resentment and Hopes specifically for you for only $16.05 $11/page Learn More Reed says that music, playing the strategic and tactical role, help paralyzing the fears (28). As the songs were the organizing tool helped African-Americans to form their communities, in XX century, people used this instrument in order to get their civil rights. Obviously, the ideas that can be hardly said that can be easily sung by thousands of people. Music is a helpful tool that absolutely corresponded to the t actic of non-violence protest. For African-Americans, music had always been a part of religion, the most helpful tool to express the feelings and emotions. Therefore, they used this instrument of engagement in order to connect people, unite them for the common good and to claim the resentment and hopes. A specific of this music proclaims the dominant position of the common interest over the commercial benefits. As a united element, the protest music helps people realize their identity and use their voices as an instrument of resistance. Reed cites the line from the song We Shall Overcome: â€Å"Deep in my heart I do believe, we shall overcome some day† in order to show how the individualized statement of the beginning transforms, getting the collective sense (32-33). Another important criterion of Reed’s analysis is a freedom as the basic idea of the protest songs. The line â€Å"we shall all be free† is a confirmation of this statement. It is the tradition has its roots in a history of the United States and the relationships between white and black populations. Using the word freedom instead of equality, the protestors indicate not the legal aspect, but rather the moral attitude. Freedom songs had been a popular way of time spending, pleasure and recreation during the centuries. In the XX century, they transformed into a peaceful weapon. Read emphasizes that â€Å"music is not the only force in shaping movement identities, but it clearly was among the most powerful† (33). We Shall Overcome has a long story of transformation and people’s development. More than hundred years ago, Charles Albert Tindley wrote I’ll Overcome Someday. As an opening and closing melody, Tindley used the song No More Auction Block for Me which is dated to before the Civil War. In 1930s, tobacco works changed it into I Shall Overcome, using this song as a material for teaching the new activists of the labor movement.Advertising Looking for essay on art and design? Let's see if we can help you! Get your first paper with 15% OFF Learn More During the decades, this song was an example of the non-violence resistance that taught young African-Americans to protect their rights in a peaceful but effective way. In 1960-s, this song became an anthem of the African-American Civil Rights Movement. We Shall Overcome demonstrates that one song can serve as a tool of forming the identity and collectivity. Although music is pleasurable, it is also an important weapon in the movement for the civil rights. Analyzing the history of the protest music, it is important to indicate that the power of this kind of arts lays in its not profitable nature and interest in the common goods. For instance, the successful example of the We Shall Overcome demonstrates that, being a pleasant time-spending, the particular song can bring people together in order to get the civil rights, integrate them in a one community. Reed, T. V. The Art of Protest: Culture and Activism from the Civil Rights Movement to the Streets of Seattle, 1st ed. US: University of Minnesota Press, 2005. Print.

Tourism websites analysis Research Paper Example | Topics and Well Written Essays - 4500 words

Tourism websites analysis - Research Paper Example The report also reflects the structure of marketing objectives, is prepared under the accrual, and outputs framework. Yours sincerely, Name: Executive summary The introductory part of this study shows the need for having marketing research. This is through analysis of tourism websites showing that taking a marketing research is necessary in order to formulate decisions and strategies for business success. In carrying out a marketing research, there is need to develop skills needed in seeking information about the market and marketing issues. This helps in assessing quality of information linking it with the business goal to make it stronger. It is also necessary to understand the competitive environment as it helps in seizing market opportunities in places where they exist making the market productive. The analysis shows that every business is analysed by the factors that affect its functions and these factors attribute for the success or failure of the business. In conclusion, hotel s are valued as a strategic community partner due to its mission of enabling people to save money to better their lives. Table of contents Introduction †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 5 Background to the problem †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 6 Methodology†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. ... †¦Ã¢â‚¬ ¦ 15 Limitation & Future research †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦18   Recommendations †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 20 Conclusion †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 21 Introduction Marketing in every industry involves change, as change is inevitable in every business practices, as business people believe that change is able to maintain a competitive position. Hiatt (2010) describes that change is an essential factor to consider for surviving in today’s market. Organisational change involves adding new people or modifying programs it also include change in mission and restructuring operations such as restructuring self managed teams or layoffs, improved new technologies and mergers. Change occurs not for any reason but to accomplish an overall goal and it is usually provoked by outside driving force such as addressing new markets or need for dramatic increases in productivity. The above study shows the impact of marketing in the tourism industry. The study will also show how organizations and among employees undertake the role of human resource in managing change. A review of tourism websites shows that taking a marketing research is necessary in order to formulate decisions and strategies for business success. In carrying out a marketing research, there is need to develop skills needed in seeking information about the market and marketing issues. This helps in assessing quality of information linking it with the business goal to make it stronger. It is also necessary to understand the competitive environment as it helps in seizing market opportunities in places where they exist making the market productive. Companies having the

Critically evaluate the approach an organisation of your choice has Assignment

Critically evaluate the approach an organisation of your choice has adopted to strategic HRM - Assignment Example The company has an effective human resource management department that continues to employ various human resource management strategies and theories thereby enhancing the company’s profitability and growth, as has been the case within the past few years as the discussion below portrays. Dessler, (2000) explains that human resource management is a vital management function of an organization often mandated with the maximization of the productivity of the employees in the organization thus enhancing the company’s profitability. Google continues to portray the importance and need for effective management of the human resource owing to their importance in sustaining the profitability and longevity of the company. As such, the company continues to employ varied strategies to motivate the employees besides creating a conducive work environment, one in which the employees maximize their productivity. Human resource management at Google just as in any other company is a policy issue. The company continues to formulate and employ various policies to govern the human resource management with the view to enhancing the company’s profitability. Google’s human resource management department has systems and resources, which it uses to monitor the productivity of the employees. The department therefore deploys such resources appropriately in creating an appropriate organizational culture to incorporate productivity as part of the culture. The company uses both human relations and human resources theories in creating a holistic organizational culture. This way, the company has succeeded in creating a friendly yet competitive working environment. The company focuses on the interests of the employees thereby creating a working environment that accommodates the diversity in the society. The company has a unique organizational culture that unites the diverse cultures of the more than forty thousand employees in over forty countries throughout the

Russban Plastics Essay Example | Topics and Well Written Essays - 1000 words

Russban Plastics - Essay Example It means that Jack together with the minor shareholders will not be able to vote for the approval of the company's dissolution; he needs to be in agreement with Ben. Therefore, Andy and Ben will be able to continue their business. However, it is recommended to negotiate with Jack and other shareholders, because their strong dissatisfaction may lead to opposition to approval of the investment decisions and bring company to a halt. 3. In order to buy out the shareholders and remaining shares at par value, and to obtain a full control over the Russband's operations, a loan of ( 120,000 - 60,000 - 21,000) + ( 250,000 - 160,000) = 169, 000 will be necessary. The bank will not have a positive view of the loan, as the amount of the loan is quite substantial, and the company's expansion plans would have to be shelved for another year. It means, at least, two more consequent years of losses and there is no proof that the market conditions afterwards will be favourable and allow achieving considerable profits. Whether the loan will be granted will depend on Ben and Andy's ability to provide a sound financial plan indicating that the company in the future will be able to generate enough cash to make principal and interest payments, and on the presence of appropriate collateral. Russban Plastics has sufficient authorized capital, more than 25% of it issued and satisfactory amount of the paid-up capital. To change the status from private to a PLC company it will need to seek certificate of trading and incorporation from the authorities before starting the financing activities. Afterwards, it will also need to submit latest financial reports and made the news and information that are likely to affect the price available to the market. In order to join AIM the company will need to: Appoint an advisor and a broker; Submit a declaration of business interest; Submit an admission document; Pay admission fee of 4,000; Incur the advisor's fees ranging from 300,000 up to 1,000,000 and 2%-5% flotation cost. Generally speaking, while going public offers an opportunity to raise a significant amount of additional funding, it will require substantial spending of the management time and costs. 5. The incremental investment amount, taking into account sale of the existing premises for 500,000, would be equal to 500,000. According to the Gordon Growth Model cost of equity will be equal to: Ce = D1/p0 + g = (50 p*0.06* (1 + 0.01))/50 p + 1% = 7.1% Considering also cost of

Influence of Pain on Quality of Life for Cancer Patients

Influence of Pain on Quality of Life for Cancer Patients Abstract Purpose: Pain is a common complaint of cancer patients which is found to significantly affect the quality of life of Head and Neck cancer patients. For patients suffering from cancer, control of symptoms and pain play a significant role in improving the overall quality of life of head and neck cancer patients. A literature search revealed that studies on the intensity of pain and quality of life before receiving anticancer therapy are lacking. Thus, this study was an attempt to assess the influence of intensity of pain on quality of life of cancer patients before receiving anticancer treatments Methods: A total of 100 histopathologically confirmed cases of head and neck cancer were interviewed. Intensity of pain was evaluated using the Brief Pain Inventory and the quality of life of patients was evaluated using EORTC QLQ-C30 module.. Results: The results showed that majority of patients suffering from oral cancer belonged to 5th and 6th decade of life. Kruskal Wallis test showed statistically significant in the quality of life and tumour stages. Chi square test also gave significant association between the quality of life and pain. Conclusions:. Assessment of Quality of life in cancer patients will direct the attention of clinician to the most important symptom; pain. Thus appropriate interventions can be instituted at right time along with palliative care to improve the Quality of Life of cancer patients. Keywords: Pain, Quality of Life, Cancer, Palliative care Introduction: Head and neck cancer encompasses a group of tumours involving the lip, oral cavity, nasal cavity, larynx, pharynx and paranasal sinuses. By incidence, it is the sixth leading cancer worldwide and eighth by fatality. Every year 0.5 million new cases are reported. It usually develops in 6th-7th decade of life and five year survival rate in a patient suffering from HNSCC is 40-50%. Approximately 40% of these tumours occur in the oral cavity, 15% occur in the pharynx, and 25% occur in the larynx; in 90% of the cases, the most common histologic type is squamous cell carcinoma. (1) Pain is the most burdensome symptom and is one of the most common complaints in a patients suffering from Head and Neck cancer. A systematic review evaluating the prevalence of pain in cancer patients over past 40 years reported high figures in the range of 52-77%. (2) The review also stated that as the stage of cancer advanced the prevalence of pain also increased. They reported a prevalence of 62%–86% in patients with advanced cancer. (2) These figures are in contrast to rapidly increasing research work in the field of pain relief. Pain is one of the most significant symptoms of cancer patients that affects multiple domains of life ranging from its impact on physical functioning to emotional functioning. It is a usual symptom of cancer patients, accounting for 30% to 40% of their chief complaints, and is of multifactorial aetiology. Approximately 58% of cancer patients suffer from unbearable pain, and this prevalence increases to 85% in patients with cancer in advanced stages. (3. A metanalysis which was carried out in the year of 52 studies for evaluating the prevalence of pain in cancer patients, reported that head and neck cancer patients had the highest prevalence of pain exceeding gastrointestinal gynaecological, breast and lung tumours. (2) In Head and Neck cancer patients, pain distresses the oral functions and is chief complaint in approximately 58% of the patients awaiting treatment and in 30% of the treated patients (4,5). The term â€Å"Quality of Life† has been used in literature in various ways both as a concept and an instrument of measurement. Very rarely has it been defined clearly. It may be considered as a subjective term which conveys the perception of a patient about his life which may either be positive or negative. It includes an assessment of general health, satisfaction, fulfilment, ability to cope, happiness, being in control and degree of independence. (6) Not only does pain affect the life of quality of patients before seeking antineoplastic treatment, also it has devastating effect in patients undergoing treatment. Thus there has been a growing interest in the inclusion of measures for improving life quality of patients before, during and after undergoing quality of life treatments. Literature search revealed that studies on the intensity of pain and quality of life before receiving anticancer therapy are lacking. Thus, this study was undertaken to assess the severity of pain and its impact on the quality of life (QoL) in untreated patients with head and neck carcinoma using questionnaire. Also the association of pain severity with clinical stage of the tumour and lymph node involvement was assessed. Materials and Methods: The study was carried out in the patients reporting to the outpatient department of K.L.E.V.K.I.D.S and Belgaum Cancer Institute. Ethical clearance was obtained from the institution. A total of 100 confirmed head and neck cancer patients were interviewed. Untreated histopathologically confirmed head and neck cancer patients were included in the study while patients who were receiving, or had completed their course of treatment for cancer, with recurring malignant disease and with compromised physical and mental state which prevented them from answering questions were excluded from the study. Patients were divided into four groups depending on their stage of tumour as follows:- Group I = Stage I=23 patients Group II = Stage II=25 patients Group III = Stage III=25 patients Group IV = stage IV=27 patients Pain was evaluated using â€Å"Brief Pain Inventory (BPI)† (7) which was validated in the North Indian Population.(8) The BPI is a 11 point scale which is presented horizontally from numbers ranging from 0-10. The Questions were translated in the local language of the patient. Patients were asked to rate their pain in the last 24 hours at its Worst, Least and on Average. Patients were also asked to encircle the number indicating the amount of pain they were having at present. The pain was then categorized into four groups: No pain (0), Mild pain (1-4), Moderate pain (5-6) and Severe pain (7-8) The Quality of Life of patients was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (EORTC QLQ-C30) version 3.0 (9) which was validated in Indian Population (10).EORCTC QLQ-C30 is a 30 item questionnaire which consists of five functional scale, three symptom scale, six single items and Global Quality of life question.(8) The functional scale comprises a set of questions to evaluate the functioning of a cancer patient which includes Physical, Role, Cognitive, Social and Emotional Functioning. Symptom Scale includes three items to evaluate the fatigue, pain and nausea in patients. A number of single items such as Dyspnoea, Insomnia, Insomnia, Constipation, appetite loss, Diarrhoea and Financial difficulties were also included. The Symptom scale evaluated Fatigue, Pain and Nausea. Patients were asked to answer each question on a 4 point scale ranging from 1-4; corresponding to pain as Not at all (1), A little bit (2), Quite a Bit (3, Very Much (4). Patients were asked to rate the last two items (Global Quality of Life ) on a horizontal scale ranging from 1-7. All the scores thus obtained were linearly transformed to be expressed on a scale from 0-100. All the data was tabulated and non-parametric tests were applied. The data was subjected to Descriptive statistics, Mann-Whitney and Kruskal – Wallis test. Results: 100 histopathologically confirmed cases were enrolled in the study. The results showed that head and neck cancer was common in patients in 5th and 6th decade of life (35% and 32% respectively) with a mean age of 54.8 years (age range-24-86 years). Strong predominance of male population (79%) was seen. Out of a total 100 patients, 67% patients had the site of primary tumour in Oral cavity followed by Oropharynx (22 %), Larynx (6%)and Hypopharynx (5%). Lymph node involvement was present in 66% patients. The Mean scores for all the items on the scale was obtained using the EORTC QLQ-C30 Scoring Manual. Patients in the early stages of tumour scored significantly higher on function scale indicating higher functionality and ease in their daily activities. On contrary patients with advanced cancer scored higher on symptom scale indicating hampered quality of life and greater difficulty in doing their day to day work. Kruskal wallis test showed significant difference in the quality of life and the tumour stages, which was statistically significant .(p value On applying Mann Whitney test significant differences in the quality of life of patients with lymph node involvement and without lymph node involvement. (p value Chi square test also gave significant association between the quality of life and pain. (p value Discussion: This study was carried out to assess the influence of pain severity on quality of life of head and neck cancer patients before receiving any antineoplastic treatment. With approximately one million of new cancer cases being added every year in India and 80% of them presenting in advanced stages ( stage III and stage IV)(11)the need for pain relief and palliative therapy is imperative. Cancer pain still being one of the most dreaded and burdensome aspects of cancer patients draws attention to the management of pain in head and neck cancer patients. Inspite of introduction of WHO’s step ladder pattern for the management of pain control in cancer patients (12) it has been reported that less than 3% patients in India have an adequate access to pain relief. (13) . The present study also showed signification association between the cancer pain and stage of tumour. Patients with advanced stage of tumour experienced more difficulty in talking, swallowing etc. and poorer quality of life thus indicating a greater need for the institution of pain relief measures. The findings were consistent with the study done by Oliveira KG et al (14) who concluded that patients in advanced stages showed higher impairment in their functional status. Similar findings were noted by Connely et al (4) who reported that patients with squamous cell carcinoma experienced significantly incr eased function-related intensity of pain rather than spontaneous. The reasons for under treatment and inadequate pain relief could be attributed to poor resources, inaccessibility to morphine, misconception about the drugs for pain relief e.g. addiction, opiophobia of patients and communication problems. (15) Also the nature of Cancer pain is not fixed. It has multiple complex aetiologies and is recurring in nature. One of the very important reasons for the inadequate pain relief in cancer patients is that currently no such medication exists for chronic cancer pain that will provide more than 30% relief to the cancer patients.(16) This makes the institution of palliative and support care even more essential. The World Health Organization has defined Palliative care as â€Å"An approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial, and spiritual.† (17) WHO emphasizes on meeting the psychological, social and mental needs of the patients so as to improve their quality of life. However, it has been reported that approximately 85% of patients who are admitted to palliative care centres have inadequate relief of pain. (18). Despite the fact that HNC has the highest pain prevalence of all the cancers and is one of the initial symptoms that motivate the patients to seek medical opinion, health care professionals concentrate solely on the surgical aspects, radiotherapy and chemotherapy. The management of chief complain of the patient i.e. pain is neglected which leads to poor quality of life. Therefore an evaluation of cancer patients before initiating any antineoplastic treatment is critical to because most of the studies concentrate on the assessment of pain during or after treatment. Conclusion: The average time from the admission of patients to palliative care unit and their death is usually less than a month thus indicating that palliative care is usually initiated only in the terminally ill patients, An assessment of quality of life of cancer patients before treatment will draw the attention of the clinician to the most symptomatic and feared aspect of cancer i.e. pain. Thus appropriate measures for pain relief along with supportive and palliative care can be instituted right from the beginning of the treatment which will greatly enhance the quality of life of cancer patients. References: Parkin DM, Bray F, Ferlay J, Pisani P:Global cancer statistics, 2002. CA Cancer J Clin2005,55:74-108. Van den Beuken-van Everdingen MH1, de Rijke JM, Kessels AG, Schouten HC, van Kleef M, Patijn J. Prevalence of pain in patients with cancer: a systematic review of the past 40 years. Ann Oncol. 2007 Sep;18(9):1437-49. Cuffari L, de Tesseroli SJT, Nemr K, Rapaport A:Pain complaint as the first symptom of oral cancer: a descriptive study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod2006,102:56-61. Connelly ST, Schmidt BL: Evaluation of pain in patients with oral squamous cell carcinoma. J Pain 2004, 5:505-510 Epstein JB, Emerton S, Kolbinson DA, Le ND, Phillips N, Stevenson-Moore P, Osoba D: Quality of life and oral function following radiotherapy for head and neck cancer. Head Neck 1999, 21:1-11. Bjordal K1, Kaasa S. Psychometric validation of the EORTC Core Quality of Life Questionnaire, 30-item version and a diagnosis-specific module for head and neck cancer patients. Acta Oncol. 1992;31(3):311-21. Cleeland CS, Ryan K: Pain assessment: global use of the Brief Pain Inventory. Ann Acad Med Singapore 1994, 23:129-138. Saxena A , Mendoza T,. Cleeland C. The assessment of cancer pain in north India: the validation of the Hindi Brief Pain InventoryBPI-H. J Pain Symptom Manage. 1999 Jan;17(1):27-41 Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, de Haes JCJM, Kaasa S, Klee MC, Osoba D, Razavi D, Rofe PB, Schraub S, Sneeuw KCA, Sullivan M, Takeda F.The European Organisation for Research and Treatment of Cancer QLQ-C30: A quality-of-life instrument for use in international clinical trials in oncology. Journal of the National Cancer Institute 1993; 85: 365-376. Chaukar DA, Das AK, Deshpande MS, Pai PS, Pathak KA, Chaturvedi P, Kakade AC, Hawaldar RW, DCruz AK. Quality of life of head and neck cancer patient: validation of the European organization for research and treatment of cancer QLQ-C30 and European organization for research and treatment of cancer QLQ-HN 35 in Indian patients. Indian J Cancer. 2005 Oct-Dec; 42(4):178-84. Seamark D, Ajithakumari K, Burn G, Saraswalthi Devi P, Koshy R, Seamark C. Palliative care in India. J R Soc Med. 2000;93:292–5. Vardy J, Agar M. Nonopioid drugs in the treatment of cancer pain. J Clin Oncol. 2014 Jun 1;32(16):1677-90. Khosla D, Patel F, and Sharma S. Palliative Care in India: Current Progress and Future Needs. Indian J Palliat Care. 2012 Sep-Dec; 18(3): 149–154. Oliveira KG, von Zeidler SV, Podestà ¡ JR, Sena A, Souza ED, Lenzi J, Bissoli NS, Gouvea SA. Influence of pain severity on the quality of life in patients with head and neck cancer before antineoplastic therapy. BMC Cancer. 2014 Jan 24;14:39. Thapa D, Rastogi V, Ahuja V. Cancer pain management-current status. J Anaesthesiol Clin Pharmacol. 2011 Apr-Jun; 27(2): 162–168. Bloodworth D. Opioids in the treatment of chronic pain: Legal framework and therapeutic indications and limitations. Phys Med Rehabil Clin N Am. 2006;17:355–79. Geneva: World Health Organization; [Last accessed on 2012 Mar 02]. â€Å"WHO Definition Of Palliative Care â€Å"Available from: http://www.who.int/cancer/palliative/definition/en . Lin YL, Lin IC, Liou JC: Symptom patterns of patients with head and neck cancer in a palliative care unit. J Palliat Med 2011, 14:556-559.

Gang Violence and Biker Gangs :: essays research papers

Gang violence is a major problem in our society today. Gang violence could take place in our neighborhoods and corrupt the young children easily influenced by the violent behavior as well. In the two poems, ?Leather-Jackets, Bikes and Birds? by Robert Davies and ?Street Gang? by H. Webster, the two poets write about gang related issues discussing the ill-mannered bikers who cause these problems to other around them. These poems discuss the violence, death and illegal activity in which a number of people participated in, which like reality is the problematic truth. Both poems are similar because their main intention is gang related violence issues in society today and the distinctive character of the darker side in human nature which causes the harmful consequences of a corrupt humanity. The communication strategies used by both poets are able to grasp the reader?s interest due to the fact that both poems have similar methods of word selection which is diction and are able to describe the psychological minds of aggressive behavior. The poem ?Leather-Jackets, Bikes and Birds? has sentences that describe the type of characteristics gang members have and illustrate their overall presence around others. For example when the poet writes, ?pretending they are looking for trouble demonstrates that the individuals of a gang gather not to enjoy themselves but to cause excitement among themselves for the wrong reasons. Another quote from the poem that describes the psychological mind of gang members is ?because you?ve got to be hard to be a leather-jacket this quote shows that gang members have a mind set that they must be tough, strong and overall powerful to gain their respect. Similarly, the poem ?Street Gang? the description of violence used and the defeat against law is well detailed by the actions caused by aggressive behavior. For example when the poet writes ?the law overthrown describes that the street gang members do not consider the law at hand and make a choic e based on their psychological mind structure and use forceful actions upon their victims. Furthermore, literary devices such as imaginary, alliteration, repetition, oxymoron, onomatopoeia, simile and parallel structure used in both poems displayed a greater understanding towards poetry and defined both as comparable poems. The poems ?Leather-Jackets, Bikes and Birds? and ?Street Gang? are not in rhyme and I believe both poets have formed the poems without rhyme because the tone of seriousness towards this issue was to be brought out to the reader?

Acupuncture as a nonconventional chronic neck pain treatment Essay

Acupuncture as a nonconventional chronic neck pain treatment Introduction Abstract   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Chronic neck pain is an ailment that is characterized by pain in the neck that lasts for a period of more than three months. It is usually different from common medical conditions of neck pains that last for only days. In most occasions, chronic neck pain is an ailment that may even take years without success in its treatment, particularly in the mainstream medical practices. Research assert that chronic neck pain is usually associated with a number of disorders, as well as diseases that can involve any of the tissues around the neck. The study was carried out to fully analyze the effectiveness of acupuncture in the reduction of chronic neck pain, and also to examine whether the possible effects attributed to the therapy are long lasting. The data used in this study was collected through specified procedures to ensure credibility of the results in regard to the use of acupuncture in health care to provide a remedy for chronic neck pain in both short and long term basis. Using a well-structured methodology to guide the research patients were carefully analyzed in regard to the various methods of acupuncture to determine the respective effectiveness of each method. Further, a thorough analysis of the data collected is subsequently discussed showcasing the viability of the medical alternative. Lastly, recommendations for further research of acupuncture as an ideal treatment for individuals with chronic pain of the neck is well provided in this paper. See more: Social process essay   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Research indicate that acupuncture as a recognized nonconventional alternative for chronic neck pain that is increasingly becoming popular across the world. Acupuncture therapy is among world widely known health care procedures that is used to treat over 30 health conditions and diseases, with a major emphasize of relieving pain to different ailments. One of the main uses of acupuncture is to relieve pain, hence it is one of effective remedies for chronic neck pains. Research has for a long time hinted on the benefits of acupuncture for relief of chronic neck pain, as well as other body pains such as chronic shoulder pain, migraines and osteoarthritis among others(Blossfeldt 2004, p. 146). Researchers have provided data from over 30 high quality studies involving more than 18,000 patients with different chronic pains. As a nonconventional remedy for different pains, acupuncture is commonly used in different methods, providing flexibility i n its treatment procedures, as well as a provider of choice for patients who opt to use acupuncture as a remedy for chronic neck pain(Salter et al, 2004, p 10).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Further, researchers assert that although acupuncture is increasingly being used for various conditions including chronic neck pain treatment, the evidence of its effectiveness remains inconclusive. This indicates that there is a need for a further well designed research. With the use of a variety of methods or options on the use of acupuncture to relieve pain, there is also a need to establish the key features required for the design, as well as implementation of larger scale trial on acupuncture for neck pain. Acupuncture is believed to decrease pain by enhancing the release of the chemicals responsible for blocking pain, commonly referred to as endorphins(Liang et al, 2010, p. 8). Most of the acu-points are usually found near the nerves. In this regard, when stimulated, the nerves cause a dull ache, a feeling of fullness in the patient’s muscle. The stimulated muscle then sends a message to central nervous system subsequently cau sing a release of endorphins. These are crucial elements in the human body that are automatically released to modify the nerve impulses, hence reducing or nullifying the effect of pain to the patient.The endorphins together with other neurotransmitters subsequently block the message of pain from being taken up to the brain, hence a relief to the patient(Blossfeldt 2004, p. 146). Acupuncture may be used as a reliable treatment for chronic neck,and therefore, should be included as a part of an extensive and comprehensive pain management programs for relieving pain in patients.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The scope of this paper is to ascertain the effectiveness of acupuncture in the treatment of chronic neck pain. The paper seeks to understand the role played by the various methods of acupuncture that are used to relieve pain for patients ailing from neck pains. Shallow, Sham and randomized acupuncture therapies are well explained in regard to their role in relieving pain.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Lastly, the main purpose of this study is to establish the use of acupuncture in individuals with chronic pain of the neck. The paper focuses to establish the effectiveness of three acupuncture therapies used as alternative medical conventions to relieve pain. Additionally, the study proposes to explain both the short term and long term effects of acupuncture therapies in the treatment of chronic neck pain. To establish the viability of acupuncture therapies in the treatment of chronic neck pain. To understand how sham, shallow and randomized acupuncture therapies are utilized in the treatment of chronic neck pain. To provide a conclusive evidence of the success of acupuncture as an ideal method of relieving pain. To establish the effects of the three acupuncture therapies in the treatment of individuals with chronic pain of the neck. To offer recommendation of the viability of acupuncture as a treatment option that can be used by people with chronic neck pains. Basic approach to acupuncture as a nonconventional chronic neck pain treatment   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The use of acupuncture as an alternative chronic neck pain treatment is based on the medical understanding of the specific elements responsible for alienating pain or sending messages of pain to the brain. The study of acupuncture is based on the thought that decrease or alienation of pain can be enhanced by releasing the chemicals responsible for blocking pain, referred to as endorphins. Most of the acu-points are usually found near the nerves(Liang et al, 2012, p. 8). The approach of this study is based on the understanding that, when stimulated, the nerves cause a dull ache, a feeling of fullness in the patient’s muscle. The stimulated muscle then sends a message to central nervous system subsequently causing a release of endorphins. These are crucial elements in the human body that are automatically released to modify the nerve impulses hence reducing or nullifying the effect of pain to the patient(Willich et al, 2006, p. 98). T he endorphins, as well as other neurotransmitters, subsequently block the message of pain from being taken up to the brain, hence a relief to the patient. The findings of this study will pin point out how the alienation of pain is conversely connected to the various elements thought to treat people suffering from chronic neck pains. Basic Background information   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Acupuncture used in the modern day alternative treatment for pain is a branch of a traditional Chinese medicine practice. It is a practice that has historically been tired, and equally tested as a health care practice that has in practice for thousands of years, particularly in China and South East Asia. For centuries, acupuncture has been gradually developed, tested and researched, as well as refined over many centuries giving out a complex, and rather detailed understanding of the energetic balance of the human body. The first known record of Chinese Medicine was a book, the classic of Internal Medicine of Yellow Emperor, which dates back to between the 1st century BC and the 1st century AD(Sun et al, 2009, p. 850). It is essential to acknowledge that all the styles of acupuncture found in the modern day health care practices trace their roots to this particular text.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Without the help of the modern day scientific equipment, scholars from the Ancient China discovered many aspects of biomedical science, like the effect of emotional stress on an individual’s immune system. The traditional acupuncturists were not less scientific or sophisticated that it is the case with the western clinicians with their understanding of the functioning of the body, although the contemporary acupunctural practices depict that of the culture and historic origin of the Chinese medicine. The traditional Chinese medicine has vividly remained in the shadow of the western medicine, until a certain period between 1934 and 1935, where the without drugs sick and wounded faced death. It was the intervention of traditional Chinese medicine, which generally used acupuncture and other several traditional treatment methods(Witt 2004, p. 99). From this point, the traditional and western medicines started to be practicing side to sid e in China. In the contemporary, the practice has gained popularity across different region of the world. More people with chronic pains, where it is primarily being used to treat such case, as it with the alienation chronic neck pain. Methods Population   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The research data collected in this study focused on patients suffering from chronic neck pain. The individuals used in the research fell within the age of 21 and 55 years old. Although there are many patients who report about neck pain ailments in different health care facilities across the United States, patients with the age of 21 and 55 years old were ideal for a research. This is due to the fact that they are easier to track their progress of healing over a longer period of time. Elderly patients over the age of 55 years are not best placed in this research considering the various attributes in the healing processes of such people, which is proven to be relatively lower. Most of the data about individuals with chronic pain of the necks was randomly collected in health care facilities in the State of California, United States. The majority of these patients was diagnosed with chronic neck pain and were put under a special focus while t hree acupuncture methods of therapies were performed(Witt 2004, p. 99). The study generally involved a thorough investigation of 191 patients in California’s health care. It is important to acknowledge that the various patients were deliberately initiated to acupuncture treatment as their decision to try the alternative medical practice after allegedly failed treatments in the mainstream medical procedures.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   There were certainly no limitation on the sex of the patients, hence the research involved both male and female patients. Additionally, there were no specified number of male or females in the study, as patients, as treatment and progress of treatment of patients was randomly taken. Further, it was assumed that both male and female patients presented similar responses to the different acupuncture therapies performed in the study(Sun et al, 2009, p. 850). The research was also not limited by either ethnicity or race, although believed to have different characteristics in regard to various medical procedures. Variable and Delimitations   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The dependent variables in this study included the neck pain as an ailment caused by various aspects such as physical injury and disease or condition among others. The rates of cases involving chronic neck pains during the period of this study was generally unprecedented as the causes of such ailments greatly varied. Chronic neck pain among the patients varied in regard to the specific causes, which in this case included degenerative disc disease, neck injury, neck strain, herniated disc as well as pinched neck(Sun et al, 2009, p. 850). The first step in the treatment procedure involved a thorough diagnosis of common neck infections that caused the chronic pain.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The key delimitations were based on neck pain due to common infection like virus infection of the neck and lymph nope swelling, as well as other infections such as tuberculosis of the neck, meningitis, and infection of spine bones around the neck.The different patients involved in this study had chronic neck pains attributed to extremely different causes, which included physical injuries, some rare infections, and virus infections among others(Witt 2004, p. 99). The patients with this problem are generally taken through the three acupuncture therapies, regardless of the cause of their condition(Hush 2004, p. 1533). The fact that all patients are uniformly taken into similar medical procedures without being categorized in relation to their specific cause of chronic neck pain remain as the greatest delimitating attribute of this research. Search Criteria   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The key terms I commonly used while searching for the relevant articles included: chronic neck pain, cervical pain types of acupuncture, alternative medicine, sham acupuncture, Shallow acupuncture and randomized acupuncture. Short statements were also useful in searching for relevant information about the use of acupuncture in the treatment of chronic pain. These statements included: Alternative treatment of chronic pain, use of acupuncture in the treatment of chronic neck pain, and the acupuncture methods used in the treatment of chronic neck pain(Witt 2004, p. 99). I thoroughly searched in various databases for article that provided information for patients suffering from chronic neck pains, specifically those individuals between the age of 21 and 55 years old. I further categorized the data collected to form two groups of patients of the age bracket of 21 and 34 years and those between 35 and 55 years old. The creation of these two grou ps was essential as taking a wider range of people of ages 21 to 55 years old would present relatively a higher deviation in the healing processes of the patients, as those above the age of 35 years present a much longer period of healing as compared to the youthful 21 to 34 years group. I also focused my research on the following: MasterFile Premier, ALT Healthwatch, US National Library of Medicine, BioMed central. Chronic Neck Pain   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Chronic neck pain is an ailment that is characterized by pain in the neck that lasts for an unusually long period of time, commonly over a period of three months. Although different from the common medical conditions of neck pains that last for only days, chronic neck pain is typically an ailment that takes even years without success in its treatment in the mainstream medical practices. Chronic neck pain is usually associated with a number of disorders, as well as diseases that can involve any of the tissues around the neck(Witt 2004, p. 99). For instance, the common causes of this condition are strains of the neck, injury of the neck like a herniated disc, pinched disc, or whiplash, and degenerative disc disease. In addition, chronic neck pain is also linked to common infection like virus infection of the neck and lymph nope swelling, as well as other infections such as tuberculosis of the neck, meningitis, and infection of spine bones ar ound the neck. Some patients also had chronic neck pains caused by extremely different causes, which include physical injuries, some rare infections, and virus infections among others. Further, chronic neck pain is also caused by certain infections like virus infection of the neck and lymph nope swelling, as well as other infections such as tuberculosis of the neck, meningitis, and infection of spine bones around the neck. Risk Factors   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Chronic neck pain is generally caused by numerous factors ranging from physical injury to certain infections around the neck body tissues. Since neck pain affects the muscles around the body areas of the neck, it becomes painful to move the neck as it is usually painful. The risk factors for pain usually include injury from involvement in motor vehicle accidents, horse rising, contact sports and bull riding among others(De Loose, 2008, p. 475). In order to avoid or to prevent neck pains for the patients, it is always essential to consider staying away from activities may twist the neck and subsequently aggravate the already painful section of the neck(Witt 2004, p. 99). In addition, it is also advisable to have activities that will enhance neck strengthening exercise, as well as neck bracing. Types of acupuncture used in the treatment of chronic neck pain Optimized acupuncture therapy   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Optimized acupuncture therapy in the treatment of chronic neck pain involves the utilization of traditional acupuncture, which is usually followed by intradermal needle therapy, commonly referred to as INT(Hush 2004, p. 1533). The use of OAT usually consists of the use of nine acupuncture points typically selected for an optimized acupuncture therapy group on the advice and consensus of the national expert committee of the OAT procedures. In this case, four points are subsequently located by physician intending to perform the OAT. The points selected are usually the cervical positive reactions planes found in the top and bottom of the cervical planes as well as horizontally away from the corresponding cervical vertebra(Witt 2004, p. 99). This type of acupuncture practice is highly sensitive and usually need to be performed by an individual with more than five of practice experiences. Sham acupuncture therapy   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Sham acupuncture therapy involves the use of skin penetrating shallow needles on the specified sham groups’ tender points.The tender points that are used in this method of acupuncture therapy are categorized as the key areas recommended for the acupuncture, which are the Ah Shee, also referred to as â€Å"oh yes point†. The points are crucial in this therapy and have to be used throughout the treatment procedure. Typically, the location of sham points is commonly defined by 25mm lateral extending to the standard location used for the OAT group.They include: the sham point of Dazhui (GV14) 25mm, which is 25 mm vertically below the usual standard GV14, sham points of (S115) Jianzhongshu and Huatuojiaji, which is 25 mm lateral to standard S115 (Liang et al, 8).After the sham acupuncture, individuals undergoing the process or patients are treated through the use of point pressing (De Loose, 2008, p. 475). Shallow acupuncture therapy Shallow acupuncture group undergoes similar procedures as the other OAT groups.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   However, the physicians are required to insert the needles in a vertical manner in order to reach the subcutaneous level at a specified depth of not more than 3 mm (Salter et al, 2004). Needle manipulation or any other sensation is prohibited in this particular group. Ultimately, after the shallow acupuncture, the patients are additionally treated by INT through the use of a similar method as in the other OAT groups. Physiotherapy versus acupuncture   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Zhuang (2012) compares the use of acupuncture and physiotherapy in the treatment of chronic neck pain in a research that took place in China. The research involved screening of a total of 310 patients. The patients were then randomly split into two equal groups, where one group was treated using acupuncture method, while the other group received treatment through physiotherapy. The outcome of the treatment of the two procedures revealed that patients treated under acupuncture procedures had better results in relieving neck pain, particularly after a period of three months.It is essential to acknowledge that physiotherapy is an alternative medical practice that can be used in the treatment of chronic neck pain. While acupuncture therapies generally used sterilizes needles that are usually inserted in the area around the neck depending on the type of acupuncture used, physiotherapy does not involve the use of needles. Physiotherapy utilizes several types of manipulation as well as exercise to relieve pain. The common illustration of the use of physiotherapy is the stretch, strengthen and straighten up exercise movements of the neck. Adverse event and acupuncture   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   White (2001) researched about the adverse events following a use of acupuncture to treat patients with chronic neck pain. In his survey, which included a prospective survey of 32,000 consultations with physiotherapists and doctors, the researcher, Adrian White aimed at ascertaining the incidence of adverse events that are related to acupuncture treatment, as practiced by British doctors during that time. The research utilized data that were collected for the June of 1998 to February of 2000, from a total of 78 acupuncturists. Altogether the resulting significant events were 43, subsequently giving only a rate of only 14 patients of the 10,000 patients included in the data. The results of this study showed that only 0.14 percent of the patients who used acupuncture in the treatment of chronic pain experience adverse events. All the adverse events were reported to have had cleared within the period of one week after the therapy. Similar dimi nishing events were characterized at a longer period, except foronly one incident that lasted for several weeks. The result derived from the data of acupuncture treatment did not report any serious adverse events. The rates can only be classified as minimal considering that it was only 14 adverse effects out of the total 10,000 patients who were analyzed with the data provided. Generally, these event rates do not give significant risk per individual patient. Physician views on acupuncture   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The article by Chen, L. et al., (2010), offers exclusive views on acupuncture given by various physicians. The research by Chen among other authors who contributed to the article, there study targets collecting information that addresses the role of acupuncture in the management of pain in regard to opinions of physicians who manage such conditions. The research was conducted between 2007 and 2008 using a nationwide e-mail to 1083 physicians who were in active acupuncture practice in the United States. Chan et al., (2010) found that the overwhelmingly majority of the responders of the survey had a positive attitude and favorable experience of the use of acupuncture as an alternative modality in the management of chronic pain. The results of the survey subsequently indicate that acupuncture is considered effective by physicians in the management of chronic neck pain. Discussion   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Chronic neck pain commonly occur as a result of a number of disorders, and diseases that in involve any of the tissues around the neck (Witt 2004, p. 99). The risk factors of this condition have also been linked tothe strains of the neck, injury of the neck such as the herniated disc, pinched disc, or whiplash, and degenerative disc disease. Additionally, chronic neck pain is also associated with to common infection like virus infection of the neck and lymph nope swelling, as well as other infections such as tuberculosis of the neck, meningitis, and infection of spine bones around the neck. Further, chronic neck pain is also found to be caused other different causes, which include physical injuries, some rare infections, and virus infections among others. Moreover, chronic neck pain is also caused by certain infections like virus infection of the neck and lymph nope swelling, as well as other infections such as tuberculosis of the neck, me ningitis, and infection of spine bones around the neck. Despite the different causes of the chronic neck pain, the use of acupuncture has subsequently been showcased as an ideal alternative medical procedure towards the treatment of this condition. The research shows that the three types of acupuncture are equally ideal in providing effective treatment for neck pain.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Although I extensively performed research on a wide range of databases, there are some articles that may have been missed out. Since I was individually conducting this research alone, it is possible that the large number of crucial articles were subsequently overlooked. In addition, there are many external factors that could have influenced the entire result of the use of acupuncture as an ideal treatment for chronic neck pain. The majority of studies slightly differs in a number of issues such as data collected, population, or any of combinations of these factors. White (2001) preciselyresearched about the adverse events following a use of acupuncture to treat patients with chronic neck pain, with an extreme number of respondents. Chen, L. et al., (2010), had a relatively smaller number of responders, and also had collection of data to be collected only through email in his research on the effectiveness of acupuncture in the management of chronic pain in the neck. These are some of the factors that were out of the scope of the research, hence determining the effectiveness of acupuncture was difficult, since the aspect of effectiveness could easily be isolated from some external factors.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The analysis of the specific information provided by the studies of the literature review of this research paper indicate that either of the three methods of acupuncture can effectively treat the chronic neck pain. The procedural practice of sham, shallow and optimized acupuncture, though different, they present similar way of performing the acupuncture therapy, equally offering effective treatment for chronic neck pain. Liang et al, (2012) asserts that the three types of acupuncture to be based on the thought that decrease or alienation of pain can be enhanced by releasing the chemicals responsible for blocking pain. Issues of age in the study have been considered as the research only focused on individuals between 21 years old and 55 years, as they are likely to have a faster period of healing as compared to adult elderly groups of more than 55 years old. Generally, the use of acupuncture is illustrated as effective as it has previously been used to treat patients with chronic neck pain.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The loopholes evident in the research include the possibility of a prior knowledge in determining the differences that may emerge upon consideration for gender in the treatment program. In the entire study, there is no single explanation of the ratio of females against the males in finding out the effectiveness of acupuncture treatment procedures. The study focused on a general perspective of patients with chronic neck pain regardless of their respective sex or gender. The knowledge of the differences that exist between males and females could have some effects on the understanding the use of acupuncture. In addition, the paper did not focus on the causes of the various neck pain, which could also compromise the results of the study, considering that such plans are typically attributed to a wide variety of causes.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Topics that can be considered for further research are establishing the element of gender in determining the effectiveness of acupuncture while treating chronic neck problem. The various studies illustrated in the research paper did not point out the importance of understanding differences in the healing process of male and female patients with chronic neck pain. I suggest a study be conducted with a major emphasis on the aspect of gender differences between patients in order to determine the effectiveness of acupuncture treatment for neck pain in male and female patients. If this study is conducted, it will be possible to compare the effectiveness of acupuncture treatment between male and female patients within the same health condition of chronic neck pain. References Blossfeldt, P. (2004). Acupuncture for Chronic neck pain: a cohort study in an NHS pain Clinic.22(3): 146-151. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/15551941Chen, L., Houghton, M., Seefeld, L., Malarick, C. & Mao. Jianren. (2010). A Survey of SelectedPhysician Views on Acupuncture in Pain Management. 11(4), 530-534 Salter, G.C, Roman, M., Bland, M. J & MacPherson, H. (2006). Acupuncture for chronic pain: apilot for randomized controlled trial. 7(1): 3-14 . Retrieved fromhttp://www.biomedcentral.com/1471-2474/7/99 Liang, Z. H., Di, Z., Jiang, S., Xu, S. J., Zhu, X. P., Fu, W,. & Lu, A. P. (2012). The optimizedacupuncture treatment for neck pain caused by cervical spondylosis: a study protocol of amulticenter randomized controlled trial. 13(1): 2-18 . Retrieved fromhttp://www.ncbi.nlm.nih.gov/pubmed/22776567 American Academy of Orthopaedic Surgeons. (2013). neck pain. Retrieved from http://orthoinfo.aaos.org/topic.cfm?topic=a00231Chen, L., Houghton, M., Seefeld, L., Malarick, C., & Mao, J. (2010). a survey of selected physician views on acupuncture in pain management. Pain Medicine, 11(4), 530-534. Retrieved from SPORTDiscus. De Loose, V., Burnotte, F., Cagnie, B., Stevens, V., & Van Tiggelen, D. (2008). Prevalence and risk factors of neck pain in military office workers. Military Medicine, 173(5), 474-479. Retrieved from Academic Search Premier. Hush, J. M., Michaleff, Z., Maher, C. G., & Refshauge, K. (2009). Individual, physical and psychological risk factors for neck pain in Australian office workers: a 1-year longitudinal study. European Spine Journal, 18(10), 1532-1540. Retrieved from Academic Search Premier. Irnich, D., Behrens, N., Gleditsch, J. M., Stà ¶r, W., Schreiber, M. A., Schà ¶ps, P., & †¦ Beyer, A. (2002). Immediate effects of dry needling and acupuncture at distant points in chronic neck pain: results of a randomized, double-blind, sham-controlled crossover trial. Pain (03043959), 99(1/2), 83. Retrieved from Academic Search Premier. Ji-Eun, P., Myeong Soo, L., Jun-Yong, C., Bo-Young, K., & Sun-Mi, C. (2010). Adverse Events Associated with Acupuncture: A Prospective Survey. Journal Of Alternative & Complementary Medicine, 16(9), 959-963. Retrieved by Academic Search Premier. National Center for Complementary and Alternative Medicine. (2012). Acupuncture: an introduction. Retrieved from http://nccam.nih.gov/health/acupuncture/introduction.htmNational Institutes of Health. (2013). neck pain. Retreived from http://www.nlm.nih.gov/medlineplus/ency/article/003025.htmRobertshawe, P. (2008). acupuncture and physiotherapy for neck tension. Journal Of The Australian Traditional-Medicine Society, 14(3), 187. Retrieved from Academic Search Premier. Sun, M., Hsieh, C., Cheng, Y., Hung, H., Li, T., Yen, S., & Huang, I. (2010). The therapeutic effects of acupuncture on patients or individuals with chronic neck myofascial pain syndrome:: a single-blind randomized controlled trial. American Journal Of Chinese Medicine, 38(5), 849-859. Retrieved from Academic Search Premier. Vas, J., Perea-Milla, E., Mà ©ndez, C., Navarro, C., Leà ³n Rubio, J., Brioso, M., & Obrero, I. (2006). Efficacy and safety of acupuncture for chronic uncomplicated neck pain: A randomised controlled study. Pain (03043959), 126(1-3), 245-255. Retrieved from Academic Search Premier. White, A. (2001). Adverse events following acupuncture: prospective survey of 32,000 consultations with doctors and physiotherapists. 10(1), 3-14 Retrieved from BMJ Research Articles Willich, S. N., Reinhold, T., Selim, D., Jena, S., Brinkhaus, B., & Witt, C. M. (2006). Cost-effectiveness of acupuncture treatment in patients or individuals with chronic neck pain.Pain (03043959), 125(1/2), 107-113. Retrieved from Academic Search Premier Witt, C. M., Jena, S., Brinkhaus, B., Liecker, B., Wegscheider, K., & Willich, S. N. (2006). Acupuncture for patients or individuals with chronic neck pain. Pain (03043959), 125(1/2), 98-106. Retrived from Academic Search Premier. Source document

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