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Service Improvement Project to Improve the Use of Continence Pads on Elderly Patients

Share this: Facebook Twitter Reddit LinkedIn WhatsApp A service improvement project to improve the use of continence pads on elderly patients in an acute hospital setting using DMAIC Contents Introduction Ethical Considerations Context of the Problem Project aims and objectives Background Literature Reasons for Improvement / Patient Safety and Quality DMAIC/ Service improvement Methodology Define Measure Analyse Improve Control Lean Methodology Conclusion REFERENCE Introduction This proposal is looking for an improvement in the use of continence pads on elderly patients who are suffering from Urinary Incontinence (UI). Incontinence predicament was viewed by Ostaszkiewicz, Tomlinson and Hutchinson, (2018); British Association of Urological Surgeons (2018) and Abrahams et al (2010) as occurring when the bladder and bowels are incapable of controlling excretions. Incontinence was identified by the International Continence Society (2015a) as predominate to adults aged 65 years and above and also to those suffering from chronic disease, neurological disorders such as multiple sclerosis, Parkinson’s disease, strokes, and brain or spinal injuries. Numerous researches were carried out in recent years to determine continence care and issues related to UI. In respond towards UI, the Department of Health (2018) advocated for collaborated support from healthcare practitioners in the form of advice, incontinence absorbent products, and proper management use of continence pads. Thus, the need to improve the use of continence pads to elderly patients suffering from UI motivated the researcher to carry this proposal. Ethical Considerations Ethics means moral criterions that help to protect patients from physical, mental harm and abuse, (Creswell, 2010). Best and Khan (2011) further defines them as guidelines that distinguish between acceptable and unacceptable behaviour in a research study. Ethics promote mutual understanding between the researcher and participants, and there enabled the researcher to report fairly and accurately participant’s opinions without personalised bias. Israel and Hay (2006) and Carvalho, Reeves and Orford (2017) argued that adherence to ethical considerations helps to maintain informed consent, anonymity, confidentiality, objectivity, integrity, respect for intellectual property and human subjects protection, (see Appendix 1).The Nursing and Midwifery Council (NMC) (2015) viewed respect for people’s dignity as a fundamental expectation that should be adhered by healthcare practitioners as stipulated under the core values of the National Health Service (NHS) standards in UK. Context of the Problem The milieu problem identified is based on the improvement of continence pads to the elderly patients who are suffering from UI placed in acute hospital using DMAIC. During his placement at an acute hospital, the researcher observed adult patients wearing continence pads which they do not have need of and some wearing mistaken sizes. Chu-Yun, Shang-Qun and Chang-De (2017) observed UI condition as normal to the old aged and was viewed to be characterised with stigmatisation as well as unreported, under-diagnosed and under-treated scenarios. Goksin and Asiret, (2018) further argued that UI occur to women due to related changes that occur to them during pregnancy and childbirth. According to the International Continence Society (2015b), people aged 65 years were viewed to constitute a large number of acute hospital patients suffering from UI with a percentage of around 20-42%. In support of the above, Newman, Rovner and Wein (2017) observed the complications of UI as leading to skin problems that can be noticeable as rashes, skin infections and moisture ulceration. On the other hand, Ebrahimi and Chapman (2018) viewed strain in relationships, low mood, job difficulties, and difficulty participating in daily activities, social isolation, anxiety, social exclusion and depression as results of socio-psychological consequences of incontinence. The aforementioned challenges associated with UI, led to the promotion and use of other incontinence products such as pads. The researcher was motivated by the need to improve the quality of different forms, shapes and sizes of continence pads so as to control effectively UI amongst the elderly patients placed in acute hospitals. Project aims and objectives The main aim seeks to improve the use of continence pads on elderly patients in an acute hospital setting using DMAIC. Continence pads were observed by the researcher to be in different forms, sizes and shapes at which the elderly patients sometimes found it difficult to wear them. Hence, the need to rectify this problem by improving their sizes, shapes and forms so as to best suit each individual patient. The following objectives were looked at; Ascertain the ways to improve the use of continence pads on elderly patients in an acute hospital setting using DMAIC. Scrutinize the occurrence of continence pad mismanagement amongst elderly patients in an acute hospital settings using DMAIC. Suggest possible improvements that can be made on the size, form and shape of continence pads on elderly patients suffering from UI in an acute hospital settings using DMAIC. Background Literature Numerous studies were conducted in order to understand the various challenges faced by people with incontinence problems. Ostaszkiewicz, Tomlinson and Hutchinson (2018) looked at the problems of incontinence and how to enhance quality continence care. Their study surveyed 447 hospitalised adults and found out ‘dignity’ and ‘quality continence care’ as the effective ways to address incontinence problems. Dignity was viewed by Ostaszkiewicz, Tomlinson and Hutchinson (2018) to be widely used in the nursing field as it helps health care practitioners to adhere to privacy laws and legislative guidance found in health and social care settings, whilst ‘quality continence care’ was viewed to be of paramount importance in trying to maintain desired standards amongst health practitioners in acute care settings (NMC, 2015). More so, their study was considered to be a ‘central construct’, primarily based on subjective ideology. Ostaszkiewicz, Tomlinson and Hutchinson (2018) study was conducted in Australian home care based settings. To bridge this gap, this proposal looked at how to improve the use of continence pads on elderly patients in acute UK hospitals using DMAIC. Another study carried out in England by Orrell et al. (2013) examined views on strategies to manage and enhance the quality care for older people with UI. Their study revealed the failure by health care professionals as the major blockade in recognising the problems associated with UI and to acknowledge different attitudes and perspectives on incontinence. The study provided crucial information in understanding incontinence management and the related barriers faced in achieving continence pads use amongst the elderly suffering from UI. Orrell et al. (2013) sampled 16 continence care services (3 acute care trusts and 13 National healthcare trusts) using a qualitative paradigm, semi-structured interview and a purposive sampling method. To show methodology gap, this proposal adopted a mixed research approach using a case study design and a purposive sampling method. More so, Myint et al. (2008) carried out a study in UK to examine the relationship between cognition, continence and transfer status of patients suffering from stroke from the time of discharge and discharge destinations. The study found out that stroke is a major chronic illness predominated by older people and is largely associated with morbidity and disabilities. Myint et al (2008) longitudinal study deals with stroke admission cases from 1997 to 2003 and it targeted a population catchment area of about 568,000. Their study indicated that a total of 2,521 people discharged from acute care hospitals, who had suffered stroke related conditions showed signs of confusion, UI and further intensity signs of incontinence. A review of studies by Payne (2015) on the causes, challenges and effects of UI which put forward continence assessment strategies for selecting incontinence pads for a person and the problems coupled with the use of incontinence pads; found out community nurses as playing a critical role in selecting appropriate absorbent incontinence pads for patients who suffer from UI. Payne (2015) observed various types of pads which can be used by patients with different UI conditions. These pads were found to be chosen based on the pad’s absorbency and the patient’s lifestyle. Payne’s (2015) research concluded good incontinence management as a solution to restoring UI in patients, dignity and wellbeing. Nichols and Layton (2012) also carried out a study in order to discover closely the lifestyle management for those with UI. Patients with UI were assessed in terms of their daily impact of urinary incontinence, management techniques and life issues. The study used a systematic approach in selecting participants who were seeking clinical help for UI and it was open to individuals above 18 years. It was revealed by Nichols and Layton (2012) that of the 374 adult respondents, 63 percent were male with a median age of 52.5 years and 37 percent were female with a median age of 56 years. The findings revealed that 8-43% prevalence of incontinence were predominated by sampled male population which was increasing by age. Furthermore, Nazarko (2015) in her study entitled, ‘Use of Continence Pads to Manage Urinary Incontinence in Older People’, examined how nurses and healthcare professionals promote the use of incontinence pads to patients with UI. The use of incontinence pads was revealed to minimise the risks of skin damage, odour, embarrassment and leakage. Nazarko (2015) further observed that it is imperative to promote equally continence management with incontinence sensitively so as to maintain a strong person’s dignity. This was revealed to avoid complications of UI. Nazarko (2015) study collaborates with a study carried out by Dingwall (2008), who assured the design of continence pads as being adept to contain urine, maintain dignity and prevent clothing, furniture, and bedding from becoming wet. The study by Dingwall (2008) further reported that continence assessment helps the nurse to determine if the patient has mild, moderate, or severe incontinence as provided by the Bowel and Bladder Service. Moreover, a qualitative study by Brady et al. (2016) which investigated the patients’ and nursing staff’s perspectives on implementing continence care for patients after a stroke; the following themes were observed, communication about continence, mixed perceptions about continence, ambiguities, continence issues and inconsistence involved in continence care decisions. Patients were revealed to give meaningful severity of their urinary incontinence. On the other hand, staff members who were interviewed described the lack of knowledge on UI as a result of staff failure to be trained. They also enclosed continence interventions and emphasised the development of nurse-led initiatives to reduce the incidence of unnecessary catheterisation among patients admitted to the wards. Semi-structured interviews were used to collect data which include 15 patients, 14 nurses and 9 nursing assistance using grounded theory. The study was conducted in a mixed acute and rehabilitation stroke ward setting. The study concluded that there are limitations in access to continence care equipment and products to contain incontinence. This motivated this researcher to propose a study which shall look at how to improve the use of continence pads on elderly patients in an acute hospital setting using DMAIC. Reasons for Improvement / Patient Safety and Quality In healthcare practices, quality care is defined by DH (2018) as a suitable dimension of health care provisions so as to fulfil patient’s needs. Puri and Spevetz (2018) further supports that improvement of patient’s quality had a positive impact on their safety. Patient safety was defined by WHO (2011) as a way of error avoidance that might harm patients. NHS England (2013) further viewed patient’s safety as aimed at avoiding unintentional injury to the patients for the duration of the deliverance of care. Wachter (2012) and WHO (2011) viewed harm as having negative impact on patient’s health and can even cause death. Injuries that led to patient’s harm were observed by Watcher (2012) and WHO (2011) to be caused by healthcare staff’s incompetence’s. Thus, healthcare workers have a pivotal mandate to exercise cautiously their duty so as to minimise patient’s harm. Sammer (2010) states that healthcare workers need to come up with reliable ways to improve patients’ safety and quality. DMAIC/ Service improvement Methodology Define Measure Analyse Improve Control (DMAIC) methodology was viewed by Morgan and Brenig Jones (2016) to be widely used in service improvements practices which are based on quality care and well-being of patients. DMAIC is known for being an investigative methodology following Lean Six Sigma (Hylton, 2017). Morgan and Brenig-Jones (2016) defined DMAIC as a configuration of better current healthcare practices. In support, Gupta and Saini (2018) noted that DMAIC methodology is adopted to classify improvement’s prospects. The need to improve the use of continence pads on elderly patients in acute hospitals is reviewed in this proposal project. Although DMAIC was discovered by Morgan and Brenig-Jones (2016) to be difficult and takes a long time to complete the project; he suggested the need to take seriously healthcare schemes so as to sustain improvement. DMAIC use in improving patient’s quality care and well-being was observed by World Health Organisation (WHO) (2017) to be at the centre of NHS and is critical in the healthcare system. Patient’s safety was further supported by Lord Darzi (2008) as being achievable through uninterrupted development of proper provision of quality care. Quality was viewed by the Department of Health (DH) (2018) as attainable once there is clinical effectiveness, public backing and patient attachment. Sale (2005) further pinpointed out the embracement of clinical governance in order to perfect quality, preservation, specialised responsibility as well as maintaining a safe and sound setting for shareholders over an unconcealed and direct way of life. Phases of DMAIC Control Morgan and Brenig-Jones (2016) Define The first phase of DMAIC is the definition, identification of the problem and the setting of goals to eradicate the problem setting. The define stage layout the breach in quality and articulate the purpose of this service proposal (Minami et al. 2016). The setting of improper use of continence pads was identified as a problem and therefore need to improve the use these continence pads which are found in different shapes, sizes and forms on elderly patients in acute hospitals. The aims and objectives of the DMAIC methodology were viewed by Minami et al. (2016) to be identified in this first stage. Doctors, healthcare assistants, nurses, manager and deputy manager shall be involved in this service improvement proposal. Their inclusion as revealed by NHS IQ (2010) help to reduce delays in the improvement proposal. Thus, the aforementioned healthcare practitioners shall make concrete decision making on how to improve the use of continence pads to elderly patients in acute hospitals. Measure The second phase deals with measurements of the outcomes of the problem identified, (Morgan and Brenig-Jones, 2016). In addition, Langley et al. (2009) indicated that measurements are required to have an insight on the impact of change. The frequency taken by nurses to change the elderly patients with continence pads shall be recorded. Also the unwillingness and difficulties faced by the elderly patients in using continence pads shall be recorded so as to find out the severity of the problem so as to improve its proper use. Analyse The third phase includes the analysis of the problem identified. According to Morgan and Brening-Jones (2016) the analysis stage entails detection of the cause of the problem by means of confirmation of measurements. Moreover, Minami et al. (2016) further states that this stage authenticates and seek out to comprehend the origin of the problem from the data that was collected. The continuous data is going to be analysed using quantitative analysis methods such as the mean and standard deviation. Frequencies are going to be used for nominal data. The researcher shall use a Chi-Square for associations between the presence of nursing record entries on UI and elderly patients’ who wishes to improve their condition. Their association shall be based on whether their unwillingness and difficulties in using continence pads differed regarding their willingness to be questioned about UI, and their preference to be questioned about their condition. Logistic regression shall be used in this proposed study so as to control gender and unit. This shall be supported by the Fisher’s exact tests and SPSS version 11.0 (SPSS Inc., Chicago, IL, USA) for the purpose of analysing the collected data. Improve Another phase is that of improve. According to Langley et al. (2009) having identified the problem, methodology and analysed the problem at hand; practical knowledge become imperative in service improvement as follows: ● Need to improve size, shape and form of continence pads This entails the need to correctly supply the correct size, form and shape of continence pads to the elderly patients who suffer from UI. This will go a long way in helping to avoid improper use and unwillingness as well as difficulties that can be faced by the elderly patients in wearing continence pads in acute hospital settings. According to the NHS England (2015-2018) nurses have a responsibility to continuously maintain proper use of continence pads to the elderly patients as recommended in the good practises for healthcare professionals. ● Designing a poster that prompt and remind nurses and patience to take proper use of continence pads in acute hospital settings. A poster was viewed by El-Sharkawy et al. (2014) as helping to remind nurses to keep proper care use of continence pads to patients with UI. ● Taking regular check-ups to change continence pads to the elderly patients with UI. Control The last phase stage focuses mainly on ways to maintain sustainable improvements made (Morgan and Brenig-Jones, 2016).The way to sustain and control improvements was considered by Morgan and Brenig-Jones (2016) to be useful in the healthcare fraternity so as to regularly check the use of continence pads to the elderly patients in acute hospital’s assessment amongst staff and patients. Lean Methodology Lean Six Sigma was viewed by Stamatis (2011) to be used mainly to eradicate any flaws in healthcare settings. The aim being to trim down medical mistakes, reducing death toll and recuperating quality and patient care (Stamatis, 2011). Search Strategies Various resources and viable literature were viewed to be available within healthcare and clinical databases which include Pub Med Health, CINAHL, and Cochrane. The following keywords were chosen for the purpose of this proposal, continence pads, Urinary Incontinence (UI), pads mismanagement, continence products, managing incontinence and acute hospital care. A case in point, a keyword look for ‘incontinence’ problem on CINAHL yielded 795 papers. The periphery of inclusion years in the search criterion were documents published between 2014 and 2018. A Boolean search on ‘managing incontinence’ brings up 513 documents on Pub Med Health. Also, the key phrase ‘urinary incontinence’ was sprint on Cochrane where it gives in 195 documents and on CINAHL, giving in 85 documents that corresponding to the peer-reviewed criterion. Conclusion Evidence gathered from various studies carried out on UI has shown out that there are a multitude of issues associated with continence pad management in acute care settings. The old aged patients were revealed to be at high risk of incontinence problems especially women and those who have suffered from chronic ailments (Office for National Statistics, 2017).Related literature findings have revealed the importance of giving a choice to patients when it comes to choosing their desired continence products, such as pads. That is the choice of absorbent incontinence products used. Management and proper use of continence pads enables patients to maintain dignity and avoid the complications of poorly managed UI. Thus, continence pads assessment is imperative to enable patients chose the most appropriate type of continence pads to minimise risks of skin damage, odour, embarrassment, leakage and avoid difficulties and unwillingness to wear them. (3,135 words) REFERENCES Department of Health (DH) (2010) The NHS Quality, Innovation, Productivity and Prevention Challenge: An introduction for clinicians. Available at http://somaxa.com/docs/file/QIPP_2010.pdf (Accessed 30 March 2018). DH (2013) Health Building Note 04-02 Critical care units. Available at:https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/147865/HBN_04-02_Final.pdf (Accessed 30 March 2018). DH (2015) NHS hospital stay. Available at: https://data.gov.uk/data-request/nhs-hospital-stay (Accessed 02 April 2018). El-Sharkawy et al (2014) 118hydration in the Older Hospital Patient – Is It a Problem? Age Ageing 43(suppl 1): i33–i33. doi: https://doi.org/10.1093/ageing/afu046.1 Hylton, L. C. (2017). Improving learning center usage verification processes using Six Sigma Johnstone, ( 2014). Nurses’ experiences of ethical preparedness for public health emergencies and healthcare disasters: a systematic review of qualitative evidence. Nursing
Growth is a universal element of all living things. Amid the cycle of human growth is environmental evolution, improved awareness to surroundings, and self-realization. Throughout the movie, E.T.- the Extra-Terrestrial , we witness the growth and development of Elliott, a pre-teen human and E.T., an alien. They stand in silence observing the sharpness of their physical differences. The division within this scene mirrors the perceived dichotomy between aliens and humans. Elliott touches his nose and E.T. does the same. Elliott makes a sound and E.T. repeats the sound. These scenes are symbolic of the self- discovery that occurs during infancy. E.T. is an allegorical depiction of Cohen’s monster theory using the themes of discovery, love and loss and difference. A prominent theme in the movie, E.T. – the Extra-Terrestrial is love and relationships. The two main characters, Elliott and E.T., share the ultimate friendship bond. At similar stages in their development, the characters realize that they are sharing new experiences together, the realization of which solidifies this bond. E.T. shows his profound love and commitment to the bond when he breaks his connection with Elliott, despite the fact that it implies that he may die. Elliott shows his commitment to the bond when he persuades his brother to partner with him to save E.T. from government officials who want to exploit the alien for research and profits. The relationship between the E.T. and Elliot is based on reciprocity which breeds love. The concepts of love and sacrifice are closely related and are featured consistently throughout literature. In many works of literature, we witness the times where love requires sacrifice. In the classic William Shakespeare play, Romeo and Juliet, the main characters each sacrifice the security of their aristocrat families to become married. The love and sacrifice theme in the film is also shown through E.T.’s mother. She is recently divorced and raising three children alone. The mother is shown crying over the divorce in an opening scene with Elliott and his siblings. Elliot’s mother uses sarcasm to suggest that he call his father, who abandoned the trio for another woman. She is surprised when Elliott responds, “I can’t call him, he’s in Mexico with Sally”. Elliott’s mom is visibly upset and leaves the table in tears. Ironically, this is one of few scenes in the film when the mother is upset. Her character is mostly pictured emitting positive emotions – when she is reads a bedtime story to her daughter and when the kids get dressed to go trick or treating- the loving mother traditional gender role does not go unnoticed. This implies that Elliott’s mother sacrificed her marriage. The love of her family and children compensates for the sacrifice. Labeled as one of the original modern science fiction films, there are strong elements of Cohen’s monster theory present in the film E.T (Ebert). The theory is best observed through a character analysis of Elliott. Elliott showed strong emotions of love for E.T. the first time they met. This is analogous to the fourth principle of Cohen’s monster theory which states that “The Monster Dwells at the Gates of Difference”. It explains that the monster is difference made flesh that comes to dwell among us. It represents the “Other,” the “Outside,” from what is culturally normative. (Kim) The irony of monstrosity in E.T. is that we witness two aliens as monsters, both the character, E.T., and Elliott. Elliott instantly embraced E.T.’s otherness which became a detriment to his credibility as a normal human. Why was Elliott not skeptical of E.T.’s differences? The question remains unanswered in the film; however, it is evident that Elliott’s assimilation with the alien culture led to his ostracism from humans. And although E.T. and Elliott are from different backgrounds, they are bound together as friends and also by their characterization as outsiders. E.T. is mistakenly left alone to experience life amongst humans when his spaceship ascends into the sky carrying his remaining family of aliens. Elliott feels alone although he is among family due to the absence of his father in the home. E.T. represents all of the most effective components of being a child, like discovery, wonder, and feeling. When E.T. leaves and Elliott stays, it suggests that Elliott is able to take the experience and knowledge that E.T. imparted and begin transitioning into a young man. (Ebert). The transition into adulthood is an inevitable aspect of life. Like many life transitions, the human response is dependent on environment and previous experiences. Elliott’s coming of age symbolized the human emotional responses of love, discovery and acceptance. Works Cited E.T. – the Extra-Terrestrial. Dir. Steven Spielburg. 1982. TV. Ebert, Roger. Roger and Ebert. 22 March 2002. Article. 9 August 2019. Kim, Yeon. 13 February 2017. UMMARY OF MONSTER CULTURE (SEVEN THESES) BY JEFFREY JEROME COHEN. .
Health Sciences homework help. This is a paper that focuses on the Development of Learning Curve Calculator Tool for MS Excel. The paper will identify the steps involved in the development process.,Development of Learning Curve Calculator Tool for MS Excel,Firstly, ensure you have viewed: Learning Curve Calculator (Setting up Excel Spreadsheet for Cumulative Average Model, Formulas) (,https://www.youtube.com/watch?v=R8mIkaCb38s,).This video demonstrates how to setup a Cumulative Average Model calculator in Excel. Then, complete the tasks for this activity.,Secondly, this activity addresses the following Module Outcome:, ·        Differentiate between alternative business processes utilizing the Plan-Do-Check-Act (PDCA) cycle, and various performance measures.(CO#1, CO#4),Thirdly, view the Learning Curve Calculator video. This video demonstrates how to set up a Cumulative Average Model calculator in Excel. Then, complete the tasks for this activity., TASKS, 1.     Create a Learning Curve Calculator similar to the one shown from the video Learning Curve Calculator., 2.     Create a graph of Unit Cost versus Unit Number (displaying Learning Rate) for an initial unit cost of $100 and a production run of 1,000 units. Learning rates should vary from 60% to 100% and should use increments of 5%. Also, ensure you label the x- and y-axis and provide a graph title. Lastly, the graph should be in its own worksheet. For help with moving the graph to a new sheet, go to How to Move a Chart onto a New Sheet in Excel.,3.     Using the same data from question 2 (above), graph the Cumulative Total Cost versus Unit Number. Then, select two learning rates (Option A and Option B). Answer the following questions:, a.     If each 5% increment of learning rate costs $1000, which option (A or B) would result in a low cost (Cumulative cost for 1,000 unit run added to the learning rate cost)?, b.     Does your answer change if your production run is 50 units and the learning rate cost is a one-time cost? Additionally, explain why or why not., c.      Explain how you could use the PDCA cycle to reduce the Cumulative Total Cost. Also, what are the tradeoffs to reducing Cumulative Total Costs?Health Sciences homework help
Share this: Facebook Twitter Reddit LinkedIn WhatsApp Understanding diversity in beliefs about health Getting your child vaccinated is a choice every parent has to make. There are many attitudes, beliefs and perspectives on the topic. This essay will be comparing and contrasting these views between the two groups of parents, those being the ones that decide to fully vaccinate their children and those that put off certain vaccines or don’t vaccinate their children at all. The majority group of 90.1% of parents in Australia decided to have their children fully immunised, with the remainder being the parents that choose to refuse certain or all vaccines (A. G. o. h. (2014)). Reasons for different attitudes leading to these decisions can range from the medical to the religious reasons (Douglas S. Diekema, M. D., M.P.H. (2012)). Recommendations and education about immunisation usually happens through the parents doctor or physician, since it is seen in the medical community as a big problem that parents don’t vaccinate their children (Douglas S. Diekema, M. D., M.P.H. (2012)). In some countries such as Canada it is mandatory to vaccinate your child, but in countries like Australia and the US the choice is up to the parents (Walkinshaw, E. (2011))(Douglas S. Diekema, M. D., M.P.H. (2012)). This decision a parent can make for the child can have lasting effects into adulthood and with recent recurring outbreaks of diseases like whooping cough, there is a lot of stigma surrounding the topic (Walkinshaw, E. (2011)) . A vaccination is a medical procedure where a person is injected with a substance which can prevent illnesses and diseases being caught or spreading (Shetty, P. (2010)). Parents give their children shots for each disease and a few single diseases need multiple shots just for themselves (Pediatrics. (2011)). Such diseases that children might get vaccinated for would be polio, influenza virus and the measles (Douglas S. Diekema, M. D., M.P.H. (2012)). Most parents vaccinate their children (A. G. o. h. (2014)). But there is also a high number of the population which refuses to receive their vaccinations, mainly because of skepticism (Walkinshaw, E. (2011)). This is apparent even though many doctors such as Dr Ian Gemmill try to put across messages like “Immunizations are the safest, longest-lasting and most effective ways to prevent communicable diseases” (Walkinshaw, E. (2011)). Although this is the majority of the attitudes between health care occupations, surveys show that health workers still remain divided on this issue, with a â…“ of emergency nurses in one survey expressing that they had concerns and didn’t fully trust the idea of immunizations and what the risk of side effects would be for themselves (Mary Ann Bell, P., Joseph A. Dake, James H. Price, Timothy R. Jordan, Paul Rega. (2012)). Doctors like Dr Gemmill emphasise their point by referring to statistics of immunizations, comparing disease related death from before vaccinations to after (Walkinshaw, E. (2011)). While Edda West, the coordinator of the Vaccination Risk Awareness Network has the counter argument that, a medical procedures that’s as invasive as vaccinations will always carry a risk of injury or death and this should be taken into consideration by the patients parents (Walkinshaw, E. (2011)). Also saying that many health professionals are persuading parents and not educating them about the fact that they themselves have a choice (Walkinshaw, E. (2011)). Vaccinations have health groups divided but in the end it is up to the parents and their choice in end. Vaccines overall have strong effects on the health industry (Douglas S. Diekema, M. D., M.P.H. (2012)). Parents that have their children vaccinated Parents can have a positive attitude about vaccines for a number of reasons. Most parents know about the certain diseases that could be fatal for their babies (Dannetun, E. T., Anders ; Giesecke, Johan. (2007)). Vaccines have demonstrated to have positive effects in solving this problem and this is the main motivation for most parents to have their children immunized (Dannetun, E. T., Anders ; Giesecke, Johan. (2007)). Most parents don’t give it a second thought since vaccines are widely accepted and promoted in today’s society (Douglas S. Diekema, M. D., M.P.H. (2012)). It is given out through schools and some schools even require children to be vaccinated before they can be accepted into a school (Douglas S. Diekema, M. D., M.P.H. (2012)). So one of the big influences on the beliefs of parents that are pro-vaccination come from the General health community and the government (Dannetun, E. T., Anders ; Giesecke, Johan. (2007)). The World Health Organisation (WHO) says that it wants most countries to vaccinate all their children (Dannetun, E. T., Anders ; Giesecke, Johan. (2007)). These groups push vaccinations by the parent receiving the advice from a health professional, or having the parents children face restrictions in the future like not being able to attend a certain school (Douglas S. Diekema, M. D., M.P.H. (2012)). Parents might get the feeling that they are obligated to vaccinate their child, they want the best for their child and the education they receive when looking for professional advice it leads parents to a pro-vaccination standpoint (Walkinshaw, E. (2011)). Another thing pro-vaccination attitudes are pushed with would be the parents own fear for their child (Mary Ann Bell, P., Joseph A. Dake, James H. Price, Timothy R. Jordan, Paul Rega. (2012)). Children are always at risk of getting sick, spikes in diseases like whooping cough occur in populations unvaccinated and babies die from this ((RCN), R. C. o. N. P. C. (2012)). Naturally, occurrences like these influence parents that might have not have been pro vaccine to maybe change their view. Pertussis vaccination is one of the most common and outbreaks among the unvaccinated community are not uncommon ((RCN), R. C. o. N. P. C. (2012)). Parents who are worried and don’t want to put their children at risk will mostly seek the simpler solution to ensure the safety of their child and that’s to vaccinate (Douglas S. Diekema, M. D., M.P.H. (2012)). The fear factor also leads to some pro-active attitudes to pro-vaccination. This is especially apparent in developing nations, where vaccines are on high demand and support from the government is lacking (Blecher, M. S. M., Filip ; Kollipara, Aparna ; Hecht, Robert ; Cameron, Neil A. ; Pillay, Yogan ; Hanna, Luisa. (2012)). There is a high burden of disease in places such as South Africa with high death rates due to preventable diseases such as pneumococcal and rotavirus (Blecher, M. S. M., Filip ; Kollipara, Aparna ; Hecht, Robert ; Cameron, Neil A. ; Pillay, Yogan ; Hanna, Luisa. (2012)). People of the pro-vaccine attitude might go as far to fund charities to distribute to poorer countries, with the intention that it will allow children in developing nations to receive vaccines. The most notable donator being Bill Gates, a parent himself donating $2Billion of his fortune in 1999 to vaccine distribution, his contribution has allowed many parents in poor countries to have better access to vaccines for their own children. More has been donated since (Economist, T. (1999, 5 Nov)). These actions all stem from their attitudes to vaccinations, believing that more vaccines, means less death or injury. Parents that don’t want their children to be vaccinated Children that don’t get vaccinated are said to be put at risk of coming down with a deadly illness (Douglas S. Diekema, M. D., M.P.H. (2012)). Parents are of the anti-vaccine attitude, believe that they are doing better for their child because of their own reasons or lifestyle choices (Shetty, P. (2010)). Something that could have parents take an anti-vaccine opinion, could be for non-medical reasons like the family religion or philosophical reasons (Shetty, P. (2010)) (Douglas S. Diekema, M. D., M.P.H. (2012)). But the majority of parents that don’t vaccinate their children have reasoning mainly due to their own skepticism about the vaccine shots and their possible side effects (Shetty, P. (2010)). Parents say that they don’t want their children to be exposed to “unnecessary toxins” (Shetty, P. (2010)). The risks and benefits of vaccines are weighed up by parents, it is alleged by some anti-vaccine groups that immunisations can be linked to other diseases such as autism or multiple sclerosis (Shetty, P. (2010)). The number of people with this attitude is rising globally, it is said that anti-vaccination groups would only be localised to specific areas in developed nations (Shetty, P. (2010)). But with the rise of the internet and social networking, the idea of greater safety from no vaccines in becoming to be known in more developing nations like India (Shetty, P. (2010)). Paul Offit, the chief of infectious diseases, says that many parents aren’t fully educated about vaccinations and that they shouldn’t buy into the anti-vaccination lobbies which said to basically that “vaccines are the devil” (Shetty, P. (2010)). It is also said that a possible reason for people to have this point of view is because people can see an association between, the drop in illness levels, while the rate of people that encounter either real or perceived side effects goes up (Shetty, P. (2010)). Doctors are expected to fully educate parents about such subjects, because of common misconceptions about statistics which might influence their standpoint, so parents can make a fully informed decision. Comparisons One of the similarities these two groups share is that their actions are driven by fear (Shetty, P. (2010)). Whether it be the fear of losing your child via a sickness, or the fear of the idea that they will be exposing their children to “biologicals of unknown toxicity” (Douglas S. Diekema, M. D., M.P.H. (2012))(Shetty, P. (2010)). Both parties want the best for their children. Governments are constantly pushing vaccinations (Economist, T. (1998, 5 Nov)), and Health professional anti-vaccine groups are more vocal about parents not being educated about their choice and not being able to exercise their freedoms (Shetty, P. (2010)). Parents that are anti-vaccine seem to be more scared of the side effects of the vaccine than the actual disease (Shetty, P. (2010)). Doctors of the pro-vaccination standpoint do express that there are vaccines that children might not need, but vaccines like Hep B are a must (Shetty, P. (2010)). This appeals to many parents that might be on the fence about vaccinations, there is an appreciation for a middle ground between that two population groups (A. G. o. h. (2014)). There are a lot of diseases to vaccinate against (A. G. o. h. (2014)). Parents that are of the pro-vaccination standpoint may hold off on a certain vaccine if it doesn’t seem needed, until they decide they might want to go traveling with their children, to a place where it is needed, causes for this behaviour can be linked to someone’s financial standpoint (C, H. A. E. W. R. E. I. S. N. K. M. (2012)). The same idea applies for parents of the anti-vaccination standpoint, if there is an outbreak of a disease such a pertussis in the area where they live, some parents would be happy to makes sure that their children got a shot in that circumstance ((RCN), R. C. o. N. P. C. (2012)). Impacts on Health The main population group that affects the health community are the parents which don’t decide to vaccinate, hence why doctors push it to their patients so strongly, because it is said to cause preventable traffic in the health system (Douglas S. Diekema, M. D., M.P.H. (2012))(A. G. o. h. (2014)). With more and more parents not vaccinating their children, they are pushing beyond the safe number of what’s called the herd immunity (Douglas S. Diekema, M. D., M.P.H. (2012))(Shetty, P. (2010)). Herd immunity is based off the notion that it is safe to have a small amount of children in one area that are not vaccinated, but if there is a number of children not vaccinated in the same neighbourhood then outbreaks are more likely to occur (Shetty, P. (2010)). Vaccines are also expensive though (Blecher, M. S. M., Filip ; Kollipara, Aparna ; Hecht, Robert ; Cameron, Neil A. ; Pillay, Yogan ; Hanna, Luisa. (2012)). If everyone was anti-vaccine then it would free up expenses which could be used for arguable more important aspects of health (Blecher, M. S. M., Filip ; Kollipara, Aparna ; Hecht, Robert ; Cameron, Neil A. ; Pillay, Yogan ; Hanna, Luisa. (2012)). Poorer countries need to accommodate as the demand for vaccines rises, putting more strain on their current health systems (Blecher, M. S. M., Filip ; Kollipara, Aparna ; Hecht, Robert ; Cameron, Neil A. ; Pillay, Yogan ; Hanna, Luisa. (2012)). Conclusion Vaccinations are one of the many choices parents get to make for their children and any subject relating to life or death is going to be touchy. Although there are some countries such as slovenia that don’t allow for the freedom for parents to choose, with other countries like canada looking to do the same (Walkinshaw, E. (2011)). Mainly due to strong advocacy from the health systems as a whole (Douglas S. Diekema, M. D., M.P.H. (2012)). In the nations where you are allowed choice, doctors try their best to make sure parents are fully educated on the matter so there is less of a chance that parents make their decisions for the wrong reasons (Douglas S. Diekema, M. D., M.P.H. (2012)). References A. G. o. h. (2014). Australian Childhood Immunisation Register (ACIR) statistics. Retrieved 06/03, from https://www.medicareaustralia.gov.au/provider/patients/acir/statistics.jsp Blecher, M. S. M., Filip ; Kollipara, Aparna ; Hecht, Robert ; Cameron, Neil A. ; Pillay, Yogan ; Hanna, Luisa. (2012). Financing vaccinations – The South African experience. Vaccine, 30, 7. doi: 10.1016/j.vaccine.2012.04.042 Douglas S. Diekema, M. D., M.P.H. (2012). Improving Childhood Vaccination Rates. The New England Journal of Medicine, 366(5), 3. doi: 10.1056/NEJMp1113008 C, H. A. E. W. R. E. I. S. N. K. M. (2012). A cross-sectional study of pre-travel health-seeking practices among travelers departing Sydney and Bangkok airports. BMC public health, 12(1), 1. Dannetun, E. T., Anders ; Giesecke, Johan. (2007). Parents’ attitudes towards hepatitis B vaccination for their children. A survey comparing paper and web questionnaires, Sweden 2005. BMC public health, 7, 1. doi: 10.1186/1471-2458-7-86 Economist, T. (1998, 5 Nov). Philanthropy: Gates the Good. The Economist, 1. Mary Ann Bell, P., Joseph A. Dake, James H. Price, Timothy R. Jordan, Paul Rega. (2012). A National Survey of Emergency Nurses and Avian Influenza Threat. Journal of Emergency Nursing. doi: 10.1016/j.jen.2012.05.005 Pediatrics. (2011). Meningococcal conjugate vaccines policy update: booster dose recommendations. Pediatrics, 128(6), 5. doi: 10.1542/peds.2011-2380 (RCN), R. C. o. N. P. C. (2012). The Health Protection Agency is warning parents to keep their children up to date with vaccinations for whooping cough, after an increase in the number of cases in 2011. Nursing Children and Young People, 24(3), 1. Shetty, P. (2010). Experts concerned about vaccination backlash. The Lancet, Vol.375(9719), 2. doi: 10.1016/S0140-6736(10)60421-7 Walkinshaw, E. (2011). Mandatory vaccinations: no middle ground. CMAJ: Canadian Medical Association Journal, Vol.183(16), 2. Share this: Facebook Twitter Reddit LinkedIn WhatsApp

Instructions Our last writing assignment is a two-part evaluation, both of the class and of yourself. 1) First, the last DQ of the course asked you to share some information about your final paper and discuss some things that you learned about the process

Instructions Our last writing assignment is a two-part evaluation, both of the class and of yourself. 1) First, the last DQ of the course asked you to share some information about your final paper and discuss some things that you learned about the process. I’m trying to study for my English course and I need some help to understand this question.

Instructions

Our last writing assignment is a two-part evaluation, both of the class and of yourself.1) First, the last DQ of the course asked you to share some information about your final paper and discuss some things that you learned about the process of writing. Now that your paper is done, and now that you have had some feedback from classmates on that post, tell me about how you feel about the paper you submitted to me. Be honest with me – I want to know what you feel you learned, both about your topic, and also about the process of writing about it. I’m interested in your process of writing as much as I am what you shared with me in your actual paper. Take some time and really think about it, and then tell me about all of it. Did your process change from the beginning of the class? Did you take the suggestions from the class and follow them? Please honestly assess yourself. This assessment is for you to evaluate yourself, and rest assured that I won’t use any of this to negatively affect your paper grade. 2) Second, what did you feel were the most useful parts of the class for you? Were there topics or sections of the class that especially helped you? Did you learn something specific that you will carry forward in future writing? You can also tell me if you didn’t feel that this class was useful to you, but if so, you need to share why so that we can try to change that. Any other information you’d like to include, such as suggestions to improve the class, ideas for changes, things you didn’t find helpful, etc. are welcome. This assignment needs to be at least two full pages, in APA format. Make it a good one, since it’s the last one

Instructions Our last writing assignment is a two-part evaluation, both of the class and of yourself. 1) First, the last DQ of the course asked you to share some information about your final paper and discuss some things that you learned about the process

The Body Shop International Case Study Business Essay

online dissertation writing The Body Shop International Case Study Business Essay. The Body Shop International (Body Shop) is a multinational company which is mainly producing ecological skin and hair products.The company offers over 1200 naturally produced healthy and beauty products generally target at woman. The products focus is shampoos, conditioners, bath products, soaps and skin creams but also includes fragrance, spa products, and beauty-related accessories. Their products are solely based on natural ingredients and manufactured according to an ethical code which is opposed to animal testing. The cosmetics franchise is considered to be one of the biggest around the globe with a well established reputation in 54 countries. L’Oreal, the dominant company in the beauty industry, acquired Body shop in 2006. Although Body Shop has become a subsidiary of L’Oreal S.A it still acts according to its own policy, values and ethical code. The acquisition has solved Body Shop’s financial problems and has provided the means for expansion to a bigger market share.(1***************) The updations since the case study was written can be summarised as: In 2002 Anita Ruddick launched her own website “www.AnitaRoddick.com” in 2001 and an activism portal “www.TakeItPersonally.org” in 2004. At that time number of shops were were1500 Body shop but nowit exceeded over 2500. During 2003 The Body Shop launched a global campaign to raise awareness and funds to help those affected by domestic violence. The Stop Violence in the Home campaign builds on almost a decade of campaigning on the issue in a number of markets, including Canada, the USA, and West Malaysia. The campaign aims to highlight the issue, raise money to support the work of groups. . In 2007 The Body Shop join forces with MTV in a new brand partnership to raise funds and awareness about HIV and AIDS amongst young people, through the Spray to Change campaign. The money raised goes to the Staying Alive Foundation, a charity who fund with grass roots organizations raising awareness and educating young and at-risk groups about HIV and AIDS .(1***************)(2) . Task 2 A brief review and discussion on company’s key acheivements and significant changes over the last few years and how the company has adopted to emerging themes like corporate social responsibility ,ethical marketing, globalisation,etc. 800 words Significant Changes: The first The Body Shop store was opened by Anita Rodrick on 26th March 1976 in Brighton, on the south coast of England. It was declared a public company in 1985 and soon after that it created an Environmental Projects Department of its own. The first Community Trade product of The Body Shop was a Footsie Roller which was produced in 1986 by a supplier in southern India. In 2006, as part of the ongoing Stop Violence in the Home and for conducting the study on domestic violence against children, The Body Shop created a partnership with UNICEF and the United Nations Secretary-General’s Study on Violence against Children. The Body Shop becomes part of the L’Oréal Group and de-listed from the London Stock Exchange on July 12 2006. It operates independently within the L’Oréal Group and was led by the current management team of The Body Shop. Key acheivements The body shop was the first international cosmetics company to sign up to the Humane Cosmetics Standard, supported by leading international animal protection groups. The Body Shop Values Reports are recognized (1995The Body Shop International Case Study Business Essay

fix the problems according to the comments in pdf

fix the problems according to the comments in pdf. I need an explanation for this Excel question to help me study.

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fix the problems according to the comments in pdf

Effect of Azadirachtin on Insects

Effect of Azadirachtin on Insects. INTRODUCTION Humans have always been in direct competition with a myriad of insects, pests from our ancestral beginning. This competition for food with insects intensified when humans began to cultivate plants converting the natural ecosystem to an agroecosystem. Also insects serve as vectors of various diseases caused by bacterial, filarial nematode, protozoans and viruses. Therefore control of insects posed a major concern for the development of the economy. In 1939, the discovery of insecticidal properties of DDT (Dichlorodiphenyl trichloroethane) by Paul H. Mueller changed the scenario of pest management. During World War 2 DDT was extensively used to prevent epidemics of several insect vectored diseases such as yellow fever, typhus elephantiasis and malaria. This drew attention to the possibilities of more synthetic insecticides and as a result the use of pesticides in various arenas soared from 1940-60, complete reliance on pesticides intensive pest management was leading agriculture on a “pesticide treadmill”. The overreliance on synthetic pesticides from late 1940s to mid-1960 was referred to as “Dark Ages” of pest control. The cheapness and effectiveness of synthetic insecticides threw natural compounds into shade. But very soon other shades also began to appear. In 1962, the appearance of book “Silent Spring” (by Rachel Carison) showed that pesticide residues were building up in ecosystem with detrimental effects on wildlife and beneficial insects. Due to extensive and intensive use, misuse and abuse of insecticides the following problems were becoming prominent and intolerable (ecological backlashes): Development of insecticide resistance- many insects started developing resistance against pesticides which increased the cost of management. Due to killing of natural controlling agents, the phenomenon of pest resurgence became more evident. Also minor pest were achieving the status of major pest i. e. secondary pest outbreak due to significant decline in its natural enemy (predators and parasites). Ecological imbalance due to poisoning of all the realms of environment. Increase in the concentration of hydrochlorinated insecticide in food chain. Intolerable residues on the food made the food obtained after such treatment uneconomical as it became unfit for consumption and unfit for exports due to high toxic residues. Killing and harmful effects on Non target organisms became more prominent (like birds, fishes and other wildlife). Overviewing these effects, there was an utmost need for the development of environmentally sound management practices. This lead to the idea of Integrated Pest Management (IPM) . A panel of experts put the concept of IPM in 1968. IPM as defined by FAO is a system which in consideration with the present environment and pest population dynamics, integrates all the sustainable techniques of pest management as compatible a manner as possible and maintain the population of pest below the level which can cause economic damage (i. e. below economic injury level). The approach is to minimize the dependence on insecticides and maximize the use of ecofriendly methods so as to cause minimum damage to the environment. Botanical pesticides, thus is an very important component of IPM as They are easily degradable. Don’t affect non target organisms, natural controlling agents such as predator, parasites. Don’t form residues And has no harmful effect on humans as they are very specific in action. Botanical pesticides refer to the use of chemical or organic compound produced by plants, plant products, which have harmful effects on the growth, development and survival of insect pests. Plants are a rich source of such organic compounds. HISTORY The practice of utilizing the derivatives of plant i. e. botanical pesticides in agriculture dates at least two millennia back in ancient China, Egypt, Greece and India. Even in North America and Europe, the documented use of botanicals extend back more than 150 years before the discovery of major class of synthetic chemical insecticides (OP, carbamates and pyretheroids) in mid 1930s to 1950. It is very clear from the recent history that the chemical insecticides have essentially relegated the botanical pesticides from an important role in agriculture to a trivial position in the market among various crop protection strategies. The total number of 20 phylochemicals is estimated to be 500000, so far only 10000 of these have been isolated. At present four major types of botanicals are being used for the control of insects. These include: Pyrethrum Neem (Azadirachtin). Rotenons. Essential oils. Others are in limited use like Ryania, Nicotine, Sabdella. Whereas Nicotine, Rotenene, Natural Pyrethrins constitute the outstanding example of older botanicals, extracts and compounds from the Neem tree (A. indica) have emerged as the most prominent phytochemical pesticides in recent years. Among the various biologically active compounds that can be extracted from the Neem tree like- triterpenoid, phenolic compounds, carotenoids, steroids, ketones; the tetranortriterpenoid azadirachtin has been the most extensively studied pesticide as 1) it is relatively abundant in Neem kernels. 2) has biological activity on a wide range of insects. PLANT SECONDARY METABOLITES Plants produce a large, diverse array of organic compounds that appears to have no function in growth and development. These substances are known as SECONDARY METABOLITES or secondary products or natural products. Secondary metabolites differ from Primary metabolites (amino acids, nucleotides, sugars, acyl lipids) as: They have no direct roles in photosynthesis, respiration, protein synthesis etc They have restricted distribution in plant kingdom. In a seminal paper Fraenkel stressed the role of secondary metabolites as defense system against insects, pests and other natural enemies. Though they play no role in growth and metabolism they play important ecological role in plants: They protect plants against being eaten by herbivore and being infected by microbial pathogen. They serve as attractants for pollinators and seed dispersing animals and as agents of plant-plant competition. Because of their ecological role, plant secondary metabolites are classified as ALLELOCHEMICALS, a term coined by WHITTAKER. An allelochmical is defined as a non nutritional chemical produced by an individual of one species that affects growth, health, behavior, population ecology of another species. Plants produce an astonishing array of Secondary metabolites. Even a single plant species may produce an extensive pharmacopeia of recondite chemicals. Periwinkle for example contains about more than 100 monoterpenoid indole alkaloids. It has been estimated that plant kingdom synthesizes hundreds of thousands of different secondary metabolites. The no of identified compounds now exceeds 10000. Secondary metabolites as plant defense is result of co evolution between plants and herbivores Plant secondary metabolites can be divided into three chemically distinct groups: TERPENES PHENOLICS NITROGEN CONTAINING COMPOUND TERPENES The terpenes constitute the largest class of secondary products . the diverse substances of this class are generally insoluble in water. They are biosynthesized from acetyl coA. Terpenes are classified by no of five carbon units they contain as: Monoterpenes: Contain 2 five carbon skeleton Sesquiterpenes: Contain 3 five carbon skeleton Diterpenes: Contain 4 five carbon skeleton Triterpenes: 30 carbons Tetraterpenes: 40 carbons Polyterpenoids: (C5)n,where n>8 Some terpenes have role in growth and development Terpenes defend against herbivore in many plants. Terpenes are toxins and feeding deterrentsto many plant feeding insects, thus they appear to play important defensive role in plant kingdom and protection of agricultural crops. Examples of important Terpenes: PYRETHROIDS: These are monoterpenoid that occurs in leaves and flowers of Chrysanthemum species show very striking insecticidal activity. Both natural and synthetic pyrethroids are popular ingredients in commercial insecticide because of their low persistence in the environment. Pyrethrum is the predominant botanical in use accounting for 80% of global botanical insecticide. ESSENTIAL OILS: These are the mixture of monoterpene and sesquiterpene that lends a characteristics odor to the foliage . e. g Menttholin Peppermint oil and Limonenein lemon oil are monoterpenes. Essential oils have well known insect repellent properties. They are frequently found in glandular hairs and serve to advertize the toxicity of plant repelling potential. Phytophagus insects even they take a trial bite. VOLATILE TERPENES: In cornEffect of Azadirachtin on Insects

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