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Sole proprietorship

Sole Proprietorship: A sole proprietorship is a business owned by a single person. Advantages of the Sole Proprietorship: A. Simplicity B. Autonomy C. Sole Gain D. Single Tax E. Shelter Income Disadvantages of the Sole Proprietorship: A. Limited resources B. Unlimited and Unshared Liability Key Characteristics: A. Liability-Liability is totally the sole proprietor’s. Meaning that there is no difference between the sole proprietor business and personal assets they are one and if the business fails or the sole proprietor is sued the creditors and litigants can come after both as if they are one. B. Income Taxes-The sole proprietor and the business are taxed as one. C. Longevity or Continuity of the Organization-If the sole proprietor dies the business goes with him. D. Control-The sole proprietor controls everything in the business. He and/or she can do it all their own of hire someone else to do it. E. Profit Retention-The sole proprietor keeps all of the profits F. Convenience of Burden-There are only a few instances when you have to have a register with the state or federal government. When you run a business under a different name then your own or you supply certain things that require licensure. General Partnership: By definition, is when two or more people come together to run a business. Advantages: A. Partners keep all the profit. B. The partnership is free from Federal income tax. C. Partnerships profits or losses pass directly to the partners as personal income for federal tax purposes. D. Partnerships permit pooling of capital, talent and a sharing of risk. Disadvantages: A. The death of a partner may automatically end the partnership-with serious consequences to all concerned. B. Unlimited personal liability of all the partners. Key Characteristics: A. Liability-The partnership has unlimited personal liability. B. Income Taxes-There is no Federal tax for the partnership, but they can claim their profits and their losses on their personal taxes. C. Longevity -The longevity of the business is based on the contract they had drawn up before the business was started in case of buyout and/or Death. D. Control-The control of the business is based on what the partners agree on. E. Profit Retention-All the profits go to the partners. F. Convenience or Burden-The partnership should have a contract drawn up that describes exactly what each partner has contributited to the business, what share of the profits each partner will receive, duration of the partnership and the breaking up and closing of the business in case circumstances arise. If this is done then a partnership would be a good venture. Limited Partnerships: By definition, the limited partnership is at least one limited partner and at least one general partner. Advantages: A. The limited partner can make a profit without much effort. B. If the company fails, the limited partner only losses the amount they had invested. Disadvantages: A. The limited partner has a very limited control in the running of the business. B. It is very hard for the limited partner to get there investment out of a limited partnership. Key Characteristics: A. Liability-The majority of the liability is taken on by the general partners not the limited partners. B. Income Taxes-If the partnership has two or more of the following things then it will be taxed as a corporation; Freely transferable ownership papers Continuing of life Participation of limited partners in management of the business Very limited liability of the limited partner in the debt of the business if it goes bankrupt (All Business, 2010) (All Business, 2010) C. Longevity-The longevity of the limited partnership is based solely on the contracts drawn up. D. Profit retention-The limited partner gets a percentage of the profits. E. Convenience or Burden-The limited partnership is best for the limited partner if they want to use it as an investment tool. C – Corporation: By definition, the C – corporation means closely held corporation. They are small none traded corporations, usually but not always limited to no more than 30 shareholders. Advantages: A. The closely held corporation is its own legal entity, as long as all the rules and bylaws are followed at the local, state, and/or federal level then there is limited liability. B. Closely held corporations can have benefit health plans, which will be better retirement and health insurance plans then those of non-corporation businesses. C. The health insurance is fully deductible and up to a certain amount of group term life insurance benefits per employee. D. Should a shareholder die or wish to cash out his or her shares, the corporation will still continue. E. It is a lot easier to get investment capital in a corporation then it is in other businesses. F. Employees can be offered stock option plans. Disadvantages: A. Double taxed. Which means after the corporation pays its taxes on the income the corporation makes, the shareholder will be taxed again on the profits they receive from their profits on their shares. B. You must follow the local, state and/or federal laws when it comes to incorporating to the letter. If they are not followed then the shareholders may be held liable for any situation that comes along. C. It costs more to have a corporation than any non-corporation business. D. It takes more time and effort to maintain a corporation then a non-corporation. Key Characteristics: A. Liability -As long as all the local, state and/or federal laws are followed then there is very limited liability. B. Income Taxes-A C-corporation is what is called double taxed. Meaning once the corporation pays the business tax then any profits the shareholders make are then taxed again. C. Longevity -The only way a C-corporation can be dissolved is if it is voted on and agreed to by the shareholders and very careful set of rules are followed. It doesn’t matter if a shareholder dies or cash’s in their shares the corporation continues. D. Control-A c – corporation usually has a president, vice president and secretary-treasurer. Anyone or all of those people control the corporation. E. Profit retention-The closely held corporation’s profit depends on what percentage of stock each shareholder holds. F. Convenience or Burden-In order to form a c-corporation there has to be different local, state and/or federal law that must be followed and certain things that must be done to incorporate the business. S Corporation: By definition, the S Corporation means Subchapter S – Corporation, it comes from the tax code from which it is taxed. An s-corporation is limited to no more than one hundred shareholders. Advantages: A. Since the corporate losses are passed thru to the shareholders, they are able to take is as a loss on their taxes. B. You will have limited personal liability without having to pay high corporate taxes. C. It is a lot easier to get investment capital in a corporation then it is in other businesses. Disadvantages: A. There are a lot of rules to follow and the amount of shareholders is limited. B. It will be costly to set up and follow the rigid set of corporate rules and laws. C. There will be close scrutiny by the I.R.S. D. All shareholders must be U.S. citizens. E. All shareholders must vote for the S corp. F. The corporation can’t deduct the benefits like health and or accident insurance. Key Characteristics: A. Liability-the shareholder is only liable for the debts the corporation has up to how much they have invested. Exceptions Include: 1. If the shareholder guarantees a business loan. 2. If it is ruled by the courts that the business is a scam. B. Income Tax-S corporations are corporations that elect to pass corporate income, losses, deductions and credit through to their shareholders for federal tax purposes. Shareholders of S corporations report the flow-through of income and losses on their personal tax returns and are assessed tax at their individual income tax rates. This allows S corporations to avoid double taxation on the corporate income. S corporations are responsible for tax on certain built-in gains and passive income. C. Longevity-The S corporation is a perpetual entity and is not affected by the death of a shareholder. D. Control-The shareholders, the board of directors and the officers of the corporation all control the corporation. E. Profit Retention-In an S corporation all Officers, the Board of Directors and shareholder-employees must be paid a reasonable salary from the corporate earnings. F. Convenience or burden-Many rules and regulations must by follow the corporation, including the number of shareholders. Also, it can be costly to set and follow corporate formalities. LLC By definition, an LLC means Limited Liability Company. It is a business that brings a partnership and a corporation together. Advantages: A. LLC’s offer pass-through tax statues similar to that of a partnership. B. Corporations are required to hold meetings and record minutes on those meetings each year; LLCs are not. The amount of paperwork needed to purchase assets, open bank accounts or make changes within the company is also significantly reduced in an LLC. C. LLC’s provide owners with a degree of liability protection, such as also provided by a C corporation. Owners of both C Corporations and LLC’s are typically not responsible for the debts and liabilities of the business. Disadvantages: A. Many investors will not invest in LLC’s, because it’s a business structure that is not understood. B. LLC’s don’t have employee stock option plans. C. You can’t switch from an LLC to a C or S corporation like you can switch from a C to S corporation. D. Some states don’t allow single-member LLC’s. Key Characteristics: A. Liability-LLC’s are not personally responsible for debts of the business. B. Income tax-LLC’s are taxed at the personal level. C. Longevity or continuity of the organization-Operating agreement can require a number to obtain interest beyond transferring interest. D. Control-persons and other legal entities composed of persons (such as trusts and other corporations can have the right to vote or receive dividends once declared by the board of directors. In case of for-profit corporations, these voters hold shares or stock and are thus called shareholders or stockholders. When no stockholders exist, a corporation has members who have the right to vote on its operations. Voting members are not the only members of a “corporation”. The members of a non-stock corporation are identified in the Articles of incorporation and the titles of the member classes may include “Trustee,” ”Active,” ”Associate,” and /or “Honorary.” However, each of these listed in the Articles of Incorporation are members or the corporation. E. Profit retention-Members share in the profit are proportion to how they invested in the business. F. Convenience or burden-LLC’s don’t allow single member companies, LLC’s aren’t conducive to employee stock option plans and Investors will not invest in LLC’s. (Haus, 2011) (All Business, 2010) (All Business, 2010) (All Business, 2010) (All Business, 2010)
The keyword to be an successful country is develop two important abilities that will help you think in a different and intelligent way to develop your ideas and your beliefs. The purpose of this research is to develop the creativity and innovation in developing countries by increasing the systems education in three different ways. Furthermore, this paper discuss about the importance of develop creativity and innovation for the future of countries. Creativity is define like the ideas that come up to your mind to follow anything that you want to do and innovation is the process to became your ideas or inventions in something that help the people or the environment. Finally, the main idea of this paper is to find the best solutions to solve the problem of creativity and innovation by improving the traditional model of system education. Keywords: creativity, innovation, system education, develop. There are so many countries in the world, and this countries are classifieds according to how much developed they are. First of all, we have countries that are developed a lot of because they produces many things like technology, weapons, food, raw material (wood, iron, cotton, crude oil, etc) for the others that doesn´t have this advantages. Therefore, these develop countries are in the top, but how could they develop more than the others? the answer is very simple. These develop countries made a change in their system education by improving so many things that will help students to be prepared in the future because they know that students are the 100% of their future. As a result, the best solution to improve the road of being a develop country in the world is focused in creativity and innovation of each people could have, but how we can improve this skills? We can improve these skills by following the next steps: First, schools should increase hours of extracurricular classes. Secondly, students must interact with the environment. Finally, using technology in the process of learning-teaching can help to everyone with innovate ideas. Schools should increase hours of extracurricular classes Currently, schools are an important parts of our lives because there we learn how to front any problem that we could have, and also we learn many skills that help us to develop in the future. But what is wrong with schools nowadays? the problem is that they are killing the creativity and innovation by obligating us to think in the way that they want. The recently model of system education have one purposed, and it is to became students in university professors. They have in mind that if you made less mistakes, you will be a perfect person. So this means, education system just are focused in science subjects such as math, chemistry and physics, and this is a big problem because each person believe that you will be successful if you have lot of science degrees. But no one knows that they could be better if they develop creativity and the capacity of innovate (Robbinson, 2006). Of course we can develop creativity in schools by increasing hours of extracurricular classes because in that classes we learn how to be an artist, and when you said artist everyone thinks in creativity. Scientists says that every person in the world develop the 80% of their brain when they are in the childhood, so what they need? They need classes about science, but they also need extracurricular classes like music or dance because in that classes they will express their creativity in an easily way. For example, a little girl called Gillian was accused that she has a learning disorder because she can´t get focus while she was receiving classes. So her mom took her to the doctor because she was worried, but the doctor was talking with Gillian alone, and while they were talking Gillian was dancing, So he understand that she didn’t have any disorder learning. Then he goes to Gillian’s mom and he said that Gillian doesn´t have problem, he explain that her daughter is a dancer, she needs to move to think. After, Gillian´s mom understand that her daughter need to go to learn dance and finally Gilliam became in a professional choreographer and she made important works such as “Cats” and ” Phantom of the Opera” (Robbinson, 2006). In a brief, people lost their creativity because in schools they just learn mechanically and they don´t learn how to develop their ideas or how to express their opinions. Students must interact with the environment Everyone could become in creativity people if they learn by themselves. Many people in the world are autodidact people because they like o learn by their own methodology. This is an excellent way to became in a creativity people because you find out or sometimes you create your ways to make easily studies. A big example could be scientist because they are always looking for new things, so what they need is a lot of creativity and innovative ideas to get what they want. However, people says that scientist are not creativity people because they use statistics and data, so for the people this is not creative is just like a lot of information (Ossola, 2014). The main idea is to add the option for students that can interact with their environment to understand better and increase their creativity. For example, if students are learning about the nature, they should go outside to the forest and they will be able to learn how everything works in the environment, and also this is an interesting and funny way to learn because is not boring and you will be entertaining. Moreover, you can find another advantage about learn interacting with the environment because when you are outside you will found many information just looking, you don’t need search it on the internet or books, is an easily way to obtain real and good information about something. Using technology in learning-teaching process Nowadays, technology is the best sources that humans could created. Technology have many uses in all the world. We could find technology everywhere like in medicine, weapons and even in our houses. Technology is everything and also is an important tool for education because we could use it for teach and also learn in schools or colleges. Furthermore, each school has technology to support the knowledge of students, but while more technology have schools, they will be considerate better than the others. The last step to improve developing countries into develop one is improving all the technology from schools as many as they can. For example, people could use Duolingo – platform that teaches language through gaming (Segal, 2016) to learn in a funny way and creative way. Also technology is an excellent way to teach students because they like new things, and they want to discover things. So technology is like a motivated tool that make students want to learn by themselves. In summary, we could improve any developing country by increasing important skills such as creativity and innovation because creativity is process that you develop to make sense any ideas that you have in mind and innovation is the success of created any idea. So there are many steps to develop your abilities like the importance of schools should increase the hours of classes that help you develop your ideas and also it help you to make strongly opinions about any topic. References Ossola, A. (2014). Scientist Are More Creative Than You Might Imagine. The Atlantic , np. Robbinson, S. K. (nd de February de 2006). TED. Recuperado el 15 de February de 2017, de TED: Segal, S. (2016). The case for disruption in Latin America´s classrooms. Usa Published , np.
Art assignments. I need an explanation for this Art & Design question to help me study.

A. What parallels if any do you see between Islamic, Africa, Oceanic and the Americas Art? Post your discussion here by the due date and respond to 2 other students by the end of day.
150 words for A
B. Answer each of the following questions in a few complete sentences:

What are some community functions for art in Africa?
What basic belief about human origins is widely shared across Polynesia?
Which Native American art forms are traditionally reserved for women?
What cultural forms did the civilizations of pre-conquest Mexico share?

Art assignments

What must companies focus on in order to survive in today’s business environment?

What must companies focus on in order to survive in today’s business environment?.

I’m working on a information technology project and need support to help me study.

What must companies focus on in order to survive in today’s business environment? Use at least two unique references. Length: 4-5 paragraphs (at least 100 words per paragraph). Read the case: Prime Bank of Massachusetts. Develop a list of changes for the operations function that should be considered by the bank. Use at least one unique reference. Begin by identifying operations management decisions that would be involved in operating a bank, for example, layout of facility, staff, drive-through service. Then identify ways that they can be improved at Prime Bank in order to support the strategy focused on customer service. Use at least two unique references. Length: 4-5 paragraphs (at least 100 words per paragraph).In the product screening stage of new product development, what are some questions that may need to be explored by the operations function? By marketing? By finance? Use at least two unique references. Length: 4-5 paragraphs (at least 100 words per paragraph). Describe how consumers can use the Internet to shop in new ways. Use at least two unique references. Length: 4-5 paragraphs (at least 100 words per paragraph). APA format is required. References should be listed immediately after the question that is being answered. Each question lists a minimum number of unique scholarly references; the textbook is considered one unique reference (per question) regardless of how many times it is used. All references should be from the years 2007 to present day.
What must companies focus on in order to survive in today’s business environment?

The Relevance of Islamic Economics Essay

research paper help Table of Contents Summary Key Learning Points Relevant Statements to the Session Critical Analysis Practical Implications Learning Reflections References Summary The article refers to both Islamic and conventional economics. Conventional economics has been studied for a long time, unlike Islamic economics. As much as both forms of economics have very similar concepts, they also differ greatly. Some of the concepts that Chapra (2000) discusses in the article include vision, mechanism, worldview, and the method. The vision of Islamic economics is to study the allocation of resources in many of the Islamic based countries. There are a few countries that still govern using Sharia Law. Some of these countries are, however, not very strict on the Sharia Law given that they would like to fit in the other non-Muslim circles. This creates a difficulty in realizing the vision of the study. The mechanism, on the other hand, is defined as how the allocation of materials is done. There are three main factors to consider when discussing types of mechanisms. These are filtering motivation, and socio-economic restructuring. The role of the worldview is to give an individual their political perspective among other perspectives. For example, if Muslims believe that it is wrong to steal, they will also believe that cutting the hand of a thief so that he cannot steal again is acceptable. Key Learning Points When it comes to the history of Islamic economics, Chapra (2000) argues that there are very many scholars who have aided in expanding the subject. He mentions Shah Waliyullah and Abi Yusuf, among others, as some of the scholars who have contributed greatly to the study. According to these scholars, Islamic economics is very different from some of the conventional economics that are present in the world today.The key learning points are the vision, the relevance of Islamic economics, history, and the future of Islamic economics. The vision is what Islamic economics wants to achieve. Even though this presents a good challenge to all scholars, it is very difficult to study the exact impacts of Islamic economics because there are very few countries that use Islamic economics at the moment. The relevance of Islamic economics has also been debated over the years. Several scholars have explained that there is no relevance in studying Islamic economics since it is already categorized under the conventional economics of today’s world. Last, but not least, the learning point is the future prospects of the study. Many scholars believe that Islamic economics will not survive in the future. According to Chapra, Islamic economics has focused on explaining itself and how its concepts can change the current world economy for the better. It has not explained how different it is from the other known economies. The concepts involved in Islamic economics also entail the use of the Islamic religion. Most of the world’s population is not Muslim. This makes the future of Islamic economics very dim. Relevant Statements to the Session The relevant statements in the session include: Chapra (2000) mentions that “If well-being were to be defined in a purely material and hedonist sense, then it would be perfectly rational for economics to give prominence to the serving of self-interest and the maximization of wealth, bodily pleasures, and sensual satisfactions” (p. 23). “If the market, the family, the society, and the state all have a role to play in human well-being then the question is how to make them play their roles in a manner that complements and does not hinder the effective performance of their roles by others” (Chapra, 2000, p. 24). Get your 100% original paper on any topic done in as little as 3 hours Learn More “If the mechanisms chosen by economics are not in conformity with the desired concept of well being, or if the desired restructuring is not, or cannot be brought about, then that kind of well being can fail to be realized” (Chapra, 2000, p. 27). Critical Analysis Chapra’s argument supports Islamic economics in some ways. However, there are several things that go against this kind of economics. One of these reasons is that all religious economics are treated as conventional economics. Separating Islamic economics from other religious and conventional economics will, therefore, be impossible. He also argues that Islamic economics is very different from both Capitalist and Communist economies. The Capitalist economy has been known to encourage self-growth in terms of acquiring a lot of wealth and bodily pleasures. Islamic economics is against this. The communist economy, on the other hand, encourages social growth and selflessness. This is very similar to what Islamic economics encourages. This goes to show that Islamic economics borrows mostly from the Sharia Law and the other systems of economics. However, Chapra (2000) still argues that the two types of economics are different in other aspects. It can be argued that Islamic and conventional economics are not very different. Chapra (2000) explains that the Islamic worldview is almost similar to the worldview of the other religious entities in the world today. However, all these religious worldviews are different from conventional economics’ worldview. The argument presented is that the Islamic worldview does not encourage secularism, Darwinism, and materialist behaviors. These are all present in conventional economics, but the issue of whether conventional economics supports them is not conclusive. The Islamic worldview suggests that everyone is equal and everything on the earth is owned by God. Therefore, the allocation of resources should be done with this fact in mind. This worldview upholds the well-being of human beings. However, this is not practical in the real world today. Looking at the countries that support Sharia Law, there is still inequality in terms of the distribution of wealth and resources, despite the fact that most of the countries with Sharia Law also encourage Islamic economics (Azhar, 2010). Practical Implications Islamic economics would not have worked in a real business scenario in a cosmopolitan country. This argument is based on the fact that many clients today are not religious, yet Islamic economics revolves around the Muslim religion. However, some aspects of this type of economics can be used in a real business scenario. For example, one of the concepts of Islamic economics is the upholding of everyone’s well-being. This can be useful in any business setting as it allows the employer to make better decisions with regard to the welfare of the employees. Employing Islamic economics in such a scenario would result in better payments and better working conditions and encourage mutual respect among the employees. Learning Reflections I have learned that Islamic economics is a bit different from conventional economics. Islamic economics should, therefore, be studied as a different entity, instead of combining it with conventional economics. The future of Islamic economics is very bleak considering that the world gets more secular as the days go by. However, the relevance of Islamic economics should not be ignored. Islamic economics was very prominent in the past and it should, therefore, be studied further today. References Azhar, R. A. (2010). Economics of an Islamic economy. Leiden, The Netherlands: ICD Publishers. We will write a custom Essay on The Relevance of Islamic Economics specifically for you! Get your first paper with 15% OFF Learn More Chapra, M. U. (2000). Is it necessary to have Islamic economics? Journal of Socio-Economics, 29, 21-37

Antibiotics for Treatment of Acute Otitis Media

The role of Antibiotics for Treatment of Acute Otitis Media in Prevention of Subsequent Development of Acute Mastoiditis in Children Introduction Acute otitis media (AOM) is considered to be one of the most common infections in children. Most of the time it is self-limiting disease without need for antibiotic therapy; however, some children have individual potential for serious complications such as mastoiditis. Acute mastoiditis is still the most common complication of acute Otitis media and is defined as an acute inflammation of the mastoid air cells which are contiguous with the middle ear cleft and arising as a result of spread of infection from acute otitis media beyond the middle ear. The incidence of acute mastoiditis was significantly reduced following the antibiotic era and the overall incidence of mastoiditis as a complication of acute otitis media dropped to less than 1%.1,3. But some recent literature indicated an increase of the disease incidence especially in countries with less antibiotic prescription [2], while others reported that no increased incidence despite the national restriction guidelines of antibiotics prescription [4]. Most recently published guidelines reported that acute otitis media should be treated initially with supportive therapy with discretionary clinical follow-up and antibiotic treatment is reserved for cases in children younger than 6 months, unresolving cases, or otherwise complicated cases. The aim of this study was to carry out a retrospective analysis of all children admitted with acute mastoiditis and to study the role of antibiotics prescribed for acute otitis media on development of acute mastoiditis. Patients and Methods The medical records of all children admitted, diagnosed and treated as acute mastoiditis in the Ear, Nose and Throat department in King Hussein Medical center, Amman- Jordan during the period 2002 to 2012 were studied retrospectively. Patients were divided into 2 groups: Group I: patients who received antibiotics for acute otitis media 2 weeks pre hospitalization. Group II: patients who did not receive antibiotics prior to hospitalization. The clinical criteria for the diagnosis of acute mastoiditis were based on the following: Clinical and Otomicroscopic evidence of acute otitis media on admission or recent episode of otitis media within 2 weeks before admission. Post-auricular inflammatory signs (swelling, erythema and tenderness). Anteroinferior displacement of the auricle. Exclusion criteria were: Patients with incomplete data or in which the diagnosis was not conclusive. Patients suspected to have cholesteatoma. Immune compromised patients. Patients with ventilation tubes in situ. Patients who had undergone prior ear surgeries. Data regarding the age, gender, and duration of pre hospitalization antibiotic therapy, the clinical and microbiological findings, treatment modality and the outcome of the disease were recorded. Results During the study period, a total number of 63 children were admitted with the diagnosis of acute mastoiditis (42 males and 21 females) aged from 7 months to 13 years with a mean age of 5.7 years. Out of 63 patients, 56 (88.9%) patients had post auricular inflammation only whereas the remainder 7 (11.1%) cases had a subperiosteal abscess. The preadmission history demonstrated that 52 (82.5%) patients had a history of antecedent acute otitis media within 2 weeks before admission. Before the development of acute mastoiditis, we recorded that 41(65.1%) children were taking oral antibiotics 2 weeks before admission prescribed for acute otitis media (Group I) with duration of therapy ranging between 1-13 days (mean duration 3.6 days). The most commonly prescribed antibiotic prior to hospitalization was amoxicillin–clavulanic acid (n=30) followed by amoxicillin (n = 6), and first or second-generation cephalosporin (n = 5). On other hand 11 patients did not use any type of antibiotics before admission which was confirmed by the Parents of patients (Group II). The duration of illness before admission of patient was ranging between 1-14 days (mean 3.5 ± 3.1 days). Acute otitis media in the left side was reported to be more common than the right side (25 cases vs. 20 cases, respectively), Whereas 7 children were reported to have bilateral acute otitis media. None of our patients reported to have bilateral mastoiditis. The Clinical features of children with acute mastoiditis on admission are shown in table I. Computerized tomography of the Temporal bone was performed on admission in all patients and cloudiness of the mastoid was demonstrated in all the patients. In 7 cases there was destruction of cortex with subperiosteal abscess. Data regarding microbiological culture findings was recorded in 48 patients, of whom 25 (52%) cultures were taken from middle ear aspirate during myringotomy; culture of pus from the external auditory canal was obtained in 11 patients (23%), from subperiosteal abscess in 7 patients (14.6%) and from the mastoid cavity during mastoidectomy in 5 patients (10.4%). The most commonly isolated organisms were Streptococcus pneumonia, Streptococcus pyogenes, Staphylococcus aureus, Pseudomonas aeroginosa, Proteus mirabilis and Haemophilus influenzae. On admission, all of the patients were treated with intravenous antibiotics and the most commonly used antibiotics were ceftriaxone, cefuroxime, Ceftazidime and Metronidazole. In addition to Intravenous antibiotics, some patients were underwent tympanostomy tube insertion, abscess drainage and cortical mastoidectomy. All patients in our study were recovered uneventfully with these treatment modalities and none of them developed recurrences of mastoiditis within a period of at least one year of clinical follow up. Discussion Although, in the literature the incidence of acute mastoiditis decreased in the last decades, there is some evidence that in recent years, this entity is rising, as Papournas and Kudo [6,9] have reported. However, our series includes 63 cases of acute mastoiditis in 10 years period. The demographic data collected in this study with regard to gender and age was consistent with other series [3, 7, 1 2]. Acute mastoiditis has been reported to be more predominant in boys as has been noted previously [11—14]. The use of broad spectrum antibiotics as initial treatment for acute otitis media, a rather common practice in our country, might play a role in selecting resistant microorganisms. In our study, in which 65.1% children were taking oral antibiotics for otitis media before admission provides evidence for the assumption that widespread use of antimicrobials in treatment of acute otitis media does not provide complete protection against acute mastoiditis. Furthermore, the symptoms of acute mastoiditis may be abated, in consequence of the treatment, requiring a high degree of awareness by contemporary clinicians to watch for manifestations. Therefore, antimicrobials should be used judiciously in treatment of acute otitis media, avoiding the employment of broad-spectrum drugs as an initial regimen. Yet, complete abstention from use of antibiotics in treatment of suppurative otitis media is not advisable, as this seems to increase the risk of complications in general and of acute mastoiditis in particular [15,16]. Recently, some authors observed that the number of children admitted to some hospitals with acute mastoiditis has risen [12-14]. However, Luntz et al [15] reported that the use of antibiotics is not a safe guard against acute mastoiditis and it may lead to a latent (masked) mastoiditis. Also, Kvaerner et al [4] – In their registry based study on 399 Norwegian children proved that the incidence of acute mastoiditis has not been increased in Norway despite the national restricted use of antibiotics in primary care. Findings in children with acute mastoiditis are well described in clinical studies. In agreement with our findings the children are young, and present with retroauricular oedema, protrusion of the ear and abnormal tympanic membranes in addition to various degrees of general discomfort [1,5 – 9]. The most frequent symptom in our study was abnormal tympanic membrane with retroauricular erythema. During the last decade several reports show a decreasing rate of cortical mastoidectomy as the treatment of choice for acute mastoiditis. The rate of surgery varies greatly from 12 – 98% in different studies [1,4 – 8]. This may be due to different criteria for the diagnosis and may also reflect the fact that an increasing portion of children are treated in pediatric wards. The increasing tendency for conservative treatment during the recent years may also reflect an increasing availability of CT or MR scans to exclude complications. Microbiological culture findings were recorded in 48 patients in this study and Streptococcus pneumonia was the most commonly isolated organism. Similar results have been reported by other authors [2,6,12,15,16]. Other identified organisms were Streptococcus pyogenes, Staphylococcus aureus, Pseudomonas aeroginosa, Proteus mirabilis and Haemophilus influenzae. Our data do not support that general use of antibiotics in acute otitis media will prevent the subsequent development of acute mastoiditis. Neurological complications was reported in 5 – 20% in the literature [2,3,15], although recent publications show a lower rate of complications [6,12]. In our material none of the patients developed neurological complications. Conclusion References Table I Clinical features on admission of 63 children with Acute Mastoiditis Clinical Feature No. of patients (%) Otalgia 48 (76.2 %) Fever ( ≥38°C) 21 (33.3 %) Abnormal tympanic membrane 63 (100%) Otorrhea 26 (41.3 %) Retro-auricular swelling 58 (92 %) Retro-auricular erythema 63 (100 %) Retro auricular abscess 7 (11.1 %) Displaced pinna 59 (93.7 %) More than one sign 60 (95.2 %) History of antecedent acute otitis media 52 (82.5 %) Absence of previous acute otitis media 11 (17.5 %) History of Pre-admission antibiotic treatment 41 (65.1 %)

MDCPS Laboring Woman Biochemical Attack & the Emergency Department Journal Entry

MDCPS Laboring Woman Biochemical Attack & the Emergency Department Journal Entry.

Personal goals & objectives due.You are in the drive-up area of the emergency department helping to unload a laboring woman brought by private vehicle. As you are helping the woman into a wheelchair a bus pulls into the drive-up next to you. The driver stumbles out of the bus and collapses on the pavement. You notice that the bus is filled with people who are panicking and displaying signs of dyspnea.1. What is your immediate action?As you process the scene you realize that this bus may have been the target of a biochemical attack. The semi-conscious bus driver says someone threw a “smoking canister” through a bus window.2. What possible biochemicals could be responsible for the above scenario?The occupants of the bus begin to spill out of the door and enter the emergency department, screaming for help.3. What do you do now?It becomes apparent that a serious situation is occurring when a second bus pulls up to the emergency department with similarly affected people. You notice that hospital employees and visitors who have arrived to see what is happening now look sick as well.4. What special actions must be taken when a health care facility is at risk in a disaster?
MDCPS Laboring Woman Biochemical Attack & the Emergency Department Journal Entry

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