Gastroesophageal Reflux Disease Essay Example | Topics and Well Written Essays - 4500 words

Gastroesophageal Reflux Disease - Essay Example The superficial layer of the esophagus is known as adventitia. The adventitia attaches the esophagus to surrounding structures. The esophagus secretes mucus and transports food into the stomach but it does not produce digestive enzymes. The stomach contents can reflux (back up) into the inferior portion of the esophagus when the lower esophageal sphincter fails to close adequately after food has entered the stomach; the condition which is known as gastroesophageal reflux disease (GERD). In GERD, the basal layer of of the epithelium is is thickened, and the papillae of the lamina propria are elongated and extend toward the surface. Abnormalities of the lower esophageal sphincter, Hiatus hernia, Delayed esophageal clearance, Gastric contents, Defective gastric emptying, Increased intra-abdominal pressure, and Dietary and environmental factors may be the factors involved in GERD. Clinically, GERD may be diagnosed by radiographic examinations using dyes, endoscopy, and esophageal pH-metr y. PPI trial is also an accepted method of first line diagnostic test. Treatment involves both non-pharmacological treatment measures as well as pharmacotherapy. Non-pharmacological treatment include avoidance of foods and medications that exacerbate GERD, smoking secession, weight reduction, taking a small meal at a time, avoidance of alcohol and elevation of the head of the bed. Drugs for treating GERD include H2 receptor antagonists like cimetidine, ranitidine, famotidine or nizatidine. Proton pump inhibitors such as omeprazole, pantoprazole, lansoprazole and rebeprazole are found to be very effective to reduce acid reflux and hence inflammation. H2 blockers were found to heal ulcers and erosions but the typical reflux changes of the squamous epithelium of the esophageal mucosa are not recovered. Studies confirmed that PPIs not only heal ulcers and erosions but also cures basal cell hyperplasia and elongation of the papillae. The percentage of normal epithelium were also reported to increase significantly after PPI administration in patients with GERD. Two commonly employed treatment alternatives for GERD are antirefluctive surgery and Endoscopic Treatments. Surgery is preferred only when the patient fails to respond to pharmacological treatment, when the patient prefers surgery, in those patients who have complications of GERD like barrett's esophagitis, or if the patient has atypical symptoms and reflux documented on 24-hour ambulatory pH monitoring. Several randomized controlled trials have confirmed that open fundoplication and medical treatment have similar long-term effects for GERD. Laparoscopic antireflux surgery is also reported to have similar outcomes to the open procedures. Endoscopic Treatments for GERD include plicating gastric folds methods (Endoscopic Gastroplication, ELGP method, thermal tissue remodeling /neurolysis method, and bulking injection method. These endoluminal treatments augment the reflux barrier. Section I: Organ system structure and Function. Explain the accepted normal healthy structure of parts and function of organ system; How it works The esophagus is a collapsible muscular tube, about 25 cm (10 in.) long that lies posterior to the trachea. The esophagus begins at the inferior end of the laryngopharynx and passes through the mediastinum anterior to vertebral column. Then it pierces the diaphragm through an opening called the

Triage protocol Dissertation Example | Topics and Well Written Essays - 1000 words

Triage protocol - Dissertation Example The protocol is defined in such a manner that its implementation depends on the definition of the treatment to be offered; this is because it contains both inclusion and exclusion criteria, which appropriately informs the triage nurses about the exact time to request X-Rays to avoid subjecting patients to excessive radiation. Constant review of the protocol will be conducted quarterly to ensure its appropriateness. 2. Outline the rationale for selecting the change The triage protocol suggested for implementation will help provide rapid health care services for patients in critical conditions within the emergency rooms in hospitals. Request of X-rays by triage nurses through the protocol reduces the waiting time by about 18 minutes, which leads to satisfaction of both the patients and the hospital staff (Crinson, 1999). This process entails the involvement of triage nurses, who must possess the ability to make quick decisions. In addition, triage nurses must have a high level of liste ning and communication skills and extensive knowledge of warning signs and symptoms. It is important to note that these field nurses must have vast experience in emergency medicine to be able to become triage nurses (Ward, 1999). According to the Department of Health (1997), triage is critically important since it is the foremost assessment in patient care. The surest way to save resources is to identify and separate the critically injured from the patients with less severe conditions. The new triage protocol is ready for implementation to ensure that patients’ safety is taken care of and that patients are identified accurately (Davies, 1994b). 3. Discuss the organisational impact you hope the change will have and the expected outcome(s) According to the Department of Health (1997), the new triage protocol has diverse impacts in terms of how hospitals operate. The protocol is expected to bring quality in health care provision through effectiveness and efficiency of healthcare delivery. The program will also boost the employee welfare in terms of the learning and education of the nurses. Triage is, therefore, very important in hospitals, most so in emergency departments worldwide, as it helps prevent overcrowding. Therefore, it improves emergency care through prioritization during clinical emergencies. Despite resource consumption variations in patients, triage nurses are urged through ESI resource and through prediction thinking to solve the presented emergencies (Cutts, 1999). It is also in addition that resources in emergency departments consume general resources. For instance, a provider seeing a very old patient with an in dwelling urinary catheter and complaints of fever and cough will call for blood order and urine test with chest X-Ray. The triage nurse can, therefore, accurately predict the patients’ needs for two or more resources and thus be able to classify the patient as ESI level 3 through triage protocol. According to the Department of Health (2000), the outcomes of this change will be the ability for the future advancement of the same protocol; it will also ensure that there is ease in distinguishing between the responder and the

The Law of Contract Coursework Example | Topics and Well Written Essays - 750 words

The Law of Contract - Coursework Example The rule takes into account parol evidence in addition to other evidence as regards to a contract. Contractual capacity is the ability to understand and reason. What is the difference between someone who is crazy versus someone who has been previously declared insane by a judge? How does this affect the contract? Someone who is crazy is simply one who behaves weirdly, while someone who has been previously declared insane by a judge is one who does not have the mental capacity to make a reasonable decision on his/her own. This means that crazy persons can be capable of making reasonable decisions on their own, or they may not be capable depending on the magnitude and source of their crazy behavior. If a judge declares a person as insane, then it is assumed that such person does not have the capacity to comprehend their acts, therefore, any contract that is made by such person after being declared insane is not enforceable. Consideration is one of the requirements of an enforceable contract. Therefore, a simple contract must be supported by a consideration otherwise it is not enforceable as a contract. In other words, consideration is the negotiation aspect of a contract. It can be defined as â€Å"an act or promise offered by the one party and accepted by the other party as a price for that others promise.† (Collins 252). The following are examples of considerations: i. UCC  § 2-204(4): this section acknowledges the legal impact of the contract created through electronic instruments. It originates from means such as the communication between an individual and an electronic instrument or through the communication of electronic instruments of the involved parties.

Industry Analysis, Target Market, and Competition Analysis of Plastic Essay

Industry Analysis, Target Market, and Competition Analysis of Plastic Surgery Center in Morris County, NJ - Essay Example Plastic Surgery Center in Morris County, NJ is one of the most well-known centers in this region. The present marketing activity of Plastic Surgery Center in Morris County profiles as well as overviews industry and situational analysis. A comprehensive overview of the SWOT and industry on the whole give insights on marketing strategy to follow in order to retain existing and attract new customers, who would become regulars. Thus, the analysis identifies marketing problem and offers marketing focus, objectives, program as well as tactics for the marketing plan implementation. The final part provides information on evaluation and control of the marketing implementation. The Plastic Surgery Center provides beauty services to men and women. The main types of services are Breast augmentation, Breast lift, Breast reconstruction, facelift, liposuction, total body lift, Botox, laser skin resurfacing, chemical peels, different types of message, etc. Plastic Surgery Center surgeons pride themselves on superb-quality services with innovative and stunning technology that provide excellent value to the customers. Plastic Surgery Center has positioned itself as a provider of superior service and products to all clients at an affordable price in convenient locations appealing to all family members. The centre has managed to position itself on the high-end of the service providing due to high standards for its customers, who are specially trained for high performance and consulting (Black 44). The strategic focus of all companies in this industry is providing hairdressing services with the superior quality and value for the customers. Efforts are aimed at providing friendly, efficient service from professional surgeons who are well-trained doctors to make the experience memorable and provide for loyal customers. The efforts are incorporated with the Centre's mission and vision as well as with the corporate culture instilled in the team, which according to the company's belief are the things that can bring a big difference (Doyle and Stern 98). The Plastic Surgery Center vision statementis to be a great business that is based on principles of: Profitability Friendliness Creativeness Consistency Great Value Cutting Edge Community mindedness ("Practice Philosophy". 2009). The Plastic Surgery Center puts emphasis on its clients receiving a service of a great value. The goal of marketing campaign, thus, is to retain existing customers and attract new customers, who would become long-term regular loyal customers, by the means of primary services as well as pleasant additional elements, which range from prices to the superior professional and products in terms of provided services. Situation analysis provides an insight on the Centre's position within the industry as well as overview of competitors, customers, industry trends. SWOT analysis outlines Plastic Surgery Center key strengths and weaknesses as well as describes opportunities and threats that its salons may face (Plastic Surgery Center in Morris County NJ 2009). Strengths Established brand equity and name in the industry Strong and business committed franchisees Well-trained medical professionals with high standard skills and creative customer-focused approaches Convenient locations and physical evidence elements in the centres, which are located

Media Literacy and Ethics Essay Example | Topics and Well Written Essays - 1000 words

Media Literacy and Ethics - Essay Example Media Literacy is a subject that is gaining relevance in the Information Age that we inhabit today. This is because a passive digestion of news content that is offered on a platter is unlikely to lead to a healthy understanding of that content. This is especially true in the highly privatized and commercialized environment of today, where much corporate and political propaganda gets passed on as objective news. Hence, there is no doubt as to the importance of Media Literacy to the general public. Yet, it is only a fraction of the population that could claim to possess a critical understanding of how different mediums of information operate. (Pavlik & McIntosh, 2011) The rest of this essay will foray into what all comprise Media Literacy and also analyze how media literate the author of this essay is. Firstly, media literacy seeks to address the proliferation of new literacy practices â€Å"in an increasingly mobile, global, digital world. Broadly analogous to print literacy,  medi a literacy  promotes the analysis (reading) and production (writing) of texts in a variety of forms. In practice, conflicting assumptions about the definitions, practices, and impact of  media literacy are at the heart of contentious debates about its fundamental aims, purposes, and value. Consequently, as  media literacy promotes greater access to a wider range of tools and texts, it is increasingly mired in age-old debates about the uses of literacy to frame, shape, and control public discourse. In the process, it touches on the relationships between  media literacy, cultural narratives, and the arts.† (Tyner, 2009, p.3) One of the key features of Media Literacy is the cultivation of strategies for a scientific analysis of media content. In this sense, Media literacy can be said to offer the citizens a range of critical approaches to gain insight into the nature of media content. Those studying the media should understand that it is merely the messenger of informatio n without any inherent moral character. What ascertains the value is the list of attributes attached to it, including â€Å"who is producing the message, what the function is, and the target audience.† (Silverblatt, 2007, p.4) Several academics in the field of Media Studies have defined Media Literacy in various different ways. Some claim that a comprehensive understanding of how news and program content is produced, including selection, edition and presentation are essential. In the case of news media, for example, without a complete understanding of these behind-the-scene processes, the audience/reader would not be in a position to critically evaluate the quality of journalism. Some of the criteria for measuring quality of journalism are objectivity, editorial neutrality, standard of presentation and detail. It is only a Media Literate person who would be able to evaluate how the medium he/she is using is performing on these counts. Such an evaluation will help him/her in d eciding to continue with the medium or switch over to another medium or actively engage with its managers in order to improve its overall standards. (Pavlik & McIntosh, 2011) It used to be the case when the term Media Literacy was used entirely in the context of print media. But ever since the invention of the Internet and other digital technologies the methods of information transmission have changed greatly. So, where Media Literacy previously meant the ability to â€Å"decode, understand and communicate in print†

Project breif Literature review Example | Topics and Well Written Essays - 2250 words

Project breif - Literature review Example This research proposal concerns the conduct of a dissertation involving the investigation, assessment and analysis of various challenges involved in the management of government projects in Saudi Arabia and the provisioning of appropriate recommendations for their successful management. As a means of reducing inefficiency and maximizing productivity, stakeholders throughout the business world have come to appreciate the power of timely and relevant project management theory (Al-Otaibi et al., 2013). As such, globalization has created a situation in which firms from around the globe integrate with businesses and projects in other countries. Therefore, engaging in a deeper and more efficient means of globalised project management is a step towards modernization and development; a goal towards which this proposal is fundamentally directed. While the implementation of infrastructural projects is undoubtedly increasing in the developing and emerging economies, project management in these countries is associated with a number of specific challenges (Frame, 2002). Such challenges increase when projects are undertaken for governmental organisations and departments (Frame, 2002). Extensive project work is occurring in Saudi Arabia, with the Kingdom’s government focusing on building infrastructure in areas of power generation, transportation, roads and medical facilities (Meed Media, 2013). Whilst project activity in the country does provide strong opportunities for project management organisations, the successful execution of such projects involves the anticipation, recognition and overcoming of diverse types of challenges with specific political, bureaucratic and legal ramifications (Meed Media, 2013). The proposed research study aims to examine the various challenges associated with management of government projects in Saudi Arabia and the providing of appropriate recommendations for overcoming

Texas Roadhouse Wont Scrimp on Making Employees Happy Essay Example for Free

Texas Roadhouse Wont Scrimp on Making Employees Happy Essay 1. â€Å"If we take care of our employees, they will take care of our customers† is a common phrase. In your experience, is it actually practiced or is it just a clichà © on the wall? Discuss the implications of your answer. â€Å"If we take care of our employees, they will take care of our customers,† this quote mostly depends on the individual company and how they perceive their employees. Some companies realize that in order for them to succeed, they must invest in their employees, as employees are the key to a successful and highly profitable business. And in order for employees to remain motivated and continue to flourish, they need recognition, which is a basic human need, regardless of status or job type. Once employees have been acknowledged for their good performance, they feel more appreciated, and as a result will demonstrate greater levels of commitment and dedication. Thereby, producing top results for the company and treating its customers with royalty. During recessions some companies such as Texas Roadhouse, continue to demonstrate employee appreciation through employee gatherings, cash reward bonuses and annual company conferences, in which spouses are invited (Noe et al., 2011). Companies such as Texas Roadhouse and other companies are leaders who want to succeed in today’s competitive world, and they realize that even during hard economic times, there’s still the strong need to maintain programs which are aimed at recognizing employees for work place accomplishments. And when employees are truly happy and motivated, they will care for the customers and give their best. Even through our suffering economy, many other companies also continue to celebrate employee’s performance through various recognition programs such as, cash bonuses, flexible work hour schedules, award celebrations, gift cards, employee appreciation day, company cook-outs, discounted family membership incentives, floating days and many others. Finally, most good leaders appreciate what employees do for the company, and will try to find ways to show love and appreciation. 2. Texas Roadhouse uses money as a motivator for employees. In today’s economy, describe alternative methods that could be used to motivate their employees. Texas Roadhouse has traditionally been known for their generous cash bonuses in recognition of employee appreciation, such generosity included, cash bonuses ranging from $500.00 in fun money to $20,000 for best meat cutter (Noe et al., 2011). However, in today’s unstable economy, the smart business leader will find other ways to show love and appreciation for their employees. Texas Roadhouse managers realize that employees are its biggest contributing factor for success or failure, and will find other ways to motivate employees, even during such economic uncertainty. For many companies, non-cash recognition is still a very powerful motivator, and will still foster ways to attract and retain good employees. And even though money is always a great motivator, effective employee compensation goes beyond money, in terms of individual needs being met; such needs as psychological needs, which define human relationships and the importance of employees connecting with customers, coworkers and managers. Employees also need to feel that they are a part of a group that has achieved success (Armstrong., 2010). Texas Roadhouse could customize a flexible-hours plan that would cater to restaurant staff. And even though most employees wouldn’t necessarily have the luxury of working from home, they would still have Flexible work hours and would be given the freedom to switch time schedules with coworkers, possibly allowing them more balance between work and home-life, while demonstrating an established trust between manager and employee. With flexible work schedules, employees can leave earlier or come in later, rotate shifts, or readjust their work schedule to make it more conducive to their life-style (O’Toole et al., 2011). Another great non-cash employee incentive for Texas Roadhouse could be that of various trainings and self-developmental opportunities. Trainings are very informational and can benefit employees in many ways, as they promote excellent ways for companies to learn of their top talent, trainings will also also satisfy employees will skill deficiencies. Trainings show the employees that their employer supports career development and advancement. The various trainings will expound on existing skills by including missing tools such as, education, updated technological skills and will help promote the company’s vision for valued progress. Trainings such as employee leadership offer employees development and confidence in independent problem-solving. Texas Roadhouse could also utilize multiple customer service trainings, since they provide direct service to exterior customers. And in order for them to continue on a successful path, they must continue to find ways to teach and reteach their employees the values of world class standards and its quality to customer satisfaction. As employees are exposed to various training programs, their knowledge potential becomes greater, creating more valuable human capital to the company. 3. Discuss the possible effectiveness of each of your alternative methods. Regardless of the economy’s condition, a good leader is able to inspire and motivate its employees, as they understand that happy employees will result in the success of the business. Effective employees are a result of effective managers, and good managers reward employees for good performance through communication and various reward methods. Alternatively, non-cash rewards, such as trainings and flexible hour plans can promote happier, healthier and more motivated employees, which will lead to more productivity. A flexible hours plan can prove very effective, as this method allows employees the freedom to switch shifts, to rotate hours around the clock, or change the time of day in which the tasks will be completed. As employees are allowed this flexibility, there sense of responsibility and confidence increase, as trust and an honor system is established between the employee and the manager. Through the flexible hours plan, employees are less stressed, as they are finding more balance and time to fulfill family obligations as well, all resulting in increased employee productivity. Employee trainings may also prove to be a very effective means of motivating employees. Trainings provide many benefits, as they help to build employees skills and talents, they also can foster a greater team environment, thereby giving employees a wider range of support and comfort. Trainings and other developmental strategies can be a powerful tool, which can aid a struggling worker. Through various training sessions, employees gain problem-solving abilities, learn up-to date technology skills, and become less dependent on the manager. And finally, trainings can help manager’s spot top talent within the company. 4. Analyze how transferrable is the Texas Roadhouse way of motivating employees in other organizations. Texas Roadhouse way of motivating their employees through large cash bonuses and other annual motivational conferences are incentives, which are based on the individual managerial leadership style, and cannot be transferred to other organizations, as every leader exhibits a distinct leadership style. It is agreed that such large cash bonuses will create keen competition between employees, but each leader have their own intangibles or uniqueness, which is spelled out through their leadership strategies. And during an economic hardship, the leader may decide on future investments that would offer the employee various training sessions to build upon their existing skills and knowledge, thereby, offering the employee promotional opportunities which would increase the employees financial gain, as well as making an upgrade to the companies potential success. Leaders must also consider that different people are motivated by different things. While some employees may have financial goals, others may have professional or personal goals, and cash compensation can’t possibly fulfill all human needs. Finally, based on the needs of a company, a good leader will know what to do and how to go about planning in order to achieve a successful outcome. References Armstrong, M. (2010). Armstrong’s handbook of reward management practice. (3rd ed.). Philadelphia, PA: Kogan Page Noe, R. A., Hollenbeck, J. R., Gerhart, B., Wright, P.M. (2011). Fundamentals of human resource management (4th ed.). New York, NY: MCGRAW-HILL. O’Toole, J., Lawler, E. (2007). The new American workplace. New York, NY: Palgrave Macmillan.