Googles Strategy in 2010 Essay Example for Free

Googles Strategy in 2010 Essay What is Google’s business model? The answer is complex because it makes up of lots of different factors. The top 10 principles of Google’s corporate philosophy is what keeps them doing what they do best. (Gamble, 2010, pg. C-175). 1.Focus on the user and all else will follow. 2.It’s best to do one thing really, really well. 3.Fast is better than slow. 4.Democracy on the web works. 5.You don’t need to be at your desk to need an answer. 6.You can make money without doing evil. 7.There’s always more information out there. 8.The need for information crosses all borders. 9.You can be serious without a suit. 10.Great just isn’t good enough. Their mission statement is to organize the world’s information and make it universally accessible and useful. (www.google.com). These 10 principles have helped them achieve their goal within their mission statement. Google has kept it simple but efficient. These 10 principles have guided them from the beginning and it has work. They don’t need to fix something that is not broken. Examine the financial reports in the case to determine the company’s profitability, liquidity, leverage and activity ratios. Based on these ratios what is your assessment of the company’s performance? Justify your answer? Profitability ratios are measures of performance that indicate what the firm is earning on its sales or assets or equity. There are the operating profit margin, net profit margin, return on total assets, return on equity, and basic earning power ratios. (Mayo, 2007). Operating profit margin = Earnings before interest and taxes/Sales 8,381,189/23,650,563 = 35.4% Net profit margin = Earnings after interest and taxes/Sales 6,520,448/23,650,563 = 27.5% Return on total assets = Earnings after interest and taxes/Total assets 6,520,448/40,496,778 = 16.1% Return on equity = Earnings after interest and taxes/Equity 6,520,448/36,004,224 = 18.1% Basic earning power = earnings before interest and taxes/Total assets 8,381,189/40,496,778 = 20.6% Leverage ratios measure the firm’s use of debt financing. There are two ratios; debt/net worth ratio and debt ratio. (Mayo, 2007). Debt/net worth ratio = Debt/Equity 4,492,554/36,004,224 = 12.4% Debt ratio = Debt/Total assets 4,492,554/40,496,778 = 11.0% Activity ratios measure how rapidly the firm is turning its assets into cash. The two activity ratios are inventory turnover and receivables turnover. Google does not have any inventory so there is no inventory turnover. (Mayo, 2007). Receivables turnover = Annual sales/Accounts receivable 23,650,563/3,178,471 = 7.4% Liquidity ratios measure the ease of which assets may be converted into cash without loss. There are two liquidity ratios; quick and current ratio. (Mayo, 2007). Quick ratio = Current assets – Inventory/Current liabilities 29,166,958-0/2,747,467 = 10.6% Current ratio = Current assets/current liabilities 29,166,958/2,747,467 = 10.6% Since Google does not have any inventory, the quick ratio and current ratio is the same. This shows that Google does have more assets than current liabilities. Overall, Google is doing extremely well all over the board. Their debt ratio is low sitting at 11 percent. They paid their bills on time because their receivables turnover is sitting at 7 percent. Investors know that Google is a good company to buy stock into. Perform a SWOT analysis of Google. Strengths Number one search engine with established name Simple interface-user friendly Their interface has 88 different languages-Global usage Localized search results Infrastructure Weakness Contextual ads targeted by click fraud Can’t expand to offline products Opportunities Acquisitions of other business Increase online advertising Alliances/partnerships with other companies Launched their own operating system Google TV Threats Facebook Click fraud Yahoo, Microsoft, and Amazon Slow economy Describe Google’s value chain. What is the source of the company’s competitive advantage? Since Google does not have any â€Å"raw† materials to process into finished goods like a traditional company, their value chain is different. Ben Morrow (2009) their value chain is more nuanced. Google gathers all the web users it can (the raw material) by enticing them to use its stellar search product with highly relevant results delivered promptly. Then, through assorted â€Å"signs† (text advertisements) it directs these same web users in the form of traffic to its advertising partners who transform the traffic into â€Å"conversions† or sales on their sites (finished good). Their added value is that they know where to direct the users to their sites that they needed to go. The source of Google’s competitive advantage is learning by doing as stated by Hal R. Varian, Google’s chief economist (Lohr, 2008). Basically, they arelearning from their competitors. For example, with Microsoft antitrust problems, they are now making antitrust training is mandatory for Google managers (Lohr, 2008). Some of Google’s competitive advantages are their value, rarity, imitability, and substitutability. Value because it is part of their value chain. Rarity because their user interface is so simple and user friendly. Also, it is hard for competitors to imitate because of the large infrastructure requirements to serve the relevant pages quickly. Google has servers all over the world all synced up and all running on a very large quantity of RAM, fast computer memory. (Morrow, 2009). References Lohr, S. (July, 7, 2008). The New York Times. Google, Zen Master of the Market. Retrieved on April 11, 2012 from http://www.nytimes.com/2008/07/07/technology/07google.html?pagewanted=1_r=1. Mayo, H. (2007). Basic Finance: An Introduction to Financial Institutions, Investments Management: 9 Edition. Thomson: United States. Morrow, B. (Feb. 22. 2009). Internal Analysis of Google Inc. Retrieved on April 11, 2012 from http://www.benmorrow.info/research/internal-analysis-of-google-inc/. Thomson A., Peteraf, M., Gamble, J., Strickland, A.J. ( 2012). Crafting Executing Strategy. McGraw-Hill.

Solid Lipid Nanoparticles of Clobetasol for Psoriasis

Solid Lipid Nanoparticles of Clobetasol for Psoriasis Formulation and Evaluation of Solid Lipid Nanoparticles of Clobetasol for Topical Treatment of Psoriasis CHAPTER 4 Methodology 4. METHODOLOGY MATERIALS USED: Table 5: LIST OF CHEMICALS USED WITH SUPPLIERS Table 6: LIST OF EUIPMENTS USED WITH SUPPLIERS Physicochemical study on the drug: Melting point determination Melting point is the temperature at which the pure liquid and solid exist in equilibrium. In practice it is taken as equilibrium mixture at an external pressure of 1 atmosphere; this is sometimes known as normal melting point. The Thiel’s tube method of melting point determination liquid paraffin was used in present study. UV spectrum UV scanning was done for pure drug from 200-400 nm in the dilution medium of methanol and in the dilution medium of phosphate buffer pH 7.4 Standard calibration curves of Clobetasol: Reagents Methanol Phosphate Buffer pH 7.4 114,115 Medium- Methanol  116 50 mg accurately weighed CP was dissolved in the methanol and volume was made up to 50ml with methanol [Stock 1]. From stock 1, different dilutions were prepared in the concentration range of 5, 10, 15, 20 and 25 µ g/ml using methanol as dilution medium. The absorbance of these solutions was measured against blank as methanol in UV spectrophotometer at 240 nm. Medium- Phosphate buffer pH 7.4 solution 50 mg accurately weighed CP was dissolved in the methanol and volume was made up to 100ml with methanol [Stock 1]. From stock 1, different dilutions were prepared in the concentration range of 5, 10, 15, 20, 25, 30 µ g/ml using Phosphate buffer pH 7.4 solution. The absorbance of these solutions was measured against Phosphate buffer pH 7.4 solution as blank in UV spectrophotometer at 239 nm. Compatibility studies of drug and polymers: FTIR spectra of pure clobetasol, physical mixtures, and SLN formulations are carried out to determine if there was any interaction between the drug and the other formulation components117. Since IR is related to covalent bonds, the spectra can provide detailed information about the structure of molecular compounds. In order to establish this  point, comparisons were made between the spectrum of the substances and pure compound. The Preformulation study was carried out prior to the development of the dosage forms. The compatibility of the drug and the excipients used were determined by IR spectrometer Shimadzu 8400 series. The spectra of formulations were compared with that of pure drug in order to ascertain for any possible interaction between polymer and drug. Preliminary studies: Initially, SLN was prepared by solvent injection method by using clobetasol (drug), carnauba wax and beeswax as lipid phase, cetyl alcohol and lecithin soya as surfactants. Tween 20 as co surfactant phase and finally distilled water to make up the volume. Where in this method, both liquid phase and lipid phase were heated to 70-75oC. When lipid phase was heated to desired temperature drug was dispersed in it and added to aqueous phase under the magnetic stirrer for 30mins. The lipid phase is added in to aquoes phase by drop wise using syringe. Thus SLNs were formed due to rapid crystallization of oil droplets and precipitation. This respective formulation design is shown in table 7. But the formed SLN was not dried and unstable. Therefore lipid extrusion method was used to prepare various formulations with different concentrations of lipid in an effort to optimize the formulations for the particle size ranging in nano scale. Table 7: Formulation design for solvent injection method The lipid extrusion method was adopted to prepare SLN. At 25mg of CP is kept constant in all formulation. Initially, the drug with different lipids tried with different concentration constant speed. The SLN were evaluated for particle size. The composition of formulation is shown in table. Formulation design:11,17,18 Procedure for preparation of SLN by lipid extrusion technique: Lipid extrusion is carried out at temperatures above the melting point of the lipid and is similar to the homogenization of an emulsion. A pre-emulsion of the drug loaded lipid melt and the aqueous emulsifier phase (same temperature) is obtained by high-shear mixing device (like Polytron PT 1600E homogenizer). High pressure homogenization of the pre-emulsion is done above the lipid melting point. Usually, lower particle sizes are obtained at higher processing temperatures because of lowered viscosity of the lipid phase. Fig 11: Schematic representation of SLN preparation by lipid extrusion Table 8: Formulation design for lipid extrusion method Table 9: Formulation design with stirring speed and duration of rotation using Polytron pt 1600E for Formulation F EVALUTION OF SLN: Physical Evaluations: Visual appearance pH: The pH of SLN formulations were measured using pH paper. Rheological studies Rheological properties (study of deformation and flow of matter) are required in various pharmaceutical areas. It helps to monitor the effect of vehicles consistency on release of drug from the preparations and subsequent percutaneous absorption. Also it is important from the manufacturing point of view. Viscosity measurements were carried out using a Brookfield viscometer (T – bar spindle). The formulation of SLN was kept in 100ml beaker and dial readings was noted at 3, 5, 6, 10, 12, 20, 30, 50 and 60 rpm. The speed was then successively lowered and the corresponding dial readings were noted. Particle Size Analysis118: The particle size should be less than 1000 nm in nanoparticles. It can be analyzed by using Malvern particle size analyzer. Particles in the size range of colloids display constant random thermal motion which is known as Brownian motion. This motion causes the intensity of light scattered by the particles to vary with time. The larger the particle slower their motion and hence the smaller the variation in intensity of light scattered. Photon correlation spectroscopy uses the rate of change in the intensity to determine the size distribution of particles. The zetasizer has a correlator with 64 channels. Each of this channel measures changes in light fluctuation over a defined time span. The time span is known as the sample time or delay time the correlator measures the light intensity by counting photons. For a very short time period the changes in light intensities will be very small as the particles had very little time to move. The position of the particles can be statistically defined as being highly correlated, Contrast to this with a long sample time, particles will have moved randomly from their initial positions. Therefore the particles can be described statistically as not being correlated. Zeta potential measurement Zeta potential of the SLNs were measured by malveren zetasizer. The zetasizer mainly consist of laser which is used to provide a light source to illuminate the particles within the sample. For zetapotential measurements this light splits to provide an incident and reference beam. The incident laser beam passes through the centre of the sample cell, and the scattered light at an angle of about 130 is detected. when an electric field is applied to the cell, any particles moving through the measurement volume will cause the intensity of light detected to fluctuate with a frequency proportional to the particle speed and this information is passed to the digital signal possessor and then to a computer. Zetasizer software produces a frequency spectrum from which the electrophoretic mobility hence the zeta potential  is calculated. Scanning Electron Microscopy (SEM): Surface morphology of the specimen will be determined by using a scanning electron microscope. Procedure: The samples are dried thoroughly in vaccum desicator before mounting on brass specimen studies, using double sided adhesive tape. Gold-palladium alloy of 120 °A Knees was coated on the sample sputter coating unit (Model E5 100 Polaron U.K) in Argon at ambient of 8-10 with plasma voltage about 20mA. The sputtering was done for nearly 5 minutes to obtain uniform coating on the sample to enable good quality SEM images. The SEM was operated at low accelerating voltage of about 15KV with load current about 80mA.The condenser lens position was maintained betwee 4.4-5.1. The objective lens aperture has a diameter of 240 microns and working distance WD=39mm. Drug content119: The drug equivalent to 10 mg of formulation was taken and dissolved in small quantity of methanol. Then the formulation is warmed on the water bath so that the drug present in the formulation was completely dissolved. Then the solution was filtered through Whattman filter paper in 25 ml. volumetric flask and volume was made up to the mark by methanol to give concentration of 1000 ÃŽ ¼g/ml. for Clobetasol. Then 1 ml. was pipetted out in 100 ml. volumetric flask to give concentration of 10ÃŽ ¼g/ml and then absorbance was measured at 240 nm. In-vitro release studies114,115,120: In Franz diffusion cell, 6 gm. of sample was kept in donor compartment. The entire surface of cellophane membrane was in contact with the receptor compartment containing 50 ml of phosphate buffer pH 7.4. The receptor compartment was continuously stirred using the magnetic stirrer. The temperature was maintained 35 °C. The study was carried out for 24 hrs and the sample was withdrawn at 30 minute time interval and same volume was replaced with free phosphate buffer. The content of clobetasol from withdrawn sample was measured after suitable dilution. Stability studies: Whenever a new formulation is developed, it is very essential to establish that the therapeutic activity of the drug has not undergone any change. To conform this, the selected formulations were subjected to stability studies. Generally, the observation of the rate at which the product degrades under normal room temperature requires long time. To avoid this undesirable delay, the principles of the accelerated stability studies are adopted. The International Conference of Harmonization guidelines titled â€Å"stability testing for drug substance and product† describes the stability tests requirements for drug registration applications in the European Union, Japan and United States of America. Table 10: International climatic zones and climatic conditions Table 11: General stability testing consideration Study

Malnutrition Effects on Quality Of Life

Malnutrition Effects on Quality Of Life The focus of this assessment is quality of life and specifically this paper considers how malnutrition affects quality of life of community settings patients. According to the Scottish Governments publication Older people living in community Nutrition needs, barrier and interventions: a literature review, malnutrition is an umbrella term for undernutrition, overnutrition and imbalance diet intake (The Scottish Government, 2009). Malnutrition has previously been described in the various ways (The Scottish Government, 2009). However, for purpose of this assessment the following term will be used as defined by World Health Organisation (WHO) the cellular imbalance between the supply of nutrients and energy and the bodys demand for them to ensure growth, maintenance, and specific functions (see European Nutrition for Health Alliance, 2005). According to Saunders, Smith and Stroud (2010) 2 per cent of the UK population is underweight: Body Mass Index (BMI) is lower than 18.5 kg/m. However, they agreed that patients could be still at risk of malnutrition whatever their BMI is (Saunders, Smith and Stroud, 2010). Malnutrition, as well as other factors, has negative effect on the persons quality of life (The Scottish Government, 2009). In the UK, hospitals admission rate and mortality were greatest in patients with BMI below 20 (kg/m2) (Teo and Wynne, 2001). During nutrition screening survey in the UK various settings it was found that malnutrition doubles risk of mortality in the hospital patients and triples morality in elderly patients in hospitals following discharged (RCN and NPSA, 2009). Care Homes nutrition survey shown that 30 per cent of service users recently admitted to care homes were at risk of malnutrition (RCN and NPSA, 2009). According to Hickson (2006), malnutrition may be secondary to certain health conditions which is increasing risks for patients to become malnourished and those risk factors will be discuss later in this assessment (Hickson, 2006 and Teo and Wynne, 2001). However, European Nutrition for Health Alliance (2005) argued that malnutrition should be classified as independent disease (European Nutrition for Health Alliance, 2005), its due to undernutrition has a negative effect on all organs systems such as muscle-skeleton, cardiovascular, respiratory, gastrointestinal, endocrine systems and in addition, malnutrition has a psychosocial effect (Saunders, Smith and Stroud, 2010). It was found that undernutrition could cause following health conditions: in the healthy individuals and has advance exacerbation effects upon existent illnesses or injuries, reduced psychological wellbeing (increase anxiety, depression apathy, and loss of concentration and self-neglect) (Webb and Copeman, 1996 and Saunders, Smith and Stroud, 2010). According to Morley and Kraenzle (1995), balanced diet in general, is improving cognitive and memory performance in elderly (see Vetta et al, 1999). Chandra (1993) found that undernutrition is depressing organism immune function (see Webb and Copeman, 1996). It could be due to impaired cell-mediated immunity and cytokine, complement and phagocyte function this most commonly could lead to developing bacterial and parasitic infections and poor wounds healing (Saunders, Smith and Stroud, 2010). Malnourished patients have reduced muscle function, loss of cardiac muscle and reduce cardiac output, which results in impact on the renal function (Saunders, Smith and Stroud, 2010). The same individuals have reduced respiratory response to oxygen deficit by poor diaphragmatic and respiratory muscle function (Saunders, Smith and Stroud, 2010), increased risk of hypothermia, increase risk of falls and injuries (Webb and Copeman, 1996). In addition, redaction of fat and muscles mass are more obvious signs of malnutrition (Saunders, Smith and Stroud, 2010). According to Clayton (1991), malnourished elderly clients have a poor prognosis for recovery from following fractured femur, hypothermia, pressure ulceration and other conditions (Clayton, 1991). Fracture risk is high then calcium, magnesium and vitamin D intake is insufficient, during the weight loss bone mass is reducing as well (Saunders, Smith and Stroud, 2010). Early stage of malnutrition leads to loss of digestive enzymes that result in intolerance of lactose. The colon loses its ability to absorb liquid, electrolytes, and secretions of small and large bowels, which results in diarrhoea (Saunders, Smith and Stroud, 2010). According to Saunders, Smith and Stroud (2010), endocrine system is affected in malnourished patience. For example, chronic malnutrition will change the pancreatic exocrine function by reducing the insulin secretion (Saunders, Smith and Stroud, 2010). An author is currently working a nursing and residential care home for elderly patients as well as nursing and social recruitment agency, which is covering biggest part of the North West of England. Being allocated in hospitals and nursing homes the author noticed that patiences nutrition needs are being met well but where are still some areas for improvement. During the study carried out in the large the UK hospitals, it was found that 40 per cent patients admitted to hospitals were malnourished and two-thirds subsequently lost weight during their hospital stay (Teo and Wynne, 2001). During the service users meeting in the care home author working in, carried out in January this year, all 14 service users have stated that they are satisfied with food they are getting. However, two patients are still at risk of malnutrition. They have been referred to the GP for dietician support. The author strongly believes that nursing home is providing adequate food to the service users. Catering manager in the UK hospitals compare to chefs in nursing home have a small budge of  £11 to  £15 per patients a week (Teo and Wynne, 2001). The authors care home spends around  £30 per service user a week. However, in March 2007, Royal College of Nursing (RCN) carried out survey questioning nearly 2200 of their member relating nutrition issues. Survey has revealed that 42 per cent said the food provided for patients were below overage expectancy (RCN, 2011). In various reasons government and health profession organisations are now advising for routing screening of all patients admitted to any healthcare facilities (RCN and NPSA, 2009). In authors opinion, the main priority for addressing this issue is promoting patiences health and wellbeing and cutting financial cost. For example, annual financial cost of treatment malnutrition patience and any associated illnesses in the UK was estimated around 7.3 billion pounds. This figure includes treatment malnourished patience in the hospital setting, round 3.8 billion pounds and long-term care facility such as care home, round 2.6 billion (Elia M., et al., 2005). Causes of Malnutrition The author is currently looking after two service users who are scoring on the MUST. All two patients are elderly from 65 to 80 years old, with different background and health conditions. Patient No 1 is 87 years old female, was diagnosed with Alzheimers Disease, history of Transient Ischemic Attack (TIA), high blood pressure, right wrist fracture and Dysphasia. Current BMI is 19, which was stable after referral to dietician and commencing on oral supplements, than BMI was 17 back in the October 2010. Patient No 2 is 72 years old man, diagnosed with alcohol excess, CA oesophagus, Gout, Heart Failure. Current BMI is 23, which was stably increasing over past months following admission to nursing home, than his BMI was 17. Both patients have a poor appetite at present. Nursing homes staff cannot establish reasons for anorexia and BMI reduction in one patient. There are number of risk factors, which could cause malnutrition among elderly population. However, the most important factor leading to undernutrition is reducing of oral intake (Saunders, Smith and Stroud, 2010). Inadequate dietary intake is depending on various factors (Saunders, Smith and Stroud, 2010), which could be divided into three main categories: medical, social and psychological (Hickson, 2006). Firstly, age related changes such as changing in appetite or sensory (Teo and Wynne, 2001). Working in the care homes author noticed, an appetite is reducing with advanced age. Some people refused or preferred to omit meals, for example, one patient does not take breakfast, then the author asked her why she is not taken breakfast that patient replied that she is not a breakfast person. In addition, during the study carried out in USA it was discovered that elderly population are consumed less energy intake and follow more traditional eating pattern then younger population (Teo and Wynne, 2001). Poor appetite or anorexia is a most common factor leading to malnutrition in both young and old generation (Hickson, 2006). However, during the study commenced by Roberts et al (1994), it was found that ageing seemed to affect the ability to control food intake and weight lost will take longer to re-gains in elderly men compare to young (see Hickson, 2006). In addition, according to work of De Castro (1993), older people are less responsive to stomach contents than younger people, in term of hunger (see Hickson, 2006). Anorexia may occur as process of aging as well as during underlying illnesses (Teo and Wynne, 2001 and Hickson, 2006). Hetherington (1998) argued that changing in taste and smell could lead to loss of appetite through a perceived decline in the pleasantness of food. Loss of taste and smell could be associated with advance age and medications therapy mechanism of these changes are remains unknown (see Hickson, 2006). In authors care environment patients prefer to eat strong flavour and taste meals such as a roast meat with gravy, bacon, fish which are being served with traditional sauces or salt and vinegar to encourage patients to their food. According to Hickson (2006), a few works have been done to find out that improving the flavour of the food can improve diet intake and follow weight increase in hospitals and community healthcare patients (Hickson, 2006). A few patients do not like vegetables, intake of which have being recommended by NHS 5 a day complain based on the WHO (NHS, 2009). Patient No 1 and Patient No 2 do not have own teeth which is reducing ability to chew tender food. For both patients oral problems have not been reported. However, according to Finch et al (1998), National Diet and Nutrition survey, energy consumption was lower in edentate individuals compare to individuals with own teeth (see Hickson, 2006). Dysphasia or swallowing problem is leading concern in reducing dietary intake (Hickson 2006). The author has experienced that often care and catering staff do not understand the different between soft and liquidised diet and which diet should be given to each patients with dysphasia. Moreover, care staff that is responsible for feeding patients, needed assistant, every often do not understand the sings for swallowing problem. This concern has been addressed in the care home that the author is working in by appointed care staff for appropriate training section provided by Liverpool Primary Care Trust (PCT). According to research carried out by Mowe et al (1994), swallowing problem is showing up in 64 per cent of in-patience elderly (see Hickson, 2006). In addition, Gariballa et al (1998) argued that post Cerebrovascular Accident (CVA) patients with Dysphasia had a worse nutrition status then those patients without swallowing problems (see Hickson, 2006). The author strongly believes that malnutrition caused by various factors combined together such as old age and health or mental health problem (Saunders, Smith and Stroud, 2010). In the UK, it was estimated that around 8 per cent of patients with chronic diseases living in the community are malnourished (Teo and Wynne, 2001). According to Hickson (2006), diseases-related malnutrition is usually associated with cancer, physical disabilities, endocrinology disorder and respiratory disease, gastrointestinal disorders, neurological disorders, sources of infection and other psychological factors such as depression and Dementia (Hickson, 2006 and Teo and Wynne, 2001). Medical factors increase the risk of patient to become malnourish through, for example, nausea or vomiting, diarrhoea or constipation, anorexia and malabsorption (Hickson, 2006). Cultural factors or social (Vetta et. al. 1999) and food habits are also playing an important role in developing malnutrition as independent illness (Hickson, 2006). As example, an individual who had a long-term hospital stay or had no nutrition support while in the community would not used to have full nutritional meals. Moreover, individual who has been admitted to the authors care home used to take fast food or sandwiches at all the time while at home, instead of cooked meals. According to Hickson (2006), there are lifestyles and social risk factors for malnutrition in elderly people are lack of knowledge about food, nutrition and cooking, isolation and loneliness, poverty, inability to shop or prepare food (Hickson, 2006). Dementia has a great effect on individuals relationship with food (Alzheimers Society, 2011). Dementia patients or patients with low mental status appeared to lost weight due to reducing self-feeding ability, acute sense of smell and taste that is depending on severalty and progression of disease (Teo and Wynne, 2001). Berkhout et al (1998) has confirmed that weight lost in demented patients is caused by patients ability to feed them rather than by dementia as illness (Hickson, 2006). According to Incalzi et al (1998), study carried out for in-hospitals patients found out that cognition is causing impairment to ability or desire to eat (see Hickson, 2006). Progressive dementia is usually associated with uncontrolled weight lost and changing eating habits (Claggett, 1989 see Hickson, 2006). Nutrition screening and risk assessment In 2007, RCN commenced Nutrition Now campaign, which has a wide response from members of public as well as members of multidisciplinary teams. The RCN Principles for Nutrition and Hydration were published in 2007. That principals aim to help of all health professionals grades to improve nutrition and hydration of patience. This paper is highlighting three principles of nursing care: accountability, responsibility and management to improve the patience nutrition and hydration (RCN 2011). Nutrition screening pathway, nutrition risk assessment are widely used which assist nursing staff to indentify the risk of malnutrition or/dehydration and appropriate actions to be taken. Risk of malnutrition screening should be a routine process in all healthcare settings (RCN and NPSA, 2009). In the authors care home as required all service users are being screened for malnutrition on the admission and once a month or more often if required, using Malnutrition Universal Screening Tool (MUST) as recommended by government bodies and Care Quality Commission (CQC) as registration body. Part of the admission documentation is to collect and record patiences food likes and dislikes. According to Saunders, Smith and Stroud (2010), MUST is reliable and valid screening tool in diagnostic or prediction of malnutrition (Saunders, Smith and Stroud, 2010). However, nutrition assessment was only done for patients who have been referral to their GPs following scoring, weight loss of 1 to 2 per cen t per week, 5 per cent per month or 10 per cent over period of six months (Mitchell, 2003). According to RCN and NPSA (2009), purpose of nutritional assessment is details identification of nutritional status and for special dietary plan to be formulated and implicated (RCN and NPSA, 2009). In the authors care home, dietician or dieticians assistant based on the information provided by staff nurse on duty normally carries out the nutritional assessment. As far as author concerns, nutrition assessment should be done by care home nurses as they are working in close contact with patients and their families on the daily basis, know better persons food likes and dislikes. However, special nutrition trainings are not always available to the nursing home staff. This could lead to complicated nutrition issues not to be addressed as quickly as they should be due to community dieticians waiting time is usually 6 weeks. In the authors nursing home all necessary equipments are available such as weight scales and height measures. However, weight scales calibration has not been done which could lead to poor nutrition screening assessment (NPSA). After completing the MUST, the author and colleagues will formulate the personalised care plan for each patient in order to meet nutritional requirements. Nutrition care plan could be based on the information or guidance provided by dietician or other health professions. Treatment According to Hark and Morrison (2003), the nutrition needs of healthy older adults are mainly the same as for middle age adults (Hark and Morrison, 2003). The intake of food containing Calcium, Vitamin D, Folate, Vitamin B12 and B6 should be increased for the elderly population (Hark and Morrison, 2003). Protein intake recommendation is variable from 0.8 g/kg per day in the USA (Mitchell, 2003) to 0.75 g/kg in the UK (McKevith, 2009). However, according to Mitchell (2003), one established nutrition needs recommendation cannot be used for all ages population (Mitchell, 2003). In addition, patients lifestyle, height and weight should be taken in account (Mitchell, 2003). There are number of fundamental support of nutrition available at present such as enteral and parenteral nutrition support (Hark and Morrison, 2003). At this assessment only oral nutrition support (ONS) will be discussed. The aim of the nutrition support is to ensure an individual gets enough energy, proteins, macronutrients and micronutrients to meet patients nutrition requirements (Saunders, Smith and Stroud, 2010). Saunders, Smith and Stroud (2010) argued that provision of regular meals with better nutrition content, wide menu choice and assistant with feeding should be enough to meet nutrition requirement and reduce nutrition risk (Saunders, Smith and Stroud, 2010). Numerous studies show that nutrition support could reverse weight loss, only if underlying health conditions under control (Saunders, Smith and Stroud, 2010). However, not all patients react at the same way (Hickson, 2006). At what reasons care and treatment should take an account of individual needs and preferences (RCN and NPSA, 2009). In practice, knowledge of food preferences and past medical history, following personalised nutrition care plan, serving patients with small meals (Teo and Wynne, 2001) or using a small plate could encourage service user to finish all meal. Currently some of the UKs hospitals commenced to use red tray scheme for serving the meals to patients. A purpose of using red trays is to alert hospital staff that patience with red tray is at nutrition risk and need assistance or supervision with diet intake (Bradley and Rees, 2003 see Davis, 2007). Protection of mealtime scheme is also widely spread across the UK. The purpose of this scheme is to create an environment for hospital patients free from hospital activities and unnecessary disturbance during a mealtime. In addition, this scheme is to assist nursing staff with concentration on the meeting nutrition need of hospital patients (NS, 2007). People with Dementia could loss an ability to use cutlery that could lead to weight loss and malnutrition. Providing those patients with available finger food could improve nutrition status (Alzheimers society, 2011). Teo and Wynne (2001) argued that the possible benefits from using energy supplements in elderly patients have received little or no evaluation in clinical practice (Teo and Wynne, 2001). However, during the study carried out by Volkert et al (1996), it was found that patients consuming food supplement while in-patience and 6 months in community have develop positive nutritional status compare to group of patients without food supplements (see Teo and Wynne, 2001). The author has come across the situation then GP has refused to prescribe food supplement to one of the patience and recommended full fat milk instead. In addition, during controlled trial for six months in patients who have been discharged from hospital and prescribed ONS has no economic benefit. To compare, using ONS in community is costing more than using ONS in hospitals (Elia et al., 2005). However, malnourished patients using could be at risk of re-feeding syndrome, which could results in death (Saunders, Smith and Stroud, 2010). Re-feeding syndrome is associated with water retention leading to fluid overload due to decay of potassium, magnesium, phosphorus and sodium in blood plasma (Mallet, 2002). Saunders, Smith and Stroud (2010) recommended that during re-feeding saviour malnourished patients potassium, phosphate and magnesium should be prescribed and thiamine (for patients with history of alcohol excess) (Saunders, Smith and Stroud, 2010). Conclusion The UK elderly population is rising, currently about 16 per cent of the population is above 65 (Hickson, 2006) and by 2050 over 30 per cent European population will be over 60 which will result in prevalence of malnutrition to rise (European Nutrition for Health Alliance, 2005). Many changing associated with aging have been documented, however, how senescence leads to the health conditions, related to aging, is still unknown (Mitchell, 2003). It was found that ageing is leading to slow reduction of weight and modification in body composition. It is due to declines in bone, muscle mass and body cell mass. Bone mass reduced due to inadequate intake of Calcium and inadequate exposure skin to the sunlight to encourage production of Vitamin D (Sahyoun, 2002). In general, people are gaining weight until they 60th birthday and after gradually reducing weight, usually 10 per cent between 70 and 80 (Mitchell, 2003). Weight loss related to aging and malnutrition should be indentified during initial nutrition assessment. In addition, community healthcare is facing many concerns. Firstly, malnutrition remains under-recognized problem facing patients, their families and health professions (Saunders, Smith and Stroud, 2010). Secondly, according to, Hark and Morrison (2003) argued that there are no single physical or biochemical screening tools could accurate predict the nutrition status in elderly (Hark and Morrison, 2003). Food prices are constantly rising and ONS are costing too much to the local PCT. In the authors opinion, providing service users with good quality food, offer choice of menu and snacks between meals are solution to fight malnutrition. The significant role in education medical students and junior doctors in nutrition has widely recommended (Saunders, Smith and Stroud, 2010). However, inadequate knowledge in nutrition of nursing and care staff could increase risk of malnutrition (Saunders, Smith and Stroud, 2010). In the authors care home nutrition in elderly is not mandatory training for the care staff. Following this assessment, the author will provide relevant care staff with information on the nutrition in elderly service users. This could be achieved through supervision sections and face-to-face talks. Moreover, there it is possible, elderly population and their families should be informed about the latest nutrition recommendations related to their age, lifestyle and health conditions and should encouraged to apply those recommendations to individuals lives (Sahyoun, 2002).

Essay --

Learning objectives To provide exercise professionals with an overview of resistance training benefits, safety issues, and programming guidelines for patients who have been diagnosed with osteoporosis or at risk of getting it. Key words Osteoporosis, Bone Mineral Density, Resistance Exercise, Quality of life, Postmenopausal Women, Strength Training, Osteoporosis is a major public health problem that will likely escalate as the population ages. Osteoporosis is a skeletal disease characterized by a significant decrease in bone mass, which can lead to an increase in bone fragility and susceptibility to fracture. Women are three times more likely than men to be diagnosed with osteoporosis during their lifespan. 2,6,9,17,21,24,33,50 Bone is a dynamic tissue that continually adapts to its functional demands to produce a structure that is strong enough to prevent fractures during typical activities. 3,14,23,29,32,33, Studies have clearly shown the importance of regular physical activity for optimal skeletal growth during development and maintenance of mineral mass and density in adulthood. Because this disease is characterized by a progressive decline in bone density, resistance training is often recommended as a complementary treatment. This article will review both the current body of knowledge with respect to the effects of resista nce training on osteoporosis symptoms as well as the current recommendations for a resistance-training program. Disease Background Osteoporosis is a manifestation of bone atrophy that leads to great susceptibility to fractures, which occur even as a result of small trauma. The most common fractures occur in the spine, wrist and hip and are not uncommon in the ribs, humerus and pelvis.3, 18,20,26,3... ...ng is preferable to lower intensities and is generally safe because the load is relative to individual capacity. In middle-aged and older persons, especially postmenopausal women and patients treated with medications that may cause bone loss should be given an exercise prescription. Resistance exercise targeting major muscle groups is recommended 2 to 3 days per week at ~70% to 80% of 1 RM, 2 to 3 sets, and 6 to 8 repetitions per set. They should begin with lighter loads, adding weight in small increments until desired loads are achieved. Proper posture and lifting technique are crucial concerns, so that they do not injure themselves during exercises. Exercise programs for elderly women and men should include not only weight-bearing endurance and resistance activities aimed at preserving bone mass, but also activities designed to improve balance and prevent falls.

Night by Elie Wiesel :: Night, Elie Wiesel

Night is a horrible tale of murder and man’s inhumanity to man. Wiesel saw his family, friends, and fellow Jews degraded and murdered. Wiesel also states in his book that his God, to whom he was so devoted, was also "murdered" by the Nazis. In the novel Wiesel changed from a devout Jew to a broken young man who doubted his belief in God. When Wiesel first comes to the concentration camp and sees all the walking skeletons, he can’t believe that this is real. He feels that he might be dreaming. However, as Wiesel faces each day and witnesses the starvation, the beatings of innocent people, and the tortures, his faith in God begins to waiver. By the end of the book Wiesel has lost his belief in God. If there is a God, how could he allow this to happen, he wonders. As the days go by, there are frequent selections. A man with a little stick decides who will live and who will die. This man acts like God. To the right you live, to the left, you die. As Wiesel watches the evil that exists, his belief in the existence of God continues to deteriorate. Wiesel asks, "Where is my God? Where is He?"(61) Wiesel continues to witness hangings, beatings, starvation, and torture. One day when Wiesel comes back from a day’s work, he sees three gallows being assembled. The whole camp has to witness the hangings. Among the 3 people who would die that day, was a young child. Wiesel wondered what that poor innocent boy had done to deserve to die in this manner. Wiesel watched the boy struggling between life and death. The death was a slow agony. At this point Wiesel lost all faith in the existence of God. "Where is God now? Where is He? Here is - He is hanging here on this gallows..."(62) After this incident Wiesel could no longer believe in God.

Flexicurity a Relevant Approach in Central and Eastern Europe Essay

Flexicurity Introduction   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Flexicurity is an integrated approach for endorsing security and flexibility in the labor market. Flexicurity endeavors to merge employers’ call for for a flexible labor force with workers’ call for for security. Employee call for security implies the confidence that the employees will not go through stretched periods of joblessness. Flexicurity is a new policy that is called upon because of the increased nee of security and flexibility faced by national governments, European Union, individual workers and companies, as well as sectors of industry. Legislators, policy-makers, employers and trade unions organizations have a strong call for new flexicurity policy concepts and models that guarantee to reunite the strategies of endorsing security and flexibility at the same time.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Flexibility and security has for a long time seen as incompatible, thus this new policy will be very significant in industrial relations. The EU aim of enhancing security and flexibility in the labor market is to achieve a competitive advantage and open knowledge-based economy across the world that is proficient of sustainable economic expansion with immense cohesion and more and superior job opportunities. The new flexicurity approach is common within the European Employment strategy. The European Employment Guideline 13 formulated in 2001, under the Adaptability pillar, clearly tackle both security and flexibility strategies and also welcomes social stakeholders to mediate and implement appropriate agreements to update the how work is organized, incorporating flexible working programs, with an objective of achieving high productivity, required balance between security and flexibility as well as competitiveness.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Flexicurity is very vital since appropriate balance between security and flexibility will increase productivity and quality of work, competitiveness and help corporations to adapt to changes in the economy. Flexicurity is important to European employment policies and update of EU labor law especially in the recent economy which is faced by increasing globalization, financial and economic crisis. The position of social dialogue and social partners is greatly emphasized in flexicurity. Swedish industrial relations and labor laws system is based on cooperation between stakeholders, self-regulation and collective bargaining. Collective bargaining is estimated to be 90% and trade unionization is estimated to be about 70 percent. Salaries and other job conditions and terms are set by collective bargaining. European Union member states apply different approaches to flexicurity depending on industrial relations, their labor laws, and social securi ty systems.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Countries implement the new flexicurity policy with an aim of cutting down market segmentation and enhance changes. Equal treatment of all employees can be attained via values of equal treatment and non-discrimination and appropriate reforms to the guideline of employment security and fixed-term occupation. Flexicurity policies call upon enterprises to make reforms on their existing laws and police in order to accommodate security and flexibility. Functional flexibility has led to a heated debate in the labor markets. In order to come up with effective flexicurity firms should examine the existing internal and external flexibility. Internal flexibility help employees to adjust labor input in case of transitory fall in demand while conserving jobs which are feasible in the long run. Flexicurity poicy can account for the resilience in many European nations especially helping them maintain low and stable unemployment rate. This is because fle xicurity protect employees from income losses connected to key lay-offs and plant closures. However, external flexibility of many firms remained unchanged for the last three decades. Research reveals that income losses of misplaced workers have reduced since the workers can get swift re-employment.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Flexicurity has faced many criticisms from the people who proposed that flexicurity was developed with an aim of eliminating employment protection legislation, but it encourages a suitable blueprint of employment protection legislation. Open-ended contract between an employee and the employer would be redesigned to incorporate gradual development of job security. The job protection would gradually build-up with the job term, until full job security is attained. The tenure track approach is very significant since it reduces the incidents of employees being trapped in less protected contracts. Reforms of the employment due to economic crisis are aimed at addressing length of procedure, bureaucracy, improve lucidity and make the procedure more dependable. The starting job protection policies may take into consideration notification periods, the procedural phase of dismissal protection and the amount of severance pay.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   European Expert Group on Flexicurity propose that use of fixed-term agreement should be reduced and undeclared work should be cut short as swiftly as possible by raising valuable inspections. It is crucial to acknowledge that outside the sphere of the European Employment plan, the open technique of coordination and Europe 2020 Strategy, the flexicurity policy has not yet brought up fresh legal suggestions associated to employment security. Flexicurity slightly regulate the employment security at EU level with an aim of achieving their main objectives and meet the requirement of member states in areas such as protection of workers whose employment contract is abruptly terminated. EU agreement of Fundamental Rights state that every employee has the right to safety from groundless dismissal as per the national and union laws and policies.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Flexicurity has been able to increase flexibility in the labor market while at the same time maintaining security via promotion of more employment opportunities and enough ground of employment benefits. Counties with solid employment protections tend to go through fewer incidents of labor market disruptions as compared to nations with weaker employment security. Flexicurity has dominated over the famous Commission’s labor market policy prescriptions. The interest of flexicurity in labor market originated from Netherlands and Denmark which serve as an example. These countries enjoyed the lowest unemployment rates in the global economy crisis in Europe while maintaining adequate unemployment benefits. The main reason was that Denmark and Netherlands emphasized on active labor market measures accompanied by modest employment protection. European Commission has gradually incorporated flexicurity policies when developing its labor market policy instructions and has persuaded the EU members to develop labor market laws that conform to flexicurity plan. In endeavors to direct development of national policy, the commission highlighted four pillars of flexicurity which include: flexible and dependable contractual agreement between employer and employees, comprehensive long-lasting learning scheme to enlighten the workers, successful active labor market policies and updated social security systems.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   In conclusion, flexicurity is a very significant strategy that will help countries to cope up even during economic hardship. Flexicurity also offer the employee allows flexibility at work and at the same time maintaining security. This ensures firms acquire competitive advantage, increase productivity and quality of work and help employees and corporations to adapt to changes in the economy. Nations are called upon to incorporate flexicurity policy in their labor markets so that they can enjoy various benefits associated with this new strategy. However, appropriate measures must be undertaken to ensure there is the required balance between security and flexibility. References Cazes, S., & Nesporova, A. (2006). Flexicurity a Relevant Approach in Central and Eastern Europe.. Geneva: International Labour Office. Flexicurity: perspectives and practice.. (2010). Dublin: European Foundation for the Improvement of Living and Working Conditions. Source document

Ghent Altarpiece Reflection

The Ghent Altarpiece is considered by scholars to be one of the most ambitious and complex paintings of the 15th century. Its detailed panels convey its sacred matter with such realism that art historians mark It as the start of the Northern Renaissance. The altarpiece, also known as the â€Å"Adoration of the Lamb†, was begun in 1425 The exterior frame of the altarpiece Indicates It was started by painter Hubert van Eyck who died before he could finish, and then completed by his brother Jan van Eyck In 1432 The painting was then acquired by a wealthy patron Jodocus VIJd for placementIn the church of saint John, Ghent, Belgium. The work Is an excellent piece of study because the painting Is so complex. The panels display a variety of detailed scenes, but the center of the altarpiece Is Jesus Christ, the Virgin, and saint John the Baptist. And below them, a host of saints assembled around the lamb. The masterpiece consists of 24 panels of varying size and shapes aligned two rcv . . s so that the 12 panels are vlslble opened and then 12 panels are vlslble when the panel Is closed. Measuring 1 IXI teet and painted In oils the altarpiece can be lett open or closed.The pictures themselves are laid out in two tiers. Jan van Eyck used oil paint to create tiny vibrations ot light within the saturated colors most ot which are symbolic significant. The Ghent Altarpiece was commissioned by the wealthy businessman Jodocus Vijd tor his chapel and hence the creation ot the masterpiece. The altarpiece represented a â€Å"new conception of art', in which the idealization of the medieval tradition gave way to the observation of nature and a more exact representation of the human being. se live layout and alignment guides Click the image below and drag It around the page With Images that have text rapping, the text moves around the picture so you get a live preview of the new layout. Try to line the Image up with the top of this paragraph to see how the alignment guides c an help you position It on the page. Click the Layout Options button next to the Image to change how t interacts with the text Learn more at offlce. com 2. ollaborate In Simple Markup Vlew The new Simple Markup revlslon view presents a clean, uncomplicated view of your document, but you still see markers where changes and comments have been made. Click on the vertical bar on the left side ot the text to see changeslike this one. Or llcK tne comment Icon on tne rlgnt to cnecK out comments aoout tnls text. Learn more at office. com 3. Insert Online Pictures and Video Add and play online videos inside your Word documents.Add your pictures from online photo services without having to save them first to your computer. Click Insert ; Online Video to add a video to this document. 4. Enjoy the Read Use the new Read Mode for a beautiful, distraction-free reading experience. Click View ; Read Mode to check it out. While you're there, try double clicking on a picture to get a closer view. Clic k outside the image to return to reading. 5. Edit PDF content in Word Open PDFS and edit the content in Word. Edit paragraphs, lists, and tables Just like familiar Word documents.Take the content and make it look great. Download this helpful PDF from the Office site to try in Word or pick a PDF file on your computer. In Word, click File > Open and navigate to the PDF. Click Open to edit the content or read it more comfortably using the new Read Mode. Ready to get started? We hope you enjoy working in Word 2013! Sincerely, The Word Team Learn More Keep going. There are lots more new features and ways to work in Office. Check out our Getting started with Word 2013 page online to dive right in.