Critically discuss some of the ways in which a range of childrens Essay

Critically discuss some of the ways in which a range of childrens services can be shaped by the participation of children. What is the role of the practitioner in enabling participation - Essay Example Indeed, listen to young people and children can play a very important role in the planning, commissioning, and delivery of children services. One way of improving various children’s services by participation of children is, according to Foley & Leverett (2008), listening to children’s views and considering them as part of decision-making. Apparently, children are considered to have ideas and views that are unique to their experience; this means that their contribution to decision-making is critical and legitimate. For instance, in order to improve children’s educational standards and opportunities, it would be prudent to listen to their ideas and views with regards to which teaching methods they think would best work for them, what factors result in truancy and school dropouts, how to better promote inclusion of girls, how to improve attendance rates, whether or not the curriculum is relevant, and how to better ensure effective discipline and good behaviour. Further, children can also participate in improve their services through advocacy, peer representation, evaluation of services that are meant for them, use of media and publicity, managing their own institutions, for instance, schools, and analysis and development of policy (Wright et al. 2006). For this participation to be successful and useful, it is important that their involvement is directly linked to their own experience-first hand. It is the role and duty of practitioners to enable the participation of children, by directly working with them through listening and responding to their voices. Further, it is also the role of practitioners to provide favourable environments where all young children can feel safe, powerful and confident; this will ensure that the children have the space and time to express their ideas and opinion in the form that best suits them. In fact, it is

Kateryna by Taras Shevchenko Essay Example | Topics and Well Written Essays - 750 words

Kateryna by Taras Shevchenko - Essay Example The essay "Kateryna by Taras Shevchenko" explores the painting by Ukrainian artist Taras Shevchenko, Katerina. Shevchenko painted this painting during Austria, Hungary, and Russia. Austria and Hungary took over the Polish regions, Romania, and other Western territories of the Ukraine. Tsarist Russia occupied the Eastern Ukraine. Kateryna is set in a time where Ukrainians were forbidden to explore their culture through language or art. Several of Shevchenko’s paintings were done in exile. The cultural aspect of the Ukrainian dress on the woman to the peasant sitting on the ground shows the plight of the Ukrainian nature at the time. The Ukrainians were poor and conquered, but never defeated. The Russian riding a horse shows the powerfulness of the Russian soldiers and symbolizes the mighty country. This style is romanticism. The idea of throwing off aristocratic views with paintings depicting strong emotion is exemplified in Kateryna. The strong emotions of a seduced or raped w oman carrying an illegitimate child tug at most individuals’ emotions. Shevchenko wanted to cause outrage and anger against the occupying soldiers of Russia and the Tsarist government in general. The light colors also are considered a trait of the Romanticism era. Kateryna has a barefooted peasant girl in the forefront with a beggar at her feet. A dark animal jumps a little to her left. In the background is a large tree to the right. A windmill was placed in the top left corner. Between the windmill and girl is a Russian soldier.

We Dont Sell Foods, We Sell Health Research Paper - 2

We Dont Sell Foods, We Sell Health - Research Paper Example The target market for this ad is basically full-time housewife who wants taking good care of family and people who are interested in changing body condition by eating healthy foods. In this case, I choose to design this ad looks like a shopping receipt. My core idea is to tell customers Whole Foods Market sells health instead of foods and they buy more percentage to live well with the most competitive prices possible. According to Jenkins, an advert should capture the attention of the audience at a glance (Jefkins & Yadin, 2000). I used the font as the same one on the formal receipt in my ad because I want my audience to recognize it as a receipt immediately. The font color is black and the logo is green just like the Whole Foods current logo. The receipt also seems to be laying on the desk and a little curve in order to make it more stereoscopic and attractive. This feature enhances the clarity of the advert to the customer and brings out more attention and focus on the information provided. The final ad features â€Å"total health† in order to equip the knowledge to customers of the true nature of services available. It shows that complete health awareness is found here. The advert aims at increasing the awareness of customers of the significance of high-quality foods. This implies care on the part of the seller to the customers in promoting the quality and health in life. Vincent argues that an advertisement needs to be colorful and attractive depending on the media used. This captures the attention of the audience and sends a good message with clarity (Vincent, 1989). This receipt is suitable for magazine advertising since it lacks color and can be outstanding in the colorful magazine layout. The message is precise and the advert has been designed in a mode to fit in a small part of the magazine.  Ã‚  

International Human Recourse Management Essay Example for Free

International Human Recourse Management Essay Undertake research to examine current trends and emerging issues within the field of International Human Resource Management (IHRM). What are some contrasting and recent frameworks, models and perspectives applied within the field of IHRM? The meaning of International Human Resource Management (IHRM) becomes more and more important in the last few years. The first time the term IHRM was used was in 1990, around the same time period ‘globalisation’ began. Initially the main function of IHRM was the organisation and management of expatriates (Festing, et al. , 2013, p. 161). In 2012 the foreign affiliates of Multinational Enterprises (MNEs) of the United Nations had reached 69 million workers (Dowling, et al., 2013, p. viii). Due to this fact it becomes clear the tremendous challenge IHRM faces in our time. Furthermore the world is getting more uniform and standardised because of the globalisation. With the impact of technical, commercial and cultural development, companies must rise to new challenges and a different way of thinking (Durham Kellner, 2006, p. 659). If we put all the different aspects together we can define IHRM as examining the HRM issues, problems, strategies, policies and practices which firms pursue in relation to the internationalisation of their business (Brewster, et al., 2011, p. 10). On the basis of current research, this essay will investigate trends and emerging issues in the field of IHRM. In the first wide field of global assignments and careers there have been changes in recent years due to the development of technology and worldwide integration. As organisations are increasingly affected by the forces of globalisation and the competition between the different companies, the prerequisites for employees are increasing as well. Due to these facts, the work life balance (WLB) has been subject to increasing investigation and has led to a significant emerging issue for all people especially international business travellers (Festing, et al., 2013). As a consequence,  WLB is receiving attention in the IHRM field. WLB consists of two different concepts: achievement and enjoyment. You cannot get the full value from life if you are only concentrated on one concept (WorkLifeBalance, 2014). One’s daily focus on achievement and enjoyment is based in all four life quadrants: work, family, friends and self WLB. WLB is already a significant topic for HRM, however it is ev en more important for frequent travellers. Due to this fact, in the field of IHRM, work life balance has been  investigated by Iris Kollinger-Santer and Iris C. Fischlmayr (2013). They focused on the difference between female and male international travellers and their WLB, finding that the different stressors related to travelling have a variable intensity according to gender. For instance, the lack of time for social contact or leisure activities is a stronger stress factor for women than for men. The family situation in particular is an important influence on each gender, with women missing their family more than men. Coping strategies also vary according to gender (Kollinger-Santer Fischlmayr). Beauregard and Henry (2009) bring different concepts to the issue of WLB. These authors try to make a link between work life balance practices and organisational performance. Therefore they discuss the differing importance of factors according to national context, job level, and managerial support and come to the conclusion that WLB practices are often combined with high organisational performance (Beauregards Henry). Another emerging challenge beside WLB is the different types of global assignments. In recent years, working abroad as an expatriate to get international experience and to develop global skills was considered an important skill. Organisations openly promoted this process. They wanted to give their employees work experience and transcend national boundaries. However, employees are often unwilling to work abroad or those who are  willing to work abroad are leaving their international assignments early or quitting their organisations once they repatriate because of the positive effects, such as promotions and salary advancement. Another aspect that favours this situation is to compensate for the out-of-sight, out-ofmind problem that occurs when employees are physically away from their home country’s organisation (Shaffer, et al.). Due to this fact a new emerging issue is taking place within IHRM. Organisations are looking for global work alternatives for their employees to gain global work experience without losing the employee afterwards. Besides the well-known kinds of work experience, such as corporate expatriation or self-initiated expatriation, some new ways to achieve global work experience are now offered to employees. Shaffer et al. (2012) sums up the existing ways to achieve international work experience and subdivided them along the three dimensions; physical mobility, cognitive flexibility, and nonwork disruptions. Based on this knowledge, the authors interpret the major findings from their review and develop a taxonomy of these experiences as a theoretical framework for analysing past studies. They point out that all of the global work  experiences were associated with different personal and nonwork demands especially, stress and family issues. However, Shaffer et al. claim that the specific stress factor varied by the different types of global work experience. Finally, they conclude that the real challenge is not the different types of global work, but is the combination of physically moving to a foreign country with the family and learning to adapt to a new culture that creates unique family demands associated with expatriate assignments (Shaffer, et al.). In addition to the new methods to get global work experience, Vaiman and Haslberger (2013) focus on the importance of  self-initiated expatriations and take a closer look at foreign executives in local organisations (FELOs). A FELO is a rare international crosscultural management phenomenon. To find the differences between an expatriate assignment and a FELO, one must take a deeper look at the subsidiaries of multinational organisations (FELO Research, 2014). Vaiman and Haslberger derive four different types of FELOs and various types of localised FELOs as well as typologies and organisation forms. Finally they examine global careers outside of traditional, company-backed expatriate assignments, and highlight the fact that there is a rising number of foreign executives appointed in recent years (Vaiman Haslberger). Global talent management (GTM) is a rapidly growing field within IHRM. GTM includes the connection between the importance of talent management and success in global business. In general the aim of talent management is the identification of well qualified employees in a global context and placing those people in key positions where they have the potential to impact the competitive advantage of the organisation (Scullion Collings, 2011, pp. 3-4). GTM is still an emerging field with debates regarding many aspects of its relevance IHRM (Festing, et al., 2013). For instance, Schuler et al. (2012) focus on various challenges in the area of GTM like dealing with talent shortages, talent surpluses, locating and relocating talent, and compensation levels of talent. They present strategic opportunities and their implications for organisations in regards to these challenges, concluding that organisational need must be linked to the direction of organisational strategy and talent strategy in particular (Schuler, et al.). Clearly there is a wide area of unspecified topics in the field of GTM. In countries such as Germany, China or India, research on this subject is particularly limited, thus there has been much debate over the continuing significance of talent management in the recent years. There are two different views of the importance and the impact of talent  management (Festing, et al., 2013) According to Walk et al. (2013), talent is the most consistent and frequent factor in business success within a global context. For this reason, organisations compete across borders to get the most talented employees. The authors discovered that from the standpoint of an organisation, cross-cultural students are the most valuable, thus they tend to recruit their future employees from this group. Walk et al. also assess work expectations across diverse cultural backgrounds and concluded that differences in expectation are less between Chinese, Indian, and German students than one might suspect (Cf. Walk, et al.).  Ewerlin’s (2013) research on GTM focusses on the influence of talent management program’s attractiveness on an employer. Due to the fact that talented individuals are rare, organisations need to take care that they can position themselves as attractive employers in order to secure the best employees. Talented employees are able to pick and choose between several attractive job offers, therefore they are looking for an additional factors such as good talent management programs. Ewerlin could not confirm that there is a direct relationship between employer attractiveness and their GTM program, however she indicates that these programs should be designed for culturally differences and that personality also plays an important role in shaping the needs of individual employees (Ewerlin). If you compare the current trends and emerging issues of IHRM to the development of other departments within an organisation, especially due to the influence of other areas, there is constant change in IHRM. Additionally to the constant changes IHRM have made, there are a lot of increasing factors to the global market. Several aspects are crucial in the two huge fields of global assignments and careers and global work experience. In the first field there are different facts like work life balance and global work experience. The second area includes the current topics such as GTM programs and the connection to the attractiveness to an employer. Finally there are a lot of new areas of investigation that need to be explored and due to the fact of technical progress and the increasing globalisation it is important  to deal with new challenges in order to stay competitive in the international market. Reference List: Beauregards, T. A. Henry, L. C., 2009. Making the link betwen work-life balance practices and organizational performance. Human resource management review, September, pp. 9-22. Brewster, C., Sparrow, P., Vernon, G. Houldsworth, E., 2011. International Human Resource Management, London: CIPD House. BusinessDictionary.com, 2014. BusinessDictionary.com. [Online] Available at: http://www.businessdictionary.com/definition/expatriate.html Dowling, P. J., Festing, M. Engle, A. D., 2013. International human resource management, 6th Edition. Hampshire: Cengage Learning. Durham, M. G. Kellner, D. M., 2006. media and cultural studies. Carlton: Blackwell. Ewerlin, D., 2013. The influence of global talent management on employer attractiveness: An experimental study. German Journal of Research in Human Resource Management, pp. 279304. FELO Research, 2014. feloreseach. [Online] Available at: http://feloresearch.info/ Festing, M. et al., 2013. Current issues in International HRM: Alternative forms of assignments, careers and talent management in a global context. German Journal of Research in Human Resource Management, pp. 161-166. Kollinger-Santer, I. Fischlmayr, I. C., 2013. Work life balance up in the air Does gender make a difference between female and male internation business travelers. German Journal of Research in Human Resource Management, 09, pp. 195-223. Schuler, R. S., Jackson, S. E. Tarique, I., 2012. Global talent management and global talent challenges: strategic opportunities for IHRM, New York: Journal of World Business. Scullion, H. Collings, D. G., 2011. Global Talent Management. New York: Routledge. Shaffer, M. A., Kraimer, M. L., Chen, Y.-P. Bolino, M. C., 2012. Choices, Challenges, and Career Consequences of Global Work Experiences: A Review and Future Agenda. Journal of Management, pp. 1281-1327. Vaiman, V. Haslberger, A., 2013. Talent Manamgent of Self-Initaited Expatriates, Hampshire: PALGRAVE MACMILLAN. Walk, M., Schinnenburg, H. Handy, F., 2013. What do talens want? Work expectations in India, China, and Germany. German Journal of Research in Human Resource Management, pp. 251-278. WorkLifeBalance, 2014. WorkLifeBalance. [Online] Available at: http://www.worklifebalance.com/

Technology of Ultrasound Scans

Technology of Ultrasound Scans 2.1 Ultrasound 2.1.1 Physics of Ultrasound Sound is a mechanical wave that travels through an elastic medium. Ultrasound (US) is sound at a frequency beyond 20 000 Hz, the limit of human hearing. Bats orientate themselves with the help of US waves at 100 000 Hz. Ultrasound at frequencies of 200 000 Hz is used for navigation. The frequency range of diagnostic US is between 1 and 20 MHz. When sound encounters a boundary between two media of different densities some of the sound bounces back as an echo, a phenomenon called reflection. The rest of the sound continues through the medium but is deflected from its original path, this is called refraction. Acoustic impedance is the resistance of a medium to the propagation of sound and decides how much sound will be reflected at the interface between the media. Some of the energy of the sound is converted by friction into heat when propagating, this loss of energy is called absorption. When ultrasound waves encounter a surface, a small part of their energy is scattered away in random directions while most of the sound continues to propagate, a phenomenon called scatter. Reflection, refraction, impedance, absorption and scatter are all phenomena important for image formation in diagnostic ultrasound use. Artifacts, echoes that do not correspond to an anatomic structure but result from the physical properties of ultrasound propagation in the tissues, are also important to be aware of when using ultrasound. This phenomenon can also be of diagnostic help. One example is the acoustic shadowing of a gallstone, caused by total absorption of the sound by the stone. Diagnostic ultrasound is based on the pulse-echo principle. The smallest functional units of the transducer are the piezoelectric crystals. The crystals are embedded in the probe, and each crystal has a specific frequency. A pulse is initiated from each crystal in the probe and a longitudinal sound wave propagates through the body. Some of the energy is absorbed in the tissue and some is reflected. The reflected energy is received by the probe, which calculates the depth of the interface by measuring the time taken to return. We can say that the human body is composed of three basic materials differing in acoustic impedance: gas with a very low impedance, bone with a very high impedance and soft tissue with an impedance somewhere in between. The large mismatch between air and bone and tissue (â€Å"impedance mismatch†) causes 100% of the sound to be reflected at air/tissue interfaces and almost all the sound at bone/tissue interfaces. There is a small mismatch between different soft tissues in impedance, a fact that is the basis for diagnostic ultrasound. Different frequencies of ultrasound are used for different diagnostic examinations. Higher US frequencies (7-16 MHz) have higher resolution but are strongly absorbed by soft tissue and are therefore used for superficial structures. Very high frequencies (16- 20 MHz) will only travel for a few millimeters within tissue and are limited to intravascular and ocular examinations. Lower frequencies (3-7 MHz) are used for deeper structures, being less strongly absorbed and of lower resolution. There are different modes of displaying the amplitude of reflected sound waves: A- mode, M-mode and B-mode. A-mode (amplitude) calculates only the depth of the interface and is mainly of historical interest. M-mode (motion) is used to display moving structures and is used in cardiac ultrasound. B-mode (brightness) is the routine US image for most surgical applications. Here the returning echoes are displayed as shades of grey with the echo amplitudes represented by a grey level ranging from black to white. The individual image lines are stored, assessed and assembled on the monitor to create a two-dimensional B-mode image. Doppler ultrasound uses the Doppler effect. When US is reflected from a moving structure (i.e. blood) the frequencies of the waves change and the amount of frequency change is determined by the speed and direction of blood flow. The use of Doppler is obvious in vascular US but is also of use in other areas of diagnostic ultrasound. 2.1.2 History of Ultrasound Scientists, including Aristoteles, Leonardo da Vinci, Galileo Galilei, Sir Isaac Newton and Leonard Euler, have been studying the phenomena of acoustics, echoes and sound waves for many centuries. It was though not until 1877 that John William Strutt, also known as Lord Rayleigh, published a description of sound as a mathematical equation in â€Å"The theory of sound† which became the foundation for the science of ultrasound. Some years later, 1880, Jaques and Pierre Curie discovered the piezo-electric effect; that an electric potential is generated when mechanical pressure is applied to a quartz crystal, an important discovery that eventually led to the development of the modern- day ultrasound transducer which contains piezoelectric crystals. The first study of the application of ultrasound as a medical diagnostic tool was published by the Austrian brothers Karl and Friedrich Dussik in 1942. They attempted to locate brain tumours and the cerebral ventricles by measuring ultrasound transmission through the skull and concluded that if imaging of the ventricles was possible, the interior of the human body could also be visualized using ultrasound. Unfortunately it was later determined by Guttner, in 1952, that the images produced by the Dussiks were variations in bone thickness. Nevertheless, their scientific work marked the beginning of diagnostic ultrasonography in the medical field and Dussik wrote in an article a decade later: †As knife and forceps in surgery, the chemical agent in chemotherapy, the high frequency electric field in diathermy and X-ray application, so has medicine taken on a new physical tool in the last decade: the ultrasonic field†. George Dà ¶ring Ludwig, working together with Francis Struther, was the first scientist to visualize gallstones, implanted in the muscles and gallbladders of dogs, with ultrasound. His studies also resulted in the finding that the mean velocity of ultrasound in soft tissue is 1540 m/sec, a discovery that was to prove very important for future research. Much of his work was however considered restricted information, because he was employed by the military, and therefore not published in medical journals. John Julian Wild and Douglass Howry were also important pioneers in the ultrasound field. Wild was a surgeon who was able to visualize bowel wall thickness with ultrasound, and he also discovered a difference in echogenicity between benign and malignant tissue. Wild also developed transrectal and transvaginal transducers and a scanning device for screening patients for breast cancer. Howry built the first B- mode scanner in 1949 and, together with the two engineers Bliss and Posanky, he also developed the first linear contact scanner. The somascope, the first circumferential scanner, built in 1954, was also developed by Howry. The problem with these scanners was that the patient had to be immobilized and immersed for a long time. In the period 1957-58 an ultrasound scanner was developed by Howry and his colleagues where the patient was strapped to the plastic window of a semicircular pan filled with saline solution. Although not immersed, the patient had still to be immobilized for a long time. Finally, in the early 1960s, Howry developed the first hand-held contact scanner, together with Wright and E Myers. During the same time Ian Donald was carrying out ultrasound research in England and 1958 he published an article that came to be a landmark, (â€Å"Investigation of abdominal masses by pulsed ultrasound†), where he describes how ultrasound changed the treatment of a woman diagnosed with advanced gastric cancer dramatically by diagnosing a cystic mass with ultrasound; the mass was later resected and found to be a benign ovarian cyst. Donald contributed significantly to the field of obstetric and gynecological ultrasound for example by discovering the urinary bladder to be a natural acoustic window for the pelvic organs and by measuring the biparietal diameter of the fetus for the first time. A century earlier the Doppler effect had been discovered by the famous Austrian scientist Christian Andreas Doppler and presented in 1842 in a paper called ÃÅ"ber das farbige Licht der Doppelsterne und einiger anderer Gestirne des Himmels (On the colored light of the double stars and certain other stars of the heavens). In Lund, Sweden, the principal pioneers of echocardiography Inge Edler and Carl Hellmuth Hertz, developed the first echocardiogram in October 195323 . Subsequently Hertz and Ã…sberg invented the first two-dimensional real-time cardiac imaging machine 1967 and Edler and Lindstrà ¶m registred the first simultaneous M-mode and intracardiac Doppler blood flow recordings at about the same time. Ultrasound has in the last decades developed quickly and the first digital scanners were released onto the market in 1976, providing better and reproducible images. Interventional ultrasonography dates back to 1969 when Kratochwill proposed the use of ultrasound for percutaneous drainage. Regarding ultrasound for trauma the first report of the method for evaluating blunt trauma was dated 1971, by Kristenson in Germany. The development is still going on and in the light of advances in technology leading to smaller available machines combined with the prices of machines decreasing rapidly speculations have been made about the possibility that doctors in the future will routinely be equipped with their own ultrasound stethoscope for use in their daily clinical work. 2.1.3 Ultrasound Instruments It is important to have a basic knowledge in which an ultrasound image is produced. The components of scanner include Transmitter: Emits electrical impulses that strike the transducer piezoelectric crystals and cause them to vibrate thus producing ultrasound wave. Transducer: Transducer is one which converts one form of energy to another. In ultrasound it converts electric energy to mechanical energy and viceversa. It converts the electrical energy provided by the transmitter to the acoustic pulses directed into the patient. It serves as the receiver of reflected echoes, converting weak pressure changes into electric signals for processing. Receiver: When returning echoes strike the transducer face,minute voltages are produced across the piezoelectric elements. The receiver detects and amplifies these weak signals and provides a means for compensating for the differences in echo strength which result from attenuation by different tissue thickness by control of time depth compensation. Another important function of receiver is the compression of the wide range of amplitudes returning to the transducer into a range that can be displayed to the user. Scan Processor: Processor detects and amplifies the back scattered energy and manipulates the reflected signals for display. Control Console Display: Display presents the ultrasound image or data in a form suitable for analysis and interpretation. Over the years imaging has evolved from simple A mode display to high resolution real time gray scale imaging. Recording Device: Interpretation of images and archival storage of images may be in the form of transparencies printed on film by optical or laser cameras and printers, videotape or through use of digital picture archiving and communications system (PACS). Increasingly digital storage is being used for archiving of ultrasound images. 2.1.4 Transabdominal Ultrasound, Use and Limitations Transabdominal ultrasound of the female pelvis has been the conventional approach in imaging of the female pelvis. With this approach) a full urinary bladder is required to provide a window for imaging and to displace bowel gas. Transabdominal scanning (TAS) therefore required deeper penetration and a lower frequency transducer, usually 3 -5 MHz, must be used. The resolution of images is limited by the relatively lower frequency transducer that is required, and it also has great limitations in the obese lady, especially in the elderly who often cannot hold a full bladder. In the study of uterine hemodynamics in patients who are pregnant, these disadvantages may not be very significant, because the uterine arterial signal from these patients are usually strong. However, in the non-pregnant state, especially in postmenopausal ladies, studies of uterine hemodynamics with TAS could be very difficult. 2.1.5 Transvaginal Ultrasound, Advantages and Disadvantages Widespread availability of ultrasound imaging in the past two decades has dramatically changed the practice of obstetrics and gynecology. These specialists rely heavily upon this technology to make major decisions about management of their patients. Transabdominal sonography (TAS) images the pelvic organs through the anterior abdominal wall in the supra-pubic region. A distended urinary bladder is essential to displace the bowel loops and to provide an acoustic window. There are two major limitations of TAS. First is the need to use lower frequencies for imaging due to the longer distance between the transducer and the pelvic organs. Other disadvantage is the beam degrading effect of the anterior abdominal wall especially in obese patients. Both these limitations lead to degradation in image quality. To overcome these limitations of TAS special transducers, which could be introduced in the vagina, were designed in 1985. The vaginal approach reduces the distance between the probe and the pelvic structures allowing the use of higher frequencies. Trans-vaginal sonography (TVS) produces greatly improved resolution as compared to TAS, primarily due to the higher frequencies employed and also due to the absence of beam deformation by the anterior abdominal wall, Major advantages of TVS over TAS are better image quality and avoidance of patient discomfort due to full urinary bladder. Comparison of TVS and TAS is given in Table 2.1. 2.1.5.1 Indications of TVS TVS is indicated whenever a better look at the pelvic structures is required. Common indications include the following Early pregnancy Lower uterine segment in late pregnancy Ectopic pregnancy Pelvic masses Retroverted or retroflexed uterus Obese or gaseous patient Emergency cases when bladder is empty Follicle monitoring Oocyte retrieval Endometrial study to assess suitability in IVF ET techniques Cervical canal mucous Doppler examination of pelvic organs Interventional procedures The list is not exhaustive and newer indications are continuously being added. TVSTAS Full bladder Not essential Essential Probe frequency 5-7.5 MHz 3-5 MHz Resolution Very high Moderate Field of view Small Large ContraindicationsVirgins, Vaginal obstruction Premature rupture of membraneNone interventional uses Many usesLimited role Table 2.1 Comparison of TAS and TVS 2.1.5.2 Scan Technique Once the probe and the patient have been prepared, the transducer is gradually inserted while monitoring the ultrasound image. The urinary bladders normally consistent position in the pelvis relative to much more variable position of the uterus and the ovaries makes it a good landmark to use when making initial assessment of the transducer orientation. Three basic scanning manoeuvres of the probe are useful to scan the pelvic organs comprehensively: Sagittal imaging with side to side movements, 90 ° rotation to obtain semi-coronal images with angulation of probe in vertical plane, Variation in the depth of probe insertion to bring different parts within field of view/focal zone. A pelvic survey should be done first to ascertain quickly the relative position of the uterus and ovaries as well as to identify any obvious masses. This is obtained by slowly sweeping the beam in a sagittal plane from the midline to the lateral pelvic side walls followed by turning the probe 90 degrees into corona plane and sweeping the beam from cervix to the fundus. In multi-frequency probes proper selection is important for best results. Setting of appropriate focus in electronic arrays is equally important. In mechanical sector fixed focus probes the organ of interest is brought in the focal zone by changing the depth of insertion of the probe. Proper selection of frame averaging is also important. It should be low for fast moving structures like foetal heart and high for studying solid immobile tissues. For Doppler studies a steady probe position is essential and it helps if the examiners forearm is well supported. 2.1.5.3 Dynamic uses of the TVS probe The ultrasonographic examination can be enhanced by placing a hand over the lower abdomen to bring pelvic structures within the field of view/focal range of the probe. Localisation of the point of maximal tenderness by the probe will help in identifying the cause of pain. Dense pelvic adhesions can be diagnosed by the sliding organ sign. In the absence of adhesions, the organs move freely past each other and the pelvic wall in response to pressure by the TVS probe tip. Absence of this free movement may suggest pelvic adhesions. 2.1.5.4 Interventional uses of TVS There are many interventional uses of transvaginal sonography. Newer indications are constantly being added to the list. Some of the more common ones are given below:- aspiration of ova for in vitro fertilisation (IVF) aspiration of ovarian cyst drainage of pelvic collection multi-foetal pregnancy reduction non-surgical etopic pregnancy management early amniocentesis chorion villous sampling transvaginal embryo transfer sonohysterosalpingigraphy 2.1.5.5 Limitation of TVS It should be remembered that TVS provides a more limited field of view than TAS. A survey trans-abdominal scan usually be performed prior to the TVS to rule out the possibility of overlooking a mass lying outside the field of view of the TVS transducer. To avoid the need of a full bladder it has been suggested that a TVS examination may be followed by a TAS scan with bladder empty. The rationale behind this approach is that a mass lying outside the field of view of the TVS probe will be sufficient in size to be seen trans-abdominally even if the bladder is empty. The advent of the transvaginal sonography in 1985 has had a tremendous impact on the practice of obstetrics and gynaecology. The pelvic organs can now be imaged with a resolution not possible earlier. The management of infertility due to female factors depends mainly on the TVS. Addition of Colour Doppler to TVS now gives added information about the vascular supply of various pelvic organs. Details of foetal anatomy that can be depicted by TVS are far superior to that shown by TAS. As a new technique TVS has proved very useful and has a bright future.

Degenerative Joint Disease Or Osteo Arthritis Nursing Essay

Degenerative Joint Disease Or Osteo Arthritis Nursing Essay Osteoarthritis is the most common cause of disability in the United States. Osteoarthritis affects an estimated 27 million Americans. This painful condition develops when there is a breakdown of cartilage in the joints (Shaw, 2012, p.1). Osteoarthritis can occur with age, or it can be caused by a joint injury or stress on the joints from a specific job, sport or being overweight. Over time, some people experience extreme inflammation and permanent damage to the joint. The joint may even need to be surgically replaced. The chance of developing the disease increases with age. Most people over age 60 have osteoarthritis to some degree, but its severity varies. Even people in their 20s and 30s can get osteoarthritis. In people over 50, more women than men get osteoarthritis (Gazella, 2009). Bone ends are covered with a layer of cartilage and lubricated by a synovial fluid to provide less friction and a smooth surface for the bones to move over each other. The whole joint is enclosed by the synovial sac (Gazella, 2009). In osteoarthritis, the cartilage becomes thinner and rougher while the bone underneath thickens. The ends of the bones start to rub against each other which causes pain and even more damage. The bones try to repair themselves, but this is not very successful, so it results in a more uneven surface of spurs and cracks. The synovium also produces extra fluid, which results in swelling, and there are changes to the ligaments, which cause movement restriction. Muscles may also become weaker Progression is slow and many patients diagnosed with OA will not suffer a great degree of deterioration (Gazella, 2009). The most common other form of arthritis is rheumatoid arthritis (RA), which has a different pattern of signs and symptoms, although some of the symptoms may overlap. Symptoms of OA can also vary, with flares and remission, which can make diagnosis more difficult. Other factors such as the cold and damp weather often can increase pain. One complication which can occur is calcification, which is when deposits of calcium crystals form in the cartilage to cause further swelling and the joint can become hot and red. Pain and stiffness in the joints are the most common symptom. The pain is often worse after exercise and when you put weight or pressure on the joint. Your joints may ache, or the pain may feel burning or sharp. For some people, the pain may come and go. Constant pain or pain while you sleep may be a sign that your arthritis is getting worse. When you have arthritis, getting up in the morning can be hard. Your joints may feel stiff and creaky for a short period of time, until you get moving. You may also get stiff from sitting. The muscles around the joint may get weaker. This happens a lot with arthritis in the knee. Arthritis can cause swelling in joints, making them feel tender and sore. Joints can start to look like they are the wrong shape, especially as arthritis gets worse. As it gets worse, you may not be able to fully bend, flex, or extend your joints. Or you may not be able to use them at all. Your joints may make crunching, creaking sounds. This creaking may also occur in a normal joint. But in most cases, it doesnt hurt and doesnt mean that there is anything wrong with the joint. The phrase morning stiffness refers to the pain and stiffness you may feel when you first wake up in the morning. Stiffness usually lasts for 30 minutes or less. It can be improved by mild activity that warms up the joint (Shaw, 2012). There are several factors that can increase the risk for developing osteoarthritis, including heredity, obesity, injury, or overuse of certain joints. People born with abnormalities are more likely to develop osteoarthritis. Some people have an inherited defect in one of the genes responsible for making collagen a major component of cartilage; this causes defective cartilage, which leads to more rapid deterioration of joints (Gazella, 2009). Obesity increases the risk of osteoarthritis. Maintaing ideal weight or losing excess weight may help prevent osteoarthritis, or decrease the rate of progression once osteoarthritis is established. Injuries contribute to the development of osteoarthritis. For example, athletes who have knee-related injuries may be at higher risk of developing osteoarthritis of the knee. In addition, people who have had a severe back injury may be predisposed to develop osteoarthritis of the spine. People who have had a broken bone extending into the joint margin are prone to develop osteoarthritis in that joint (Osteoarthritis, 2009). Overuse of certain joints increases the risk of developing osteoarthritis. Osteoarthritis is not associated with fever, weight loss, or anemia. As of now there is no known cure for osteoarthritis, but treatments can help to reduce pain and maintain joint movement. Acetaminophen (Tylenol) can relieve pain, but doesnt reduce inflammation. It has been shown to be effective for people with osteoarthritis who have mild pain to moderate pain. Taking more than the recommended dose can cause liver damage (Mayo Clinic, 2012). Non-steroidal anti-inflammatory drugs (NSAIDs reduce inflammation and reduce pain. Over-the-counter NSAIDs can cause stomach upset, ringing in your ears, cardiovascular problems, bleeding problems, and liver and kidney damage. Narcotics typically contain ingredients similar to codeine and may provide relief from more severe osteoarthritis pain. These stronger medications carry a risk of dependence, though that risk is thought to be small in people who have severe pain. Side effects include nausea, constipation, and sleepiness (Researchers from National Research Center Describe Findings in Osteoarthritis, 2012). Working with a physical therapist can help. The physical therapist can work with you to create an individualized exercise regimen that will strengthen the muscles around your joint, increase the range of motion in your joint and reduce your pain. Find ways to go about your day without stressing your joints. Consider trying splints, braces, shoe inserts or other medical devices that can help reduce your pain. These devices can immobilize or support your joint to help you keep pressure off it (Gazelle, 2009). The Arthritis Foundation and some medical centers have classes for people with osteoarthritis or chronic pain. These classes teach skills that help manage osteoarthritis pain. Injections of corticosteroid medications may relieve pain in the joint. During this procedure the doctor numbs the area around the joint, and then inserts a needle in the space within the joint and injects medication. The number of cortisone shots you can receive each year is limited, because the medication can cause joint damage (Mayo Clinic, 2012). Injections of hyaluronic acid derivatives may offer pain relief by providing some cushioning in your knee. These treatments are made of rooster combs and are similar to a component normally found in your joint fluid (Mayo Clinic, 2012). In joint replacement surgery (arthoplasty), the surgeon removes the damaged joint surfaces and replaces them with plastic and metal devices called prostheses. The hip and knee joints are the most commonly replaced joints. Surgical risks include infections and blood clots. Artificial joints can wear out or come loose and may need to eventually be replaced (Shaw,2012). Medications and other treatments are key to managing pain and disability, but another major component to treatment is your own attitude. Your ability to cope despite pain and disability caused by osteoarthritis often determines how much of an impact osteoarthritis will have on your everyday life. Make a plan with your doctor for managing your arthritis. This will help make you feel that youre in charge of your disease rather than vice versa. Studies show that people who take control of their treatment and actively manage their arthritis experience less pain and function better (Mayo Clinic, 2012). It is also important that you know your limits. Rest when you think it might be needed. Arthritis can make a person feel fatigued and makes that person prone to muscle weakness, a deep exhaustion that makes everything you do a great effort. Resting or taking a short nap that doesnt interfere with nighttime sleep may help a great deal.

Adolescent Peer Pressure :: Peer Pressure Essays

Between the ages of twelve and nineteen is a period in a teenager's life that determines what kind of adult he or she will become. This period of adolescence, also known as the "formative years", is the subject of much study and research to determine why adolescents are vulnerable to the phenomenon called peer pressure. The disturbing number of incidents of teenage drug use, teenage pregnancy and teenage suicide is most assuredly the reason that fuels the need for such research. Perhaps it is because as children they are taught the importance of having and maintaining friends. Or perhaps they don't feel that they can talk to their parents or teachers when problems arise. Or maybe they simply want to rebel against the pressures placed on them as youths. Because adolescents spend their time either at home or in school, it is within these confines that the answers to adolescents' behavior lay. In other words, family and school can sometimes cause adolescents to give in to peer pressure because of an overemphasis on the importance of social adjustment, a lack of interest or communication on the part of the parents and teachers, and the unrealistic expectations that these entities create. Although the purpose of attending school is to receive an education, it also provides children with a medium through which they can develop relationships with other children that eventually turn into friendships. The ability to form friendships can be traced back to even the pre-school years and its importance henceforth emphasized by eager parents who want their children to fit in at school. "Interactions with friends or other peers are crucial for the development of a mature morality." (Juvonen, p.11) Most would agree that social interaction is important but sometimes parents are guilty of over-emphasizing this importance. Let's recall the numerous birthday parties where every child in the neighborhood was invited to come regardless of whether or not they were actual friends. This desire to socialize children also occurs in the classroom at school. "The classroom setting represents not only an educational arena but a powerful social context in which the psychological adjustment of children and adolescents can be affected."(Juvonen, p.248) Teachers tend to promote social interaction by assigning exercises that require working in pairs or groups. Furthermore, when a teacher spots a child playing alone, they will encourage him or her to join the other children while overlooking the possibility that the child might have preferred to be alone.