Barbie Doll free essay sample

# 8211 ; Trying To Fit The Mold Essay, Research Paper Trying to suit the cast Marge Piercy s poem Barbie Doll is an illustration of the force per unit area that is put on today s adult females. Young misss are expected to look and move a certain manner that is dictated by an unwritten set of regulations of our society. Girls are taught really early in life what is expected of them. They are given dolls, illumination family contraptions and wee lipsticks the colour of cherry confect ( 4 ) as plaything, fixing them for their future function as female parent, homemaker and pretty ornament on their hubby s arm. The verse form indicates that the miss is taking a normal happy life until she reaches pubescence. Person tells her that she has a great large olfactory organ and fat legs ( 6 ) which changes her whole life. These nine words will rob the kid of her self-esteem and finally of her felicity. We will write a custom essay sample on Barbie Doll or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page For the first clip in her life she feels abashed about her organic structure. The miss is described as holding strong weaponries and back, / abundant sexual thrust and manual sleight ( 8 # 8211 ; 9 ) which leads the reader to believe that she is slightly of a romp and has a really straightforward personality. To suit into the typical female function, she is advised to play coy ( 12 ) and behave in a more ladylike mode. No affair what she accomplishes from so on, she still sees herself as a misfit because of her physical visual aspect. She is described as healthy and intelligent, all traits that a individual should be proud of, but she can merely concentrate on her defects taking to low assurance and her changeless apologies for her defects. The girl attempts really hard to alter herself by following the advice to exert, diet, smile and wheedle ( 14 ) . Her friendly and outgoing nature shortly alterations under the changeless unfavorable judgment. When she is non able to accomplish the standardised ideal of beauty and muliebrity, she reaches a point in her life when she decides that she can no longer get by with the force per unit area. She deals with he R hurting by cutting off her nose and her legs, which leads to her decease. Ironically, after her self-destruction she eventually hears the words she was hankering for all her life: Doesn t she look reasonably? ( 23 ) . A small spot of makeup, a sham olfactory organ and a reasonably outfit bring her the regards she ever craved. The writer s pick of stoping this verse form is symbolic. The miss in the verse form kills herself by cutting off the parts of her organic structure that have caused her so much hurting and torment throughout her life. Once she has removed them, she is free of the torture and tease, but has lost her life in the procedure. It is improbable that any miss will perpetrate self-destruction by dismembering herself, but the symbolism is that by seeking to suit the ideal adult female mold, many adult females travel excessively far and stop up losing their ego regard, love of themselves and others and, in the worst instance, their lives in the procedure. The really of import point that the author is doing is our focal point on external beauty. Our ideal of the today s adult female is portrayed in the popularity of the Barbie Doll. Already, as really little kids, Barbie becomes our icon of what the perfect female should look like. Womans should be tall, scraggy, and have delicate characteristi cs. We need to take our remarks to each other, but particularly to our kids, really sagely. One careless comment can affect a immature head and influence it the remainder of its life. This verse form sums up the feelings of most every teenage miss, immature adult female, and mature adult female at some point in their life. Society has given us its thought of what we should be, and it is up to us to fight for most of our being to accomplish this end or to larn to accept and love ourselves and each other by seting more value on our internal characteristics and non our outside. The key to a healthy and happy hereafter of the female population is for our society to halt judgment based on external beauty and to accept, love and esteem adult females for who they are and what they have accomplished.

Agile Methodologies In Mobile Software Development Information Technology Essay Essays

Agile Methodologies In Mobile Software Development Information Technology Essay Essays Agile Methodologies In Mobile Software Development Information Technology Essay Essay Agile Methodologies In Mobile Software Development Information Technology Essay Essay Traditional package development design methodological analysiss included the Systems Development Life Cycle ( SDLC ) ( Fowler, 2005 ) . This was besides known as the Waterfall and there were many different versions. Fowler ( 2005 ) explains that it contained several phases from the start to complete of a undertaking including initial thought choice, induction and planning, analysis, design and execution. H explains that several pieces of certification frequently had to be produced for each phase and each phase was treated as a milepost that needed to be signed off before the undertaking was allowed to go on. This type of attack was all right when it was foremost introduced but since the early 1990 s engineering has advanced at a rapid rate and disbursement so much clip on each phase would do the undertaking about disused by the clip it was delivered ( Holler, 2006 ) . There are still a batch of undertakings that this attack would be suited to. They would be un dertakings that require a high sum of proof such as governmental or regulative systems where each phase needs to be to the full documented and signed off but this type of attack would be improbable to accommodate nomadic package development where platforms and demands quickly evolve ( Holler, 2006 ) . Such a undertaking would be more suitable to an Agile attack which would let the client more engagement in the design of the undertaking and let the undertaking to accommodate to any alterations that may be required between the initial design stage and the execution ( Holler, 2006 ) . This paper looks at package procedures for nomadic applications development. The nomadic market is really competitory at the minute due to immense technological progresss in recent old ages. It is now possible and more low-cost to hold a high powered nomadic device with an ever on internet connexion and entree to an application shop to download applications on the spell. This makes it a really moneymaking country for package developers and there are a figure of different runing systems and application shops they can develop for and showcase their work on. Due to such rapid progresss at that place has non been a batch of formal research into the best patterns for nomadic application development. This paper will look at the assorted Agile methodological analysiss and how they perform in relation to mobile application development. Traditionally systems took longer to present due to the deficiency of technological progresss and the cost of engineering ( Fowler, 2005 ) . Fowler ( 2005 ) suggests that developing package was by and large a helter-skelter activity without much of an implicit in program. The design was frequently formulated from a series of short term determinations made by the development squad ( Fowler, 2005 ) . This can work good for smaller undertakings but as the system grows it becomes progressively hard to keep or add characteristics ( Holler, 2006 ) . Such systems frequently contained a batch of bugs that needed to be removed before concluding execution, taking to a long trial stage ( Fowler, 2005 ) . This caused major issues with the undertaking bringing agenda because the clip taken to execute extended testing and debugging can non be estimated accurately ( Fowler, 2005 ) . Due to this there was a motion to present a more standardised attack to package development ( Fowler, 2005 ) . These procedures were called methodological analysiss and they imposed a disciplined procedure upon package development with the purpose of doing the package development procedure more predictable and efficient ( Fowler, 2005 ) . This was done by developing a elaborate procedure with heavy accent on planning. These methodological analysiss are known as plan-driven methodological analysiss and the Software Development Life Cycle falls into this class ( Fowler, 2005 ) . This methodological analysis allowed project squads to specify the demands at the beginning of the undertaking with a grade of certainty that the system would run into its ends even after an extended design and development stage ( Fowler, 2005 ) . There would be several paperss produced after each stage and a codification freezing was frequently implemented until the old stage had been signed off by all major stakeholders ( Fowler, 2005 ) . This attack may hold been sufficient 30 old ages ago but since the early 1990 s engin eering has progressed at a rapid rate ( Fowler, 2005 ) . It is no longer possible to specify exact demands at design stage as by the clip the system is delivered the market may hold changed and the original demands may now be disused ( Abrahamsson et. al. , 2003 ) . This has created the demand for undertaking directors to present systems faster and for the undertaking plans to accommodate to alter along the manner where necessary ( Ihme A ; Abrahamsson, 2005 ) . Fowler ( 2005 ) states that several methodological analysiss including Rapid Application Development ( RAD ) and Object Oriented Analysis Design ( OOAD ) have attempted to turn to this issue nevertheless this paper will concentrate on Agile methodological analysiss and how they lend themselves to mobile package development undertakings. Agile is a term used to depict several extremely iterative package methodological analysiss which include Extreme Programming ( XP ) and Scrum ( Holler, 2006 ) . Each methodological analysis may follow different patterns and rules but they have the same nucleus values in that they focus on heavy client engagement, on a regular basis let go ofing production quality package and being adaptable ( Ihme A ; Abrahamsson, 2005 ) . Fowler ( 2005 ) explains that they try to be adaptative to the market instead than prognostic and seek to happen a balance between no procedure and excessively much procedure ( which means less of an accent on certification and bureaucratism ) . He besides explains that they are person-oriented instead than process-oriented ( the procedure should suit around the squad instead than the squad suiting around the procedure ) . This is immensely different to traditional methodological analysiss where the client was merely involved at the initial demands phase and where each phase was completed before traveling onto the following phase, non taking the precedence of the characteristic into history. These methodological analysiss have grown in popularity o ver recent old ages as quickly altering engineering has put project squads under increasing force per unit area to bring forth package faster ( Holler, 2006 ) . 2.1 Agile Methodologies 2.1.1 Extreme Programming ( XP ) XP is one of the most popular agile methodological analysiss and the thought was foremost introduced by Kent Beck and Ward Cunningham in the late 1980 s ( Fowler, 2005 ) . They wanted an attack that was adaptative instead than prognostic and people-oriented instead than process-oriented ( Fowler, 2005 ) . Harmonizing to Fowler ( 2005 ) this attack was refined throughout the 1990 s and the construct was foremost referred to as Extreme Programming during the Chrysler C3 undertaking ( Kent Beck, Ward Cunningham and Martin Fowler wholly consulted on this undertaking ) in 1997. XP spread throughout the late 1990 s with several books and documents being published on the topic. Kent Beck s White Book is mostly credited as the inspiration ( Fowler, 2005 ) . The methodological analysis is based on five cardinal values. These values are communicating, feedback, simpleness, bravery and regard. These five values are so divided into 14 more rules and once more divided into a farther 24 patterns. This breaks the five key values ( which are abstract ) into concrete patterns that a squad can adhere to on a day-to-day footing ( Fowler, 2005 ) . Knowledge and apprehension of these patterns is the key to successfully implementing XP within an administration ( Holler, 2006 ) . There is a strong accent on proving which is why XP is frequently referred to as Test Driven Development ( TDD ) ( Fowler, 2005 ) . Every developer must compose trial instances to prove their production codification and this is done during the development stage. These trials are so integrated into a uninterrupted physique procedure which produces a extremely tested and stable platform ( Fowler, 2006 ) . The client is extremely involved and the client or a representative of the client is frequently on site to supply feedback ( Abrahamsson et al. , 2004 ) . The system is released in loops which include working functionality to a production criterion ( Abrahamsson et. , al 2004 ) . The undertaking director must specify the demands and the precedence of each piece of functionality with the client ( Fowler, 2005 ) . The functionality with the highest precedence is so passed onto the development squad and this is developed foremost ( Fowler, 2005 ) . This ensures that the system meets its nucleus demands, dropping lesser characteristics and functionality should the undertaking go over agenda or over budget. The loops besides act as paradigms for the client to prove and supply feedback to the development squad so they can include alterations in the following loop if required. Fowler ( 2005 ) suggests that XP s strong influence on package development is down to uniting the rules of agile development with a solid set of regulations and techniques that allow them to be carried out and that until XP came along Agile was abstract and did nt hold a set of regulations that could be used to implement the Agile doctrine. XP provided the tools by which the hopes of legerity could be achieved. 2.1.2 SCRUM SCRUM was besides developed in the early 1990 s. Ken Schwaber, Jeff Sutherland and Mike Beedle were all early adoptive parents and released documents based on their acceptance of SCRUM ( Fowler, 2005 ) . The methodological analysis is implemented in stages and loops across a cross functional squad ( Fowler, 2005 ) . It is a procedure that contains a set of patterns and pre-defined functions ( Sutherland, 2004 ) . The functions include the SCRUM Master who ensures the procedure runs efficaciously, the Product Owner who represents the major stakeholders and the Team who are responsible for the analysis, design and development of the undertaking ( Sutherland, 2004 ) . The undertaking is delivered in increases which are referred to as dashs and normally range between 2 hebdomads and 4 hebdomads in length ( Sutherland, 2004 ) . The SCRUM Master and Product Owner decide during a SCRUM meeting which demands from the Product Backlog ( a set of pre-defined prioritised demands ) should be incl uded in the following dash and by the terminal of the dash the developer must bring forth these demands to production criterion ( Fowler, 2005 ) . If a demand is non developed to a sufficient criterion in clip it is returned to the Product Backlog and may be considered for execution once more during the following dash ( Fowler, 2005 ) . The developer can discourse the advancement of their dash and rede whether or non all demands are on agenda to be delivered with the SCRUM Master during their day-to-day dash meeting ( Sutherland, 2004 ) . SCRUM promotes the thought of a ego organised squad with a SCRUM Master guaranting the procedure runs efficaciously and suggests that the squad should be co-located to help communicating ( Sutherland, 2004 ) . It besides accepts that client demands will alter throughout the class of the undertaking and that it is impossible to specify all major demands at the beginning of the undertaking. The Team should be able to recognize and accommodate to reac t to emerging demands ( Sutherland, 2004 ) . The Scrum attack to project direction is frequently used in concurrence with XP s technology patterns ( Fowler, 2005 ) . 2.2 Benefits of Agile Fowler ( 2005 ) suggests that Agile doctrines are adaptative instead than prognostic. In fast moving environments it is impossible to foretell the major demands at the beginning of the undertaking ( Fowler, 2005 ) . Technology continues to better at a rapid rate so it is of import to be able to recognize technological progresss and adapt consequently throughout the class of the undertaking. Many undertakings fail because the demands outlined at the beginning of the undertaking become disused while the undertaking is being developed taking to a system that no longer serves a intent ( Fowler, 2005 ) . This is why Agile does nt necessitate as much certification as traditional methodological analysiss. The demands and paperss are produced throughout the class of the undertaking through changeless interaction and feedback from the client ( Fowler, 2005 ) . It is extremely iterative and the most of import functionality is prioritised. This ensures that if a piece of functionality does nt r un into the demands of the client or if the demands change merely one deliverable needs to be amended ( Fowler, 2005 ) . This is better than gaining this at the terminal of development rhythm and holding to restart the undertaking. The deficiency of bureaucratism besides increases the velocity at which the undertaking can be delivered ( Holler, 2006 ) . Developers spend more clip working on production degree codification than composing certification ( Holler, 2006 ) . The methodological analysis is person-oriented instead than process-oriented which means the accomplishment of the squad is respected and the procedure fits around the squad instead than the squad suiting around the methodological analysis ( Fowler, 2005 ) . Based on these advantages the Agile doctrine looks as though it will impart itself good to mobile development. 2.3 Disadvantages of Agile Agile has many advantages and suits a batch of modern development undertakings but there are disadvantages excessively ( Holler, 2006 ) . Certain systems will necessitate a big sum of certification to be produced. This is frequently the instance on big undertakings for big administrations or when developing a system for a governmental or regulative authorization ( Holler, 2006 ) . Each phase of a undertaking frequently has to be signed off by the major stakeholders and if some stakeholders are nt involved straight with the development squad they may necessitate big sums of certification to be produced for each stage of the undertaking and the undertaking is frequently non allowed to come on until the old stage has been to the full accepted and signed off by all major stakeholders ( Fowler, 2005 ) . This increases the sum of clip it takes to finish a undertaking and such undertakings are non likely to be nimble or be able to accommodate to altering demands from the clip the original d emands were defined to the clip the system has been implemented ( Holler, 2006 ) . An nimble methodological analysis would non accommodate such a system ( Holler, 2006 ) . These outlined disadvantages should nt hold a major impact on the development of nomadic package applications which will be discussed in more item below. 3 Mobile Software Development Up until late nomadic devices have been comparatively closed environments ( Abrahamsson et al. , 2004 ) . It was really hard to develop individualized applications for them and handset makers did really small to promote developers ( Abrahamsson et al. , 2004 ) . Handset makers developed their ain basic applications to let their clients to utilize the basic characteristics of the French telephone. In the last three old ages nomadic phones have gone through a major development. They are now at the phase where they are fundamentally nomadic computing machines and makers have moved towards a more unfastened attack to the extent of promoting independent developers to develop applications for their platform ( Hall A ; Anderson, 2009 ) . The earliest illustration of this was the Symbian operating system which was used by several French telephone makers and is presently owned by Nokia ( Hall A ; Anderson, 2009 ) . Developers can develop for Symbian utilizing Java ME, CLDC 1.1, MIDP 2.0 and MIDP 2.1 ( Gronli et al. , 2010 ) . This led to many nomadic applications looking in the public sphere but there was no option for developers to upload their applications to a Symbian market topographic point to let other users of the platform to buy them. Apple launched the iPhone in January 2007 which came pre-installed with the iPhone OS ( Hall A ; Anderson, 2009 ) . They released an SDK and an application market topographic point where developers could upload their applications and other users of the iPhone could buy them ( Hall A ; Anderson, 2009 ) . This greatly increased the demand for nomadic applications and made it easier and more rewarding for developers to showcase their work. Google and the Open Handset Alliance released Android in 2008 with the purpose of supplying unfastened beginning Mobile package which ( unlike iPhone OS ) can be used across different French telephone makers ( Hall A ; Anderson, 2009. They besides released an SDK and an application market topog raphic point to let developers to publicize their applications ( Hall A ; Anderson, 2009. Microsoft has been fighting to vie with Nokia, Apple and Google in this country with Windows Mobile 6.5 but have been phasing this out over the last twelvemonth ( Gronli et al. , 2010 ) . In October 2010 they announced the launch of a new platform called Windows Phone 7 which they expect to vie strongly in this country. They have besides released an SDK and market topographic point to do the development procedure easier for developers ( James, 2010 ) . Hardware for nomadic devices has besides improved greatly over the last three old ages ( Gronli et al. , 2010 ) . Mobile developers are traditionally faced with many barriers such as little sums of memory available on the device, little screen size, decelerate treating power and a deficiency of input devices ( Holler, 2006 ) . Recently phone makers such as HTC, Samsung and Apple have produced phones with more powerful processors which are able t o director more powerful applications, more antiphonal touch screens and capacity to accept memory cards up to 32 GB which allows users to utilize the device as a nomadic music or picture ( Gronli et al. , 2010 ) . These recent developments have increased the demand and wages for nomadic application developers. Nokia, Apple, Microsoft and Google represent four of the largest engineering companies in the universe and they have identified the nomadic industry and nomadic application development as markets that they want to be involved in. They continue to put in engineering and selling to better growing in this country ( Hall A ; Anderson, 2009 ) . These companies have made great advancement in the consumer market and are now get downing to look at the concern market ( Ihme A ; Abrahamsson, 2005 ) . Microsoft have advertised Microsoft Office integrating on Windows Phone 7 ( James, 2010 ) . Businesss are get downing to look for better ways to pull off their work load from their nomad ic devices while they are out of the office. This creates a possible new country of package development and as of yet there has been no major research into what type of development procedure should be used when developing such applications. The platforms mentioned above and whether or non an Agile development attack suits nomadic application development is discussed is discussed in more item below. 3.1 Development Platforms Symbian applications can be developed utilizing the Java ME platform ( Gronli et al. , 2010 ) . This is a set of different profiles. Some of the most common Java ME profiles are CLDC1.1, MIDP 2.0 and MIDP 2.1 ( Gronli et al. , 2010 ) . These were designed to work on lower terminal devices with limited memory capacity and treating power ( Gronli et al. , 2010 ) . They besides work across a assortment of different platforms and devices including set-top boxes and PDA s ( Gronli et al. , 2010 ) . Gronli et Al. ( 2010 ) suggest that this attack has proved to be really popular in the past but with recent betterments in nomadic hardware many makers have looked for better package solutions. iPhone applications are developed utilizing Objective C. An SDK is provided but will merely run on an Apple computing machine and the developer needs to register as an Apple Developer Connection Subscriber in order to download it ( Hall A ; Anderson, 2009 ) . Apple besides requires that all applications are submitted to them for blessing before they are made available on their market topographic point ( Hall A ; Anderson, 2009 ) . Android applications use the Java scheduling linguistic communication with a particular Google library ( Gronli et al. , 2010 ) . Google besides supply an Android development plugin for Eclipse every bit good as a freely available SDK that can be downloaded and installed on many different runing systems ( Hall A ; Anderson, 2009 ) . Windows Mobile allows users to develop applications utilizing the.NET compact model. This included linguistic communications such as Visual C # , Ocular Basic.NET and Visual C++ ( Gronli et al. , 2010 ) . These linguistic communications allowed the developer to to the full use the devices hardware ( Gronli et al. , 2010 ) . Gronli et Al. ( 2010 ) suggest that this worked in a similar manner to how the Common Language Runtime ( CLR ) works for desktop development. Microsoft have announced that developing for Windows Phone 7 will be a batch different to any of their old nomadic releases. They have released an SDK and confirmed that development for this platform will be to a great extent based around C # ( XNA ) and Microsoft Silverlight ( James, 2010 ) . There are many development platforms to see when developing nomadic applications and there are advantages and disadvantages to all of them. Some are more unfastened and some are more restricted than others. Some hold a higher market portion while some are advanced with plentifulness of possible for growing. 3.2 Using Agile to Mobile Software Development The demands associated with the rapid bringing of nomadic applications and the of all time altering environment makes many traditional package development methodological analysiss un- acceptable picks when developing for Mobile platforms ( Holler, 2006 ) . Mobile developers need to pass the bulk of their clip authorship and proving working package so it would nt be practical for them to pass a big sum of their clip composing certification ( Fowler, 2005 ) . The rules of agile development align good with the demands for nomadic package development undertakings ( Fowler, 2005 ) . Simplicity, low concern operating expense, adaptability, rapid bringing and client feedback are the chief properties of an nimble doctrine ( Abrahamsson et al. , 2004 ) . The XP and SCRUM methodological analysiss offer the development patterns, technology rules and the model to bring forth an agile undertaking ( Fowler, 2005 ) . Agile favours lightweight undertakings with uninterrupted be aftering as opposed t o elaborate undertakings with long term planning ( Holler, 2006 ) . The bringing of package in dashs every two to four hebdomads ensures that production codification is produced for the client on a regular footing. This allows the client to utilize the loops as paradigms and they are so able to give the development squad critical feedback ( Fowler, 2005 ) . If an loop or dash fails to run into the demands so it s merely a instance of the development squad looking at that loop once more and re-working it instead than holding to re-work the full undertaking which is what frequently happened utilizing less client focussed methodological analysiss ( Fowler, 2005 ) . Abrahamsson et Al. ( 2004 ) expression at a specific Mobile development undertaking and what design doctrine should be used. Due to the above traits associated with nomadic development they decided to follow an Agile attack but due to a deficiency of extended research in this country they were diffident how to continue. They decided to utilize their ain version of Agile called Mobile-D which adopted the Agile traits they felt they needed to let the undertaking to run into its ends. It was based on XP and optimized for a squad of less than 10 developers working in a co-located office. Their end was to bring forth a to the full functional nomadic application in a short period of clip. This attack was tested across four instance surveies and in all instances systems were delivered successfully within 8 10 hebdomads with squads of changing ability accommodating to new nomadic phone extensions of database systems ( Abrahamsson et al. , 2004 ) . This shows that Agile methods can be successful when seeking to present little systems in a short sum of clip when bureaucratism and certification are less of import than acquiring a working system delivered on clip and accommodating to alterations to demands and criterions along the manner ( Abrahamsson et al. , 2004 ) . 4 Decision Agile methodological analysiss tend to accommodate fast paced environments where accommodating to alter and velocity of development is more of import than documenting the procedure. Documents are still produced but affecting the client throughout the undertaking helps cut down the sum of certification needed for the undertaking to run into its demands. Iterations of production quality codification are made available at regular intervals leting the client to utilize the loops as paradigms and supply feedback which can be added into the system for the following loop if necessary. This doctrine suits nomadic undertakings in peculiar due to the rapid development of nomadic technological inventions. More and more people want to be able to entree the cyberspace, their paperss and their applications on the spell. Mobile hardware and package has improved dramatically in the last three old ages and continues to better. Platforms have become easier to develop for. This is in big portion to maj or companies such as Nokia, Apple, Microsoft and Google establishing nomadic runing systems and promoting developers to develop for their platform by supplying SDK s and market topographic points for developers to showcase their creative activities. These factors mean that Agile or a fluctuation of Agile would be a good doctrine to follow when working with a little development squad developing package for a fast paced, of all time altering environment such as nomadic application development.

Successful Implementation of Electronic Health Information Technology Assignment

Successful Implementation of Electronic Health Information Technology - Assignment Example ting the EMR system in the hospital include quick processing of information, accuracy of information, completeness and relevance of information, increased information security based on authentication rules, and data consistency. Today, electronic health records have become an important aspect of a healthcare organization based on its role in successful completion of all tasks using the information appropriately collected, stored, retrieved, and analyzed by the electronic medical record systems. The collected information can be used by different health departments in the decision-making processes. Before actually purchasing and implementing the system, the management of my hospital conducted a survey to know the viewpoints and concerns of all indented users of the system including nurses. This reason behind this was to make every user well-informed about the working and need of the new system, as well as to address the concerns of all users. Nurses were particularly included in the survey because the management believes them to be an important role player in the overall information management system. Nursing personals play a dynamic role in the successful adoption of healthcare information systems (Hsiao, Chang, & Chen, 2011, p. 150). When the system was purchased in our hospital, the management conducted a two-week training program in which all users including nurses were provided with all relevant information about the system. Moreover, the users were also given practical training of using the system. As an end user, I feel that I have played my role in selection and planning of the new HIT system. Several issues can occur if the management does not take into account the concerns of nurses while planning for any new system. For example, if nurses are not informed about the new system before purchasing, the management can never know the exact requirements of the system as the result of which they may need to purchase another system in a short time. Similarly, if

Countervailing duty Essay Example | Topics and Well Written Essays - 5000 words

Countervailing duty - Essay Example Countervailing duties are tariffs or tax charged by an importing country to the country of origin. These duties are basically being imposed on the basis that the produce or products being exported were subsidized disproportionately. By doing so, the importing country can neutralize the effects of unfair trade practices. Countervailing duties work in different ways. These can be levied on imported goods from producers who were not subjected to sales taxes or turnover taxes. Countervailing duties may also be imposed on the domestic production of sale of goods for the benefit of foreign manufacturers. Generally, the idea of countervailing duties is protection both of the importers and exporters. However, in the framework of uneven development, how possible can the concept of fairness be pursued? Many believes that along with other trade instruments, the concept and implementation of the countervailing duties can be prone to abuse and misuse. Furthermore, countervailing duties may only s erve few giants of trade but may be irrelevant to small export-oriented countries falling under the bracket of so-called less developed and developing countries. This paper aims to delve on the analysis of the countervailing duties based how these are being implemented, enforced and resolved under the umbrella of the World Trade Organization. Also, this paper will give particular emphasis on the practices of the United States of America, as a country that tails countervailing duties forcefully1 compared to other countries in the world. I. Brief presentation on the development of countervailing duties The General Agreement on Tariffs and Trade (GATT) There were only two provisions in the General Agreement on Tariffs and Trade that categorically regulate subsidies. These are Articles VI and XVI. GATT Article VI principally provides that the importing country may levy countervailing duties on subsidized imports if these may threaten or be the source of material injury to an established domestic industry2. This Article generalizes the rules on the application of antidumping and countervailing duties. It disapproves the export-sales under normal value, especially when these cause or threaten the material injury. It also describes the basis for the determination of sales below normal value: when export price is less than comparable price. According to Article VI, when these criteria are fulfilled, the importing country is entitled to levy an antidumping duty3. This Article however has been open to different interpretations and inconsistent practices due to its profound formulation. Much more, countries like Canada and the US, despite being the two of the biggest users of antidumping duties excuse themselves from being bound to this provision asserting that their domestic antidumping laws were much ahead of the GATT. Meanwhile, Article XVI stipulates that all subsidizing countries, either the increase their exports or reduce their imports are duty-bound to be notifie d and follow a consultation procedure for limiting subsidization that may cause prejudice to other countries4. However, because Article XVI was stated in a slack one-paragraph provision, this article was widely taken for granted by many countries on the basis that states were reluctant if not playing it safe as the gesture for

Somali Pirates Personal Statement Example | Topics and Well Written Essays - 500 words

Somali Pirates - Personal Statement Example They possess automatic weapons along with loads of AK-47s, tracking equipments, advanced communication devices. They have different levels of attack and methods of dealing within each level. In my line of thinking, they are the true masters of deception and entrapment although this includes physical attack; their camouflaging is better than the chameleons themselves. One aspect of piracy which surprises me a great deal is the inability to sustain security onboard and on the seaways. In other words, world’s massive trade is moved through these very seas estimated to be at more than 90% of the world’s economy is most prone to attacks and loss of billions of money through piracy! The only explanation I can think of is a refusal to attend to the indifference. But then in my opinion these areas have the largest amount of poverty and are, one way or the other, entitled to the world’s money. And the corporations suffering the loss deserve it because poverty began when the world denied people the right to have money. Although several corporations are involved in helping the Somali pirates buy the latest technology; getting their hands on such technology is something that they cannot accomplish by themselves. It is a known fact that the waters of Somalia cannot be regulated at all much less 24/7, the reason being as simple as the government being unable to impose further responsibility on their already strained assets. Although in my opinion is it is not entirely impossible because if a huge force is to arrive on the scene, piracy can be lessened. NATO and other such organizations are patrolling the area though without guarantees of any sort. Piracy has become socially acceptable in Somalia; after all what is one supposed to do after almost two decades of unending conflict. Somalia’s need for food aid is estimated to be at about 50 % of

Active Vs Physiological Management of Third Stage of Labour

Active Vs Physiological Management of Third Stage of Labour Active versus physiological management of the third stage of labour. Introduction This essay is primarily concerned with the arguments that are currently active in relation to the benefits and disadvantages of having either an active or passive third stage of labour. We shall examine this issue from several angles including the currently accepted medical opinions as expressed in the peer reviewed press, the perspective of various opinions expressed by women in labour and the evidence base to support these opinions. It is a generally accepted truism that if there is controversy surrounding a subject, then this implies that there is not a sufficiently strong evidence base to settle the argument one way or the other. (De Martino B et al. 2006). In the case of this particular subject, this is possibly not true, as the evidence base is quite robust (and we shall examine this in due course). Midwifery deals with situations that are steeped in layers of strongly felt emotion, and this has a great tendency to colour rational argument. Blind belief in one area often appears to stem from total disbelief in another (Baines D. 2001) and in consideration of some of the literature in this area this would certainly appear to be true. Let us try to examine the basic facts of the arguments together with the evidence base that supports them. In the civilised world it is estimated that approximately 515,000 currently die annually from problems directly related to pregnancy. (extrapolated from Hill K et al. 2001). The largest single category of such deaths occur within 4 hrs. of delivery, most commonly from post partum haemorrhage and its complications (AbouZahr C 1998), the most common factor in such cases being uterine atony. (Ripley D L 1999). Depending on the area of the world (as this tends to determine the standard of care and resources available), post partum haemorrhage deaths constitutes between 10-60% of all maternal deaths (AbouZahr C 1998). Statistically, the majority of such maternal deaths occur in the developing countries where women may receive inappropriate, unskilled or inadequate care during labour or the post partum period. (PATH 2001). In developed countries the vast majority of these deaths could be (and largely are) avoided with effective obstetric intervention. (WHO 1994). One of the central argumen ts that we shall deploy in favour of the active management of the third stage of labour is the fact that relying on the identification of risk factors for women at risk of haemorrhage does not appear to decrease the overall figures for post partum haemorrhage morbidity or mortality as more than 70% of such cases of post partum haemorrhage occur in women with no identifiable risk factors. (Atkins S 1994). Prendiville, in his recently published Cochrane review (Prendiville W J et al. 2000) states that: where maternal mortality from haemorrhage is high, evidence-based practices that reduce haemorrhage incidence, such as active management of the third stage of labour, should always be followed It is hard to rationally counter such an argument, particularly in view of the strength of the evidence base presented in the review, although we shall finish this essay with a discussion of a paper by Stevenson which attempts to provide a rational counter argument in this area. It could be argued that the management of the third stage of labour, as far as formal teaching and published literature is concerned, is eclipsed by the other two stages (Baskett T F 1999). Cunningham agrees with this viewpoint with the observation that a current standard textbook of obstetrics (unnamed) devotes only 4 of its 1,500 pages to the third stage of labour but a huge amount more to the complications that can arise directly after the delivery of the baby (Cunningham, 2001). Donald makes the comment This indeed is the unforgiving stage of labour, and in it there lurks more unheralded treachery than in both the other stages combined. The normal case can, within a minute, become abnormal and successful delivery can turn swiftly to disaster. (Donald, 1979). chapter 1:define third stage of labour, The definition of the third stage of labour varies between authorities in terms of wording, but in functional terms there is general agreement that it is the part of labour that starts directly after the birth of the baby and concludes with the successful delivery of the placenta and the foetal membranes. Functionally, it is during the third stage of labour that the myometrium contracts dramatically and causes the placenta to separate from the uterine wall and then subsequently expelled from the uterine cavity. This stage can be managed actively or observed passively. Practically, it is the speed with which this stage is accomplished which effectively dictates the volume of blood that is eventually lost. It follows that if anything interferes with this process then the risk of increased blood loss gets greater. If the uterus becomes atonic, the placenta does not separate efficiently and the blood vessels that had formally supplied it are not actively constricted. (Chamberlain G et al. 1999). We shall discuss this process in greater detail shortly. Proponents of passive management of the third stage of labour rely on the normal physiological processes to shut down the bleeding from the placental site and to expel the placenta. Those who favour active management use three elements of management. One is the use of an ecbolic drug given in the minute after delivery of the baby and before the placenta is delivered. The second element is early clamping and cutting of the cord and the third is the use of controlled cord traction to facilitate the delivery of the placenta. We shall discuss each of these elements in greater detail in due course. The rationale behind active management of the third stage of labour is basically that by speeding up the natural delivery of the placenta, one can allow the uterus to contract more efficiently thereby reducing the total blood loss and minimising the risk of post partum haemorrhage. (ODriscoll K 1994) discuss optimal practice, Let us start our consideration of optimal practice with a critical analysis of the paper by Cherine (Cherine M et al. 2004) which takes a collective overview of the literature on the subject. The authors point to the fact that there have been a number of large scale randomised controlled studies which have compared the outcomes of labours which have been either actively or passively managed. One of the biggest difficulties that they experienced was the inconsistency of terminology on the subject, as a number of healthcare professionals had reported management as passive when there had been elements of active management such as controlled cord traction and early cord clamping. As an overview, they were able to conclude that actively managed women had a lower prevalence of â€Å"post partum haemorrhage, a shorter third stage of labour, reduced post partum anaemia, less need for blood transfusion or therapeutic oxytocics† (Prendiville W J et al. 2001). Other factors derived from the paper include the observation that the administration of oxytocin before delivery of the placenta (rather than afterwards), was shown to decrease the overall incidence of post partum haemorrhage, the overall amount of blood loss, the need for additional uterotonic drugs, the need for blood transfusions when compared to deliveries with similar duration of the third stage of labour as a control. In addition to all of this they noted that there was no increased incidence of the condition of retained placenta. (Elbourne D R et al. 2001). The evidence base for these comments is both robust and strong. On the face of it, there seems therefore little to recommend the adoption of passive management of the third stage of labour. Earlier we noted the difficulties in definition of active management of the third stage of labour. In consideration of any individual paper where interpretation of the figures are required, great care must therefore be taken in assessing exactly what is being measured and compared. Cherine points to the fact that some respondents categorised their management as â€Å"passive management of the third stage of labour† when, in reality they had used some aspect of active management. They may not have used ecbolic drugs (this was found to be the case in 19% of the deliveries considered). This point is worth considering further as oxytocin was given to 98% of the 148 women in the trial who received ecbolic. In terms of optimum management 34% received the ecbolic at the appropriate time (as specified in the management protocols as being before the delivery of the placenta and within one minute of the delivery of the baby). For the remaining 66%, it was given incorrectly, either after the delivery of the placenta or, in one case, later than one minute after the delivery of the baby. Further analysis of the practices reported that where uterotonic drugs were given, cord traction was not done in 49%, and early cord clamping not done in 7% of the deliveries observed where the optimum active management of the third stage of labour protocols were not followed. >From an analytical point of view, we should cite the evidence base to suggest the degree to which these two practices are associated with morbidity. Walter P et al. 1999 state that their analysis of their data shows that early cord clamping and controlled cord traction are shown to be associated with a shorter third stage and lower mean blood loss, whereas Mitchelle (G G et al. 2005) found them to be associated with a lower incidence of retained placenta. Other considerations relating to the practice of early cord clamping are that it reduces the degree of mother to baby blood transfusion. It is clear that giving uterotonic drugs without early clamping will cause the myometrium to contract and physically squeeze the placenta, thereby accelerating the both the speed and the total quantity of the transfusion. This has the effect of upsetting the physiological balance of the blood volume between baby and placenta, and can cause a number of undesirable effects in the baby including an increased tendency to jaundice. (Rogers J et al. 1998) The major features that are commonly accepted as being characteristic of active management and passive management of the third stage of labour are set out below. Physiological Versus Active Management (After Smith J R et al. 1999) physiology of third stage The physiology of the third stage can only be realistically considered in relation to some of the elements which occur in the preceding months of pregnancy. The first significant consideration are the changes in haemodynamics as the pregnancy progresses. The maternal blood volume increases by a factor of about 50% (from about 4 litres to about 6litres). (Abouzahr C 1998) This is due to a disproportionate increase in the plasma volume over the RBC volume which is seen clinically with a physiological fall in both Hb and Heamatocrit values. Supplemental iron can reduce this fall particularly if the woman concerned has poor iron reserves or was anaemic before the pregnancy began. The evolutionary physiology behind this change revolves around the fact that the placenta (or more accurately the utero-placental unit) has low resistance perfusion demands which are better served by a high circulating blood volume and it also provides a buffer for the inevitable blood loss that occurs at the time of delivery. (Dansereau J et al. 1999). The high progesterone levels encountered in pregnancy are also relevant insofar as they tend to reduce the general vascular tone thereby increase venous pooling. This, in turn, reduces the venous return to the heart and this would (if not compensated for by the increased blood volume) lead to hypotension which would contribute to reductions in levels of foetal oxygenation. (Baskett T F 1999). Coincident and concurrent with these heamodynamic changes are a number of physiological changes in the coagulation system. There is seen to be a sharp increase in the quantity of most of the clotting factors in the blood and a functional decrease in the fibrinolytic activity. (Carroli G et al. 2002). Platelet levels are observed to fall. This is thought to be due to a combination of factors. Haemodilution is one and a low level increase in platelet utilisation is also thought to be relevant. The overall functioning of the platelet system is rarely affected. All of these changes are mediated by the dramatic increase in the levels of circulating oestrogen. The relevance of these considerations is clear when we consider that one of the main hazards facing the mother during the third stage of labour is that of haemorrhage. (Soltani H et al. 2005) and the changes in the haemodynamics are largely germinal to this fact. The other major factor in our considerations is the efficiency of the haemostasis produced by the uterine contraction in the third stage of labour. The prime agent in the immediate control of blood loss after separation of the placenta, is uterine contraction which can exert a physical pressure on the arterioles to reduce immediate blood loss. Clot formation and the resultant fibrin deposition, although they occur rapidly, only become functional after the coagulation cascade has triggered off and progressed. Once operative however, this secondary mechanism becomes dominant in securing haemostasis in the days following delivery. (Sleep, 1993). The uterus both grows and enlarges as pregnancy progresses under the primary influence of oestrogen. The organ itself changes from a non-gravid weight of about 70g and cavity volume of about 10 ml. to a fully gravid weight of about 1.1 kg. and a cavity capacity of about 5 litres. This growth, together with the subsequent growth of the feto-placental unit is fed by the increased blood volume and blood flow through the uterus which, at term, is estimated to be about 5-800 ml/min or approximately 10-15% of the total cardiac output (Thilaganathan B et al. 1993). It can therefore be appreciated why haemorrhage is a significant potential danger in the third stage of labour with potentially 15% of the cardiac output being directed towards a raw placental bed. The physiology of the third stage of labour also involves the mechanism of placental expulsion. After the baby has been delivered, the uterus continues to contract rhythmically and this reduction in size causes a shear line to form at the utero-placental junction. This is thought to be mainly a physical phenomenon as the uterus is capable of contraction, whereas the placenta (being devoid of muscular tissue) is not. We should note the characteristic of the myometrium which is unique in the animal kingdom, and this is the ability of the myometrial fibres to maintain its shortened length after each contraction and then to be able to contract further with subsequent contractions. This characteristic results in a progressive and (normally) fairy rapid reduction in the overall surface area of the placental site. (Sanborn B M et al. 1998) In the words of Rogers (J et al. 1998), by this mechanism â€Å"the placenta is undermined, detached, and propelled into the lower uterine segment.† Other physiological mechanisms also come into play in this stage of labour. Placental separation also occurs by virtue of the physical separation engendered by the formation of a sub-placental haematoma. This is brought about by the dual mechanisms of venous occlusion and vascular rupture of the arterioles and capillaries in the placental bed and is secondary to the uterine contractions (Sharma J B et al. 2005). The physiology of the normal control of this phenomenon is both unique and complex. The structure of the uterine side of the placental bed is a latticework of arterioles that spiral around and inbetween the meshwork of interlacing and interlocking myometrial fibrils. As the myometrial fibres progressively shorten, they effectively actively constrict the arterioles by kinking them . Baskett (T F 1999) refers to this action and structure as the â€Å"living ligatures† and â€Å"physiologic sutures† of the uterus. These dramatic effects are triggered and mediated by a number of mechanisms. The actual definitive trigger for labour is still a matter of active debate, but we can observe that the myometrium becomes significantly more sensitive to oxytocin towards the end of the pregnancy and the amounts of oxytocin produced by the posterior pituitary glad increase dramatically just before the onset of labour. (Gà ¼lmezoglu A M et al. 2001) It is known that the F-series, and some other) prostaglandins are equally active and may have a role to play in the genesis of labour. (Gulmezoglu A M et al. 2004) >From an interventional point of view, we note that a number of synthetic ergot alkaloids are also capable of causing sustained uterine contractions. (Elbourne D R et al. 2002) chapter 2 discuss active management, criteria, implications for mother and fetus. This essay is asking us to consider the essential differences between active management and passive management of the third stage of labour. In this segment we shall discuss the principles of active management and contrast them with the principles of passive management. Those clinicians who practice the passive management of the third stage of labour put forward arguments that mothers have been giving birth without the assistance of the trained healthcare professionals for millennia and, to a degree, the human body is the product of evolutionary forces which have focussed upon the perpetuation of the species as their prime driving force. Whilst accepting that both of these concepts are manifestly true, such arguments do not take account of the â€Å"natural wastage† that drives such evolutionary adaptations. In human terms such â€Å"natural wastage† is simply not ethically or morally acceptable in modern society. (Sugarman J et al. 2001) There may be some validity in the arguments that natural processes will achieve normal separation and delivery of the placenta and may lead to fewer complications and if the patient should suffer from post partum haemorrhage then there are techniques, medications and equipment that can be utilised to contain and control the clinical situation. Additional arguments are invoked that controlled cord traction can increase the risk of uterine inversion and ecbolic drugs can increase the risks of other complications such as retained placenta and difficulties in delivering an undiagnosed twin. (El-Refaey H et al. 2003) The proponents of active management counter these arguments by suggesting that the use of ecbolic agents reduces the risks of post partum haemorrhage, faster separation of the placenta, reduction of maternal blood loss. Inversion of the uterus can be avoided by using only gentle controlled cord traction when the uterus is well contracted together with the controlling of the uterus by the Brandt-Andrews manoeuvre. The arguments relating to the undiagnosed second twin are loosing ground as this eventuality is becoming progressively more rare. The advent of ultrasound together with the advent of protocols which call for the mandatory examination of the uterus after the birth and before the administration of the ecbolic agent effectively minimise this possibility. (Prendiville, 2002). If we consider the works of Prendiville (referred to above) we note the meta-analyses done of the various trials on the comparison of active management against the passive management of the third stage of labour and find that active management consistently leads to several benefits when compared to passive management. The most significant of which are set out below. Benefits of Active Management Versus Physiological Management *95% confidence interval † Number needed to treat (After Prendiville, 2002). The statistics obtained make interesting consideration. In these figures we can deduce that for every 12 patients receiving active management (rather than passive management) one post partum haemorrhage is avoided and further extrapolation suggests that for every 67 patients managed actively one blood transfusion is avoided. With regard to the assertions relating to problems with a retained placenta, there was no evidence to support it, indeed the figures showed that there was no increase in the incidence of retained placenta. Equally it was noted that the third stage of labour was significantly shorter in the actively managed group. In terms of significance for the mother there were negative findings in relation to active management and these included a higher incidence of raised blood pressure post delivery (the criteria used being > 100 mm Hg). Higher incidences of reported nausea and vomiting were also found although these were apparently related to the use of ergot ecbolic and not with oxytocin. This is possibly a reflection of the fact that ergot acts on all smooth muscle (including the gut) whereas the oxytocin derivatives act only on uterine muscle. (Dansereau, 1999). None of the trials included in the meta-analysis reported and incidence of either uterine inversions or undiagnosed second twins. Critical analysis of these findings would have to consider that one would have to envisage truly enormous study cohorts in order to obtain statistical significance with these very rare events. (Concato, J et al. 2000) With specific regard to the mother and baby we note some authors recommend the use of early suckling as nipple stimulation is thought to increase uterine contractions and thereby reduce the likelihood of post partum haemorrhage. Studies have shown that this does not appear to be the case (Bullough, 1989), although the authors suggest that it should still be recommended as it promotes both bonding and breastfeeding. The most important element of active management of the third stage of labour is the administration of an ecbolic agent directly after the delivery of the anterior shoulder or within a minute of the complete delivery of the baby. The significance of the anterior shoulder delivery is that if the ecbolic is given prior to delivery of the anterior shoulder then there is a significantly increased risk of shoulder dystocia which, with a strongly contracting uterus, can be technically very difficult to reduce and will have significant detrimental effects on the baby by reducing its oxygen supply from the placenta still further. The fundal height should be assessed immediately after delivery to exclude the possibility of an undiagnosed second twin. (Sandler L C et al. 2000) There are a number of different (but widely accepted) protocols for ecbolic administration. Commonly, 10 IU of oxytocin is given intramuscularly or occasionally a 5 IU IV bolus. Ergot compounds should be avoided in patients who have raised blood pressure, migraine and Raynaud’s phenomenon. (Pierre, 1992). The issue of early clamping of the cord is complex and, of the three components of the active management of the third stage of labour this, arguably, gives rise to the least demonstrable benefits in terms of the evidence base in the literature. We have already discussed the increased incidence of postnatal jaundice in the newborn infant if cord clamping is delayed but this has to be offset against both the occasional need for the invoking of prompt resuscitation measures (i.e. cord around the neck) or the reduction in the incidence of childhood anaemia and higher iron stores (Gupta, 2002). In a very recent paper, Mercer also points to the lower rates of neonatal intraventricular haemorrhage although it has to be said that the evidence base is less secure in this area. (Mercer J S et al. 2006) Other foetal issues are seldom encountered in this regard except for the comparatively rare occurrence when some form of dystocia occurs and the infant had to be manipulated and represented (viz. the Zavanelli procedure). If the cord has already been divided then this effectively deprives the infant of any possibility of placental support while the manoeuvre is being carried out with consequences that clearly could be fatal. (Thornton J G et al. 1999) In the recent past, the emergence of the practice of harvesting foetal stem cells from the cord blood may also have an influence on the timing of the clamping but this should not interfere with issues relating to the clinical management of the third stage. (Lavender T et al. 2006) There are some references in the literature to the practice of allowing the placenta to exsanguinate after clamping of the distal portion as some authorities suggest that this may aid in both separation (Soltani H et al. 2005) and delivery (Sharma J P et al. 2005). of the placenta. It has to be noted that such references are limited in their value to the evidence base and perhaps it would be wiser to consider this point unproven. We have searched the literature for trials that consider the effect of controlled cord traction without the administration of embolic drugs. The only published trial on the issue suggested that controlled cord traction, when used alone to deliver the placenta, had no positive effect on the incidence of post partum haemorrhage (Jackson, 2001). The same author also considered the results of the administration of ecbolic agents directly after placental delivery and found that the results (in terms of post partum haemorrhage at least), were similar to those obtained with ecbolics given with the anterior shoulder delivery, although an earlier trial (Zamora, 1999) showed that active management (as above) did result in a statistically significant reduction in the incidence of post partum haemorrhage when compared to controlled cord traction and ecbolics at the time of placental delivery. In this segment we should also consider the situation where the atonic uterus (in passive management of the third stage of labour) can result in the placenta becoming detached but remaining at the level of the internal os. This can be clinically manifest by a lengthening of the cord but no subsequent delivery of the placenta. In these circumstances the placental site can continue to bleed and the uterus can fill with blood, which distends the uterus and thereby increases the tendency for the placental site to bleed further. This clearly has very significant implications for the mother. (Neilson J et al. 2003) There are other issues which impact on the foetal and maternal wellbeing in this stage of the delivery but these are generally not a feature issues relating to the active or passive management of the third stage of labour and therefore will not be considered further. There are a number of other factors which can influence the progress of the third stage of labour and these can be iatrogenic. Concurrent administration of some drugs can affect the physiology of the body in such a way as to change the way it responds to normal physiological processes. On a first principles basis, one could suggest that, from what we have already discussed, any agent that causes relaxation of the myometrium or a reduction in uterine tone could potentially interfere with the efficient contraction of the uterine musculature in the third stage and thereby potentially increase the incidence of post partum haemorrhage. Beta-agonists (the sympathomimetic group) work by relaxing smooth muscle via the beta-2 pathway. The commonest of these is salbutamol. When given in its usual form of an inhaler for asthma, the blood levels are very small indeed and therefore scarcely clinically significant but higher doses may well exert a negative effect in this respect. (Steer P et al. 1999) The NSAIA group have two potential modes of action that can interfere with the third stage. Firstly they have an action on the platelet function and can impair the clotting process which potentially could interfere with the body’s ability to achieve haemostasis after placental delivery. (Li D-K et al. 2003) Secondly their main mode of therapeutic action is via the prostaglandin pathway (inhibitory action) and, as such they are often used for the treatment of both uterine cramping, dysmenorrhoea and post delivery afterpains. (Nielsen G L et al. 2001) They achieve their effect by reducing the ability of the myometrium to contract and, as such, clearly are contraindicated when strong uterine contractions are required, both in the immediate post partum period and if any degree of post partum haemorrhage has occurred. Other commonly used medications can also interfere with the ability of the myometrium to contract. The calcium antagonist group (e.g. nifedipine) are able to do this (Pittrof R et al. 1996) and therefore are changed for an alternative medication if their cardiovascular effects need to be maintained. (Khan R K et al. 1998) We should also note that some anaesthetic agents can inhibit myometrium contractility. Although they are usually of rapid onset of action, and therefore rapid elimination from the body, they may still be clinically significant if given at the time of childbirth for some form of operative vaginal delivery. (Gà ¼lmezoglu A et al. 2003) relevant legal and ethical issues related to topic and midwife, Many of the legal and ethical issues in this area revolve around issues of consent, which we shall discuss in detail shortly, and competence. Professional competence is an area which is difficult to define and is evolving as the status of the midwife, together with the technical expectations expected of her, increase with the advance of technology.

Market Research :: Business and Management Studies

Market Research Finding out about what consumers want and need, and what makes them buy, is called MARKET RESEARCH. Market research is the process of gaining information about customers, competitors and market trends through collecting primary and secondary data. Why Research the Market? Businesses that are product orientated risk spending large amounts of money launching a product, which could be a failure. Research the market helps reduce this risk. It focuses research and design effort onto products, which have a chance of success in the market place. When the product is launched, a carefully researched product stands less chance of failing. Market research attempts to find the answers to questions a business might have about its market. This information is collected via desk research and field research. The information is then collected and analysed. The business then decides about what to do in the light of the information formed. Desk Research DESK RESEARCH involves the use of SECONDARY DATA. This is information that is available, both within and outside the business: Internal Sources is such as sales invoices, reports and accounts. Government is published statistics, such as consumer spending figures; reports such as Monopolies and Mergers Commission Reports. The Media is reports in newspapers, magazines, on radio and on television. Trade Associations is statistics or reports published by national organizations such as the TUC, the CBI or chambers of commerce, or industry associations such as the Engineering Employers Federation or the National Farmers Union. Research Organisations is reports prepared by specialist market research organizations such as Mintel or Mori; articles published in academic journals such as university journals. Field Research FIELD RESEARCH involves the collection of PRIMARY DATA is information which no one has yet collected. It is collected for the particular piece of research through direct investigation, that is, observation, survey and experiment.