ECON616 1501B 02ph2ip - 1898 Words

AutoEdge’s Market Fit Phineas C. Cody CTU Online Phase 2 IP ECON616-1501B-02 Professor: Hagen Introduction In order to answer the question as where AutoEdge fits in its industry in comparison to its competitors it will be helpful to look at market structure and the various areas or types of market structure. So what is a market structure? A market structure may be defined as â€Å"the characteristics of the market† (Whatiseconomics, 2014). The word characteristics is the key to fully grasping this seemingly simple definition of what market structure is. Market structure or the characteristics of the market can be sorted into two categories where one is organizational characteristics and the other is competitive†¦show more content†¦This would be â€Å"a market structure in which a few firms dominate† (Economics Online, 2015). When this occurs the market takes on a different appearance that is said to be highly concentrated because there may be several businesses operating in the same market. Heavy hitters in the retail industry would be mass merchant entities such a s Wal-mart, Costco, and Target. These massive retailers have a share interest in controlling the retail market by manipulating various barriers of entry. Similar to those barriers of entry that are associated with a monopolized market, higher costs and such, these giants can also manipulate pricing to ensure that a newcomer could not compete. Price undercutting or predatory pricing may be done even at a loss for these retail giants if means keeping the oligopoly market structure with fewer new competitors. Various may be use these oligopolists strong name and customer loyalty base. Often times an oligopoly may experience a kinked-demand curve where there are two distinct segments with different elasticities that combine to form a kink. The kinked-demand curve is a good way to explain price rigidity in oligopoly where one segment is relatively more elastic in prices increasing and the other segment is less elastic in prices decreasing. â€Å"The relative elasticities of these two s egments is directly based on the

Revenge By William Shakespeare s Hamlet - 982 Words

Revenge has caused the downfall of many a person. Its consuming nature causes one to act recklessly through anger rather than reason. Revenge is an emotion easily rationalized; one turn deserves another. However, this is a very dangerous theory to live by. Throughout Hamlet, revenge is a dominant theme. Fortinbras, Laertes, and Hamlet all seek to avenge the deaths of their fathers. But in so doing, all three rely more on emotion than thought, and take a very big gamble, a gamble which eventually leads to the downfall and death of all but one of them. King Fortinbras was slain by King Hamlet in a sword battle. This entitled King Hamlet to the land that was possessed by Fortinbras because it was written in a seal d compact. †¦our valiant Hamlet-for so this side of our known world esteem d him-did slay this Fortinbras. Young Fortinbras was enraged by his father’s murder and sought revenge against Denmark. He wanted to reclaim the land that had been lost to Denmark when his f ather was killed. †¦Now sir, young Fortinbras†¦as it doth well appear unto our state-but to recover of us, by strong hand and terms compulsative, those foresaid lands so by his father lost†¦ Claudius becomes aware of Fortinbras’ plans, and in an evasive move, sends a message to the new King of Norway, Fortinbras’ uncle. The king forbade Fortinbras to wage an attack against Denmark, and instead suggested he attack the Poles to vent his anger. Fortinbras agreed to the plan, but had no intentions ofShow MoreRelatedWilliam Shakespeare s Hamlet s Revenge1725 Words   |  7 Pages Thesis: Shakespeare s portrayal of Hamlet s revenge is not a worthy journey because he never finds his self worth, distracted between what will exemplify his purpose, and what will make him a failure in the memory of Denmark. Three quotes with analysis explaining thesis: Act 1 Scene 5 Ghost: â€Å" But know, thou noble youth, Hamlet: â€Å"Oh My Prophetic Soul! My uncle?† The serpent that did sting thy father’s life Now wears his crown.† The beginning of the â€Å"call to adventure -JRead MoreRevenge By William Shakespeare s Hamlet1625 Words   |  7 PagesRevenge can be defined as â€Å"the act of retaliating for wrongs received†. William Shakespeare s â€Å"Hamlet† is considered one of his greatest plays and the plot is centered on revenge. Euripides Medea also shares a theme of revenge. While both central characters have been betrayed, resulting in their impending revenge, there is more than one theme of revenge in Hamlet, and there are differences in the ways all decide to handle their betrayals and the outcomes of their actions. In â€Å"Hamlet,† he isRead MoreWilliam Shakespeare s Hamlet - Hamlet s Revenge1742 Words   |  7 PagesHamlet’s Vengeance Hamlet is one of the greatest literary works that has the innate ability to transcend time with the study of the human condition. William Shakespeare investigates themes of revenge, morality, sex, and familial complexities that entangle us all at one point and time. Shakespeare story of Hamlet gives us one of our first tragic heroes in modern literary history. In his quest for revenge for his father’s death we also see the systematic decline and lapses into madness that willRead MoreRevenge By William Shakespeare s Hamlet882 Words   |  4 PagesIn Shakespeare’s Hamlet, it is very evident that hatred and a thirst for revenge can turn people into something that they are not. Many characters throughout this story exemplify this, but the main two are Hamlet and Laertes. This theme of revenge is established throughout the whole play and it acts as a vital character. Revenge is seen as a cause for many outcomes. Hamlet pursues revenge on Claudius to avenge his father s dea th. Gertrude is targeted by Hamlet for wedding Claudius too quickly afterRead MoreRevenge By William Shakespeare s Hamlet914 Words   |  4 PagesRevenge = Happiness Can revenge really bring happiness? Harming and getting back at someone for upsetting you or â€Å"doing you wrong†. It’s the ultimate win, right? Wrong. Revenge is an irrepressible craving that devours the mind and creates a never ending cycle of pain and grief. â€Å"But isn’t it said that revenge is sweet?† says nearly every person in modern day society. Wrong again. We’re obsessed with the belief that revenge is what solves the issue, when in reality; it’s only ridding you of yourRead MoreWilliam Shakespeare s Hamlet - Longing For Revenge1304 Words   |  6 PagesLonging for Revenge William Shakespeare was born in England in April of 1564 and was an English poet and playwright . Shakespeare is universally known as the greatest writer in the English language. Shakespeare frequently produced tragedies that are continuously acted out today, along with many plays and sonnets.. Although Shakespeare is seen today as a great writer who changed the world, his reputation did not rise to these heights until around the 19th century. In all of Shakespeare’s astoundingRead MoreWilliam Shakespeare s Hamlet As A Revenge Tragedy1777 Words   |  8 PagesWilliam Shakespeare’s play Hamlet was written as a revenge tragedy. This play was written by Shakespeare between 1599 and 1602; no one is exactly certain about the date Hamlet was written (Hunt 2). The protagonist of this play is a prince named Hamlet; he is a prince of Denmark. Hamlet’s father was killed by his uncle Claudius, who became king afterwards. Not only did Claudius become king of Denmark, he took Hamlet’s mother, Gertrude, as his wife. This play is the longest of all Shakespeare’s playsRead MoreRevenge By William Shakespeare s Hamlet, And Sophocles Antigone2105 Words   |  9 PagesIntroduction Revenge has always been an exciting theme to incorporate into any literary work. This revenge adds conflict, action, and contrast to any story. There have been hundreds of thousands of stories and tales which cause readers to experience similar feeling to that of the main characters. With revenge, the reader may side with the main character whether or not the main character is morally right or wrong. By human nature, people around the globe have always been trying their hardest to comeRead MoreWilliam Shakespeare s Hamlet Essay902 Words   |  4 PagesTo be, or not to be; that s the question† (Act III, Scene 1, P.1127) is of the most widely circulated lines. As we all know, it is also the most important part of the drama, â€Å"Hamlet†, which is one of the most famous tragedy in the literature written by William Shakespeare between from 1599 to1602. The drama was written at the age of Renaissance that reflects the reality of the British society in sixteenth century to early seventeenth century. During that period, Britain was in the era of reverseRead MoreEssay on Vengeance in Shakespeares Hamlet - The Theme of Revenge1162 Words   |  5 PagesThe Theme of Revenge in Hamlet    In Shakespeares tragedy,  Hamlet, the thoughts of revenge are introduced early in the play. At the end of the first act, Hamlet meets the ghost of his deceased father. He is brought to see him by Horatio and Marcellus, who saw the ghost yesternight (Shakespeare 1.2.190). During this exchange of words between the Ghost and Hamlet, the Ghost tells Hamlet, [s]o art thou to revenge, when thou shalt hear. (Shakespeare 1.5.5). He is telling Hamlet to listen closely

Globalization and Its Impact on the HRM-Free Samples for Students

Question: Evaluate the Challenges facing the Organization based on the chosen Contemporary Issue in HR using third party sources such as academic journal articles, practitioner-orientated materials, and books for support in analyzing the theoretical concept that underpins the various Contemporary Issues. Answer: Introduction The main aim of the task is to provide a brief overview about the globalization and its impact on the HRM. Globalization is the biggest key issue in human resource management which influences the position of the firm. Furthermore, it talks about the business activities and operations of the Oman shell. It is one of the biggest integrated companies that aim to fulfill the demand and requirements of the energy. Shell development Oman LLC provides a central point for the coordination and cooperation of the employees. It explains that how the company is facing key HRM issues and challenges within the organization due to globalization. It tells that how the firm is overcoming and addressing these challenges and key issues in the organization. It describes that how the company is maintaining sustainability in the environment. Further, the report explains the mission and vision of the Shell in Oman. The Oman shell is one of the biggest energy leaders in the world. The company plays a significant role in order to meet the goals and objectives of the firm. It maintains an effective and unique relationship with stakeholders around the world (Minnee et al, 2013). The learning and development programs are conducted by the Shell in Oman. The company is active in Oman around the gas and oil industry and it is involved in independent activities and joint venture. Further, the company implements broad social investment programs which contribute to the sustainable development and expansion of the country (Devi, Al-Hashmi, and Sekhar, 2012). Honesty, respect, and integrity are the core values of the company. The company provides support to the government and people of the Oman through, learning, development, research and sustainable social investment programs. In todays era, the company is expanding and flourishing its business day by day. Shell involves in the construction and design of t he plant in Sur and it also involves in the development and expansion of the gas and oil business. The company representative office was established in 2002. The firm is delivering energy is an effective and responsible way in order to accomplish the needs, requirements, and desires of the people (Abejide and Raji, 2013). The Shell is a group of petrochemical and Energy Company around the world. Literature review Globalization: It is the major issue in human resource management which influences the success and growth of the firm. It also affects the quality of life and standard of life. It also influences the organizations balance sheet and product life of the organization. It also has a direct impact on monetary regulations and trade policies of the government. It also affects the culture and working conditions of the firm (Pieterse, 2015). Due to globalization, several contemporary issues are faced by the human resource management that has been discussed below. Contemporary issues in HR There are various key challenges faced by the human resource management due to globalization. After the various researchers, it has been analyzed by the Appelbaum et al (2011), where he said that contemporary issues affect the mission and vision of the company. These issues also affect the success and growth of the company while conducting business activities and operations globally. The contemporary issues that are associated with globalization have been discussed below (Taylor, 2017). Multi-generational challenges in the workplace: It is the biggest challenges in human resource management which affect the long term targets of the firm due to globalization. It affects the working capacity and productivity of the employees. The company has not been able to appoint experienced and potential employees. Therefore, it also creates conflicts and disputes in the workplace among the employees. The company is not able to take benefits of the experience and knowledge of the older employees. It is one of the biggest challenges for the human resource department (Haynes, 2011). Market competition: Globalization also increases competition in the global market. The immense and high competition will also increase and enhance the pressure on organizations to maximize the quality and eliminate the prices. It affects the financial position of the firm in the competitive market (Fujita and Thisse, 2013). The lack of skilled workforce: Globalization encourages competition in the global market. As a result, the firm needs to make effective and unique strategies and policies to stand out against the competitors across the world. Due to immense competition, the firm requires to appoint high skills and potential workforce. It is difficult process to appoint capable and skilled labor force at low prices. Human workforce is the biggest contemporary issue in HRM which has an adverse impact on the vision of the firm (Milanovic, 2016). Challenges of changing technology: Globalization also has an adverse impact on technology and innovation. Due to globalization, the firm needs to change the technology and process on regular basis that can affect the operations and activities of human resource management. Due to change management, high employee turnover and absenteeism will also increase in the organization. Sometimes, employees do not accept the organizational changes due to lack of knowledge and experience. They avoid and ignore these organizational challenges. In addition, lack of proper research and development team, the company cannot overcome on the competitors around the world. It also affects the energy and sustainability of the firm (Stromquist and Monkman, 2014). Legislation influencing workplace: The rules and regulations which are imposed by the government also influence the trading activities and operations of the company adversely. It also affects the sustainability and development of the firm. After the various researchers, it has been evaluated by Paik, Chow and Vance (2011), where they said that legislation also affects the efficiency and effectiveness of the workers. Leadership development: It is another contemporary issue in HRM which affects the productivity and performance of the employees in the workplace. The company has not been able to maintain sustainable human resource management due to inadequate resources and development (Kunze, Boehm, and Bruch, 2011). The supervisors and top management are not effective and competent to control and motivate the subordinates within the organization. The company does not provide training and development coaching to the managers and supervisors (Benera, Berik and Floro, 2015). Thus, they are not able to provide motivation and encouragement to the employees to reduce and prevent the adverse impact of globalization (Benn, Todd and Pendleton, 2010). Healthcare law compliance: The human resource management faces a number of logistics and healthcare challenges in the organization due to globalization. The firm could not set the proper and effective rules, and regulations related to the healthcare. It affects the health and performance of the subordinates at the workplace (Rugman, 2012). Recruitment: It is one of the major concerns in the HRM. It is difficult for the company to appoint potential and competent employees for doing work in the energy sector. Recruitment and selection are important to increase and maximize the revenue and profit of the company. HRM is not able to evaluate and analyze the skills and potential of the employees due to globalization. Hence, various recruitment and selection challenges are faced by the company at the workplace (De Wit, 2011). Reward and compensation: These contemporary issues exist in the organization. The firm does not provide reward and incentive to the potential and competent employees within the organization. It affects the actions and efficiency of the workers. Pepper and Gore (2015), said that reward and compensation are considered the motivational tool for the employees. If the company does not provide compensation and reward to the competent employees then they get disappointed (Larkin, Pierce and Gino, 2012). Health and safety: These are another major concern in HRM. Health and safety are the primary function of the human resource management to build and develop sustainability in the workplace and environment. Whenever safety and health issues arise in the organization then employees are not able to do work with more efficiently and effectively. Health and safety issues affect the health of the workers in the world. Lundgren and McMakin (2013) said that good and healthy working environment is essential for each and every employee to increase and maximize the revenue and profit of the company. The firm has not been able to maintain healthy and safety working environment due to globalization. Discrimination and diversity: These issues are faced by HR department of every firm. It also affects the skills and performance of the employees within the organization. The top management and manager discriminate among the employees. Sometimes, top management and managers do false commitment and promise with employees in order to increase the salary and basic pay of the employees but they do not fulfill the basic needs and requirements of the employees (Kunze, Boehm, and Bruch, 2011). Thus, it affects the efficiency and performance of the workers adversely. Apart from this, the employees do not maintain discipline and rules within the organization. It also affects the image and position of the company around the world. Further, HRM does not maintain proper records and books of accounts of the workers. It also influences the performance and quality of the workers. In addition, HRD is not able to resolve the queries and grievances of the workers related to the workplace. Thus, employe es feel unhappy within the organization. All these contemporary issues are faced by the HR department of the firm (Kunze, Boehm, and Bruch, 2011). Due to globalization, the company is not able to build and develop communication within the organization (Hitt, Ireland and Hoskisson, 2012). On the above mentioned contemporary issues, leadership development is a biggest contemporary issue in HRM. The success and growth of the organization depend on the effective and dynamic leadership. The employees of the company are not capable to become a team leader in the organization due to globalization (Crane and Matten, 2016). Thus, it affects the success and growth of the company. Leadership is important to create a reciprocal relationship with partners around the world. It also helps to know and evaluate the technology and energy of the firm. Leadership is the major part of the success and growth of the firm. The company does not use effective and unique leadership styles to guide and assist the workers in the organization. It is the biggest challenge for the company to determine its long-term mission and vision of the firm with maintaining sustainability at the workplace. Lack of leadership, the company is not able to improve the performance and quality of the subordinates in the global market. Lack of leadership styles, the firm is not able to motivate and encourage the workers within the organization. It also affects the energy and innovation of the firm. Stone and Deadrick (2015) said that a company cannot expand its trading activities globally without effective and unique leadership. Leadership styles are primary and foremost part of the organization in order to measure the sustainability of the organization (Gregory et al, 2011). Evaluation that how the organization has addressed the challenges issues The human resource management issues influence the business activities and operations adversely in various ways. Therefore, the company needs to focus and monitor these key challenges and issues to attain long-term mission, goals, and objectives of the firm. Shell must measure and identify these key challenges to maintain sustainability within the organization. There are various ways to address and resolve these key issues which have been discussed below (Schaltegger, Ldeke-Freund, and Hansen, 2012). Shell is the largest company in the world. Therefore, the company must resolve the generation issues to overcome the key challenges of human resource management within the organization. The company should provide opportunities to the young and potential people to do work in Shell with more efficiently and effectively. In this way, it helps to improve the performance and efficiency of the potential workers in the organization (Shuen, Feiler and Teece, 2014). The effective rules, legislation, policies must be made by the Shell in Oman to attract more consumers around the world. Rules and regulations determine the long-term growth and success of the firm. It also helps to reduce the key HRM issues within the organization. These rules and legislation provide guidance to the employees. It helps to run the business activities smoothly and easily (Li, Sanders, and Frenkel, 2012). The company must provide training and development coaching to the workers to evaluate and analyze the benefits of the organizational changes within the organization. Further, some unique and dynamic programs must be conducted by the company to resolve the resistance to change issues in the Shell. The top management and managers should evaluate the reasons for the refusing the organizational changes. In this way, the company can control the resistance to change issues around the world. The organizational changes are important for the company to introduce new and innovative technology in the market. The top management and managers must maintain proper collaboration and communication with employees to reduce and resolve these issues in the global market (Mandip, 2012). Further, Oman Shell monitors and evaluates the benefits of the technology advancement to gain the competitors advantages across the world. The company should invest money to introduce new technology in Shell. It helps to reduce the key obstacles to the human resource management within the organization. It also helps to sustain sustainability in the organization (Schalk, Timmerman and Van den Heuvel, 2013). Apart from technological advancement, the firm needs to monitor and focus on the leadership development to minimize the key challenges of the HRM. Leadership development plays a crucial role to build and develop sustainability in the global market. In addition, various leadership styles are developed and built by the Shell in Oman. In todays era, leadership development is becoming the key success indicator for the firm. Along with this, leadership theories and models must be used by the company to beat the competitors in the market by maintaining sustainability (Singh et al, 2012). Shell should follow the health safety act and other policies to reduce the key issues of the HRM in order fulfill the needs, requirements, and expectations of the customers. Along with this, minimum wages act and factories act must be implemented by the government to maintain sustainability and to reduce the key problems and issues of the HRM within the organization. It helps to increase and maximize the revenue and profit of the firm. The company must use some innovative and unique strategies and policies to meet and attain the business vision and mission of the Shell. These strategies and policies must b made by the government (Marescaux, De Winne, and Sels, 2012). Further, Shell in Oman influences and affects the reward and compensation system of the company across the world. The reward and compensation system should be evaluated by the Shell in order to develop and build a reciprocal and cordial relationship with the target audience in the environment (Dipboye and Colella, 2013). In addition, the company must implement health and safety act and laws within the organization to provide a favorable environment to the workers. Further, Shell also develops and builds some strategies, policies and plans to minimize the challenges and key issues of the company. Further, adequate and proper working environment should be provided to the workers to beat the competitors across the world (Anderson, 2013). The company should not discriminate on the basis of caste, religious, and culture of the employees. It affects the business activities and operations of the country. The company should provide equal rights to the employees. Top management should protect the rights of the workers. In this way, they are able to motivate the employees for doing work and task with more effectively within the organization (Long, Ajagbe, and Kowang, 2014). Shell should maintain diversity to expand and explore the trading activities globally. The employees learn a lot of things, experience, and knowledge through diversity. It also helps to maintain corporate social responsibility and sustainability within the organization. Along with this, the company must resolve the queries and grievances of the employees to provide satisfaction to them. The managers should sit with employees to listen to their problems and issues and resolve them (Chuang, Jackson and Jiang, 2016). Along with this, performance reward system must be used by the company to enhance and increase the productivity of the company. Further, performance appraisal should be provided by the company to provide job satisfaction and job security to the employees. Shell should reduce the employee turnover within the organization because it affects the image of the company. The company should provide a favorable working environment for the workers to make them happy and pleasant. Along with this, the firm must focus on the negative impact of the globalization to carry the business activities globally. It will also help to enhance and increase the capacity and effectiveness of the workers (Srivastava and Agarwal, 2012). Further, the company must develop and enhance new technologies to detect and reduce the reservoirs which are invisible. Effective utilization of resources must be done by the company to secure and protect the natural resources of the firm. The employers must maintain collaborati on and cooperation with subordinates to increase and enhance the employee engagement at the workplace. Along with this, Shell must use various approaches to maintain sustainability in the environment. Sustainability plays a vital and integral role to protect the environment of the country. It helps to increase the goodwill of the company. The company can reduce the risks and key issues of the marketing by maintaining sustainability within the organization (Den Hartog et al, 2013). Conclusion On the above discussion, it has been concluded that Shell is one of the biggest energy and petrochemical companies across the world. Thousands of workers are working in the company to provide energy and technology for a growing population. The company is working on many projects in Oman. Along with this, Shell uses various types sustainable approaches to provide a safe and secure environment to the workers. Further, the company uses core values and competencies to build a good image in the global market. The company is developing innovative technologies to manage the carbon dioxide (CO2) emissions and water consumption. In addition, the company enhances and increases the oil recovery techniques within the organization. The company is also focusing on the key HRM issues to accomplish its long-term goals and objectives within the organization. It is making effective and unique strategies, policies and plans to reduce and address the HRM issues in the organization. The firm is helping t o develop and build local economies by creating jobs, paying taxes and royalties. Shell is supporting the community projects which are based on the needs and requirements of the local communities. The firm sets high standards of ethical behavior and performance in the organization. Further, the company needs to focus on the technology to attain the long-term objectives and goals of the firm. Recommendations Although, Oman shell is making effective position in the global market by maintaining sustainability within the organization but still it needs to implement some policies and plans for the future growth and success. It is recommended that Oman Shell must focus on the technology and energy to minimize and reduce adverse social and environmental impacts. The company should do planning for future development and growth by maintaining sustainability in the organization. Further, the company should maintain an effective code of conducts and business ethics to address the HRM issues within the organization. Safety standards must be implemented by the Shell in Oman to minimize the key issues of human resources. In addition, the company should focus on the marketing campaigns and programs to increase and maximize the profit of the company. It is suggested that firm should focus on the human resource management to implement rules and policies smoothly and effectively. The HRM must focus on th e business activities, rules, and policies of the company while recruiting the candidates within the organization to address the key challenges in the more effective way. They should improve the productivity and quality of the employees by providing and enhancing the motivation to them. In this way, Shell is able to overcome the key issues of HRM. Apart from this, the organization should collect feedback from the managers to evaluate the performance of the workers. They should also appoint a person who can handle and resolve the grievances and complaints of the employees. A committee should be appointed by the company to determine the appraisal and incentives of the workers. Further, the company should focus on the advertisement and promotion strategies to expand and flourish the trading activities and operations of the firm globally. In this way, the company can improve its functions and performance within the organization. It also helps to accomplish the mission, goals and targets of the company. In addition, an effective and sustainable human resource management should be implemented by the company to tackle the issues related to the atmosphere of the company References Abejide, T.S. and Raji, A.O.Y., 2013. An assessment of environmental problems associated with oil pollution and gas flaring in the Niger Delta Region Nigeria, c. 1960s-2000.Oman Chapter of Arabian Journal of Business and Management Review,3(3), pp.48-62. Anderson, V., 2013.Research methods in human resource management: investigating a business issue. Kogan Page Publishers. Appelbaum, S.H., Roy, M. and Gilliland, T., 2011. Globalization of performance appraisals: theory and applications.Management Decision,49(4), pp.570-585. Benera, L., Berik, G. and Floro, M., 2015.Gender, development and globalization: economics as if all people mattered. Routledge. Benn, S., Todd, L.R. and Pendleton, J., 2010. Public relations leadership in corporate social responsibility.Journal of Business Ethics,96(3), pp.403-423. Chuang, C.H., Jackson, S.E. and Jiang, Y., 2016. Can knowledge-intensive teamwork be managed? Examining the roles of HRM systems, leadership, and tacit knowledge.Journal of management,42(2), pp.524-554. Crane, A. and Matten, D., 2016.Business ethics: Managing corporate citizenship and sustainability in the age of globalization. Oxford University Press. De Wit, H., 2011. Globalisation and internationalisation of higher education.rusc,8(2), pp.241-247. Den Hartog, D.N., Boon, C., Verburg, R.M. and Croon, M.A., 2013. HRM, communication, satisfaction, and perceived performance: A cross-level test.Journal of management,39(6), pp.1637-1665. Devi, M.G., Al-Hashmi, Z.S. and Sekhar, G.C., 2012. Treatment of vegetable oil mill effluent using crab shell chitosan as adsorbent.International Journal of Environmental Science and Technology,9(4), pp.713-718. Dipboye, R.L. and Colella, A. eds., 2013.Discrimination at work: The psychological and organizational bases. Psychology Press. Fujita, M. and Thisse, J.F., 2013.Economics of agglomeration: cities, industrial location, and globalization. Cambridge university press. Gregory, K.B., Vidic, R.D. and Dzombak, D.A., 2011. Water management challenges associated with the production of shale gas by hydraulic fracturing.Elements,7(3), pp.181-186. Haynes, B.P., 2011. The impact of generational differences on the workplace.Journal of Corporate Real Estate,13(2), pp.98-108. Hitt, M.A., Ireland, R.D. and Hoskisson, R.E., 2012.Strategic management cases: competitiveness and globalization. Cengage Learning. Kunze, F., Boehm, S.A. and Bruch, H., 2011. Age diversity, age discrimination climate and performance consequencesa cross organizational study.Journal of organizational behavior,32(2), pp.264-290. Li, X., Sanders, K. and Frenkel, S., 2012. How leadermember exchange, work engagement and HRM consistency explain Chinese luxury hotel employees job performance.International Journal of Hospitality Management,31(4), pp.1059-1066. Long, C.S., Ajagbe, M.A. and Kowang, T.O., 2014. Addressing the issues on employees turnover intention in the perspective of HRM practices in SME.Procedia-Social and Behavioral Sciences,129, pp.99-104. Lundgren, R.E. and McMakin, A.H., 2013.Risk communication: A handbook for communicating environmental, safety, and health risks. John Wiley Sons. Mandip, G., 2012. Green HRM: People management commitment to environmental sustainability.Research Journal of Recent Sciences, ISSN,2277, p.2502. Marescaux, E., De Winne, S. and Sels, L., 2012. HR practices and HRM outcomes: The role of basic need satisfaction.Personnel Review,42(1), pp.4-27. Milanovic, B., 2016. Global inequality: A new approach for the age of globalization.Panoecomicus,63(4), pp.493-501. Minnee, F., Shanka, T., Taylor, R. and Handley, B., 2013. Exploring corporate responsibility in Omansocial expectations and practice.Social Responsibility Journal,9(2), pp.326-339. Paik, Y., Chow, I.H.S. and Vance, C.M., 2011. Interaction effects of globalization and institutional forces on international HRM practice: Illuminating the convergence?divergence debate.Thunderbird International Business Review,53(5), pp.647-659. Pepper, A. and Gore, J., 2015. Behavioral agency theory: New foundations for theorizing about executive compensation.Journal of management,41(4), pp.1045-1068. Pieterse, J.N., 2015.Globalization and culture: Global mlange. Rowman Littlefield. Rugman, A., 2012.The end of globalization. Random House. Schalk, R., Timmerman, V. and Van den Heuvel, S., 2013. How strategic considerations influence decision making on e-HRM applications.Human Resource Management Review,23(1), pp.84-92. Schaltegger, S., Ldeke-Freund, F. and Hansen, E.G., 2012. Business cases for sustainability: the role of business model innovation for corporate sustainability.International Journal of Innovation and Sustainable Development,6(2), pp.95-119. Shuen, A., Feiler, P.F. and Teece, D.J., 2014. Dynamic capabilities in the upstream oil and gas sector: Managing next generation competition.Energy Strategy Reviews,3, pp.5-13. Singh, S., Darwish, T.K., Costa, A.C. and Anderson, N., 2012. Measuring HRM and organisational performance: concepts, issues, and framework.Management Decision,50(4), pp.651-667. Srivastava, E. and Agarwal, N., 2012. The emerging challenges in HRM.International journal of scientific technology research,1(6), pp.46-48. Stone, D.L. and Deadrick, D.L., 2015. Challenges and opportunities affecting the future of human resource management.Human Resource Management Review,25(2), pp.139-145. Stromquist, N.P. and Monkman, K. eds., 2014.Globalization and education: Integration and contestation across cultures. RL Education. Taylor, S., 2017.Contemporary issues in human resource management. Kogan Page Publishers.

Virtual Marketing Technique-Free-Samples-Myassignmenthelp.com

Question: Discuss about the Virtual Marketing Technique. Answer: Introduction: Virtual marketing is a new technique that many organizations are applying in order to introduce innovation the marketing strategies of the organizations (Barnes, 2016, p.11). Marketing is the one of the most fundamental duties of the organization. Implementation of appropriate marketing strategies can bring about desired results in the profit margin of an organization. Virtual marketing includes the practice of social networking devices and other technological advancements to achieve the virtual marketing objectives of the organization. Virtual marketing strategies are the result of the implementation of change management strategies inside the organization. Marketing strategies of the organization change according to the changing needs of the market, i.e. customers in the industry (Griffin et al. 2017, p.25). In this assignment, the impact of virtual marketing in the business development of the organization will be discussed an evaluated. Tesco is a leading general merchandise retail er. It has stores in the several countries of Asia and Europe. The organization has adopted virtual marketing strategies for their stores. Objective: Determination of objectives is important to perform any kind of activities. In this part of this assignment, selection of appropriate research objectives is significant to bring about desired outcome from this research assignment (Denham, 2016, p.41). Researcher needs to explore several avenues of business development in order to understand the implication of virtual marketing in the business development process of the organization. To develop un understanding on the changing needs of the customers with the passing of time To perceive the impact of virtual marketing strategies in the future development of the organization To evaluate the impact of virtual marking strategies in the development of overall industry Virtual Stores: The second largest market of Tesco outside United Kingdom lies in Asia, especially in South Korea. Tesco has launched their virtual stores in Seoul (Tescopoly.org. 2017). South Koreans are used to spend longest working hours. They have lesser time than others to go the traditional grocery stores to purchase products of their daily requirements. By identifying their daily needs, Tesco introduced their virtual shop concepts in the market of South Korea. Though the virtual marketing strategies prove their potentialities in the development of the organization, this study will specifically focus of the virtual stores of Tesco in South Korea. Tesco declared the decision regarding their virtual store investment in South Korea in 1999. They tied up with Samsung in order to use their mobile technologies in the virtual marketing strategies of the organization (Tescopoly.org. 2017). They introduced the use of Home plus app to implement the virtual marketing strategies of the organization in South Korea. They connected to the delivery services of the services associated with Home plus app. In 2011, Tesco introduced their first virtual store in Seoul, South Korea. Virtual stores are established in the public places like, bus stands, subways, the places which are frequently visited by the daily consumers in daily basis. Tesco used to maintain popular grocery stores in the several places of United Kingdom and other countries. Customers are accustomed with the quality of their products and services. Virtual marketing strategies of the organization may attract their additional attention towards the products and services of the organization (Wu et al. 2017, p.459). Interested customers need to download a Home plus App in their mobile phones. Customer needs to enter into the Virtual stores of the organization and use their mobile phones to scan the QR codes of the products. In the virtual stores, there are no actual products that are displayed; the posters of the actual products are designed according to the patterns of the product and shelf structure of the Tesco grocery stores. Organizations kept the look of the virtual store same as the looks of the grocery stores of the organization to make it more acceptable to the customers of the organization. The products scanned by the customers are stored in the basket of online server of the organization (Murahari and Joshi, 2016, p.21). After the payment has been made by the customers, Home plus app send a notification regarding the delivery of the products. According to delivery norms of the organization, the products are delivered to the required address within scheduled time. According to the sales performances of the Tesco, the virtual marketing strategies of the organization have been proved to be a huge success. As per the recent research data, almost the instances of 900,000 app downloads has noticed over year in South Korea. The online sales percentage of Tesco has been increased to 130 percent, after the introduction of virtual stores and relevant apps. The number of registered app users increased by 76 percent in South Korea. Organization should keep modifying their virtual marketing strategies to access further success in this regard. Relationship between the Consumers and Virtual Technology: The management of Tesco should realize the needs and requirements of the concerned customers they are serving in order to fulfill the objectives of the regarding their virtual marketing strategies. South Korea is a country having around 50 million of people. They are counted as he 12th largest economy of the world and 4th largest economy of Asia. Organization needs to understand the use of virtual technologies in the virtual marketing strategies of the organization (Verhoef et al. 2017, p.19). In these days, the shopping activities of the customers usually involve the use of technological advancements. Use of virtual technology gives the consumers a sense of physical presence in the stores they are planning to shop from. Customers want to be present in the shop before their desired products in the time of shopping. Though, their hectic schedules in life do not permit them to spend a quality time in their shopping practices. Virtual marketing strategies of the organization provide the m the opportunity to spend a reasonable amount of time to serve the purpose and criteria of their shopping (Kim et al. 2017, p.26). The behavioral concept lies behind the virtual technology is the satisfaction the customers gain being physically present in the time of their shopping. I-It Relations- Instrumental Relations between consumers and Virtual Technology in Shopping Activities: Researcher explores the previous topics on the relation between the consumers and virtual technology in order to relevant understanding on the research objectives of this assignment. In order to understand the mentioned relation, researcher needs to study the related topics, like- Development of Virtual environment in the industry Development of Virtual object in the industry Personalization of Virtual technologies Sensorial Enrichment Spatial Interaction Books and studies regarding the Development of Virtual environment in the industry helps the researcher to understand the concept of 2D and 3D technological advancements in the shopping practices of the customers in the concerned community (Kesharwani et al. 2017, p.46). This study enables the researcher to compare the utility of 2D and 3D technological devices in geometric and materialistic display of the product. In this study, researcher experienced the impact of virtual affordances in the shopping preferences of the consumers. The studies related to the Development of Virtual object in the industry focus on the interaction pattern of the consumers with the virtual objects. The concept of virtual handbag in the virtual marking strategies of the organization involves the use of different virtual objects like, web cam, TV screen, computers etc (Cisternas Vera, 2017, p.21). It helps the organization to develop user friendly strategies for their customers to provide better the shopping experiences. Personalization of Virtual technologies helps the organization to provide recommendation services to their customers. Virtual technological assistance acts as an shopping assistant for the customers. They guide customers by providing them information regarding variety of relevant products as per their choices and preferences. There are some studies which provide relevant information regarding how the relation between the consumers and virtual technologies influences the shopping experiences of the individuals by indulging them in Sensorial Enrichment (Kesharwani et al. 2017, p.46). Researcher found out the importance of auditory experiences in the shopping behavior of the consumers. Spatial Interaction implies the use of special technologies in the shopping experiences of the customers. It indicates the use of different controlling and monitoring system in the virtual marketing strategies of the organization. I- other Relations- Connected with Consumers: I-Other relation studies the influence of relations between different consumers and between the consumer and marketers in the virtual environment of the industry. Virtual technologies are useful in creating telepresence experiences in the virtual marking strategies of the organization (Deighton et al. 2017, p.137). Virtual Communication Technologies are more advanced compare to other communication techniques used by the organization. Other communication techniques used in the communication system of the organization are, text messages, email, telephone etc. Virtual communication system broadens the arena of the marketing activities of the respective organization and shopping experiences of the customers. The extensive use and availability of smart phones and internet enables the consumer to access the advanced virtual communication shopping facilities provided by the organization. Research tries to focus on the following points of this study in order to understand the marketers-consu mer and consumer-consumer relationship in the context of virtual marketing. Dissemination on virtual Communities: Virtual communities can be viewed as typical social groups with common taste in choices and preferences. Virtual communities are formed through the use of virtual media (Eli et al. 2016, p.58). Virtual communities evince collected choices of contemporary groups. Research explores the influence of these virtual communities in the marketing strategies of the organization. Trustfulness on Virtual Communities: Virtual communities share information regarding the availability and effectiveness of the products among themselves. These are helpful to increase product related awareness among the consumers (Deighton et al. 2017, p.137). Trustfulness of the virtual communities involves the issues related with online information and policies of respective organization. Social Structure of Virtual Communities: Social structure of the virtual community displays the social trust and transparency criteria of the respective virtual groups (Eli et al. 2016, p.58). The influence of social model in the virtual communication groups determines the preferences of these groups regarding the purchase of a particular product. Social Presence of Consumers in Virtual Communities: Every consumer belongs to particular society. Every society bears some particular traits of culture. Virtual communities express the cultural preferences of the respective groups in the social networking sites (Deighton et al. 2017, p.137). Researcher gets involve in some affairs of these groups to evaluate the influence of these groups in the virtual marketing strategies of the respective organization. Use of Potential Consumers, Virtual Communities as the Marketing Tools of the organization: Respective organizations use their satisfied customers and these virtual informal communities as effective marketing tools of the organization. These consumers and communities are helpful develop potential market for the products of the business organization (Eli et al. 2016, p.58). Researcher studies the effect of these communities in the virtual marketing strategies of the organization. I-World Relations- Synthesizing the concept of Virtual Shopping with the Real World Shopping: The study of I-World relation evinces the behavioral responses of the consumers regarding their virtual shopping as well as the real world shopping experiences. Researcher mainly focuses on the area where customers express their preferences in virtual shopping over real world shopping and vice versa (Panov, 2017, p.21). Tesco is providing virtual shopping experiences to their customers. They have also real world stores and customers worldwide are experiencing real world shopping through their stores. Tesco now can compare the prospects both selling and marketing strategies in the development of the organization. Consumer Perception regarding the Virtual Products in the respective Shopping Space: Virtual shopping environment helps the customers to perceive virtual imprint of the actual products. Researcher of different times and ages used to study the satisfying ways and processes of product display in the virtual shopping environment. The connection between the technological advancements and consumer preferences determines the effectiveness of virtual shopping in the contemporary industry (Irwin, 2016, p.34). Customers seem more satisfied with the 3D display of the virtual products rather than the 2D features of the online products placed in the company or retail marketing websites. 3D feature of the virtual products satisfies the selection need of the customers. Virtual Environments and Shopping Intentions: Shopping intentions come before actual shopping experiences of an individual. The marketing strategies of the respective organization concentrate on developing shopping intentions among the customers of the organizations (Panov, 2017, p.21). Researcher studies the impact of shopping intentions of the customers in increasing the importance of virtual selling strategies in the industry. Somewhere Between Bricks-and-mortar and Virtual Shopping: There is a relation between bricks and mortar shopping and virtual shopping. There are the instances of several literature concentrating on the concerned relationship. Some researcher explores the multi dimensional effect of virtual environment in the shopping experiences of the customers and the impact of such multi dimensional effects on the real world shopping experiences of the individuals (Irwin, 2016, p.34). Virtual shopping is the new idea of the business organizations and they need the support of real world shopping infrastructure in order to bring about drastic changes in the shopping practices of the industry. Conclusion: In the conclusion of this literature review, it can be said that virtual technology plays a significant part in the virtual marketing strategies of respective organization. Introduction of Virtual shopping stores by Tesco can be counted as the appropriate implementation of the change management strategies to bring about revolutionary changes in the production process of the organization. Researcher tries to meet the objectives of the study by collecting relevant information on the related topics. This study will help the organization to perceive the future development of the organization on the basis of virtual shopping strategies and environment of the organization. This study will also help the future researchers to undertake further research on the related topics. Reference Lists: Barnes, S., 2016. Understanding Virtual Reality in Marketing: Nature.Implications and Potential. Cisternas Vera, F.O., 2017. Essyas on the Impact of New Technologies on Firm-Consumer Relationships. Deighton, J., Goldenberg, J. and Stephen, A.T., 2017. Introduction to Special Issue: The Consumer in a Connected World.Journal of the Association for Consumer Research,2(2), pp.137-139. Denham, G., 2016.System and method of providing a virtual shopping experience. U.S. Patent Application 15/086,991. Eli, K., McLennan, A.K. and Schneider, T., 2016. Configuring relations of care in an online consumer protection organization.Careful Eating: Bodies, Food and Care, p.173. Griffin, T., Giberson, J., Lee, S.H.M., Guttentag, D., Kandaurova, M., Sergueeva, K. and Dimanche, F., 2017. Virtual Reality and Implications for Destination Marketing. Irwin, S.O.N., 2016.Digital Media: HumanTechnology Connection. Rowman Littlefield. Kesharwani, A., Sreeram, A. and Desai, S., 2017. Factors affecting satisfaction and loyalty in online grocery shopping: an integrated model.Journal of Indian Business Research,9(2). Kim, H.Y., Lee, J.Y., Mun, J.M. and Johnson, K.K., 2017. Consumer adoption of smart in-store technology: assessing the predictive value of attitude versus beliefs in the technology acceptance model.International Journal of Fashion Design, Technology and Education,10(1), pp.26-36. Murahari, J. and Joshi, R., Cognizant Technology Solutions India Pvt. Ltd., 2016.System and method for creating interactive personalized virtual stores. U.S. Patent Application 15/009,281. Panov, A.I., 2017. Behavior planning of intelligent agent with sign world model.Biologically Inspired Cognitive Architectures,19, pp.21-31. Tescopoly.org. (2017).South Korea | Tescopoly. [online] Available at: https://www.tescopoly.org/country/south-korea [Accessed 11 Aug. 2017]. Verhoef, P.C., Stephen, A.T., Kannan, P.K., Luo, X., Abhishek, V., Andrews, M., Bart, Y., Datta, H., Fong, N.M., Hoffman, D.L. and Hu, M., 2017. Consumer Connectivity in a Complex, Technology-Enabled, and Mobile-Oriented World with Smart Products. Wu, J., Thoreson, N., Koo, J. and Kim, A., 2017. Co-design Visual Displays in Virtual Stores: An Exploration of Consumer Experience. InManaging Complexity(pp. 459-462). Springer International Publishing.

Nastradamus Essays - Nostradamus, Divination, Pseudoscience

Nastradamus Michel de Nostredame otherwise known as the latinized name Nostradamus. Was born on December 14th, 1503 in St. Remy, France and was educated by his grandfather, Jean. Which he was taught mathematics and astrology. Also was taught three languages which include Latin, Greek, and Hebrew. Nostradamus was the oldest son of his family and had four brothers. Nostradamus was a physician in France during a time that many plagues invaded the country. Not many things were known about Nostradamus' early life except that he was homeschooled by his grandfather. In most of Nostradamus' adult life he was trying to help many French people who were infected by some of the plagues that invaded France at that time. Nostradamus did in fact go to school to get a bachelor's degree for medicine in 1532. Nostradamus is also known for being an astrologer which he did not receive a degree for, although there is no facts that he was a good or famous astrologer of his time, many people do mention that in their w ritings. Nostradamus is most famous for his book Centuries that he wrote in cryptic four line quatrains. Nostradamus does not have many accomplishments, but you could call his most famous prophecies his accomplishments because they were heard around the world. The prophecy that started his fame was one, which he predicted that the king of France would die in an accidental death. Four years later King Henri II was pitted against the count in a jousting tournament. Later on, angry mobs burned Nostradamus because of his psychic abilities. Amazingly enough, he managed to escape the mobs and continued in the completion of his book. One of Nostradamus' predictions that are thought to be the most famous is his prediction of world revolution. In his book Centuries it states, ?In the year 1999 and seven months, from the sky will come the great terror king. He will return the life of the great Mongol king. Before and after warfare happily rules.? The date that he states at the beginning is Au gust 1999. In August 1999 it is said that there will be a cross of the planets in the signs relating to the four beasts of the Apocalypse- Taurus the bull, Scorpio the scorpion, Leo the lion, and Aquarius the man. Astrologers believe that stress of this grouping could generate extreme violence, unrest, and natural catastrophe. A prediction that Nostradamus made in his book that many people now a days are scared of is the end of the world. He supposedly predicted that the end of the world would happen somewhere near the year 2000. Most of the time people do not believe Nostradamus' prophecies until they actually happen. At this point the majority of the world does not believe Nostradamus. Many people know of Nostradamus as just a famous prophet, but he had do have a job to bring in money just like the rest of us. He did put his education in medicine to good work; he treated many plagues that invaded France during the 16th century. He was also noted for being an astrologer to clients who included the Queen of France. He studied the stars and maybe he might have found one of the constellations. He once received a letter from Julius-Cesar Scaliger. Apparently Nostradamus' reply was so pleasing to Julius that he invited him to stay at his home in Agen. There, Nostradamus married a young girl of high estate. Supposedly she was very beautiful and admirable. Her name is not available but they did have a son and daughter. Unfortunately a plague came to Agen and killed his wife and two kids. He did infact, try very desperately to sane the three of them but his efforts did not work. Shortly after that tragedy he quarreled with Julius and lost his friendship. He also did produce a yearly almanac called The Prognostications, which he started sometime after 1550. Unfortunately this famous seer had to die some time; the bright side of this tragedy is he was not assassinated. There is not an exact date or even an estimation on the day Of his death, but he was buried upright in the walls of the

Microsoft Office Essays - Presentation Software, Free Essays

Microsoft Office Essays - Presentation Software, Free Essays There are many ways Microsoft Office, which include-Microsoft Word, PowerPoint, and Excel, can help me in my future career. Not knowing how to use widely-used products could greatly hinder my chances at success. These tools can make many different tasks and projects simple and easy. Think back of how hard it was just two decades ago to do presentations like we do today using PowerPoint. PowerPoint presentations have made it so we can make our point of view appealing to a wide range of people with minimal effort. Excel has made doing all sorts of organizing tasks so much easier, and the wide range of tasks it supports is indeed numerous. Microsoft word has made writing documents and letters in business format so much easier. And more accessible from a click of a button. Microsoft Office is the most widely-used productivity suite in the world and thats not for nothing. It tends to work. Of the millions that own the software however, a scarce few are probably fully aware of what power lay beneath their fingertips. (Boundless, 2014). Try thinking back to two decades ago, if anyone had an idea for a new product or a new way to do business and wanted to present this what would they have done? In order to do a presentation on this, the task would have been an overwhelming one. With only some writing material- pens, pencils, paper, and a typewriter- one would have been required to make a presentation on the various subjects. One of the only means that is like PowerPoint would have been a screen projector, which is rather makeshift compared to the PowerPoint we have today. With PowerPoint I can add facts, pictures, graphics, and sounds that make the presentation look very professional and fun. Microsoft Excel is a program that is found within the Microsoft Office Suite of computer programs that are meant to make life easier for both individuals as well as businesses of all sizes. Excel has a wide range of useful functions like spread sheets for almost everything that requires organization! Making different charts, graphs, budgets, and much more (Ruparel, 2014). Excel allows me to unlock the potential of my data, by using formulas across a grid of cells. I can use pie charts, graphs and clustered columns to add meaning to data, which otherwise may just exist as row after row of numbers. References Ruparel, A. (2014, August 07). 5 Key Uses of Microsoft Excel in the Workplace. Retrieved from learn.filtered.com: http://learn.filtered.com/blog/5-key-uses-of-excel-in-the-work-place Source: Boundless. The Advantages and Disadvantages of PowerPoint. Boundless Communications. Boundless, 14 Nov. 2014. Retrieved 01 Apr. 2015 from https://www.boundless.com/communications/textbooks/boundless-communications-textbook/preparing-and-using-visual-aids-16/using-powerpoint-and-alternatives-successfully-85/the-advantages-and-disadvantages-of-powerpoint-323-5654/

Discussion Essay Example | Topics and Well Written Essays - 250 words - 98

Discussion - Essay Example Second, is caste immobility wherein moving from one caste to another is extremely rare. However, if a person has exceptional skills that are rare in the society, he or she can ascend to a higher caste of professionals (McMahon 1). People in the higher caste hold the political power, and within the caste, people are subdivided further under language, economic, and cultural aspects. Each member within a caste knows his or her place within the caste (N.D). The caste system is a culture practiced in many societies, though; the most known caste system is the Indian system. The Indian caste system is based on the Hindu religious scriptures; though, it is practiced in other religions. Each caste, in India, has its own rules and customs. The social orders are arranged in ranks with the first order being Brahmans that consists of priests and professionals. The second caste comprises the Kshatriyas, who include rulers and warriors. The third comprises the Vaishyas who are associated with traders. The forth is the Shudras, the laborers. A group of other people not included in the four castes exists, the untouchable. The untouchable do menial jobs, such as garbage collection that made the society regard them as the impur e ones (The US History Organization

Materials Engineering Project Research Paper Example | Topics and Well Written Essays - 1250 words

Materials Engineering Project - Research Paper Example This paper has also discussed the different applications of titanium alloys and its limitations in different uses in the modern society. Introduction Titanium alloy is a metal that consists of mixture titanium as the main element and other elements. This is done to achieve high toughness and tensile strength. Generally, alloys have extreme temperature resistance, resistance to corrosion and yet they are light in weight. The process of Titanium Alloying involves the allotropic transformation of pure titanium to the cubic beta phase at very high temperatures of 882.50C (Joshi, 2006). Elements used for alloying normally act as stabilizers at beta or alpha phase. However, by using alloying additions, it is possible to have alpha phase coexisting with beta phase at room temperatures. This is the principle behind manufacture of titanium alloys that can withstand high temperatures during heat strengthening. Titanium alloys are classified into three major groups; beta alloys, alpha alloys an d alpha-beta alloys. Alpha is formed by addition of neutral alloying materials as well as alpha stabilizers such as Sn and Aluminum & Oxygen respectively. Beta alloys on the other hand contain enough beta stabilizers that enable such alloys to retain their beta phase even after quenching. The strength of beta alloys can also be increased through subjecting them to solution treatment and aging. The third category of titanium alloys is beta-alpha alloys that contains both beta and alpha stabilizers thus withstand heat treatments at various degrees. It is important to note that the nature of alloy and stabilizers used greatly influence the heat stability, toughness, tensile strength and other mechanical properties. Production of Titanium Alloys Kroll Extraction Process Titanium alloy is made from Titanium metal and other chemical elements. The main production process for titanium metal is called Kroll process. It involves treatment of the main ore known as rutile with chlorine gas in o rder to get a compound known as Titanium tetrachloride. This compound is then purified and reduced by sodium or magnesium to produce metallic titanium sponge. It is the Titanium sponge that undergoes several alloying process that involve heating and melting to produce Titanium Alloys. In this respect, the purity of titanium resulting from Kroll process is therefore critical for alloying process. According to Leyens & Peters (2003), the purity of titanium Produced depends on the purity of the starting material as well as the parameters and treatments. His is because there are several metallic elements that may cause very undesirable impacts even when they are present in small amounts. Melting Process The second stage in the production of titanium alloys is the melting process. Melting process involves combination of extracted Titanium alloy with alloying elements depending on the type of alloy to be produced. There are about five melting processes: induction Skull melting, vacuum arc remelting, plasma arc melting, Electroslag refines and Plasma Arc melting Process (Joshi, 2006). Melting process begins by blending together alloying elements with sponge followed by hydraulic pressing necessary to produce excellent blocks known as briquette. Apart from sponge, other titanium from scroll process such as scrap or Revert can also be used depending on the quality of the final Titanium Alloy

Nurse-to-Patient Ratio Research Proposal Example | Topics and Well Written Essays - 2000 words

Nurse-to-Patient Ratio - Research Proposal Example However, this factor is never considered when nurses are assigned to care for a selected number of patients. Quoting Barbara Blakeney, President, American Nurses Association (ANA), the American Association of Critical Care Nurses (AACN) endorses the fact that inadequate nurse staffing is the primary concern for the nurses and that â€Å"when RN care is insufficient, patient safety is compromised and the risk of death is increased† (Nurse-to-Patient Ratios, 2007). Shortage of nurses places extra onus on the available staff and hence seasoned nurses are matriculating away from bedside nursing. This happens primarily because the added tasks needed to be performed are not directly related to patient care. This can be evidenced in the case of Cameroon Diva, a BSN, who states that she wants to quit bedside nursing because in the hospital where she has worked, they had â€Å"extreme staff shortage and not enough nursing assistance on the floor† (Diva, 1996). Besides, the frequ ent changes in computerized charting require nurses to remain near their computers and take their time away from the primary task of patient care. It is a matter of common knowledge that higher patient-to-nurse ratios cause significant physical and mental exhaustion and result in greater job dissatisfaction among nurses. Patient well-being directly correlates to the amount of nursing care a patient receives daily. Therefore, in order to achieve the objective of providing quality patient care, administrators and managers need to ensure that healthcare institutions attain an appropriate level of patient-nurse ratio. Problem Statement: Current policy on Medical-Surgical nursing units across America’s hospitals require that Registered Nurses care for five to six (average of â€Å"5.25†) acutely and chronically ill patients in a 12 hour shift (Welton, 2007). Licensed practical nurses also care for 6 to 7 patients during a 12 hour shift. Nurses feel that added tasks take awa y a considerable portion of their time, which otherwise can be spent on patient care. The diversification in the roles of nurses today, through deployment on other tasks, calls for a closer examination of the need to change the policy pertaining to nurse–to-patient ratios. In this context, the findings of Aiken et al can be perceived as the â€Å"primary arguments for setting specific nurse-to-patient staffing ratios† (Welton, 2007). There is a definitive discrepancy between what healthcare administrators believe to be adequate the level of nurse-patient ratio and actual number of patients a nurse is required to care for. This creates impediments in administering proper care to the needy patients, which, in turn, impacts patient mortality rates. Besides, the shortage in staffing also adversely affects the job satisfaction of nurses and, as a consequence, their rate of burnout increases. Purpose of the Study: The purpose of this study is to determine whether there exist s a correlation between nurse-to-patient ratios and patient mortality. The number of patients cared for by a single nurse may have better outcomes in terms of length of hospital stay and fewer complications. Additionally, nurses who derive satisfaction from their jobs are less likely to leave their jobs. The study will also investigate the increasing trend of nurse burnout and find

Case Summary Hypertension In Pregnancy Health And Social Care Essay

Case Summary Hypertension In Pregnancy Health And Social Care Essay Mdm. SM is a 30-year-old Malay female of gravida 5 parity 3+1 who is at 37 weeks and 5 days of gestation. She was diagnosed to have hypertension in pregnancy during antenatal routine follow-up in Klinik Kesihatan Simpang Renggam at 36 weeks and preeclampsia (blood pressure 160/100mmHg, urine dipstick albumin 1+) 3 days before admission. She was admitted to Hospital Kluang and started on Tab. Methyldopa 250mg TDS. She was advised for induction of labour in view of preeclampsia at term and she requested to be transferred to Hospital Batu Pahat (HBP). She did not have any signs and symptoms suggestive of severe preeclampsia or labour. During admission to HBP, tablet prostin 1.5mg was inserted into the posterior fornix twice to induce labour but there was no change in cervical os and symptoms of labour. Decision was made to try artifical rupture of membranes. However, following the procedure, internal monitoring detected fetal distress and as spontaneous delivery was not imminent, Mdm. S M was agreeable for emergency lower section caesarean section under general anaesthesia. A healthy infant boy was delivered (weight 2.9kg, Apgar score 91105) and there were no intra or post-operative complications. Following the surgery, both mother and infant were well in the ward. Mdm. SM was ambulating and tolerating orally and by the 2nd post-op day, both had passed urine and motion. Wound inspection on day 2 showed clean, non-gaping wound. As she was well, decision was made to discharge her and she was given appointment to review her blood pressure and operative wound at the postnatal clinic at KKSR. On discharge, her blood pressure was 140/70mmHg (without medication) and urine dipstick albumin was trace. Analgesia given on discharge were mefenemic acid and paracetamol. STUDENT NAME: Paul Kong Fu-Xiang ID NO: M0508129 NAME OF SUPERVISOR: Dr. Sharifah Sulaiha ROTATION: Obstetrics Gynaecology PATIENTS DETAILS I/C NUMBER: 800318015794 AGE: 30 SEX: Female DATE OF ADMISSION: 20/6/2010 R/N: 1358593 2) CLINICAL HISTORY Chief Complaint Elevated blood pressure detected in pregnancy at 36 weeks of gestation. History of Present Illness Mdm. SM is a 30-year-old Malay female of gravida 5 parity 3+1 who is currently at 37 weeks and 5 days of gestation. She was referred to Hospital Kluang from Klinik Kesihatan Simpang Renggam (KKSR) for elevated blood pressure detected on routine antenatal follow-up and subsequently transferred to Hospital Batu Pahat (HBP) for induction of labour in view of her development of high blood pressure in pregnancy. Her elevated blood pressure was first detected during her routine antenatal follow-up at Klinik Kesihatan Simpang Renggam 10 days before admission to HBP. During this visit, her blood pressure was recorded as 150/90mmHg and she also complained of slight bilateral swelling of her feet but otherwise had no other complaints. The feet swelling resolved after 3 days. Throughout the next 7 days, she went to KKSR every alternate day for monitoring and 3 days before admission to HBP, her blood pressure was noted to be 160/100mmHg with presence of albumin 1+ on urine dipstick that was prev iously not present. She was immediately given tablet labetolol 100mg and admitted to Hospital Kluang where she was subsequently started on tablet methyldopa 250mg 8-hourly. Three days after admission to Hospital Kluang, she was advised by the doctor to undergo induction of labour and she thus requested to be transferred to HBP so her family members in Batu Pahat could take care of her. During the course of these events, she did not experience shortness of breath, headache, blurring of vision, epigastric pain, seizures, abdominal pain, vaginal bleeding, nausea, vomiting, palpitations, or recurrence of the foot swelling. At time of admission, she did not experience contraction pain, show, leaking of liquor. Fetal movements were good. Systemic Review Mdm. SM did not have fever. Her appetite was good and her urinary and bowel habits were normal. Her sleep was unaffected. Antenatal History This was an unplanned but wanted pregnancy. Mdm. SM realized she was pregnant when she missed her period, of which the last was 28/12/09. She bought a pregnancy test kit and it tested positive. She subsequently did her booking at KKSR at 7 weeks of period of amenorrhoea. At booking, her blood pressure was 120/80mmHg, hemoglobin 13.4g/dL, sugar undetected, and urine albumin negative. Infective screening was negative and blood type O positive. Her expected due date was given as 14/8/10. During follow-up 1 month later, she had her first ultrasound scan which found her uterus to be larger than dates. Her due date was revised to 6/7/10. Modified glucose tolerance test done twice during pregnancy were negative. She experienced morning sickness and vomiting during the first 3 months of pregnancy but it was not severe and she could cope without medication. Throughout the pregnancy, she was diagnosed to have urinary tract infection twice and was treated with antibiotics. A further 3 ultrasoun d scans were done and all were normal. She was also compliant to the supplements given throughout pregnancy. There were no other problems during the antenatal follow-up until the detection of elevated blood pressure 10 days before admission to HBP. Past Obstetric History This is her fifth pregnancy and her last childbirth was in 2008. She has 3 children, 2 boys and a girl, of whom all were born via vaginal delivery at postdate after induction of labour. Birth weights ranged from 2.7 to 3.0kg, all are healthy with no complications and were breastfed. However, during her 3rd pregnancy, she suffered a miscarriage during the 12th week and dilatation and curettage was performed during that admission. Gynae Menstrual History Mdm. SM achieved menarche at the age of 12. Her menstrual cycles have always been regular with 28 days per cycle and 5 to 7 days of flow. She does not experience menorrhagia or dysmenorrhoea. She has never had a cervical smear done and has never used oral contraceptive pills. She has not required medical attention for any gynaecological problem. Past Medical History Mdm. SM has never been diagnosed with any chronic disease such as diabetes, hypertension, and asthma before. She has also never been admitted for non-pregnancy related reasons. She also does not have any known food or drug allergies. Family History Mdm. SM is the eldest of three siblings. Her youngest sister also had gestational hypertension. Her father has hypertension and her mother had diabetes, but passed away 2 years ago due to tuberculosis. All family members have been screened and all tested negative for tuberculosis. Social History Mdm. SM is now a housewife. She formerly worked in a factory but decided against returning to work following her last pregnancy in 2008 for her childrens benefit. She is a non-smoker and does not consume alcohol. Her husband is a short-haul lorry driver and smokes, but only outside their home. They live slightly off Kluang, and it takes them slightly over an hour to reach HBP, and 15 minutes to reach KKSR. STUDENT NAME: Paul Kong Fu-Xiang ID NO: M0508129 NAME OF SUPERVISOR: Dr. Sharifah Sulaiha ROTATION: Obstetrics Gynaecology 3) FINDINGS ON CLINICAL EXAMINATION (Mdm. SM was examined by me on the 2nd day of admission) Mdm. SM was alert, conscious and cooperative. She was not in any pain or distress. She was sitting comfortably on her bed. On examination, there was no pallor, jaundice or pedal edema. Her reflexes were not brisk. Her clinical parameters are: Blood Pressure : 124/80 mmHg Heart Rate : 95 beats per minute. Regular rhythm Respiratory Rate : 20 breaths per minute Temperature : 37 °C Examination of the cardiovascular system, respiratory system, fundus, thyroid and breasts were normal. On examination of the abdomen, it was distended with gravid uterus as evidenced by linea nigra, and striae albicans. There was no striae gravidarum, scars, or pulsations noted. On palpations, the abdomen was soft and non-tender, uterus non-irritable, and fetal parts felt. The symphysio-fundal height was 36cm, which corresponds to dates. On examination, this is a singleton fetus at longitudinal lie with cephalic presentation, with the fetal back on the maternal left. The fetal head was four fifths palpable. Estimated fetal weight is 2.8 to 3.0kg. Liquor is adequate. Fetal heart was heard and the rate was 142 beats per minute. Vaginal examination (by medical officer on admission) revealed no perineal, vulval or vaginal abnormalities. Cervical os was 1 cm with cervix tubular, soft and axial, station high and membrane intact. Bishops score was 3/10. STUDENT NAME: Paul Kong Fu-Xiang ID NO: M0508129 NAME OF SUPERVISOR: Dr. Sharifah Sulaiha ROTATION: Obstetrics Gynaecology 4) PROVISIONAL AND DIFFERENTIAL DIAGNOSES WITH REASONING Provisional Diagnosis Preeclampsia in pregnancy Mdm. SM developed new onset elevated blood pressure of 160/100mmHg at 36 weeks of gestation and urine dipstick albumin of 1+ (300mg/L). This fits the minimum requirement of preeclampsia among the hypertensive diseases in pregnancy. However, Mdm. SM did not experience any symptoms to suggest a severe preeclampsia or impending eclampsia such as headache, visual disturbances, epigastric pain, vomiting, liver tenderness. The urine dipstick for albumin is not the best way to detect proteinuria required for the diagnosis of preeclampsia 3 and is usually only used for screening, but as the blood pressure and urine albumin were persistently elevated, it is better to err on the side of caution and treat Mdm. SM as such since patients with relatively mild preeclampsia can rapidly progress into severe disease 1. Following the repeated positive detection of urine albumin of only 1+, more definitive tests should be performed to better quantify her proteinuria 2,3. Differential Diagnosis Pregnancy-induced hypertension, late onset As Mdm. SM has been compliant to her antenatal follow-ups and did not have elevated blood pressure detected at any time before 36 weeks of gestation, it is likely that she has developed the onset of a hypertensive disease in pregnancy and it appears to be of late onset as it developed only after 32 weeks gestation. However, as subsequent visits showed urine dipstick albumin of 1+, indicating the onset of proteinuria (although poor predictive value and not as significant as 2+) 3, it might prove wiser to be more vigilant and assume that Mdm. SM does indeed have preeclampsia as it would be foolish to dismiss these warning features despite the fact that she does not demonstrate any suggestive symptoms because it is possible that even patients with no prodromal signs may suddenly progress into eclampsia 1,3. Essential hypertension in pregnancy with superimposed preeclampsia Another possibility that we may entertain is that Mdm. SM has had previously undiagnosed essential hypertension with currently superimposed preeclampsia. However, this seems rather unlikely. Firstly, Mdm. SM is young at the age of 30 and unlikely to suffer from essential hypertension as this disease common presents after the age of 40. Secondly, at no time throughout antenatal follow-up did she have elevated blood pressure recorded before that particular visit at 36 weeks of gestation. However, following delivery of her infant, she should have her blood pressure rechecked during postnatal follow-up care at 6 to 12 weeks post-delivery. If her blood pressure if still elevated at that time, then it will be more likely that she has essential hypertension. STUDENT NAME: Paul Kong Fu-Xiang ID NO: M0508129 NAME OF SUPERVISOR: Dr. Sharifah Sulaiha ROTATION: Obstetrics Gynaecology 5) IDENTIFY AND PRIORITISE THE PROBLEMS 1. Elevated blood pressure and its implications in pregnancy Mdm. SM has newly discovered elevated blood pressure at 36 weeks of gestation. This is considered late onset but is not uncommon, and gives rise to a spectrum of hypertensive disorders in pregnancy. While it seems that at first she has gestational hypertension, the mildest of the disease spectrum, she demonstrated proteinuria on her subsequent antenatal visit, therefore concluding that she has preeclampsia. Hypertensive disorders in pregnancy have the potential to put both mother and infant at increased risk of mortality. Its complications are elaborated below. During admission, Mdm. SM should be monitored for any change in her condition as she may quickly progress into severe disease states and this would require urgent intervention, the most definitive being the delivery of the infant. Ward management includes close observation of both mother and infant, and medication to control the elevated blood pressure. 2. Induction of labour in view of preeclampsia at term Termination of the pregnancy is the only definitive sure for preeclampsia. On presentation, Mdm. SM has features categorized as mild preeclampsia. Normally, severe preeclampsia would dictate the need for antihypertensive and anticonvulsive therapy followed by subsequent delivery and symptoms such as headache, epigastric pain, and visual disturbances may indicate this. The fetal age is usually an important deciding factor when it comes to inducing labour as the treatment goals seek the best outcome for both mother and infant. As Mdm. SM is already at term and there have been no issues previously detected regarding the health of her fetus, it should be safe to proceed with induction of labour. There is also no reason to prolong the pregnancy as the risk of eclampsia increases. If for any reason an obstetric reason arises e.g. fetal distress, delivery should proceed via caesaren section. 3. Impending eclampsia and other potential complications Warning signs and symptoms of impending eclampsia or severe preeclampsia include headache, visual disturbances, epigastric pain, reduced urine output, edema and ultimately, convulsions. These symptoms should be recognized early so the necessary intervention can take place. Seizures increase the risk of maternal and perinatal morbidity and mortality rates. Some maternal complications are placenta abruption, neurological deficits, aspiration pneumonia, pulmonary edema, cardiopulmonary arrest, and acute renal failure. Other major complications that may occur as a result of severe preeclampsia are HELLP syndrome, pulmonary embolism and stroke. Fetal complications include growth restriction, fetal distress, and death. 4. Risk of post-partum eclampsia It is possible for eclampsia to occur in the postpartum period especially when the patient has reached term. In such cases, up to 44% of eclampsia occurs postpartum 3. As the risk is quite high, Mdm. SM should continue to be monitored in the ward for the development of any signs and symptoms. As she is comfortable and relatively symptom free while in the ward, it appears unlikely that she may worsen into an eclamptic state but the risk should not be afforded. As there are no guidelines to suggest an optimum postpartum inward observation period, it would depend on her clinical situation during the subsequent days following her delivery. 5. Hypertension in pregnancy and its long term implications As Mdm. SM has developed preeclampsia during this pregnancy, she is at increased risk to develop hypertensive or metabolic complications in future pregnancies. The risk of recurrence is generally higher in earlier onset preeclampsia. At the same time, she should be evaluated in the postpartum period for the possibility of essential hypertension at the 6 week postnatal review. Also, women with preeclampsia are at an increased risk for developing hypertension, diabetes, hyperlipidemia, chronic renal disease, stroke and ischemic heart disease. Mdm. SM should be made aware of all these implications and should be educated on how she can prevent these via the modification of her lifestyle. She should also be advised to attend preconceptual counseling in the event of a future pregnancy and to come early for booking. STUDENT NAME: Paul Kong Fu-Xiang ID NO: M0508129 NAME OF SUPERVISOR: Dr. Sharifah Sulaiha ROTATION: Obstetrics Gynaecology 6) PLAN OF INVESTIGATION, JUSTIFICATIONS FOR THE SELECTION OF TESTS OR PROCEDURES, AND INTERPRETATION OF RESULTS 1. Urine Dipstick for Albumin To look for the presence of albumin in the urine firstly, to confirm proteinuria, and secondly, to evaluate the severity of the preeclampsia. Urine dipstick for albumin should be repeated daily in the ward. Also, if in doubt, further investigation to quantify proteinuria can be done e.g. urine protein/creatinine spot test 2,3. Results: Urine dipstick albumin on admission was trace. Results at KKSR showed 1+. Interpretation: This result could be due to the fact that the blood pressure has lowered as Mdm. SM has been started on methyldopa and her blood pressure is under control. This does not mean that she no longer has preeclampsia. She should be checked daily for any changes in both blood pressure and proteinuria. 2. Full Blood Count To look for anemia which may require correction, haemoconcentration which may indicate severe preeclampsia 1, and platelet levels as HELLP syndrome is a complication that may arise in preeclampsia. This may also serve as baseline in case operative procedures are required. Result: TWBC 12.0 x109/L à ¢Ã¢â‚¬  Ã¢â‚¬Ëœ (neutrophils 8.20, lymphocytes 2.70) Hemoglobin 10.7 g/dL à ¢Ã¢â‚¬  Ã¢â‚¬Å" Hematocrit 32.3% à ¢Ã¢â‚¬  Ã¢â‚¬Å" Platelets 354 x 109/L Interpretation: The total white cell count is slightly raised, but this is to be expected in pregnancy. The hemoglobin is slightly low but this is also expected in pregnancy and should be monitored especially if the patient requires surgery or experiences anemic symptoms. There is no haemoconcentration and the platelets are normal. 3. Prothrombin Time, INR, Activated Partial Thromboplastin Time (PT/INR/APTT) To obtain a baseline of the coagulation profile in case operative procedures are required and also to look for potential coagulopathy as it is a possible complication of preeclampsia. Result: PT 12.3s INR 1.05 APTT 39.6s Interpretation: PT/INR/APTT is within normal range. Coagulopathy appears unlikely in Mdm. SM given that her platelets are also normal and her preeclampsia is not severe. 4. Renal Profile To assess renal functions to look for elevation of creatinine as that would indicate severe preeclampsia and also to detect acute renal failure which is associated with increased risk of HELLP syndrome, placenta abruption and postpartum hemorrhage 1. Result: Urea 1.3mmol/L Sodium 140mmol/L Potassium 3.7mmol/L Creatinine 51 µmol/L Interpretation: Mdm. SM renal profile is normal and creatinine is not elevated, adding to the indicators that her preeclampsia is of the mild category. Low urea levels and good urine output also rules out acute renal failure. 5. Liver Functions Test To assess liver functions and its components such as liver enzymes and bilirubin which would be raised in severe preeclampsia or HELLP syndrome in which there is hemolytic anemia and elevated liver enzymes. Result: Total protein 73g/L Albumin 33g/L Globulin 40g/L Total bilirubin 0.5mg/ml Direct bilirubin 0.2mg/ml Indirect bilirubin 0.3mg/ml ALP 121U/L à ¢Ã¢â‚¬  Ã¢â‚¬Ëœ ALT 7 U/L GGT 7 U/L Interpretation: Liver enzymes (ALT) and bilirubin levels are not elevated, indicating a mild preeclampsia and no biochemical evidence of HELLP syndrome. The ALP is slightly elevated, but this could be due to compression of the gravid uterus on the hepatobiliary tree. 6. Serum Uric Acid Elevated serum uric acid is an early biochemical sign of preeclampsia 1 and may help to predict maternal complications in preeclampsia 4. Results: Serum uric acid 103 µmol/L à ¢Ã¢â‚¬  Ã¢â‚¬Å" Interpretation: Serum uric acid levels are not elevated and are in fact, slightly lowered. This result indicates low likelihood of severe preeclampsia or maternal complications. 7. Serum Lactate Dehydrogenase To check for elevated levels which should indicate hemolytic anemia, a component of HELLP syndrome. Results: Not done during this admission. 8. Cardiotocograph (CTG) Done on admission as a baseline for fetal monitoring. Results: Baseline fetal heart rate was 130 beats per minute, baseline variability was 5 10, accelerations present with no decelerations. Interpretation: CTG is reactive with no signs of any fetal compromise. CTG should be repeated following each procedure e.g. prostin insertion, AROM or if fetal compromise is suspected. 9. Transabdominal Ultrasonography This should be done to confirm fetal age, as confirmation of fetal age is important when it comes to deciding whether or not to induce labour in preeclampsia. Also to check for fetal well-being and growth restriction, but these requires repeated scans and plotting of growth chart over a period of time. Result: No ultrasonography was done during this admission. The last scan was done in Hospital Kluang before patient was transferred to HBP. The last scan reports fetal age corresponding to dates, AFI of 9, and no abnormalities detected with no mention of other findings. Interpretaion: As fetal age is corresponding to dates and there is no suggestion of fetal compromise or restriction, it is safe to proceed with induction of labour. 10. Urinalysis (UFEME) To check the levels of proteinuria which may be more quantitative than urine dipstick. Results: Leukocytes, nitrite, protein, glucose, ketone, urobilinogen, and bilirubin were not detected. Interpretation: No proteinuria was detected. This could mean that the patient does not have preeclampsia but rather gestational hypertension, or it could be undetected as the blood pressure has also become well controlled with medication. However, no risks should be taken and Mdm. SM should be closely observed in the ward. Either way, induction of labour and delivery would still be ideal for her as she has already reached term. STUDENT NAME: Paul Kong Fu-Xiang ID NO: M0508129 NAME OF SUPERVISOR: Dr. Sharifah Sulaiha ROTATION: Obstetrics Gynaecology 7) WORKING DIAGNOSIS AND PLAN OF MANAGEMENT ON ADMISSION Working Diagnosis Induction of labour at term in view of mild preeclampsia in pregnancy Comment: As Mdm. SM has elevated blood pressure and urine dipstick albumin 1+ but has no physical or biochemical features suggestive of severe preeclampsia, the working diagnosis is mild preeclampsia. However, she should be monitored closely in the ward for any symptoms indicative of disease progression. As she has reach term, it would also be wise to induce labour in her, especially given her history of postdates as delivery would be the only definitive management in such cases. Plan of management on admission Continue T. Methyldopa 250mg 8-hourly Daily urine albumin dipstick Vital signs monitoring 4-hourly Baseline cardiotocograph on admission Fetal kick charting and Labour progress charting To notify immediately if spontaneous rupture of membranes To notify immediately if strong contractions commence Encourage orally For induction of labour with T. Prostin 1.5mg as Bishops score unfavourable To notify immediately if any symptoms occur STUDENT NAME: Paul Kong Fu-Xiang ID NO: M0508129 NAME OF SUPERVISOR: Dr. Sharifah Sulaiha ROTATION: Obstetrics Gynaecology 8) SUMMARY OF INPATIENT PROGRESS (INCLUDING MAJOR EVENTS, CHANGE OF DIAGNOSIS OR MANAGEMENT AND OUTCOMES) Throughout the first two days of admission, Mdm. SM was comfortable in the ward with no development of any symptoms of severe preeclampsia, eclampsia, or labour. Her vital signs were stable with blood pressure ranging 122-138/70-84. On the morning of the 2nd day, tablet prostin 1.5mg was inserted into her posterior fornix under aseptic technique. Cardiotocograph was reactive and vaginal examination 6 hours post-insertion showed cervical os 3cm, cervix 2cm, soft and axial, and high station. Therefore, a 2nd tablet of prostin was inserted on the morning of the 3rd day. Once again, post-insertion cardiotocograph was reactive and vaginal examination 6 hours later showed no changes to before. Mdm. SM still did not experience any signs and symptoms of labour. She also did not have any symptoms indicating progression of her preeclampsia. On the morning of the 4th day, it was decided that Mdm. SM should undergo artifical rupture of membranes (AROM) rather than have a 3rd prostin tablet inser ted. Cardiotocograph monitoring had been difficult so decision was made to insert fetal scalp electrode at the same time for internal monitoring. Following the AROM, internal monitoring revealed a drop of fetal heart rate from 130 to 100 beats per minute with no accelerations. Cervical os was still 3cm with no symptoms of labour. Decision was made to proceed with emergency lower section caesarean section (ELSCS) under general anaesthesia and Mdm. SM gave her consent. Via ELSCS, a healthy baby boy was delivered weighing 2.9kg with Apgar score of 91105. There were no intra or post-operative complications. Post-operative medications given include IV ampicillin 500mg QID, subcutaneous heparin 5000 units BD, IV pitocin 40 units QID, IM pethidine 50mg PRN, Tab. paracetamol 1g QID and Tab. Mefenemic acid 500mg TDS. Throughout the next 2 days, Mdm. SM was comfortable in the ward and had mild operative site pain with no other symptoms and vital signs were stable. All medications except analg esia were stopped. She was ambulating well, tolerating orally and had passed urine and motion by the 5th day. As for the baby, breastfeeding had commenced and he had also passed urine and motion. The uterus was well contracted at 22 weeks size and dressing was not soaked. Inspection of the wound on the 6th day revealed a clean and non-gaping wound. She was counseled on contraception and indicated a preference for intrauterine contraceptive device. As she was well, she was discharged with appointment to return to postnatal clinic at KKSR to review her blood pressure and operative wound in 1 weeks time. On discharge, her blood pressure was 140/70mmHg and urine dipstick albumin was trace. STUDENT NAME: Paul Kong Fu-Xiang ID NO: M0508129 NAME OF SUPERVISOR: Dr. Sharifah Sulaiha ROTATION: Obstetrics Gynaecology 9) DISCHARGE PLAN, COUNSELLING AND MOCK PRESCRIPTION Discharge Plan Tab. Mefenemic acid 500mg TDS PRN Tab. Paracetamol 1g QID PRN Follow-up appointment at Klinik Kesihatan Simpang Renggam (KKSR) Postnatal clinic in 1 week to review blood pressure and operative wound. Follow-up appointment at KKSR in 6 weeks for review, cervical smear, and contraception. Counseling Advised to return immediately to the hospital if Mdm. SM has problems with the caesarean wound e.g. pain, discharge or if she develops any new or worrying symptoms. Advised on the need to be compliant to postnatal follow-up to review Mdm. SMs condition. Advised for cervical smear during postnatal follow-up as previously never done. Counseling regarding breastfeeding and contraception. Explain about the nature of pregnancy-related hypertensive disorders and its long term implications. Advised to attend antenatal clinic for preconceptual counseling if future pregnancy is desired, or to come for booking immediately once discovered to be pregnant. Advised to observe a healthy lifestyle in order to prevent development of conditions such as hypertension and diabetes. Mock Prescription Tab. Paracetamol 1g QID PRN x 1/52 Tab. Mefenemic acid 500mg TDS x 1/52 STUDENT NAME: Paul Kong Fu-Xiang ID NO: M0508129 NAME OF SUPERVISOR: Dr. Sharifah Sulaiha ROTATION: Obstetrics Gynaecology 10) REFERRAL LETTER (IF APPLICABLE) Medical Officer, Postnatal Clinic, Klinik Kesihatan Simpang Renggam, 86200, Simpang Renggam. 20th June 2010 Mdm. SM (IC.800318015794) Date of admission: 20th June 2010, Date of discharge: 25th June 2010 Problem: Late onset hypertensive disease in pregnancy Dear medical officer, Mdm. SM is a 30-year-old Malay lady of parity 4+1 who was diagnosed to have preeclampsia at 36 weeks of gestation during routine antenatal follow-up at your centre. During admission to our ward, she underwent induction of labour with tablet prostin and artificial rupture of membranes. However, fetal distress developed, picked up on internal monitoring and Mdm. SM underwent emergency lower section caesarean section under general anaesthesia. She delivered a healthy baby boy (2.9kg, Apgar 91105) with no complications intra- and post-operatively. We are discharging her into your care. Please review her blood pressure as scheduled and also offer contraception and cervical smear as previously never done. She has indicated preference for intrauterine contraceptive device. Do not hesitate to contact us immediately should the need arise. Thank you very much for your attention. Yours sincerely, Paul Kong Fu-Xiang (Final year medical student, IMU), Department of Obstetrics Gynaecology, Hospital Batu Pahat. STUDENT NAME: Paul Kong Fu-Xiang ID NO: M0508129 NAME OF SUPERVISOR: Dr. Sharifah Sulaiha ROTATION: Obstetrics Gynaecology 11) LEARNING ISSUES IN THE 8 IMU OUTCOMES 1. Disease prevention and health promotion Hypertensive disorders in pregnancy are one of the most common antenatal problems and eclampsia is a major source of maternal mortality. What are the ways in which some element of prevention can be instituted or to decrease the severity of preeclampsia? There haven been certain strategies touted to prevent or modify the severity of preeclampsia. These are categorized as dietary supplements, antihypertensive medications, antioxidants, and antithrombotic agents 5. As low salt diet is one of the recommended dietary changes for hypertensive patients, De Snoo et al 1 was one of the earliest researchers to study the effects of low salt diet in preventing preeclampsia but this practice was discarded as it yielded no significant change. Knuist et al performed a randomized controlled trial in 1998 and they reported that despite helping control blood pressure in non-pregnant individuals, a sodium-restricted diet was ineffective in 361 women in terms of prevention of preeclampsia 6. The dietary supplementation of calcium of at least 1 gram per day is recommended as class I-A evidence 2. Several studies showed that women with low calcium diets were at significantly increased risk of gestational hypertension 7,8,9. Levine et al performed a large , randomized-controlled trial and they found that there was no significant difference in outcome with calcium supplements versus placebos 10. This suggests that unless a pregnant woman has a low calcium intake, calcium supplements may have no added benefit 5. With regards to fish oil supplements and its cardioprotective fatty a