Organizing Work Essay Example for Free

Organizing Work Essay McDonalds Corporation It has become clear to upper management that the way McDonald’s has been operating over the past decade is not helping in moving the company forward. Upper management feels that the company is falling behind, and changes must be made immediately. The changes need to start with how the organization is structured. Once proper changes in structure are made, it is believed that McDonald’s will then be able to implement plans that will lead McDonalds into a successful future. The purpose of this paper is to make recommendations as to what changes in organizational structure would help McDonalds become more sufficient. Along with changes in structure the paper will also determine what work needs to be done, how it is to be done, and the approach that should be used to bring success back into the organization. Recommendations There have recently been talks between upper management about making necessary structural changes to the McDonald’s organization here in the U.S. The first recommended change is eliminating levels of management. Numbers of the past have shown that the old traditional way of communication and barriers of so many levels of management had become a barrier to decision making (Jennings, Maze, 2014). The team agrees with this change and believes that the change should be implemented as soon as possible. The basis for this change is that it will help in bring the company closer to the customers. With so many layers of management it seems as if there is more time being spent arguing and talking to each other, rather than talking to the customer and making decisions. McDonald’s marketing has shown that they need to adapt to the current customer’s needs of what they want. McDonald’s  president has worked for McDonalds for the last ten years, and he has seen numbers drop drastically which means, it is time for change (Jennings, Maze, 2014). Essentially it is safe to say that McDonalds is losing its relationship with its customers. Another huge change that McDonalds has been thinking about is changing the number of divisions here in North America from three to four. It is believed that grouping the regions into four divisions, as well as eliminating some levels of management will allow for regional leaders to have more autonomy, and will allow leaders to set a menu based on the restaurants geographic location. According to the McDonald’s website, Jennings, Maze, (2014), â€Å"The changes are highlighted by the elimination of layers of management, giving leaders of its 22 U.S. regions more autonomy in setting the menus and making marketing decisions.† These changes will also allow McDonald’s leaders to restructure the menu to be more diverse to any one’s eating habit. They will be allowed to market more things on the menu than just burgers and fries. Change is good, and they are excited to embrace it. How to do Work Effectively Every organization has its’ own structure to follow. McDonald’s current structure is failing when it comes to the customers’ wants. This is why upper management has been talking about restructuring the design by dividing McDonald USA into four divisions. These divisions would include, Northeast, South, Central and West (Jargon, 2014). Each region would have a president in charge. Under each president there should be different types of managers who know the culture of each region. This will allow for the company to deliver the right product to the customers. They also need to remove some of the managerial levels because having too many managers’ results in decisions not being made. Eventually leading to a lack of growth in the business. McDonald needs to adapt according to the changes that are taking place in the world such as; the economy, competitors and technology. They need to have basic meals that fit all regions; in addition to that, they need to create new products to fit with the culture of each region. Sweet tea is a good example of a product that fits in with the culture in the south. Therefore it would be good for McDonalds restaurants in the south to  promote sweet tea. However, sweet tea is not very popular in the Northeast so it would be pointless to spend money promoting a product that no one is interested in. This is where the president of the region would need to find another product to promote. One that will fit the culture, and interest of the people in the Northeast. This means that management in each region needs to focus on research and development in order to make the right decision. In addition, technology is really important nowadays that is why McDonald needs to work with Apple to create an account in Apple Pay. Customers can pay quickly and order their food ahead of time. This will satisfy their customers because most of them do not have the time to wait to pick up their meal. It will take both an individual and team effort for McDonalds to complete the work. Upper level managers will need to work individually to make the right decisions. For instance, upper level manager should study the region and try to figure out how they can enhance the product or create a new product to fit the culture. Lower level employees need to work in teams so they can satisfy the customers. For example, the worker operating the grill cooks the meat and when it is done he or she passes it to another worker to make the sandwich according to the customers preference. Each team member is important because if they are not motivated to do their work the whole team will fail to deliver the product to the customer. It is very important that there is manager in each branch to motivate and coach the employees. Managers must be able to fill the role of an employee if the branch was crowded and direct them to do the right job. The manager should focus on increasing the sales by satisfying the customers. Best Approach McDonald’s Corporation needs to embrace that changes that are set to take place. Upper management will need to stick by their decisions, and have faith in their management. This means allowing the presidents in each of the four new divisions to take full control of operations within their regions. The division’s presidents must look to regional managers for input on necessary changes. It is up to them to find out what the customers want, and what the customers want is what they should get. Ideally McDonalds is looking to do two things when making these structural changes. The first is to keep the same basic product menu in every region, but allow for different  regions to add certain products that cater to the customers in that region. Second is to allow for decisions to be made more efficiently and effectively. Conclusion The planning for these changes has already begun and sometime in the immediate future the changes will be implemented. These are good changes and the team feels that they will eventually make a significant difference in the overall success of McDonalds Corporation. It is going to take time, but we feel these changes will lead us into the future on the right path. References Jennings, Maze,, L.J. (2014). McDonald’s Reorganizes US into Four Regional Divisions. Retrieved from http://nrn.com/mcdonalds/mcdonald-s-reorganizes-us-four-regional-divisions Jargon, Julie, (2014). McDonalds Plan to Change U.S. Structure. Rettrieved from http://online.wsj.com/articles/mcdonalds-to-change-u-s-structure-1414695278

Improving Structure and Links for User Navigation Session

Improving Structure and Links for User Navigation Session Improving Structure and Links for Analysis of User Navigation Sessions Bhagyashri Biranje, Priti Harpale, Dushyant Singh, Meenal Jadhav, Sindhu M.R. ABSTRACT In this paper, we are designing a well-structured website to facilitate effective user navigation to relink webpages to improve navigability using user navigation data. We will completely reorganized new structure of a website, which can be highly unpredictable. It will also illustrate how to improve a website without introducing substantial changes. Here specifically, we are using a data mining algorithm to improve the user navigation on a website while minimizing alterations to its current structure. We will also test the model on large synthetic data sets to demonstrate that it scales up very well. Key words: Website design, user navigation, web mining, data mining algorithm. Corresponding Authors: Meenal Jadhav, Sindhu M.R. INTRODUCTION Nowadays, the more use of internet provides people more knowledge and information in detail. Number of users of internet is increasing day by day. For a user finding desired information is not always easy. Therefore, designing effective websites is not easy. Even though there are high profile websites, if they are unable to view the desired information, then users will ignore these websites. Ratings will be down. Less numbers of users will be the visitors [1]. There are so many examples of user navigation. The restaurant services such as making reservations, processing orders, and delivering meals generally requires waiters to input customer information and then transmit orders to the kitchen for menu preparation. When the customer pays the bill, the amount due is calculated by the cashier. Although this procedure is simple, it may significantly increase the waiters’ workload and even cause errors in menu ordering or in prioritizing customers, especially when the number of customers suddenly increases during busy hours, which can serious degrade overall service quality. Websites are having difficulties in searching and locating the target pages, because of poor website design. To design a website, developers should understand how to construct a website, which is different from previous website structure. This will be useful in such cases where users were unable to search or locate the desired information. So, to avoid such problems is not easy while creating a website. Because web developers may or may not have proper understanding of user’s preferences and they organize pages on their own preferences of their own judgments. Therefore to fulfill the user’s need, the webpages should be organized in such a way that it should be match with user’s preferences [2]. The success of any organization of web site will be determined largely by how well site’s information architecture matches users’ expectations. A logical, consistently named site organization allows users to make successful predictions about where to find things. Various methods of organizing and displaying information permit users to extend their knowledge from familiar pages to unfamiliar ones. If a developer misleads users with a structure that is neither logical nor predictable, or constantly uses different or ambiguous terms to describe site features, users will be frustrated by the difficulties of getting around and understanding what you have to offer [3]. Developer don’t want user’s mental model of web site to look like fig.1. Fig.1 Confusing links are made by a developer. Don’t make such a confusing web of links. Designers aren’t the only ones who make models of sites. Users try to imagine the site structure as well, and successful information architecture will help the user build a firm and predictable mental model of your site [3]. EXISTING SYSTEM If existing site has more than a few dozen pages, your users will expect web search options to find content in the site. In a larger site, with maybe hundreds or thousands of pages of content, web search is the only efficient means to locate particular content pages or to find all pages that mention a keyword or search phrase. For example, as with popular books at the library or the hit songs on iTunes, content usage on large web sites is a classic â€Å"long-tail† phenomenon [3]: a few items get 80 percent of the attention, and the rest get dramatically less traffic. As the user’s needs get more specific than a browser interface can handle, search engines are the means to find content out there in the long tail where it might otherwise remain undiscovered (fig. 2). Fig.2 The â€Å"long tail† of web search. Large sites are just too large to depend solely on browsing. Heavily used pages are likely to appear on browsing menus pages. Website Structure: In this project, the website structure consists of three components: layout templates, URL patterns, and linkage structure. Layout Template Most web pages consist of HTML elements like table, menu, button, image, and input box. The layout of a web page describes what HTML elements are included in the page, as well as how these elements are visually distributed in page rendering. Essentially, a page layout is represented by a so called DOM (Document Object Model) tree. In this project, a layout template is considered as a group of pages which have very similar layouts (DOM trees) [3]. In a website, pages are generated based on distinguishable templates according to their functions. That is to say, visually similar pages usually have same function. In this way, user can easily identify a page’s function at a glance. (b) (c) Fig. 3 Typical layout templates from the ASP.NET Forums [3]. Following are several typical layout templates identified from the ASP.NET Forums [3]. Their functions are to show a) a list of discussion thread, b) a list of thread posts, and c) user profile, respectively. They are designed to show: a) a list of discussion thread, b) a list of thread posts, and c) user profile, respectively. URL Pattern A URL pattern is a generalization of a group of URLs sharing similar syntactic format. In general, a URL pattern can be represented with a regular expression.Following we show some example URL patterns discovered, again,from the ASP.NET Forums [2]. List-of-thread pages ^http://forums.asp.net/d+.aspx$ ^http://forums.asp.net/d+.aspx?PageIndex=d+forumoptions=d+:d+:d+::$ List-of-post pages ^http://forums.asp.net/t/d+.aspx$ ^http://forums.asp.net/t/d+.aspx?PageIndex=d+$ ^http://forums.asp.net/p/d+/d+.aspx$ ^http://forums.asp.net/ThreadNavigation.aspx?PostID=d+NavType=(Previous|Next)$ User profile pages ^http://forums.asp.net/user/Profile.aspx?UserID=d+$ ^http://forums.asp.net/members/[^/?]*$ Itis noticed that one layout templates can have more than one related URL pattern. For example,a bookseller website usually designs one template to show a list of books,andprovidesdifferent query parameters to generate such a list. Various query parameters in this scenario will lead to different URL patterns, but the search results are shown with the same template. Another common case is duplicate pages, i.e., pages with the same content (and very likely the same layout)but different URLs [3]. Link Structure Based on the layout templates and URL patterns, we can construct a directed graph to represent the website organization structure. That is, each layout template is considered as a node in a graph, and two nodes are linked if there are hyperlinks between the pages belonging to the two nodes. The link direction is the same as the related hyperlinks.And each link is characterized with the URL pattern of the corresponding hyperlink URLs. Again, it should be noticed thatthere could be multiple links from one node to another if the corresponding hyperlinks have more than one URL pattern. Fig. 2 gives an illustrative example ofthe sub-graph constructed based on the layout templates and URL patterns above. Fig.4 An illustrative sub link-graph for the ASP.NET Forums [3]. PROPOSED SYSTEM In our proposed system, we have two main modules- Client and Server. 1] Module 1: Client Fig.5 Client Client has two functions: Browse Website Submit User Experience User or client used to browse the website. The client browses the website. The information of user such as history, time of visiting website, links etc. is known as user’s experience. It is then submitted to server. 2] Module 2: Server Fig.6 Server We are using tomcat apache as a Server. Client and Server are connected through network using Servlet. Server is used to store activity log of all user’s based on session in the database. Using Data Mining algorithm this database, website can be restructured to provide better, easier and faster interfaces. SYSTEM ARCHITECTURE Fig. 7 Architecture In this architecture, there are two modules, client and server. Client browses the website and submits its experience to the server. Then data is stored into the database. Data mining algorithm is applied to get improved website structure. It improves a website rather than reorganizes it hence is suitable for website maintenance on a progressive basis. This model is very effective to real-world websites. It optimally solves large-sized problems in a few seconds in most cases on a desktop. Data Mining Algorithm: The Data mining algorithm we are using is K-Means. The Algorithm K-means (Mac Queen, 1967) is one of the simplest unsupervised learning algorithms that solve the well known clustering problem. The procedure follows a simple and easy way to classify a given data set through a certain number of clusters (assume k clusters) fixed a priority [4, 5]. The algorithm is composed of the following steps: 1. Place K points into the space represented by the objects that are being clustered. These points represent initial group centroids. 2. Assign each object to the group that has the closest centroid. 3. When all objects have been assigned, recalculate the positions of the K centroids. 4. Repeat Steps 2 and 3 until the centroids no longer move. This produces a separation of the objects into groups from which the metric to be minimized can be calculated. CONCLUSION This model is useful for static websites and not suitable for websites that purely uses dynamic pages or have volatile contents. Using Data mining algorithm we will improve the navigation effectiveness of a website with minimal changes to its current structure. It will improve a website rather than reorganizes it. Most complex web sites share aspects of all three types of information structures. Site hierarchy is created largely with standard navigational links within the site, but topical links embedded within the content create a web like mesh of associative links that transcends the usual navigation and site structure. Except in sites that rigorously enforce a sequence of pages, users are likely to traverse your site in a free-form web like manner, jumping across regions in the information architecture, just as they would skip through chapters in a reference book. So, it will be the clearer and more concrete our site organization is, the easier it is for users to jump freely from place to place without feeling lost (fig. 7). Fig.8 Optimized path [3] We will structure sites as hierarchies, but users seldom use them that way. A clear information structure allows the user to move freely and confidently through our site. References [1] Min Chen and Young U. Ryu,† Facilitating Effective User Navigation through Website Structure Improvement†, IEEE Transactions on Knowledge and Data Engineering, Vol. 25, No. 3, March 2013. [2] G. N. Shinde and Inamdar S.A.,† Web Data Mining Using An Intelligent Information System Design†, G. N. Shinde,Inamdar S.A, Int. J. Comp. Tech. Appl., Vol 2 (2), 280-283. [3] Patric J Lynch and Sarah Horton, â€Å"Website Style Guide 3rd Edition† [4] J. B. MacQueen (1967): Some Methods for classification and Analysis of Multivariate Observations, Proceedings of 5-th Berkeley Symposium on Mathematical Statistics and Probability, Berkeley, University of California Press, 1:281-297 [5] Brian T. Luke: â€Å"K-Means Clustering†

Complications Of Skeletal Traction Health And Social Care Essay

Complications Of Skeletal Traction Health And Social Care Essay In the last two decades, there have been major changes in the management of lower limb long bone fractures, surgical management has become the norm. Skeletal traction is now rarely used as the definitive form of management. Most of the patients admitted to our hospitals have skeletal injuries, and these patients have prolonged length of stay as they are initially managed non- operatively. Complications of traction have been looked at since 1947 and have been published but literature from the developing countries is lacking. This study is being conducted to evaluate the prevalence of complications associated with skeletal traction with lower extremity fractures. Objective : To determine the proportion of patients with Lower Extremity fractures who develop complications associated with skeletal traction. Study Design:- This is a Hospital based Prospective Descriptive study, that will be carried out from December 2010 to March 2011. Study Setting :- The study will be carried out at the KNH orthopaedic wards. Materials and Methods :- Patients who are put on lower limb skeletal traction will be recruited into the study, They will be reviewed weekly for complications namely pin tract infection, pressure sores, venous thrombo-embolism, orthostatic pneumonia and knee stiffness, until upto the point they are taken off traction. The data will be collected using pre-designed questionnaires. INTRODUCTION Fractures of the femur are almost always the result of great violence and are sometime a threat to the patients life, not only because of the immediate complications such as bleeding or associated injuries but also because of subsequent complications related either to the treatment of the fracture or to the complications of the associated injuries. Immobilization of the fracture was recognised as essential for union. The development of splints, such as the Thomas splint and the subsequent combinations of the splints with traction methods either fixed or balanced, allowed for better control of the fracture, patients never the less had to remain in traction for three months or longer before the fracture was sufficiently stable to allow ambulation. Skeletal traction is seldom used in modern practice, usually it is only a temporary mode of treatment. Internal Fixation is still the treatment of choice for most closed injuries, this is because of higher union rates, lower rates of complications, earlier weight bearing, shorter hospital stays and early return to daily activites. In KNH majority of the patients admitted with femoral fractures are managed initially on skeletal traction. Patients with proximal femoral fractures are on Russel Hamiltons traction while patients with femoral shaft fractures are on Perkins traction. When the patient is managed on skeletal traction the patient is on prolonged bed rest and hospital stay increases also nursing care is difficult and the patient is at risk of developing morbidities due to the skeletal traction and prolonged immobilisation. The cost of care is increased and as seen in our setting most of the patients we manage come from a low socio-economic background who have difficulties in financing their healthcare. The prolonged confinements of the patients on traction is associated with certain complications, such as pin tract infections, decubitus ulcers, which can be overcome by better nursing care, but the complications of prolonged bed rest such as bladder and bowel derangements, deep venous thrombosis, osteoporosis, muscle wasting, to mention only a few cannot be prevented hence the need for early internal fixation. Literature Review Motor vehicle crashes are the leading cause of death in adolescents and young adults (1,2,3,4) and of the estimated 856 000 road deaths occurring annually worldwide, 74% are in developing countries (5). In both Nigeria (6,7) and Kenya (8), for example, a fivefold increase in traffic-related fatalities was observed over the last 30 years. Injuries cause profound morbidity and are one of top 10 causes of death and disability in both developing and developed economies (9). Kenya, like other developing countries, lacks organised efforts to reduce the burden of injuries. Although there is debate as to whether trauma systems in high-income countries are transferable to developing economies, baseline studies providing accounts of injury and injury trends in least developed countries are scanty.(10) Media reports have raised concern over rising road accident injuries in Kenya. Most of these occur in the capital city, Nairobi (11). Those injured mainly receive treatment at the Kenyatta National Hospital (KNH) the citys main hospital. The city lacks a systematic pre-hospital care and the patients arrive at the institution at any time and unannounced. As demonstrated in Saidis study, the injured are transported to hospital by private vehicles in the majority of cases. Ninety two per cent of the casualties arrive at KNH without any pre-hospital optimisation. (10) Saidi et al (12)found 31.0% of all admissions at KNH are due to injury indicating that a large volume of trauma admissions is handled at this public hospital. The average length of hospital stay of 14 days is from Saidis study is much longer than in reports from established trauma facilities. At the Vancouver General and Teaching Hospital, Canada, the length in 1997 was 9.14 days despite caring for patients with severer injuries (24% with ISS > 16) than in Saidis (12) cohort of patients (13.4% with ISS > 15) [12,13]. The excess length of hospital stay at KNH is caused by the predominance of skeletal injuries. Long bone fracture fixation is usually performed late, a practice occasioned by the local economic environment and a limiting factor for external validity of this outcome measure. An initial period of nonoperative care, which may last up to 4 weeks, is inevitable. The delay is caused by time spent to raise funds for desired implants. Many patients (90%) pay for the services out of their pockets [14]. If a policy of early fracture treatment incorporating a care reimbursement system that does not delay the operative intervention is introduced, the average length of stay may improve. This early fixation would additionally prevent pulmonary failure state, alleviate pain, ease nursing care, reduce complications [15], and allow early rehabilitation and return to work. The principles of traction are a pulling force that is applied to part of the body i.e. the limbs, the pelvis or spine and another force applied in the opposite direction called counter traction. The forces involved in traction are based on Newtons third law of motion, which states for every action there has to be an equal and opposite reaction. Malgaigne characterized as the greatest surgical historian, and author of the 1st comprehensive work on the diagnosis and the treatment of fractures (18), credits Guy de Chauliac with the introduction of continuous, isotonic traction in the treatment of fractures of the femur. This was accomplished by suspending a weight, attached to the leg by a cord over a pulley at the foot of the bed. The use of traction dates as far back as 3000 yrs. The Aztecs and the ancient Egyptians used manual traction and made splints out of tree branches and bark. (19) In 1847, Malgaigne introduced the first effective device which grasped the bone itself, these hooks were designed for the Rx of displaced patella fractures, the hooks were pressed through the skin and subcutaneous tissue to engage the proximal and distal fragment of the patella.(18) During World War One there was a rapid spread of the use of skeletal traction by application of tongs to the femoral condyles. After the war the tongs were extensively used in the United States but their popularity gradually decreased because of the complications, particularly infection associated with their use, tongs are now mainly reserved for skull traction.(21,22,23,24,25) Skeletal traction by means of the Steinman pin was popularized by Bohler and his students. Isotonic traction still remains an essential element in the closed treatment of many fractures. In many places worldwide it is standard practice to apply skeletal or skin traction to the injured limb following acute fractures prior to surgery Billsten 1996; Brink, 2005 (41). Traction may be either skin or skeletal. The main theoretical advantages of traction are that it will reduce pain at the fracture site and assist the reduction of the fracture thereby making the subsequent operation easier to perform. For intracapsular fractures reduction in circulatory complications has been proposed as traction may reduce any tamponade effect (Pressure caused by build up of excess fluid) which will compress blood vessels and block blood flow within the joint. Traction however has potential disadvantages, it makes nursing of the patients more difficult for e.g. use of a bed pan by the patient, pressure area care prior to surgery. Other adverse effects especially of skeletal traction include complications of sepsis at the pin site, pulmonary complications and knee stiffness because of the prolonged immobilization. In the last two decades there have been major changes in the management of lower limb long bone fractures, where resources permit, surgical management of open closed femoral tibial fractures has become routine.(26) Traction should now be rarely used as the definitive form of management. Orthopaedic surgeons have come to appreciate that there are 4 main treatment goals for fracture management (27). These goals were created by the ASIF (association for the study of internal fixation) and are: Anatomic reduction of the number fragments, ensuring alignment, length, and angulation and rotation are corrected as required. Stable internal fixation to fulfil bio-mechanical demands Preservation of blood supply to the injured area of the extremity. Active pain free mobilization of adjacent muscles and joints to prevent the development of fracture disease There are several studies done to determine the usefulness of pre-op traction, (32,33,34,,35,36,37,38,39), though these studies are mainly looking at proximal femoral fractures. Traction prior to surgery is standard practise in some hospitals, a survey of 78 hospitals in Sweden (40) showed that a quarter of those, routinely applied skin traction to all patients with hip fractures, while another survey done by Brink et al in 2005(41) found that pre-op traction was standard practise in 20% of trauma departments in the Netherlands. These studies have shortfalls in that the type of traction used is mainly skin fraction, and the maximum duration patients are on traction is 2.3 days Brink 2005(41), while in our setting patients are on traction for minimum one week prior to internal fixation . In this study only 4 patients were put on skeletal traction of the total patients put on traction, reasons for the difference are not given. From the Cochrane review article on the pre-op benefits of traction, not many studies have looked at the complications of patients put on skeletal traction. The main outcome measures in these studies (32,33,34,35,36,37,38,39,40,41) were degree of pain, analgesia use, length of surgery, ease of fracture reduction, and it seems like incidence of pressure sores and other complications were secondary objectives. One of the earliest accounts of complications of skeletal traction is from 1946, by Kirby Fills (42) they mainly looked at complications associated with trans-fixation pins and wires in skeletal traction, from a series of 305 fractures of long bones, complications occurred in 12, of these only 3 were related with Steinman pin use one of the patients had pin tract infection (PTI), and 2 had peroneal nerve palsy, however the author clearly states many patients who had a little drainage from the pin but no signs of inflammation were not regarded as pin tract infection . Pin tract infection is defined as an abnormal condition associated with skeletal traction or external fixation devices and is characterized by infection of superficial, deeper or soft tissues or by osteomyelitis. These infections may develop at skeletal traction pin sites. Some of the signs of pin tract infection are erythema at the pin sites, drainage, pin loosening, elevated temperature, and pain. The bone pin construct is not a sterile interface, but it is a pathway between the surface of the skin, which is normally colonized by bacteria, and the medullary cavity which is sterile (43). Factors which predispose to pin tract infection are thermal necrosis (44) and accumulation of fluid around the pin (45). Regular pin care prevents crusting around the pins, thus minimizing fluid accumulation and hence transmission of bacteria, within the underlying tissues (45). Pin insertion using a hammer leads to splintering of the cortex (46). Insertion of the pin using power tools has been indicated as the main cause of thermal necrosis (44) hence hand drills are preferable for insertion. Necrosis of osteophytes and tissues due to the temperature elevation provide a fertile bed for any pathogenic bacteria. Patients who are put on skeletal traction suffer from morbidities associated with prolonged bed rest. A feature peculiar to these patients is morbidities associated with pin tract infections, which results in pain, pin loosening and subsequently need for removal of the pin. Neglect in these cases can lead to abscess formation and osteomyelitis (43). Similar morbidity of pin tract infection is associated with pins used in external fixators. Reported incidence in the world literature on pin tract infection is 5-10% (47,48,49,50). This incidence increases in cases of transfixation pins upto about 80% (51). The prevalence of pin tract infection varies dramatically in the literature from a 1% prevalence of major infections to an 80% prevalence of minor infections (52). Even in the study identified by the Cochrane review (53) the prevalence of pin tract infection varied, based on the treatment of pin sites, from 8-25% (54). A common factor in most studies of pin site complication is the lack of a standard definition of what constitutes a PTI is it inflammation around the pin site as reported in upto 41.6% in one series (55), or is it cellulitis around the pins or pin sites with draining sero-purulent discharge or is it pin loosening. Therefore this study is being done to establish what the rates of pin tract infection are when all the signs of inflammation will be used to diagnose pin tract infection. Looking at studies done closer to home in 1962 procter reported his series of 41 patients in SA (56), he was looking at use of perkins traction in femoral fracture management. PTI was found in 15% of the patients, while all the patients had full knee ROM at a period of 10 weeks. A few years later Usdin reported his own series of 58 patients, managed by perkins traction, and 5 of these patients 8.6% developed pin tract infections, and 2 cases had residual knee stiffness (57). More recently Gosselin in his series of 53 patients from Sierra Leone in 2005 reported that 23 patients (42.6%) of his patients had a pin tract infection and at an average 29 days after being put on traction.(59) Therefore it is noted incidence of PTI varies from centre to centre and is dependent on several factors , it is the purpose of this study to establish what proportion of patients on skeletal traction develop a PTI. Other complications associated with skeletal traction are decubitus ulcers, venous thromboembolism, Knee stiffness and pneumonia. There is sparse literature which reports on the occurrence of these complications in association with skeletal traction. Butt et al in his RCT of operative versus non-operative treatment of distal femoral fractures found that in the non-operative arm, a total of 26 patients developed complications. 3 of these patients had DVT, 4 had chest infections, 4 had pressure sores, 4 had UTIs (58) and 5 out of 26 patients developed pin tract infection. When critically ill patients are under our care it is important to protect them from further deterioration or delays in recovery, especially due to complications that are not related to the underlying pathophysiology that brought the patient to hospital. Immobility is associated with increased risk of VTE, decubitus ulcers and pulmonary insufficiency. Bed rest is a highly un-physiologic form of therapy and can lead to a number of complications (table1). Immobility-Associated Complications System Complications Respiratory Atelectasis Pneumonia Pulmonary embolus Cardiovascular Hypovolemia Dampened carotid baroreceptor response Orthostatic hypotension Deep venous thrombosis Gastrointestinal Constipation Ileus Renal Renal calculi Urinary stasis Endocrine Hyperglycemia Insulin resistance Musculoskeletal Muscular atrophy and deconditioning Bone demineralization Joint contractures Skin Decubitus ulcers Psychosocial Depression Decreased functional capacity Decreased respiratory excursion and stasis of secretions leads to atelectasis and pneumonia, lesser muscle contractions of the lower limbs results in reduced venous return, venous stasis and VTE. Reconditioning, loss of skeletal muscle mass and strength, is often seen because of immobilization. Bone demineralization due to absence of weight bearing stress on the skeleton, joint contraction occurs because of muscle atrophy. Pressure sores develop because of prolonged pressure on bony prominences. DVT and PE have long been recognized as major causes of morbidity and mortality in patients undergoing both elective and emergency orthopedic surgery. Numerous studies have investigated the incidence of DVT PE associated with hip and total knee arthroplasty, also the role of prophylactic anti-coagulation has been extremely investigated. When considering orthopedic trauma patients extrapolation from the arthroplasty literature is not appropriate. The incidence of DVT PE in association with hip and pelvic fracture has been looked at extensively, however there is insufficient information on patients with femoral fractures managed with skeletal traction, so as to allow the orthopedic surgeon to determine the risk or benefit rational of anti coagulation. In a prospective study done in Canada a co-host of 349 following major trauma was studied, and DVT cross found in 126 of the 182 with lower extremity orthopedic injuries, 61% of patients with pelvic fractures, 80% of patients with femoral fractures, 77% of patients with tibia fractures had confirmed DVT using venographic studies. Patients with fracture of tibia, femur are known to be at almost a 5 times more risk to have DVT as compared to patients without fractures. Geerts et al also found that only 3 of the 201 patients with confirmed DVT (ODS 1.5%) had clinical characteristics suggestive of DVT, therefore it is questionable whether clinical characteristics are adequate to make a diagnosis of DVT. Although it is well known that elderly patients have an increased risk of thrombosis. Geerts et al also found that younger patients with trauma those that are under 30years had a 46% incidence of DVT. The incidence of DVT in patients with femoral fractures on skeletal traction is unknown. The purpose of this study is to determine the incidence of DVT with positive clinical characteristics and confirmed by Doppler U/S in patients on skeletal traction for femoral fractures. Respiratory problems are common after long bone fractures, The main common complication of long bone fracture is fat embolism syndrome (FES),(60) followed by respiratory dysfunction and insufficiency.(61,62) Despite the development of medical and anesthetic management, evidence indicates that early treatment of the fractures in a multiply injured patient has a profound effect in reducing the risk of subsequent respiratory complications. (61,63,64,65,66) There are numerous studies showing that early fixation of femoral fractures can decrease the incidence of ARDS and multiple organ failure (MOF).(67,68,69,70,71,65) Over the last decade the beneficial effects of early stabilization of femoral shaft fractures by intramedullary nailing have been challenged. The association between early femoral fixation with reamed nailing and a higher risk of ARDS/MOF has been suggested.(56,64,60,61,65,66,) The first prospective study on this subject showed that among 178 patients, the incidence of pulmonary complications was significantly higher in those with late stabilized fracture.(71) In patients with single fracture, the complication rate after late fixation was 22% in comparison with 4% after early stabilization. In multiple fractures, these rates the traction were100% and 32%, respectively.(69,70) Early fixation can lead to the prevention of thrombosis, subsequent bed ulcers, and decreases the needs for analgesics.(65,74) Furthermore, early stabilization eliminates the need for supine position for skeletal traction, it improves pulmonary function and prevents atelectasis.(63,65,67,74,75) This study is aimed to determine the incidence of respiratory problems in patients who have single femoral or multiple fractures, and are awaiting operative stabilization. Severely restricted knee motion is a recognized complication of operative procedures or trauma around the knee. This is a significant problem in underdeveloped countries where the initial management of many of these injuries is suboptimal. The reported rate (76,77,78,79) of significant knee stiffness after various injuries and procedures around the knee is as high as 11% in the western literature, but may be much higher in underdeveloped countries, where ideal management of trauma is not readily available (80). A large percentage of these cases present with adhesions inside as well as outside the knee, and the management of these cases then becomes complex. Loss of extension is labelled more debilitating in western cultures, with small extension deficits impeding normal walking ; restricted flexion however is a serious problem in the Asian countries, where social and religious mores make sitting on the ground a normal requirement of everyday life. Flexion loss is mostly due to intra-articular fibrosis and scarring in the quadriceps-femoral mechanism. Anterior adhesions involve the quadriceps expansion in the lateral and medial recesses, the suprapatellar bursa, muscle adhesions to the femur, patella , or even shortening of the rectus femoris (77). A number of studies have described the complications of traction however no study from the region where patients are primarily managed on skeletal traction have looked at the complications due to skeletal traction and those associated with prolonged immobilization. STUDY JUSTIFICATION:- American College of Surgeons Committee on Trauma has recommended that femoral shaft fractures in polytrauma patients be treated within 2-12 hours after injury, provided they are hemodynamically stable.(81,82) Studies have also shown the significant benefit of intervention within the first 24 hours. Immediate fixation has been shown to decrease fatalities, respiratory complications, multisystem organ failure, and the length of ICU stays in most patients. The type of early fixation used can be debated, but the timing appears to be what makes the difference (83,84). World over fracture fixation has evolved whereby early fixation is advocated for. In the resource-poor local setting with large volumes of patients occasioned by persistently high RTA, the primary management modality is skeletal traction. There is lack of skilled personnel (surgeons/traumatologists) in most peripheral hospitals and hence most patients who have sustained fractures of the lower limb are put on skeletal traction as ORIF cannot be done therefore it is important to establish what are the common complications suffered by these patients. There is a large volume of patients who are seen at KNH, this is mainly because of the poor infrastructure at peripheral hospitals in managing major orthopaedic injuries hence most patients are referred to KNH causing a strain on its resources and ultimately leading to substandard orthopaedic care. The complications associated with skeletal traction and prolonged immobilization have been reported by several authors however most of the numbers of patients who are managed on skeletal traction in these studies are few. In our setup most of the patients with femoral fractures are put on skeletal traction while awaiting operative management therefore it is important to know what the incidence of these complications in our setting are. The incidence of pin tract infection in most studies is not adequately reported as there is no standardized definition of pin tract infection therefore this study will look at pin tract infection broadly . In KNH patients with femoral fractures are put on skeletal traction while awaiting fixation, this is mostly done on an elective operating list and it is not known what duration these patients are on traction, from this study we will establish what the mean waiting time is for a patient with femoral fracture to be internally fixed. It is not known what number of patients with femoral fractures who are put on traction in our setting develop complications hence this study is being done to establish the proportion of patients who get pin tract infections, and other complications associated with skeletal traction. BROAD OBJECTIVE:- To determine the proportion of patients with Lower Extremity fractures who develop complications associated with skeletal traction. SPECIFIC OBJECTIVE:- To determine the proportion of patients on skeletal traction for LE fracture who develop pin tract infections venous thrombo-embolism knee stiffness pressure sores orthostatic pneumonia 2. Determine the proportion of those who recover from the complications 3. To determine the duration patients are on traction 4. Proportion of those with adverse outcomes following complications PATIENTS AND METHODS STUDY DESIGN This is a Hospital based Prospective Descriptive study. STUDY SETTING:- The study will be carried out at the KNH orthopaedic wards. STUDY PERIOD:- The study will be carried out over a period of four months or?until the sample size is achieved SELECTION CRITERIA :- All patients eligible to the study will be enrolled until the sample size is obtained. INCLUSION CRITERIA:- All skeletally-mature pts with lower extremity fractures put on skeletal traction as a definitive or temporary treatment option Those consenting to be recruited in to the study. EXCLUSION CRITERIA:- Skeletal immaturity determined radiologically. Pre existing disease: pneumonia, VTE, pressure sores SAMPLE SIZE CALCULATION:- The sample size will be determined by the use of the following formulae to achieve an adequate sample to accurately estimate the prevalence of complications in pin tract infection in the study population. n = Z2ÃŽÂ ±/2 X P (1-P) D2 Where n = required sample size P = prevalence of pin tract infection (42.6%, 24%  [1]  , 26%  [2]  ), based on the estimated prevalence from a similar study in Sierra Leon by Gosselin. This is the only study in the developing country performed in a similar setting. D = Precision with which to measure prevalence, set at plus or minus 1%. The ZÃŽÂ ±/2 is the cut off points along the x-axis of the standard normal probability distribution that represents probability matching the 95% confidence interval (1.96). Substituting the above in the formulae we get; n à ¢Ã¢â‚¬ °Ã‹â€  93.9 = 94 patients DEFINITIONS OF COMPLICATIONS AS WILL BE USED IN DATA COLLECTION :- Pin Tract Infection :- will be defined by signs of hyperemia,pain,crusts,seropurulent discharge around the pin site or pin loosening. Venous Thrombo-embolism :- Patients with unilateral leg swelling, calf pain, will be subjected to doppler u/s to confirm presence of a thrombus. Pressure sores : Trochanteric,sacral,calcaneal regions of the body will be examined and the use of the pressure sore grading system will be used to record presence of pressure sores :- Grade 1 :- non blanchable erythema of intact skin Grade 2:- Partial thickness skin loss involving epidermis,dermis or both Grade 3:- Full thickness skin loss involving damage o or necrosis of subcuataneous tissues that may extend down to but not through underlying fascia Grade 4 :- Full thickness skin losswith extensive destruction, tissue necrosis or damage to muscle or bone. Knee Stiffness :- Patients have a reduced range of motion of the knee of the injured limb and will determined by range of motion of less than 30 degrees, less than or equal to 90 degrees or more than 90 degrees. Pneumonia :- Patients who have recorded high temperatures, respiratory distress, cough, chest pain will be used to make a diagnosis of pneumonia. DATA COLLECTION:- Patients will be recruited into the study Consecutively Use of a questionnaire to gather data, including demographics, cause of fracture, traction system and its duration, incidence of complications and their outcome. Data will be collected as pertains to the date of commencement of traction up to the date patient undergoes operative management or is taken off traction. Patients will be recruited into the study as they are put on traction, and will be followed upto the time they are taken off traction. DATA ANALYSIS:- The data will be collected using a structured questionnaire. The questionnaires will be coded to make the data entry easy. The filled questionnaires will be kept in a safe place ready for the data entry and for the confidentiality of the patients details. After cross checking the questionnaires for any missing entries a data base will be designed in MS Access which will allow the researcher to set controls and validation of the variables. On completion of the data entry exercise the data will be exported in a Statistical Package (SPSS Version 15.0 Chicago , Illinois) for analysis. The data will be presented in tables and figures where applicable. Non- Parametric tests (Mann Whitney U test) will be used to examine whether there is any significant association between the continuous variables e.g. age and duration count, while chi-square will be used to establish the significant associations between the categorical variables. Odds Ratios (OR) and associated 95%C

Sophia Western vs. Lady Bellaston On the 4th episode of the novel Tom J

Sophia Western vs. Lady Bellaston On the 4th episode of the novel Tom Jones Sophia Western vs. Lady Bellaston On the 4th episode of the novel Tom Jones, the author has once again given its audience another surprise. Sophia Western and Lady Bellaston are both secretly fighting for the love of the same man. They both like Mr. Jones. However, they refuse to let each other know about their own feelings towards this man. Although they are both wealthy women, they differ in their appearance, attitudes, and most important on their feelings towards Mr. Jones. They look very different from each other. Ms. Western is very young, probably in her early 20s. She has long blonde hair and does not need any makeup to appear beautiful; she is a natural. Lady Bellaston, on the other hand, is much older, probably in her 50s. She is a slim redhead, perhaps with more need to dress up to impress the younger man of her delight. Sophia dresses elegant but rather simple. She could even be considered an old fashioned woman in London. Conversely, Lady Bellaston is very modern and sensual...

Edgar Degas :: Essays Papers

Edgar Degas Edgar Degas was a French artist, some people would refer to him as the expert of drawing the human figure in motion. He was known as an Impressionists, and was different from all the other artist of his type. Edgar Degas was a person who, at certain times, brashly defied propriety and common social practice. Although he could be the nicest person, at times he would go into rages during social gatherings, becoming hostile with the people who disagreed with his ways and opinions. Edgar Degas was born on July 19, 1834, at Saint-Georges in Paris. His father was a French banker, and his mother was an American from New Orleans. While Degas was growing up his idol was the painter. He began his artistic studies with Louis Lamothes, a pupil of Ingres. After studying there he moved on and started classes at the Ecole des Beaux Arts. In 1854, he left and went to Italy. For 5 years he stayed there and studied Italian art, mainly works. Edgar Degas was known as an Impressionist. The Impressionist were artist who exhibited their works of art in independent shows from 1874 to 1886. It was the common desire to make an open forum for artist to show their work that united the group. The word "Impressionist" was created by the critic Louis Leroy after seeing paintings in the first Impressionists exhibition in April of 1874. The name that Leroy gave his article in the French periodical was Charivari "Exhibition of the Impressionists" and sarcastically protected the new style of painting that ignored details, bared brushstrokes, and put unblended colors beside each other. Just like most of the French public, Leroy did not take into consideration the works by Claude Monet, Berthe Morisot, Pierre-Auguste Renoir, and Edgar as art that deserved serious attention. In 1859 he returned to Paris. There he painted portraits of family and friends and many historical subjects, where he used both classical and romantic styles. In the late 1860’s he switched to contemporary themes, painting both theatrical scenes and portraits with big emphasis on social and intellectual implications of props and setting. Around 1868 Degas began to get recognized as an artist. During the early 1870’s, the female became Degas’s favorite theme. In his studio he sketched from a live model and put poses together in groupings that illustrated rehearsal and performance scenes. In 1872 he visited some of his relatives in Louisiana, he painted The Cotton Exchange at New Orleans, which is his only picture that was aquired by a museum in his lifetime.

Appendix a – Meditation Worksheet

Appendix A – Meditation Worksheet Veronica P. Sally-Garner PSY/211 ESSENTIALS OF PSYCHOLOGY Thursday, October 20, 2011 Instructor: Terry Browning Appendix A Meditation Worksheet Directions: Locate two resources on the Internet that explain meditation techniques. Copy and paste the web address into the top of the matrix. After reviewing the website, provide a brief summary for each source. Below your summary, list two interesting facts you learned from each site. Try the techniques you located in your Internet search. Provide a brief description of what happened in your experience. Be sure to answer the two questions below the matrix also. Web Address (URL):| http://bestmeditationtechniques. org/the-basics-of-meditation| http://www. mum. edu/meditation. html? gclid=CKOsutyS-KsCFQ1U7Aod9HlUKw| Summary of resource:| Things happen so quickly in this fast-paced world. Decisions are made without thought. This could cause stress to build and affect the way people deal with life. Everyone needs to stop and take a few minutes to calm down. So if life is stressing you out, it’s time to slow down. Meditation can help relieve stress and worries. The practice of meditation is a way to be still for a while and let our minds become focused until we become calm enough to deal with the daily pressures of life. | Mediation can mean different things to different people. Mediation can be defined in three main types: focused attention- concentration, open monitoring-contemplation, and automatic self-transcending – the Transcendental Mediation Program. Transcendental Meditation also known as TM. TM is the most widely practiced, most researched, and most effective method of self-development mediation technique. Two interestingFacts: | 1. Meditation can improve Concentration. Two commonly used exercises are: Mantra – a phrase or a sound that is recited repeatedlyBreathing – achieved by inhaling through the nose, letting the diaphragm (not the chest) expand and exhaling through the mouth 2. Breathing is an integral part of meditation. Proper breathing is required in many practices of meditation and is therefore an im portant tool to be possessed by people who wish to mediate. The practice of proper breathing while meditating slows down a person’s heart rate which leads to a relaxed mood. While this may sound easy, it can be quite challenging when done for the first time. | 1. Transcendental Meditation is the most popular technique. It is practiced by people of all ages, cultures, and religions. More than five million people worldwide practice this simple, natural technique. 2. People who practice Transcendental Meditation find themselves more alert, calmer, more energetic, dynamic, yet somehow wiser, as if you have a broader perspective on their daily activities and experiences. | What happened after you tried each technique? | After trying each technique one should feel relaxed and a sense of heighten awareness. Meditation helps the mind become less distracted. | After trying Transcendental Meditation one should have more confidence and higher self esteem. | 1. Do you think meditation leads to heightened sensation and perception? Explain why or why not. ————————————————- Mediation can lead to heightened sensation and perception. Each is different but ————————————————- complements each other. Sensation is the process by which we sense through touch, smell, ————————————————- sight, taste and smell. Perception is our way of interpreting what these sensations mean and ————————————————- how to make sense of it. 2. Have you considered integrating meditation into your own lifestyle? If so, list one strategy for fitting meditation into your schedule. If not, explain why. ————————————————- I have integrated meditation into my personal lifestyle with physical exercise. Physical ————————————————- exercise promotes overall fitness, helps manage emotional stress and relieves tension.

Analysis for Costa Coffee Essay

A well-recognized and wide-accepted brand image is one of the most valuable assets of the company. (Aaker, 1991). Costa Coffee has a welcoming and comforting brand image; however, the promotion of this brand image is at a disadvantage compared with its biggest rival Starbucks. In order to reverse the weakness into its strength, Costa Coffee needs to keep improving its brand image and brand awareness. Costa Coffee founded Costa Foundation, which is a charity aiming to offer long-term support especially in education for the coffee-growing farmers and their communities. Thus, Costa Coffee could strengthen its publicity of its efforts in sustaining the vulnerable group. By continue to maintain its social responsibility which could have  reflected its â€Å"responsible† image to the whole public, it would help Costa Coffee gain more reputation and build a better brand image. Launch new products One of the weaknesses of Costa Coffee is its fixed menu and the blank page of new product webpage. Compared to Starbucks and other cafà © shops, having limited choices on the menu would pose a disadvantage to Costa Coffee. The new products might not always attracted to all customers; however, those new products could draw people’s attention and encourage them to come into store and purchase which could be a way of promoting the brand to the public. Create new products and presenting it regular would help Costa Coffee appeal to more potential customers.In the same time, it would also help to create an image that Costa Coffee are trying their best to satisfy their consumers. Cooperate with universities – Costa campus stores or Bring Costa express into campus Costa Express machines have won the hearts of the purchasers as the self-serve coffee machines. As the success of launching Costa Express, Costa Coffee should grab the chance and continue exploiting this opportunity making it to its advantage. Cooperating with other organizations and co-operations would add its consumer base and in the same time it is a lower-risk approach for its further growing. Building campus-based Costa Coffee shops or introducing Costa express into teaching and living areas is a convenient way for students and teaching staff getting their coffee. Besides, it also could increase the probability for more customers to familiar with the Costa Coffee brand itself. Partner with universities allows Costa Coffee better targeting student customers who have the greatest potential to become Costa’s loyal customers in the long run. Reference Aaker, D.A. (1991, Managing Brand Equity: Capitalizing on the Value of a Brand Name, The Free Press,New York, NY.