Is Price the Only Factor That Determines a Buyers Decision Essay Example for Free

Is Price the Only Factor That Determines a Buyers Decision Essay When consuming products and services, customers pay attention to several factors to make sure that they have made a sensible decision. Perhaps, the very first thing to be taken into account, under some circumstances, is price. However, it should not always be the sole consideration for purchasing decisions. From my point of view, apart from price, there are other determinants that can have a strong impact on a buyer’s decision, namely quality, buyer psychology and commitments that a firm offers its customers. To begin with, it can be said for sure that for most wise consumers, the quality of products or services is remembered long whereas the price is soon forgotten. When people make up their mind to consume something, they definitely want it to be worthy of their money. To be more specific, they are willing to have their ideal products although their prices can, sometimes, be very costly simply because of their durability. Long-lasting products are preferable, especially for careful consumers who are always in pursuit of the stability of the products. From another context, in terms of buyer psychology, many customers are not afraid of high cost to own certain products since not only do the products serve their needs, but they also help them to express their fashion-consciousness and status. For example, fashionable clothes enjoy increasing demand from celebrities every year though the producers set high prices. In addition, pricing low does not always work, even it can be counter-productive because consumers may assume that the products are below normal standards or the firm is going bankruptcy, which may lead to the damage of the company’s image and prestige. Last but not least, commitments to customers that a producer makes are also of great importance. These commitments usually come along with guarantees or after-sales services. Customers may pay higher amount of money for the products, however, in exchange, they are certain that they can have substitutes or indemnities when problems associated with the products happen. In other word, regardless of high prices, consumers are satisfied because they are offered certainty. In these cases, prices are also not the matter. In general, price is a significant factor that affects buyer decisions, but it is not the only determinants. Wise customers always seek for perfection from the products or services; hence, price should only be one of the aspects to be considered.

Inter-Professional Education, Working and Learning

Inter-Professional Education, Working and Learning What do you understand by the terms inter professional education (IPE), inter professional working (IPW) and enquiry based learning (EBL)? Discuss the potential benefits and difficulties associated with them The modern NHS is constantly evolving and arguably has done so since its inception. This evolution has been on many different levels. In this essay we shall consider some of the changes in the professional working and learning practices of the nurse with consideration of the topics of inter professional education (IPE), inter professional working (IPW) and enquiry based learning (EBL). We shall consider each in turn and then examine its relevance to modern day practice. Interprofessional education (IPE), IPE has been defined in a number of ways. One of the most complete is: The application of principles of adult learning to interactive, group-based learning, which relates collaborative learning to collaborative practice within a coherent rationale which is informed by understanding of interpersonal, group, inter-group, organisational and inter-organisational relations and processes of professionalisation. (Gough D.A et al. 2003) When reading the literature on the subject, one quickly becomes aware that there are a number of commonly used terms that are virtually synonymous with IPE, and contribute to the â€Å"semantic quagmire† referred to in the McPhearson paper (discussed later) that surrounds terms such as multi-disciplinary learning and multi-professional education. (Scottish Office 1998). In broad terms they describe the process whereby two (or more) professions or disciplines come together for the purposes of learning (Jackson, N et al. 2004). The important functional features of such a system are not that the individuals concerned learn the same material together but that there is a learning both about and from each other to improve collaboration and the overall quality of care provided and it is this latter feature which distinguishes the term IPE from the rest of the group mentioned earlier. (NCIHE 1997) The emergence of multidisciplinary teamwork and the seamless interface concepts (Yura H et al. 1998) have highlighted the need for smoother integration of both processes and knowledge (as well as other less tangible concepts such as mutual respect and understanding) between the caring professions. (CAIPE 1997) Quite apart from the ideological requirement for such processes to be adopted, we note that there is an increased pressure of guidances coming from central sources, primarily the Dept. of Health, that specify IPE as essential to the task of healthcare professionals and also a number of enquiry reports (such as the Kennedy report and other in the field of child abuse and mental health such as the Laming inquiry (2003)) that have highlighted the need for strengthening both IPE and interprofessional working Interprofessional Working (IPW) IPW is, to a large extent, a direct and natural consequence from the adoption of the concepts of IPE. (Molyneux J 2001). In essence, it describes the process of healthcare professionals collaborating in working together more effectively to improve the quality of patient care thereby allowing for both flexible and coordinated services and a skilled and responsive workforce. (McNair R et al. 2001). We should note that the adoption of IPW is seen as a key element in the optimum working of multidisciplinary team working which allows healthcare professionals to work competently and confidently across previously defined professional boundaries and it enables effective role substitution (Finch J et al. 2000) Enquiry based learning (EBL) This is essentially a description of a process of learning that is driven by a process of enquiry. It is complementary to the process of project based learning (PBL) which is determined by the end point of the solution of a problem and usually requires the creation of a finished product such as a project report or a dissertation. EBL is characterised by deep involvement and engagement with a complex problem and incorporates structures and forms of support which can help the student carry out their enquiries and can cover a broad spectrum of different approaches. The characteristic feature of this type of structured learning is that the tutor establishes the topic and the student then pursues their own lines of enquiry, both seeking evidence to support their views and also taking responsibility to present this evidence appropriately. In the words of Barrett: It promotes personal research†¦ the student becomes familiar with the multifarious resources at their disposal such as e-journals and databases. There is the opportunity to support one another in research and explore different avenues of information. The whole experience becomes one of interchange where students can share opinions, research and experience to achieve an end result. (Barrett et al. 2005) Collaborative working In essence, the forgoing paragraphs all come under the over-reaching concept of collaborative working. This is not an isolated academic concept, it is a very practical one. The literature on the subject is very informative. If we consider a number of specific examples from recent journals, we can cite the paper by Rogowski (J A et al. 2001) which produced an ingenious design of study to assess the degree to which a number of neonatal intensive care units (NICUs) could make improvements in both the quality of care and also the economic functioning of their departments by embracing the concept of collaborative multidisciplinary working. Ten NICUs adopted the collaborative multidisciplinary working model and their outcomes were compared with nine â€Å"controls† who did not. The paper is both long and complex and the analysis is exhaustive but, in essence, the authors concluded that such collaborative working practices could certainly achieve cost savings (which were comparativel y easy to quantify). They noted that these were certainly obtainable in the short term and most were sustainable in the long term. They also commented on the improvements in the quality of care parameters (which were much harder to quantify). There was an improvement in a number of indices of quality of care including patient (parent) satisfaction levels, staff satisfaction levels and this was not accompanied by any reduction in clinical outcome. On a wider consideration, one can turn to the paper by Anderson (P et al. 2003) Which describes the WHO’s collaborative survey on the management of alcohol problems in a primary health care setting. The paper starts with the premise that the handling of alcohol-related problems in primary healthcare is poor (and cites many reasons for this). (Aalto, M et al. 2001) . The relevance to our discussions here is that the paper considers the outcomes in this area when such problems are treated by the GP alone and when they are treated by a multidisciplinary primary healthcare team (IPW) and it is clear that the later group has a generally better outcome. These two papers are presented to support the hypotheses that IPW and collaborative working are not simply new mechanisms without foundation or substance, they are a demonstration of their ability to work in a practical field. If we now consider the benefits and shortcomings of IPE and IPW within the context of the modern NHS, we note that there is not only a consideration of the benefits of IPW between the various healthcare professional’s specialties but some authors also call for IPW between those healthcare professionals who work in primary healthcare teams and those who work in a hospital setting. The current structure of the NHS is such that hospital based practitioners tend to train, work, and have their horizons limited by the confines of the hospital environment. When the patient leaves this environment they become â€Å"someone else’s problem† and the care is then taken over by another team of healthcare professionals. Parsell ( G, et al. 1998) calls for both IPE and IPW to accommodate this rather artificial divide and to educate healthcare professionals into the consideration that it is the patient who is the constant factor and that considerable levels of collaborative work ing are required to provide optimum levels of patient care. A more recent paper by McPherson (K et al. 2001) takes this argument a stage further. It is both analytical and well written and the authors have an impressive pedigree (two professors of medicine and a lecturer in health administration). The paper puts education at the centre of the modernisation debate They make the very pertinent observation: Most health needs require the collaboration of a group of health professionals. The professionals involved may work together in the same space or be scattered throughout several hospital departments or sectors of care. Whether or not the caregivers see themselves as part of a team, each patient depends on the performance of the whole. The paper then makes a number of analyses form both practical experience of the authors and the current literature. They suggest that, in order to work well a work group or team should have the following characteristics: Clear aim: shared understanding of goals. Clear processes: knowledge of (and respect for) others contributions, good communication, conflict management, matching of roles and training to the task. (Headrick L A et al. 1998) Flexible structures that support such processes: skilled staff, appropriate staffing mix, responsive and proactive leadership that emphasises excellence, effective team meetings, documentation that facilitates sharing of knowledge, access to needed resources, and appropriate rewards. (Firth-Cozens J 2000) The authors cite an impressive and persuasive evidence base that IPW and collaborative working have been demonstrated to produce patient benefit in a number of specific areas including reduced mortality for the elderly. (Rubenstein L Z et al. 1991), morbidity after CVA (Langhorne P et al. 2001) and mortality after CABG (OConnor G T et al. 1996) to mention just three. Despite these clear and demonstrable benefits, the authors make the point that IPW is not just something that happens when professional training is completed, it should ideally be considered as part of a continuum of learning starting with the pre-qualification experience, continuing into postgraduate education, and extending into continuing professional development. They make a call (which has been echoed by many others viz. CGME 2000) for learning in the field of healthcare to be about healthcare as a whole, rather than a series of disjointed â€Å"chapters† in order to help the developing healthcare professionals to acquire a deeper understanding of the processes of care and also to prepare the professionals to be in a better position to contribute to the development of a better system in the fullness of time One of the impediments to a wholehearted embracing of these concepts is perhaps a clinging onto the older concepts of trying to blur boundaries between what a nurse and a doctor might do or perhaps how an occupational therapist or a psychologist might approach management issues. It seems to be a fundamental issue that need to collectively understand the different ways of thinking and problem solving that the different specialties require so that the different skills and knowledge bases can be combined in a way that benefits patients. (Koppel I et al. 2001) Part of the requirement of the writing of this essay is to reflect on the experiences gained in the EBL group work and the learning derived from the research for this essay. Gibbs reflective model is ideal for this purpose. The descriptive elements are largely contained within this essay and, in addition, my experiences within the various groups. It has to be said that the groups that I was involved with were largely harmonious and entered into the various learning exercises in a spirit of self-help. I am aware however, that a number of the other groups did not share this experience and I have been told about a number of heated discussions that apparently tool place within these other groups. My feelings are that instinctively I find the former more conducive to a positive learning experience. Although it can be useful to enter into a heated debate on a subject, it rarely helps to persuade you to a different point of view. (Taylor, E. 2000). The evaluation of the episode was that it gave me a personal insight into how other healthcare professionals consider and manage problems in their own sphere and, as such, I feel that I have learned a great deal and formed a deeper understanding of their perceptions and knowledge of certain issues. In terms of what I might have done differently, I believe that I was able to assimilate a great deal of useful information from these groups which will almost certainly help me in my professional career. On reflection, I think that I was not as vociferous as I might have been in putting my own viewpoint forward, and it occurred to me that the other healthcare professionals in the group may therefore not have had the same opportunity to assimilate my particular viewpoints and opinions and may therefore have been disadvantaged by this. (Palmer 2005). It is certainly clear to me that there is considerable benefit to be obtained in both IPE and IPW and the mechanism of EBL is a valuable tool to obtaining that benefit. In terms of a discrete action plan, I have every intention of engaging as fully as I can in any further measures in this regard and will try to make my own viewpoint available for others to assess and assimilate as actively as I have tried to assess and assimilate theirs. (Van Manen, M. 1997). I feel that this is a positive step in making all of us more fully professional and able to contribute more fully to the healthcare systems that we will eventually work in. References Aalto, M., Pekuri, P. and Seppa K. (2001)  Primary health care nurses and physicians attitudes, knowledge and beliefs regarding brief intervention for heavy drinkers.  Addiction 96 : 305–311 Anderson P, Eileen Kaner, Sonia Wutzke, Michel Wensing, Richard Grol, Nick Heather, and John Saunders 2003 ATTITUDES AND MANAGEMENT OF ALCOHOL PROBLEMS IN GENERAL PRACTICE: DESCRIPTIVE ANALYSIS BASED ON FINDINGS OF A WORLD HEALTH ORGANIZATION INTERNATIONAL COLLABORATIVE SURVEY Alcohol Alcohol., November/December 2003 ; 38 : 597 601. Barrett T, MacIbrahim I, Fallon H (eds) 2005  Handbook of enquiry and problem based learning  Galaway : CELT 2005 CAIPE (1997)  Interprofessional Education A Definition.  CAIPE Bulletin. No. 13, 19. CGME 2000  Council on Graduate Medical Education National Advisory Council on Nurse Education and Practice. Collaborative education to ensure patient safety: report to US Department of Health and Human Services and Congress. A Report on a Joint COGME-NACNEP meeting and implications of the IOM Report. Washington, DC: Health Resources and Services Administration, 2000 : 9–18. Finch J, May C Mair F et al 2000  Interprofessional education and teamworking: a view from the education providers.  British Medical Journal 321 : 1138-40. Firth-Cozens J. 2001  Multidisciplinary teamwork: the good, bad, and everything in between.  Quality in Health Care 2001 ; 10 : 65–6. Gibbs, G 1988  Learning by doing: A guide to Teaching and Learning methods EMU Oxford Brookes University, Oxford. 1988 Gough D.A., Kiwan D., Sutcliffe K., Simpson D. Houghton N. (2003).  A systematic map and synthesis review of the effectiveness of personal development planning for improvement student learning  London : EPPICentre, Social Science Research Unit. 2003 Headrick L A, Wilcock O M, Batalden P B. 1998  Interprofessional working and continuing medical education.  British Medical Journal 1998 ; 316 : 771–4 Jackson, N. Ward, R. 2004  A fresh perspective on progress files. A way of representing complex learning and achievement in higher education  Assessment Evaluation in Higher Education Vol. 29 : No. 4, August 2004. Koppel I, Barr H, Reeves S, et al. 2001  Establishing a systematic approach to evaluating the effectiveness of interprofessional education.  Issues in Interdisciplinary Care 2001 ; 3 : 41–9. Laming, Lord. 2003  The Victoria Climbie inquiry: report of an inquiry by Lord Laming.  London: The Stationery Office. 2003 Langhorne P, Duncan P. 2001  Does the organization of postacute stroke care really matter?  Stroke 2001 ; 32 : 268–74. McNair R, Brown R Stone N et al (2001)  Rural interprofessional education: promoting teamwork in primary health care education and practice.  Australian Journal of Rural Health 9 : s19-s26. McPherson K, L Headrick, and F Moss 2001 Working and learning together: good quality care depends on it, but how can we achieve it? Qual. Health Care, Dec 2001 ; 10 : 46 53. Molyneux, J. (2001)  Interprofessional teamworking:what makes teams work well?  Journal of interprofessional care. vol. 15. (1) p29-35. NCIHE 1997  The National Committee of Inquiry into Higher Education (1997) Higher education in the learning society : Report of the National Committee of Inquiry into higher Education  London : HMSO. 1997 OConnor G T, Plume S K, Olmstead E M, et al. 1996  A regional intervention to improve the hospital mortality associated with coronary artery bypass graft surgery. JAMA 1996 ; 275 : 841–6  Palmer 2005  In Learning about reflection from the student Bulpitt and Martin Active Learning in Higher Education. 2005 ; 6 : 207-217.  Parsell G and J Bligh 1998 Interprofessional learning Postgrad. Med. J., Feb 1998 ; 74 : 89 95. Rogowski J A, Jeffrey D. Horbar, Paul E. Plsek, Linda Schuurmann Baker, Julie Deterding, William H. Edwards, James Hocker, Anand D. Kantak, Patrick Lewallen, William Lewis, Eugene Lewit, Connie J. McCarroll, Dennis Mujsce, Nathaniel R. Payne, Patricia Shiono, Roger F. Soll, and Kathy Leahy 2001 Economic Implications of Neonatal Intensive Care Unit Collaborative Quality Improvement Pediatrics, Jan 2001 ; 107 : 23 29. Rubenstein L Z, Stuck A E, Siu A L, et al. 1991  Impacts of geriatric evaluation and management programs on defined outcomes: overview of the evidence.  J Am Geriatr Soc 1991 ; 39 : 8–16S ; discussion 17–18S. Scottish Office (1998)  Higher Education for the 21st Century: Response to the Garrick Report.  London: HMSO. 1998 Taylor, E. (2000).  Building upon the theoretical debate: A critical review of the empirical studies of Mezirow’s transformative learning theory.  Adult Education Quarterly, 48 (1) , 34-59. Van Manen, M. (1997)  Linking Ways of Knowing with Ways of being Practical.  Curriculum Inquiry 6 (3) , 205-228. Yura H, Walsh M. 1998  The nursing process. Assessing, planning, implementing, evaluating. 5th edition. Norwalk, CT: Appleton Lange, 1998. ################################################################ 19.11.06 Word count 3,069 PDG.

The quantitative data analysis

The quantitative data analysis Quantitative data analysis has been an inevitable part of social science research. Like any other discipline, the theories are taught to students to give them an idea and generalisation of social facts and books, journals and other sources are used for the same. However, at times these sources are not adequate and research needs to be done in order to gain a deeper knowledge. That is when quantitative data analysis comes into picture. There have been questions raised on the need to study quantitative data analysis with the emergence of importance of qualititative data (Bryman 1988a), but the formers importance has waned little. It helps that a larger proportion of empirical research that is conducted draws upon quantitative data. The research design for any research study undertaken includes the method that needs to be applied for the purpose of collecting and analysing data. Data collection can be done two ways- primary collection and secondary analysis of data. When the researcher collects data on their own for the sole purpose of the research that they are conducting, they are making use of primary data collection. The procedures used in these collection best suits the research problem at hand. The secondary analysis of data involves collecting data for a different research purpose but that is reused for the present research question. Primary and Secondary Data As explained before, data collected for the specific problem, primary data involves addition of new data to the existing store of knowledge surrounding the research area. When this material is used by other researchers, then this becomes secondary. Hox and Boeije (2005) maintain that the primary data can be used for: Description of contemporary and historical attribute, Comparative research or replication of original research, Reanalysis for the purpose of asking new questions which were not addressed originally, Research design and methodological advancement and lastly for 5. Teaching and learning Secondary analysis utilises the existing data, collected for the purposes of a prior study, in order to pursue a research interest which is distinct from that of the original work (Heaton 2002). Secondary data analysis is usually made of quantitative data where the information is made of researched objects whose characteristics have been coded in variables that can have a range of values. In fact, secondary analysis of quantitative data is common but the practice is not the same when it comes to qualitative data (Hinds, Vogel and Clarke-Steffen 1997). Strengths and Weaknesses Social science researchers undertaking research have a choice of opting to go for primary data- information that they need to collect by themselves or for secondary- searching for data that relates to the research problem in hand. There are distinct pros and cons of going for both. In this section, we will discuss what advantages or disadvantages the researcher faces when using any of these data collection methods. One of the important advantages of going the way of primary data collection is that making use of the theoretical constructs, research design and the data collection strategy can be built with the research question in mind. This will ensure that the research study is coherent and the data collected is distinctly relevant to the problem at hand. A disadvantage lies in the fact that primary data collection can be quite time consuming and expensive affair and considering the limitations of certain research study in terms of time and budget, primary data collection might not be a viable option for many researchers. Another aspect of primary data collection is in its error inducing nature. Sampling errors made by inefficient field workers can skew up the research. Some of the prominent data collection methods in primary data are: experiments, surveys like interviews, mail and web surveys. In the case of the experiment, the researcher is able to have a control on who participates in the research and the research situation being under the researchers control means that there is strong control of design and procedure permitting causal interpretation of the results. Thus the ability to have some control may be a distinct advantage for primary data, however this can turn into a disadvantage too as one might say that the researchers control has made the research artificial. In an experimental laboratory, variables are easily manageable and there is no place for the circumstantial issues that dominate in everyday life. While conducting surveys, the researcher is able to gather both subjective as well as objective characteristics of the population. If interview questions are carefully designed, evaluated and tested, surveys are a very method to obtain first-hand valid responses from respondents. Effectively, this leads us to understanding of the advantage of secondary data analysis. Secondary data is far easier to collect and is less expensive and the access to relevant information is faster. The disadvantage lies in the fact that secondary data was collected originally for a different purpose and therefore might not be optimal for the research problem that is being considered. Heaton points out another argument favouring the use of secondary data analysis stating that it can be used to generate new knowledge, new hypotheses supporting an existing theory and it also reduces the burden that is placed on respondents (for primary data collection) by removing the need to further recruit subjects thus allowing a wider use of data from rare and inaccessible respondents. Not all social research problems can allow the usage of secondary analysis. It has been determined that it is more convenient for certain researchers, namely students and in some cases by researchers re-using their own data rather than by independent analysts. (Szabo and Strang 1997). In their own right secondary data analysis is an effective tool in teaching as it helps in introducing students to a discipline and provides a supplement to the process of teaching (Sobal 1982). But the cons behind using the same are numerous. The researcher will need to locate the source of data that is more relevant to the study and this can be time consuming as pointed out earlier. The researcher should also be able to retrieve the data, which at times can be difficult. Also, the data should be able to meet the quality requirements of the present research. Besides, the reliability of the secondary data is also a major function of the organisation that gathers, organises and publishes the data. Another crippling factor that arises in the use of secondary analysis is that it differs from systematic reviews and the meta-analyses of qualitative studies that aim towards compiling and assessing the evidence relating to a common research concern or area of practice (Popay, Rogers and Williams 1998). An issue that doesnt come in forefront when discussing secondary analysis is the principle of ethics behind using it. In using sensitive data, the researcher cannot assume informed consent. A professional judgement needs to be made about the usage of the secondary data and whether that violates any contract between the researchers and the original researcher (Hinds, Vogel and Clarke-Steffen 1997). Conclusion In conclusion, one may say that there are several advantages and disadvantages of secondary data analysis to collection of ones own primary data, and its usage is best suited to some research issues. But secondary data analysis is a valuable asset as they can act as a model for the collection of primary data. Suffice it to say that there might not be a need to choose between primary data and secondary data analysis at all, as the researcher can easily incorporate both in their research to gain a degree of balance between their strengths and weaknesses. What is most important is that both primary as well as secondary data should be accurate, reliable, appropriate, valid, precise and timely. References: Bryman, A. 1988), Quantity and Quality in Social Research, London: Routledge Heaton, L; Secondary analysis of qualitative data, 2003, in R. Miller and J. Brewer (eds.) The A-Z of Social Research, Sage, pp 285-288 Hinds, P.S., Vogel, R.J., Clarke-Steffen, L. (1997) The possibilities and pitfalls of doing a secondary analysis of a qualitative data set, Qualitative Health Research, vol. 7(3): 408-24. Hox, J.J. and Boeije, H.R. (2005). Data collection, primary versus secondary. in K. Kempf-Leonard (Ed.). Encyclopedia of Social Measurement, pp. 593-599 Popay, J., Rogers, A., Williams, G. (1998) Rationale and standards for the systematic review of qualitative literature in health services research, Qualitative Health Research, vol. 8 (3): pp. 329-40 Sobal, J. 1982, The Role of Secondary Data Analysis in Teaching the Social Sciences, Library Trends, vol. 30, n3, p479-88. Szabo, V. and Strang, V.R. (1997) Secondary analysis of qualitative data, Advances in Nursing Science, vol. 20(2): 66-74.

Efficiency and Web Page Design :: Internet Cyberspace Essays

Efficiency and Web Page Design One of the biggest challenges for web designers today is trying to have a ‘killer app’, yet make it efficient enough for the common surfer. We’re talking about file size. Zona Research (June 1999) reported that 70% of online users were only connected at 56K or less. Granted this number may have decreased a bit in the last 16 months, but the fact is, most people have a slow connection. As a surfer browses through the numerous sites on the web, they want to see the information the site has to offer. Some studies indicate that if you page takes longer than eight seconds for something to start appearing, you will probably lose your visitors. You need to be able to deliver your pages and information in a neat yet efficient manner. There are several factors that cause your visitors to have slow downloads. One might be the network or connection speed they have. They may also have poor performing hardware. Not much you can do about these. Maybe it is your server, it could be upgraded; but more than likely it has to do with your files. The size of the files can be caused by large images, or it may just have inefficient code. In order to decrease the download time we will first look at the code and find ways to make the files more ‘lean’; we want to ‘trim the fat’ and get them in the best condition possible. Next we will look at graphics and ways we can optimize them for maximum performance and minimal download time. Finally there are numerous other hints and tricks that can be added to your code to make them download in record times. Making ‘mean’ and ‘lean’ code Every character and space that appears in your code takes up file size The following suggestions can help you to trim up your files and cut second off your site downloads. Make your file names and directory names simple and short. This may sound trivial, but every little bit counts. For example: or Use relative addressing instead of absolute addressing.

The Turn of the Screw by Henry James Essays -- The Turn of the Screw H

The Turn of the Screw This novel was, surprisingly, interesting. The intensely complex and intricate (if not confusing!) sentences, upon first thought, made me expect an experience of complete, utter, and total confusion; however, they served not only to keep my interest in the novel – for I had to concentrate to grasp the full, rich meaning of his thoughts – but also to create in me a sense of enjoyment, that of being enriched with the experiences of the main character so that my life and that character's became inseparable, only it occurred not only with the main character, but with the entire plot at once – all characters, all scenes (to which I shall come late), all conversations... everything. I have never seen a man so able to express so much in one sentence, and still be able to have the reader follow his thoughts throughout the entire process. Henry James was a master of expression and grammar. His ability to form a complex, yet coherent sentence did nothing but add to the quality of the novel. The characters alone added to the quality of the novel. It is not so much as they were entirely believable, but they were believable to the extent of their being in a ghost story. The things that happened to these poor characters were not natural in any sense, but they were completely acceptable from within a ghost story. Miles, for example, was too beautiful in action, too simple in thought, and too tempting in appearance (for both the governess and Mr. Quint) to be co... The Turn of the Screw by Henry James Essays -- The Turn of the Screw H The Turn of the Screw This novel was, surprisingly, interesting. The intensely complex and intricate (if not confusing!) sentences, upon first thought, made me expect an experience of complete, utter, and total confusion; however, they served not only to keep my interest in the novel – for I had to concentrate to grasp the full, rich meaning of his thoughts – but also to create in me a sense of enjoyment, that of being enriched with the experiences of the main character so that my life and that character's became inseparable, only it occurred not only with the main character, but with the entire plot at once – all characters, all scenes (to which I shall come late), all conversations... everything. I have never seen a man so able to express so much in one sentence, and still be able to have the reader follow his thoughts throughout the entire process. Henry James was a master of expression and grammar. His ability to form a complex, yet coherent sentence did nothing but add to the quality of the novel. The characters alone added to the quality of the novel. It is not so much as they were entirely believable, but they were believable to the extent of their being in a ghost story. The things that happened to these poor characters were not natural in any sense, but they were completely acceptable from within a ghost story. Miles, for example, was too beautiful in action, too simple in thought, and too tempting in appearance (for both the governess and Mr. Quint) to be co...

Enhance Intrinsic Tendon Healing Health And Social Care Essay

To measure the functional result after flexor sinew fix with application of simple postoperative protocols that advice early controlled motion taking to heighten intrinsic sinew healing, minimising adhesion formation, and therefore bettering the functional result. METHODS. These survey was between June 2005 and May 2008, as a prospective survey that included 225 instances with flexor sinew hurts. All the injured sinews were repaired utilizing the Modified Kessler ‘s technique, so splinting of the carpus and metacarpophalangeal articulations was done in 20 and 40 degree flexure severally, and dynamic splinting of fingers was done. Early motion was induced get downing from the first postoperative twenty-four hours with hurting control. Evaluation of the result was assessed by the manus clasp strength and by mensurating the sum of active flexure of proximal and distal interphalangeal articulations. RESULTS. 11 patients did n't go to for follow up and were excluded from the concluding analysis. 205 patients out of 214 ( 95.8 % ) achieved an first-class to good functional class in the concluding result, while 9 patients ( 4.2 % ) achieved a just to hapless result. Merely 3 patients experient tendon rupture ( 1.4 % ) . Average follow up period was 5.2 months. CONCLUSION. The usage of proper technique for fix of flexor sinews of the manus, followed by early controlled motions as a method of pick that on scientific background should heighten intrinsic sinew healing is ; executable, safe, and has a good functional result.Cardinal words: flexor tendon – hurtIntroductionThere are many different protocols and research attacks to tendon direction. With so many picks, today ‘s manus healer must understand non merely what those picks are, but besides why and when to utilize them. The most of import difference between the assorted attacks to mend postoperative digital flexor sinew, is rehabilitation and how the repaired sinew is treated during the first three to six hebdomads, in the earliest phases of mending. The specializer who does non understand how current techniques evolved is ill-equipped to plan the appropriate intervention for a given patient ( 1 ) . Tendon fix began to be accepted on 1752, when Albercht Von Haller, a Swiss research worker concluded that sinewy construction was insensitive to trouble. In 1959, Verdan described the zones of flexor tendon fixs of the manus. In 1967. Potenza studied tendon mending based on extrinsic fibroblastic invasion and proliferation with adhesion formation. Lundborg explored intrinsic sinew mending based on synovial fluid nutrition. Strickland, Manske, Gelberman, and others studied the delicate balance between mending and tendon gesture, with respect to growing factors, fibronectin, the ration of extrinsic to intrinsic sinew healing, tendon sutura techniques, strength of fix, and the consequence of early active postoperative gesture on result ( 2 ) . The contentions in tendon fix may be as follows ; in the initial phases of sinew healing, the formation of functionally weak tissue can non defy the tensile forces that allow early active scope of gesture, and so, there is a hazard of rupture of the fix. In the same clip, immobilisation of the figure may advance healing, but necessarily consequences in the formation of adhesions between the sinew and tendon sheath, which leads to clash and decreased glide. Besides, lading during the healing stage is still critical to avoid these adhesions, but once more, it involves an increased hazard of rupture of the repaired sinew. It is clear that understanding the biological science and organisation of the native sinew and the procedure of morphogenesis of tendon tissue is necessary to better current intervention modes ( 3 ) . In our work, we managed flexor sinew hurts ; by one of the most popular sinew fix methods ( modified Kessler technique ) , so leting for early passive and controlled early active motion of the figures taking for heightening the intrinsic sinew healing and minimising adhesions formation, therefore giving the best opportunity for an first-class functional recovery for the repaired sinews.Flexor Tendon AnatomyThe flexor sinews of the carpus, flexor wrist radialis ( FCR ) and flexor wrist ulnaris ( FCU ) are strong and thick sinews, while the flexor pollicis longus ( FPL ) has a distal musculus belly. The flexor sinews of the fingers are arranged into three beds ; flexor digitorum supericialis ( FDS ) sinews of the center and ring fingers are most superficial ; superficialis sinews of the index and small fingers are in the center, while the deepest bed is composed of the FPL and the four sinews of the flexor digitorum profundi ( FDP ) . There is frequently a tendon faux pas from the FDP of the index to the FPL, which may necessitate deletion to forestall post-surgical complications ( 4, 5 ) .Clinical Tendon Zones of VerdanThese zones are used to depict flexor tendon hurts of the manus and carpus ; Zone I: extends from the finger tip to the midportion of the in-between phalanx ( the Green Zone ) . Zone II: extends from the midportion of the in-between phalanx to the distal palmar fold ( No-Man ‘s Land or the Red Zone ) . Zone III: extends from the distal fold to the distal part of the transverse carpal ligament. Zone IV: overlies the transverse carpal ligament ( carpal tunnel ) . Zone V: extend from the carpus fold to the degree of the musculotendinous junction of the flexor sinews. Zones III, IV, and V constitute the Yellow Zone ( 6 ) .Pulleys ‘ systemPulleies are inspissating along flexor sheaths lined with synovial membrane. They improve biomechanics of flexor sinews by forestalling bowstringing of sinews during flexure. Fingers have 5 annulate blocks and 3 cruciate blocks. Annular blocks are A1 at metacarpophalangeal articulation ( MPJ ) , A2 over the proximal phalanx, A3 at the proximal interphalangeal articulation ( PIPJ ) , A4 over in-between phalanx, and A5 at the distal interphalangeal articulation ( DIPJ ) . A2 and A4 are the most of import to forestall bowstringing. Cruciate blocks are between the annulate blocks, they are thinner and less biomechanically of import than annulate blocks. The pollex has 2 annulate blocks ; A1 at MPJ, A2 at interphalangeal articulation, and one oblique block, which is an extension of adductor pollicis fond regar d that lies between A1 and A2 and it is the most of import pollex block to forestall bowstringing ( 7 ) .Nutrition of Flexor sinewsTendons have two beginnings of nutrition, an internal beginning provided by vascular perfusion, and external beginning provided by synovial fluid ( 6 ) . Tendons without synovial sheath receive blood supply from longitudinal anastomotic capillary system, that receive segmental blood supply from ; Vessels in the perimysium and vass at the bony interpolations. The beginning of foods for the flexor sinews with synovial sheath is either ; vascular perfusion and synovial fluid diffusion. The segmental blood supply of the sinews is from vass from muscular subdivisions in the forearm, vass in the environing connective tissue via the mesotenon conduit â€Å" vincula † , vass from the bone, at the interpolation, and vass from periosteum near interpolation ( 8 ) . In the last decennaries, many surveies of synovial perfusion of the flexor sinews within the synovial sheath have been done ( 9 ) . Studies demonstrates that synovial fluid perfusion was more effectual than vascular perfusion, so when the sinew was isolated from its vascular connexions, diffusion could supply the entire nutrition demands to all sections. Synovial diffusion besides contributes in sinew healing as the longitudinal sinew vasculature may be easy occluded by suturas, therefore sheath fix or Reconstruction is indicated.Tendon MendingThree stages of sinew healing are present ; Inflammatory stage ( first hebdomad ) , Proliferative stage ( 2nd-4rth hebdomad ) , and Remodeling stage ( 2nd-6th month ) . Tendons exhibits two types of healing, with different ratios. Extrinsic healing: Fibroblasts migrate from the sheath into the injured site, and besides from adhesion. This type healing is enhanced by postoperative immobilisation ( 7 ) . This explains why immobilisation protocols to reconstruct tendon congruousness consequence in cicatrix formation at the fix site, instead than a additive hempen array, and peripheral adhesions that limit tendon motions ( 10 ) . Intrinsic healing: Tendon cells can migrate across closely approximated terminals and heal with foods from synovial fluid. Peripheral adhesions do non take part in intrinsic sinew mending. Although some writers believed that adhesions formation is indispensable in sinew healing, several surveies demonstrated the intrinsic ability of flexor sinews to mend via foods supplied by diffusion from the synovial fluid ( 11 ) .Patients AND METHODSThis prospective survey was performed in the Emergency Unit, Kasr Al-Aini Hospital ( Faculty of Medicine, Cairo University ) in the period between 6/2005 and 5/2008. Table ( 1 ) shows the human ecology of the included patients. The figure of instances included was 225 instances enduring from flexor sinew hurts in zones I, II, III, IV, and V, but 11 instances were excl uded from the concluding analysis as they were non present during the follow up period ( table 2 ) . Included instances were instances with flexor sinew hurts showing within less than 24 hours from the hurt. Exclusion standards were ; kids below 12 old ages for expected bad conformity, late presentation, infected, contused and crushed lesions, and shocked poly-trauma patients.Table ( 1 ) Demographic distribution of patientsNumber of patients214Sexual activity ( Male & A ; Female severally )153 ( 75 % ) & A ; 61 ( 25 % )Age in old agesBetween 12 and 63 old agesManual Workers122 ( 60 % )Table ( 2 ) Distribution harmonizing to zone hurtsZone I injury33 ( 15 % )Zone II hurt48 ( 22 % )Zone III hurt36 ( 17 % )Zone IV hurt38 ( 18 % )Zone V hurt59 ( 28 % )Entire214 First assistance was done for every instances, including guaranting of equal general position of the patients ( airway, take a breathing, circulation ) , followed by IV analgesia, IV antibiotics ( individual dosage of 3rd coevals cephalosporine ) , booster dosage of antitetanic anatoxin was administrated. Clinical appraisal of the manus hurt ( vascularity, diagnosing of injured sinews and associated injures ) . The lesion was washed by unfertile saline, bovidone I, IV explored under either general anesthesia or IV Bier ‘s block, and a pneumatic compression bandage was indispensable portion in all instances ( with monitoring of the tourniquet clip ) . Minimal handling of the sinews was deliberately done. Tendons were repaired by nucleus suturas by modified Kessler ‘s technique utilizing 4-0 polypropene suturas and peripheral suturas. The carpus was splinted in 20 grade of flexure, and metacarpophalangeal articulation at 40 grade of flexure. Dynamic splint was applied to th e fingers utilizing rubber bands. Early passive and active motions were done with the control of hurting. Motions started from the first postoperative twenty-four hours, hourly, for 10 repeats of active extension and flexure of fingers while the manus is in the splinted place, and passively the DIPJ is so to the full flexed. Curative ultrasound was applied for 19 instances to heighten intrinsic healing. Follow up was done twice hebdomadally for one month, and so weekly for two months, so every month. Follow up ranged between 6 months and 18 months.ConsequenceFrom the 225 patients, 11 patients did n't go to the follow up period and were excluded from the concluding analysis. All the included patients continue with the follow up for at least 3 months, while merely 193 completed a period of follow up of 6 months. So, the concluding analysis was based on consequences recorded after 3 months of follow up. Average follow up period was 5.2 months. Evaluation of the result was based upon manus map, and this is the of import issue in tendon fix, and besides it is impossible to measure the sum of intrinsic healing to the sum of intrinsic healing in a life homo. So, the consequences of the fix were assessed by clinical rating of sinews ‘ map. This was done by measuring the manus clasp strength and by proving for the sum of active flexure of the distal interphalangeal articulations and proximal interphalangeal articulations, so deducting the sum of active extension shortage at these articulations during active extension. The consequences were graded as Angstrom: excellent ( & gt ; 132 grade entire gesture ) , B: good ( 88- 131 grade ) , C: just ( 44- 87 grade ) , and D: hapless ( & lt ; 44 grade ) . In patients with multiple flexor sinew hurts, the norm of the concluding functional result of all sinews was done. Concluding manus clasp strength norm was 80 % in comparing to the un-injured manus, with 15 % shortage, that is after taking in history the 10 % regulation. In measuring the concluding result, 205 out of 214 ( 94.1 % ) achieved an first-class to good functional class ( A or B ) , while 9 patients ( 4.2 % ) achieved a just to hapless result ( C or D ) . Functional result of grade C or D was related more to district II hurt ( 4 instances, stand foring 8.3 % of zone II hurts ) . The other 5 instances of grade C or D functional result were as follows ; two instances of zone I, two instances in zone V and a individual instance in zone IV. That ‘s average 6 % of hurts in zone I, 3.4 % of hurts in zone V, and 2.6 % of hurts in zone IV. All instances of zone III hurt had either rate A or B functional result. Minor complications related to the tegument lesion and that did non impact the concluding result occurred in 12 patients ( 5.6 % ) , that ‘s including mild wound infection that was self-controlled, haematoma that may hold required aspiration, hypertrophic cicatrix in which Si spot was applied, and an disciple cicatrix occurred in individual patient. Entire failure of the fix occurred merely in 3 patients, whom experienced tendon rupture ( 1.4 % ) and necessitate re-suturing ( two instances in zone II and one instance in zone I, and concluding result of such instances was added to the old consequences ) .Table ( 3 ) Final result harmonizing to the injured zone.Injured zoneEntire figureExcellent- Good resultFair- hapless resultZone I( Green ) 33 ( 14 % ) 31 ( 93.9 % ) 2 ( 6.1 % )Zone II( Red ) 48 ( 23 % ) 44 ( 92.7 % ) 4 ( 8.3 % )Zone III( Yellow ) 36 ( 17 % ) 36 ( 100 % )––Zone IV( Yellow ) 38 ( 18 % ) 37 ( 97.4 % ) 1 ( 2.6 % )Zone V( Yellow ) 59 ( 28 % ) 57 ( 96.6 % ) 2 ( 3.4 % )Entire214 ( 100 % ) 205 ( 95.8 % ) 9 ( 4.2 % )DiscussionTreatment of sinew hurts is an of import portion of manus surgery pattern worldwide. Adhesion formation, rupture of the fixs, stiffness of finger articulations, remain the chief jobs of primary sinew fixs. Tendon hurts happen in all parts of the manus and forearm, but the sinew hurts in the digital flexor sheath country ( zones 1 and 2 ) are the most hard to handle and stay a focal point of both clinical attending and basic probes ( 12 ) . There is now ample grounds to confirm several of import facts. As an illustration, intrasynovial sinews receive their nutrition via both intrinsic vascular supply and perfusion of synovial fluid. This means that the sinews do non necessitate to organize adhesions to environing sinews to have nutrition adequate for mending ( 1 ) . In our survey, we designed a program for mending injured flexor sinews that was wholly based on the background known from the physiology of sinew healing. We included instances in which we could execute primary sinews fix, as there is no uncertainty that primary sinews repair gives better functional recovery than secondary tendon fix or transplant ( 13 ) . In respect the timing of fix, Swiontkowski, 2001 ( 6 ) stated that acute sinew hurts require pressing attention, ideally within 24 hours of hurt. Zidel, 2007 ( 4 ) considered that primary fix can be done within 24 hours and considered delayed primary fix with the 1st twenty-four hours up to the fourteenth twenty-four hours. In our survey, we included instances that were showing to the exigency unit within less than 24 hours. Assortment of methods may be used for tendon fix, but the modified Kessler fix is still widely used for the nucleus sinew sutura ( 14 ) . Besides, modified Kessler fix is a good illustration of high-strength, low-friction fixs that minimizes clash between the sinew and flexor sheath while keeping sufficient strength to the fix ( 15 ) . We used the modified Kessler fix in all of our instances as the criterion nucleus sutura in add-on to peripheral suturas. Managing sinews was atruamatic to minimise mobilisation as possible during readying, and suturas were preferentially placed nearer to the palmar surface to least interfere with intratendinous circulation that enter dorsally. Appropriate direction of tendon sheath and block is concern of manus sawboness in covering with tendon hurts in digital sheath country. Suturing the sheath is controversial. Avoiding compaction of the repaired sinew by the tightly closed sheath is considered of primary importance in handling the injured sheath ( 16 ) . Closing of the synovial sheath is still controversial. Some writers mention that it is indicated, based on the fact that since intrinsic sinew vasculature is easy occluded by suturas and so, synovial nutrition may be required for mending ( 8 ) . In other ‘s sentiment, it is no longer considered indispensable ( 17 ) . Based on the fact of that the synovial nutrition has a function in tendon healing and that it may be plenty for mending even without the demand of intrinsic sinew vasculature, the sheath was sutured in all instances, taking for heightening intrinsic sinew healing and therefore minimising adhesions ( 18 ) . Our direction protocol for the block was as prescribe by Tang, et Al, 1996 ( 19 ) , which is the saving of a sufficient figure of blocks is critical to tendon gesture. Loss of an single annular block ( including a portion of A2 block or the full A4 block ) when other blocks are integral does non ensue in loss of map. Therefore, loss of a individual block ( A1, A3, or A4 ) or a portion of the A2 block does non necessitate fix. In instance of sinew fixs within narrow A2 or A4 blocks, some sawboness advocate venting a portion of the A2 or full A4 block to let go of the compaction of the repaired sinews ( 20 ) . Postoperative sinew gesture exercising is popularly employed after primary sinew fix, but exact protocols for rehabilitation vary greatly among states or even among manus surgery centres in the same state. Protocols for inactive flexure ( active extension of the fingers with gum elastic set grip ) are still in usage in some manus units. However, over the last 5-10 old ages, there has been a tendency towards combined active-passive finger flexure without gum elastic set grip, because gum elastic set grip bounds full extension of the finger ; while extension loss is a frequent complication ( 21 ) . In Duran and Houser, 1975 protocol, a dorsal splint or dramatis personae holds the carpus in 20 grades of flexure and the finger in a relaxed unspecified place of protective flexure by agencies of a gum elastic set attached to a sutura through the fingernail, to maintain the sinew on slack. Two times a twenty-four hours, the patient performs six to eight repeats of two exercisings. Both exer cises push flexor sinews proximally and so draw them distally: inactive flexure and extension of the DIP articulation while the PIP and MP are held in flexure, and inactive flexure and extension of the PIP while the DIP and MP are held in flexure. Through intraoperative observations, it was observed that these exercisings imparted 3 to 5 millimeters of inactive semivowel to the sinew, and they considered this to be sufficient to forestall formation of restrictive adhesions. Strickland and Glogovac, 1980 introduced the modified Duran attack which is in usage by many healers today: a dorsal splint holds the carpus and MP articulations flexed, and the interphalangeal ( IP ) articulations are strapped in extension between exercising Sessionss. The original Duran exercisings are supplemented by composite inactive flexure and active extension every bit far as allowed by the splint. Both logic and clinical surveies tell us that including composite inactive flexure will bring forth greater inactive flexor sinew motion. Some of the best consequences with an early inactive mobilisation protocol are in patients who unwittingly or consciously flex their fingers actively. This makes great sense logically. Passive flexure efforts to force the sinew proximally, but the sinew is designed to draw, non to force. Edema is a normal portion of mending after fix, even if the sinew is cut flawlessly, with minimum hurt to next tissues, and is repaired efficiently and good. Any fix is bulkier than an uninjured sinew. Any associated hurt will bring forth extra hydrops. All of these factors produce opposition to tendon motion. Some have noted †buckling † of the sinew instead than gliding with inactive motion. Obviously, carefully controlled active flexure should bring forth greater sinew motion than does inactive flexure. These active mobilisation protocols are possible merely because of the development of surgical techniques. It is good established that the strength of the nucleus sutura is related to the figure of strands traversing the fix ) and that a strong peripheral sutura both improves gliding and additions suture strength ( 22 ) . In our survey, farther direction was based on the fact of that early mobilisation will heighten the intrinsic healing of the sinew, minimizes adhesions, stiffness, and therefore minimizes the restrictions of motion. And in the same clip, immobilisation helps extrinsic sinew healing and adhesion formation. So, we splinted the carpus in 20 grade of flexure and MPJ at 40 grade ( 23 ) , we planned for dynamic splinting of involved figures with early passive and active but controlled gestures to avoid possible jobs related to early motion such as rupture of the repaired sinew. Controlled active motion ( CAM ) after flexor sinew fix was advised by several writers since the last decennaries till now ( 24, 25, 26, 27, 28 ) . We found that the CAM protocol that was described by Elliott, 2002 ( 23 ) easy to be described to and to be applied even by the patient him/her ego. The protocol starts the CAM from the first postoperative twenty-four hours, every hr for 10 repeats active extension and f lexure of fingers while the manus is in the splinted place, and passively the DIPJ is so to the full flexed. In our application, we waited till postoperative hurting subsided during which the patient may be hospitalized as describe besides by Elliot, et Al, 1994 ( 29 ) . The usage of Postoperative curative ultrasound from the fifth twenty-four hours, was done for a limited figure of instances, taking of cut downing hurting during finger motion, cut downing hydrops, and heighten ripening of the collagen fibres and intrinsic sinew healing. That was based on the survey done by Gabriel and Dicky, 2007 ( 30 ) who used curative ultrasound on sinew Achilles. In decision, immediate active mobilisation following fixs of complete subdivisions of the flexor sinews is, at present, a challenge in manus surgery which faces two major faltering blocks.. On one manus, sawbones has to obtain a sufficiently solid fix to allow active finger flexure and, on the other manus, to find a sector of mobilisation which would let maximum jaunt of the fix site without extra hazard of early rupture ( 18 ) . The tensile strength and glide maps are greater in the postoperatively mobilized sinews, whereas adhesion formation is greater in immobilized sinews ( 11 ) . We found our protocol is a safe, simple, scientifically accepted protocol and gives an first-class functional consequences for a repaired sinew with no or at least minimum morbidity.

Receptive and Expressive Language in the Classroom Setting Essay

Receptive or expressive language plays a significant role in a typical lesson plan. The efficiency and success of a lesson plan, when implemented in the classroom, is partly dependent on the communicative skills and responsiveness of the students. The lesson plan contains all the learning objectives, activities, and learning outcomes that must be completed by the teacher and the students within a given period of time. In addition, the lesson plan is designed to produce learning and desirable results from the students, as well as the teacher. For this to happen, there is a need for students to apply receptiveness and expressiveness in language. For instance, if the teacher presents the lesson, the students should be receptive or in other words attentive and focused to be able to understand the information presented to them and retain it in their minds. For the teacher to evaluate whether learning took place within the classroom, the students should be able to express and communicate what they have learned through formative tests, and other evaluation techniques administered by the teacher. Students who are not receptive and expressive enough would find it difficult to participate in classroom activities because they may not be able to understand the lesson or they cannot express or communicate their difficulties during the learning phase, thus resulting to unfavorable results during evaluation. When this happens, this means that the lesson plan failed in meeting its objectives of affecting learning and desirable results within the students. For students with communication disorders, it would be best to put them in special education programs that are specifically designed to meet the unique needs of students who are deprived of communication skills. Other alternatives would be to include them in the regular classroom setting, however, making sure that teaching aids and specialized techniques (ex. sign language, mechanized communication programs available through the use of computers, etc. ) are provided and implemented for them to facilitate learning and desirable results despite their condition.