A reflective essay to reflect the feeling of pulse taking and tongue reading Essay Example for Free

A reflective es plead to reflect the feeling of pulse rate taking and language reading Es enounceOne of the soonest references to pulse diagnosis appears in the Huangdi Neijing, also known as The Yellow Emperors Internal Classic or The Yellow Emperors Classic of Internal Medicine. A going in the book notes that, In diagnosis, observation of the spirit and facial color, and palpation of the pulses, are the two methods that were emphasized by the ancient emperors and revered teachers, which implies that the practical hold of pulse diagnosis existed long before the Huangdi Neijing was written. Pulse and spit diagnosis are two of the more important diagnostic puppets in Chinese medicine. They are two utilize to derive a TCM diagnosis for your groom which is used to plan your treatment. Of the diagnostic tools, pulse diagnosis is one of the more important tools used in Chinese acupuncture and herbal medicine. While barbarism diagnosis provides valuable clinical informat ion, the pulse laughingstock be used to gain a deep understanding of the enduring on many levels. Pulse diagnosis is the ancient art and science of detecting status of a persons automobile trunk, mind and spirit. rase at basic levels, the pulse provides immediate and specific information that preserve servicing clarify contradictory diagnostic information and symptomology .The pulse can be influenced by factors like age ,in this case the enduringness and quality of the pulse will decline as a person ages ,or gender , Men are generally stronger on the left and Women are generally stronger on the right. Another factor is the season when you gull a more wiry pulse in Spring time ,stronger in the Summer and deeper in the Winter. Tongue and pulse diagnosis are both used to derive a TCM diagnosis for your condition which is used to plan your treatment. Generally the tongue, is much easier to learn and less subjective than pulse diagnosis. It is less meridian specific than the pul se, however, the tongue will show the noesis and nature (hot, cold, etc.) of an imbalance and it is less effected by short-term influences such as nervousness. The tongue is also useful as a measurement tool to gauge the progress of a disorder. I believe the TCM is about energy and energy function conditionmedicine culture, it is more than construction medicine culture, the pulse diagnosis is a energy feeling diagnosis, no only a stead touch feeling diagnosis. In an ideal situation, the pulse is taken in the morning while the person is still calm and rested.In actuality, however, the procedure usually takes place in the clinic during the initial interview. It is important to let patients who have moreover arrived rest for a while to allow the pulses to settle down. Otherwise, it would be easy to mistake a rapid pulse for a heat condition when it is in reality due to the persons hurrying to make the appointment. This is one situation when sitting in the waiting room is to the pa tients advantage. From my personal experience in the clinic I can say some of the patients find pulse taking strange (on the first session) and also they give earm to be a little bit uncomfortable when you direct to see their tongue. The pulse can be felt in a number of locations, the primary location is at the radial-ply tire artery in the carpus. Each wrist has three positions that correspond to different variety meat. The left wrist corresponds to the heart, liver , and kidney yin .The right wrist gives information about the lungs, spleen , and kidney yang . In clinical practice, we have to continuously combine the pulse information with the whole picture derived from looking, listening, smelling, and asking.Through this process, traditional Chinese practitioners are able to accurately diagnose the patterns of imbalance in their patients without the help of laboratory tests or expensive diagnostic equipment. To make the patient feel more comfortable when the pulse is being take you must ensure you slip in yourself to the patient, explain the procedure answering any questions they may have, ask for their consent and also make sure they are sitting comfortably, with their arm rested. Sometimes what the patient says contradicts the pulse qualities, in which case the acupuncturist will want to ask more questions to get at the truth. Without the pulse diagnosis he wouldnt have known to ask more questions, to delve deeper, and might have done the wrong treatment. If the patient is taking medication, or just been taking strenuous exercise, pulse taking may not work. If the patient is under the influence of social drugs it may not reveal much. Some patients have arteries that travel on the thumb side of the radial bone so you cant feel the pulse in the normal position. Some patients have pulses so small (itself a pointer to their health) that they are genuinely hard to take. Thepulse quality often changes within a few seconds of inserting the needle in the right place.As the right treatment progresses, the pulse qualities and strength improve, so that the acupuncturist knows, from pulse diagnosis, that the patient will start feeling better soon. There are three positions a practitioner is looking for, and each position represents a different organ or part of the body. This is the reason we take the pulse on both sides, not just one. By taking the pulse, we can tell if patients eating habits are good, if they have a cold coming on, and if their energy is high or low. We can also take note of how your organs are functioning at that time. The tongue has a special relationship with the Heart, in that the Heart opens to the tongue. The tongue is said to be an offshoot of the Heart, or flowers into the Heart. The tongue, containing water, electrolytes, mucus, and enzymes, is a very sensitive organ and its appearance changes with many physical changes in the body.In Chinese medicine, the tongue is a map of the internal body. Like the face, the tongue is divided into five-element zones that correspond to your internal organ networks. The tongue reading its all about finding what areas are stagnated, which need to be nourished, which are getting too much circulation or too little circulation, too much energy or too little, and how to balance out the body so that everything is in harmony. When we use the tongue as a tool for analysis and diagnosis, we are looking at the shape, shadings, markings, wetness, texture and even the way someone sticks out her tongue. Having this knowledge can help describe the current state of a patient health, as well as his or her genetic tendencies. It is a diagnostic technique, and it can reveal an existing disease process and disclose many things about a person on many levels. All the organs and the entire body can be located on specific regions of the tongue.The beauty of tongue diagnosis is in its simplicity and immediacy. Benefits of tongue diagnosis include assesses a persons current health condition informs the practitioner about the underlying cause of disease is an accurate way of determining what is happening in the digestive system liver, stomach, spleen, small and large intestines reveals the stage and progression of a particular illness reflects the quality of the circulation of blood, bodily fluids and essence mirrors the condition of the bodily fluids, function of the organs, strengths and foresight of the pathogenic factors in thebody shows the quality of the individuals energy production.A normal tongue should be pink, muscular without tooth marking or discoloration, and have a very thin clear coating that exhibits proper salivary secretions. Tongue diagnosis is more objective than pulse diagnosis, though pulse diagnosis takes a long time to master, while basic tongue diagnosis can be taught in a short period of time. Before examining the tongue for diagnosis, make sure the patient has not eaten pickles, cayenne pepper, curry and other hot things. Th ey will temporarily turn the tongue red. It takes a few hours for the tongue to get its normal coat back after the person has scraped it as well. And smoking turns the coat yellow.From my personal experience in the clinic I can say its common to see thick tongues, purplish tongues, tongues with teeth marks in them and tongues with cracks in various places. I also have noted tongues with coats both white and yellow, sticky and thin. Primarily a preventive discipline, acupuncture, especially through pulse diagnosis, the acupuncturist can detect disturbances in the qi at the earliest manageable stage, before disease develops and restores balance through acupuncture treatment and herbs.References www.acupuncture.comwww.yinyanghouse.comWalsh S. King, E. (2007) Pulse diagnosing . Churchill LivingstoneChen, J.X. (2007) Chinese Medicine Study Guide Diagnostics .Pulse Diagnosis .Dupler D. In Krapp K, Long JL (eds.) Gale Encyclopedia of Alternative Medicine. Farmington Hills, MI Gale Group, 2001Tongue Diagnosis in Chinese medicine by Giavanni Macciocia

Canadian forests Essay Example for Free

Canadian forests EssayGary Paulsons Hatchet is set in Hampton, New York, but mainly in the north Canadian forests, in particular a region known as the Canadian Shield. The main characters of the invention argon Brian Robeson, the protagonist, a thirteen year old boy his parents and two pilots, one of whom flies Brian into north Canada before giving up the ghost at the controls, and the second pilot who rescues the young boy stranded in the wilderness.The main events of the novel revolve around Brian, who travels by airplane, Cessna 406, from his hometown, Hampton, New York, to visit his father who is workings as a mechanical engineer in a Canadian oil field. The young boys parents are divorced, and this is the first summer that Brian is passing game to spend with his father after the divorce. Brian travels as a single passenger in the airplane, before the pilot of the plane dies of a heart attack difference the young boy to crash land the airplane all by himself.The plane la nds in an isolated lake somewhere in the north Canadian forests. And, Brian possesses cipher to face the tragedy, except a hatchet that his mother had presented to him before his departure. The hatchet thus becomes the boys tool for survival in the wilderness. He mustiness figure aside how to make fire by striking the hatchets blade a growst a rock. He must also figure out what to eat in order to survive. Moreover, he must deal with unusual circumstances such as the presence of a bear, a porcupine, a moose, a skunk, in addition to a tornado.Eventually, the boy learns to hunt and fish after making special tools for himself. The events proving Brians ability to manage himself in the wilderness are very important in the novel. The last major event occurs after a violent storm that hits the forest and tosses the wreckage of the airplane to the land surface. The teenager manages to see to it into the airplane to recover the survival pack. He finds a transmitter in the pack, which, up on activation, connects him to a pilot who finally comes to rescue him in an airplane.The main conflict in the novel is between Brian, the protagonist, and nature, the antagonist. The young boy must find a way to overcome the unusual circumstances he finds himself in. He must difference of opinion against threats posed by wild animals as well as natural disasters. Similarly, he must fight against his own natural tendency to give up in the face of the difficulties that confront him. Another conflict presented in Hatchet is between Brians natural, emotional weakness and the strength that he needs to gain emotional freedom.The boy knows a Secret about his mother that had led to his parents divorce. Time and again the Secret confronts him with emotional distress. Yet, Brian must learn to let go of the distress and face the challenge of accepting his circumstances as they are. The novel thus deals with maturity the theme of growing up from boyhood to manhood. Brian has no human univer se to rely on at the time that he is stranded in the wilderness. Yet, he must face all sorts of dangers to find his way out of his troubles, both emotional and physical.The major strength of the novel is that Brian succeeds despite all odds, using his intelligence as best as possible. He finds his way out. Hence, his story becomes a lesson for all teenagers who may or may not face the kinds of challenges that Brian faces. The story is also recommended for young readers of fifth and sixth grades, who are sure to be providential by Brians mettle of strength and endurance. As a matter of fact, even adults may be able to remind themselves about the resilient, surviving spirit of humanity by reading Hatchet. Thus, the novel may be recommended for all readers.

Impact Of Cardiopulmonary Resuscitation Education Use Of Difibrillator Nursing Essay

Impact Of cardiorespiratory Resuscitation Education Use Of Difibrillator Nursing EssayPoor knowledge and skill retention following AED and cardiopulmonary resuscitation planning for nursing and other medical staff has been observed. Resulting of the increasing of the mortality rate CPR and AED reading argon central for nursing staff and is historic as the nurses a lot are the commencement witness for the victim with cardiac freeze in hospital great dealting. The come to the forecome of teaching approach is necessary to smash the knowledge and skill of the nurses and other medical team that increase the survival rate.AimThe aim of this literature revue was to describe teaching approaches for cardiopulmonary resuscitation precept in relation to acquired skills and knowledge in the utilize up of an machine-controlled out-of-door defibrillation in a cardiac drive away blot in a clinical setting.MethodThe authors sport selected a literature review for this study and k ey discussion that employ are Cardiopulmonary resuscitation and prepa balancen, nursing, continuing, cardiopulmonary resuscitation, nursing skill and reading and cardiopulmonary resuscitation. Papers published twain month ago since 04-2011 from m either sources, such as books and Pubmed database including 10 years period. Those published paper in English language which covers strategies to improve the knowledge and skills of the nurses and other medical staff in cardiopulmonary resuscitation and automatise external defibrillation using. In addition manual re take care has been use to get more information.ResultThere are many contrary teaching approaches groundwork be used in cardiopulmonary resuscitation and automated external defibrillation sending such as Digital Video Disc without manikin, DVD with manikin with scenario, confederate tuition and instructor facilitated methods which the best method. The quality of development in cardiopulmonary resuscitation and auto mated external defibrillation training croup be affected by the type of teaching approach which has been used. The education and refreshment of cardiopulmonary resuscitation and automated external defibrillation training can enhance skill and knowledge of nursing staff and give self confidence during resuscitation time and in using automated external defibrillation, which can lead to increase the survival rate and improve the quality of long-sufferings manner.ConclusionNurses in hospital setting who seldom encounter cardiac arrest, should received automated external defibrillation and cardiopulmonary resuscitation training to avoid time delays in resuscitation. Staff should be evaluated by using manikin with feedback system and adept instructors to ensure the quality f chest compression are satisfied at the time of training. The availability of resuscitation training equipment in unit and ward can enhance the nursing staff for self education and refresh their skill and knowledge .INTRODUCTIONEach year in United States of America there are 325,000 victims of sudden cardiac arrest. The mortality rates due to cardiac arrest are frequently observed in some of need situation, which is most often the result of ventricular tachycardia (VT) according to Mosesso, Shapiro, Stein, Burkett, Wang (2009). Moreover, cardiovascular attacks cause unmatched third of all deaths in the world today (Lindstrand, Bergstrm, Rosling, Rubenson, Stenson Tylleskr, 2010).The nursing staffs are often the first witness for cardiac arrest in a hospital setting (Dwyer, Mosel, 2002 Gombotz, Weh, Mitterndorfer Rehak, 2006). Moreover, the nurses are more efficient in training of automated external defibrillation (AED) as stated by Xanthos et al.2009. Bardy et al (2008) point out that due to the way outiveness of automated external defibrillation, it becomes recommended in public places such as public places are airports, schools, restaurants, planes, and crowded places. Furthermore they recommend that the AED machine is red in color with instructions for use. In spite of the effectiveness of AED in cardiac patients, a punter understanding and knowledge about the use of AEDs is required (Hancock, Roebuck, Farrer Campbell, 2006 Martinez-Rubio, et al.2003).Therefore, the authors see a need to explore how Cardio-Pulmonary Resuscitation (CPR) education can enhance and improve nursing skills and knowledge in the use of AED in order to reduce mortality rate in cardiac patients.BACKGROUNDAutomated external defibrillationwww.priceit.inAED is an electronic devise which has two paddles sternum and apex which can help to deliver the shock to the heart of the patient. This machine has been created and upgraded to convert the VT and ventricular fibrillation (VF) to sinus normal heart rhythms, which are the most emergency situation that needs immediate medical intervention (Anas, Lee, Hasan, 2010). Moreover AED whitethorn be used in hospital setting or out of the hospital sett ing (Nettina, 2001). Winkle (2010) stated that around 250 000 victims are dying in United States of America every year caused by cardiac arrest 40% are resulting of VF.Therefore medical staff must be aware ,trained in using AED to enhance the quality of life of cardiac arrest patient. However, using this machine needs medical education and knowledge as stated by (Ammirati et al.2011).As mentioned above Brown, Rittenberger, Ammon, Harrington Guyette (2010) stated AED can have affect only in shockable rhythms interchangeable VF.Types of automated external defibrillationThere are two types of AED Monophesic which gives (360 joules) and the secound type is Biphasic which gives 150-200 joules (Sraj, 2005).The different between the two types according to (Sraj, 2005)FeatureMonophesicBiphasicDirection of the mensesMoves in one direction only from paddleMoves in both direction (first positive direction then in milliseconds in a prejudicious directionJoulesForm 360150 (Some machines can go up 200)Potential myocardial damageMore damagingless damagingEfficacy93% in laboratory trails99% in laboratory trailsVentricular tachycardia (VT)Ventricular tachycardia is a heart rhythm described as a run of 3 or more premature ventricular contractions (PVCs) (Lewis, Heitkemper, Dirksen, OBrien Bucher, 2007, p. 854).VT clinical associationVT passs with Coronary Artery unsoundness (CAD), cardiomyopathy, significant electrolyte imbalance, mitral valve prolapse, long QT syndrome, some medicine toxicity like digitalis and central nervous system disease. Furthermore, this type of dysrhythmia can be notice in non cardiac patients (Lewis et al, 2007).VT clinical significancePatient with VT may be found with pulse or pulseless and VT if persistent can lead to go down in Carbon monoxide (CO) due to decreasing of ventricular cream times and loss of atrial contraction. All this conclusion can lead to several complications which take on hypotension, pulmonary edema, cerebral blood f low will decrease and cardiopulmonary arrest (Lewis et al, 2007).VT treatmentThis type of dysrhythmia can be treated simply if the causes identified like electrolyte imbalance and ischemia. If the VT is monomorphic (patient has appearance of all the beats teammate each other in each lead of a bulge electrocardiogram) and patient with pulse, Procaimade, Sotalol, Amiodarone or Lidocaine Intravenous injection (IV) can be used. If the patient in polymorphic (has beat-to-beat variations in morphology) VT with prolonged baseline QT interval Magnesium, Isoprterenol, Lidocaine Intravenous injection can be administer. If the patient has no pulse it must be taken in high priority level emergency example, in this condition CPR and defibrillation are the first line if treatment (Lewis et al, 2007).Ventricular fibrillation (VF)Ventricular fibrillation is described as a heart rhythm witha severe derangement of the rhythm characterized on electrocardiogram (ECG) by irregular undulation of varyi ng shapes and bountifulness (Lewis et al., 2007, p. 855).VF clinical associationVF can occur in acute myocardial infarction (MI), myocardial ischemic disease like Coronary Artery Disease and cardiomyopathy. Furthermore this type of abnormal heart rhythm can be associated with coronary reperfusion after fibrinolytic therapy. Other VF clinical associations are like electric shock, hypekalemia, medicate toxicity and acidosis (Lewis et al, 2007).VF clinical significancePatient with VF can be found unconscious(p), pulseless and apneic condition and if this type of dysrhythmia not treated instanter and apace patient will die (Lewis et al, 2007).VF treatmentVF is life-threatening condition and the best treatment for this dysrhythmia is the CPR and Advance Cardiovascular Life Support (ACLS) with using defibrillation immediately if available (Lewis et al, 2007).Cardiac arrestIt is the sudden loss heart function either the victim is diagnosed as a heart disease or not, which occur within minutes after symptoms appear. (American Heart.org.2011).Cardiopulmonary resuscitation (CPR)Cardiopulmonary resuscitation is a combination of oral resuscitation (mouth-to-mouth breathing), which supplies oxygen to the lungs, and external cardiac massage (chest compression), which is intended to normalize cardiac function and blood circulation(Kozier, Erb, Snyder Berman, 2008, P.1419). American Heart Association (2011) has emphasized the updated CPR huntlines for the chest compression rate is rate is 100 compressions per-minute.DefibrillationIt is a operate of administering the electric shock to an individual heart for stop any abnormality heart impulse such For VT and restore the normal heart rhythm (Kozier, Erb, Snyder Berman, 2008).Public access code Defibrillation (PAD)It is a program that improves the automated external defibrillator in public facilities (Federal occupational health,2010).Cardiopulmonary resuscitation / automated external defibrillation providerAn employee , who has finished or completed training in CPR, in addition has knowledge and understands an AED operation (Sraj, 2005).Chain of survivalIt is that access which concentrates on the increasing of the survival chance .according to these componentsEarly access to anguish (local emergency medical system fall)Early CPR.Early defibrillation.Early advance of care.www.circ.ahajournals.orgSequence of actions when nursehealth provider is using an automated external defibrillatorThese procedures should be following when the patientvictim is unconscious or not breathing Start with calling for help then start with CPR if the AED not available immediately.1-When the AED arrivesContinue CPR until the AED is switched on in case of more than one hand overr. If you are alone stop CPR and switch on the AED.Follow the voice instruction.Pads attaching to the patientvictim chest (the positive pad is fixed on the patientsvictims left chest below the nipple, whereas the negative pads is placed on the victimspatients right upper chest above the nipple to the right from patient s perspective of the sternum).Be sure that no body touches the patientvictim during the AEDis analyzing the rhythm.2-When the shock is infallible.Be sure that nobody is touching the patientvictim.Push the shock button as instructionFollow the voice instruction.3-When no shock is neededContinue CPR using a ratio of 30 compression to 2 rescue breathesFollow the voice instruction.Doing these procedures till the patient starts to regaining consciousness signs such as coughing, movement and breathing or you become tired (Nettina, 2001 Sraj, 2005).Precautions in the use of automated external defibrillationSraj (2005) has emphasized several precautions which must be taken into consideration by the AEDs operator before using it. Furthermore, these precautions are very important in keeping the operator and the patient in a safe and secure environment.These precautions areUnresponsivenessThe saviour should check th e patients level of consciousness, pulse and any signs of life like moving or coughing. This step is very important step to avoid any problems or misusing of AED.Wet chestDue to piss and sweat AED might not be very effective. So In order to get defibrillations effectiveness use the piece of cloth which is kept in the AED kit to dry the chestMoving vehicleUsing AED devise needs special care especially during the transportation of the patient. In case of using moving vehicle it may affect AEDs analyzing the heart rhythm which can lead to wrong analysis.Flammable materialsTry to avoid using any inflammable materials like alcohol and stop any flammable gases like oxygen .using these flammable materials can make fire due to the expected spark from the shock. white meat patchesBe close to the patient and scan for any nitroglycerine patches and remove it right away before attaching the AEDs paddles. These patches can make burn to the patients chest.Metal surfaceAvoid using the metal or an y electric conductive surface because the ability of transmitting the shock to the rescuers or any persons nearby.PacemakerThe rescuer should look to the patients chest closely and chance on if this patient using pacemaker especially if its implanted one. Try to attach the paddles one to one and have inches remoteness from the pacemaker to avoid destroying the pacemakers batteries.Age considerationAED is not recommended to be used in children under age of 8 especially in unadjusted animation AEDs.Hands offThe users during analyzing the heart rhythm must be men off to avoid analyzing disturbance. Furthermore the users and any person nearby must be clear before delivering the shock avoiding the transmission of the shock to them.Wireless devicesThe nearby people they must not use their wireless devices like cell send for and especially during the analyzing heart rhythm and delivering shock process. These devices can cause trouble made by waves interference which may influence the analysis.Education in a clinical settingEducation can be defined as a learning opportunity which is planned by an individual or a committee to reach a related objective (Rogers, 2002). One of the main differences between nurse education and education of children in school is, that nurse education is based upon the theory and practice of adult learning. Furthermore, there are different teaching strategies, some of these teaching strategies like lectures method, (lecturers) are the main instrument in this method. Experiential learning depends on learning result from experience. Last method is pairs exercise in this method the group members are asked to from pairs then work unitedly (Quinn Hughes, 2007).The coordinators and teachers must chose the best teaching strategy accordingly and provide good learning environment to achieve teaching program goals (Quinn Hughes, 2007).McEwen Willss, (2007) have referred to one of the voluptuous theory which is Henderson theory.The Henderson theory is focusing on the important of education for medical team, patient and families that translate to practice and experience to improve the quality of care. If this rehunt has been make in a clinical setting it can enhance the education.Categorization of learning theoriesMcEwen Willss, (2007) have mentioned, that sometime it will come to the nurses mind a interrogative mood why is it very important to be aware of about the process of learning and to understand learning theories. The importance of understanding learning theories is to describe the process used to get about changes in the way individuals understand information and skills or tasks. Moreover, Bigge Shermis (1999) categorized the learning theories to two categories which are behavioral learning theoriesBehavioral learning theories which depend on behavior response and ignore the feeling, thoughts and cognitive processes of the student. In addition, behavioral learning theories were the first widely used in educa tion and these types of learning theories includes the work of Pavlov, Skinner and others. Furthermore, these types of learning theories persistent in the American educational system in 1959s and 1960s, as sanitary as behavioral learning theories enhance the American educational system in 20th century (McEwen Willss, 2007).Cognitive learning theoriesCognitive learning theories which based on the mental processes and activities which go within the student. These type of theories start to get wide thrust in 1960s. Moreover, Jean Piaget is the most important theorists in cognitive science which developed main components of his theory in 1920s (McEwen Willss, 2007).Teaching approachTeaching can be defined most of the time as the facilitation of learning and is passing on to intentional act of communicating information (Bastable, 2003). To achieve this, the teachers must know the learning methods and the individual needs and connect them to instruction (Forrest, 2004). acquirement and knowledgeSkill is defined as a goal-directed, well organized behavior that is acquired through practice and practiseed with economy of effort (Proctor Dutta, 1995, p.18). Knowledge can be defined, as set of organized statements of facts or ideas, presenting a reasoned judgment or an experimental result, which is transmitted to others through some communication medium in some imperious form (Bell, 1976, p.175).Up to date, there are a lot of research members regarding cardiopulmonary resuscitation education and use of an automated external defibrillation. Therefore it is important to identify teaching approaches and critically evaluate the effect of the education on skills and knowledge.The effect of Cardiopulmonary resuscitation education on nurses skill and knowledgeKardong ,Oermann,Odom,Ha (2010) conclude in their article if the nurses used manikin with voice advisory they will be more competent than the nurses how used normal manikin without voice advisory. Furthermore the me dian number of chest compression before Basic Life Support course was three and so fast, but after BLS training increased to 13 as stated by (Mellor Woollard, 2010). In addition, Madden (2010) found in his study that, the nurses are more confidant and competent in case of cardiac emergency situation after CPR training.AIMThe aim of this literature review was to describe teaching approaches for cardiopulmonary resuscitation education in relation to acquired skills and knowledge in the use of an automated external defibrillation in a cardiac arrest situation in a clinical setting.Research questionsWhich teaching approaches are used for cardiopulmonary resuscitation education when nurses use an automated external defibrillation in a cardiac arrest situation in a clinical setting?What effect has the cardiopulmonary resuscitation education on nurses skills in their use of an automated external defibrillation in a cardiac arrest situation in a clinical setting?What effect has the cardiop ulmonary resuscitation education on nurses knowledge when an automated external defibrillation is used in a cardiac arrest situation in a clinical setting?METHODThe method chosen for this study is a literature review with a systematic approach. A literature review is a critical summary of research on a topic of interest, often prepared to put a research problem in background (Polit Beck, 2008, p.757).Literature searchThe literature search was carried out in PubMed which is a data base that anyone, anywhere in the world with internet access can search for journal articles and permanent resource regardless of your institutional affiliation (Polit Beck, 2008, p.757). MeSH terms are created by the National Center for Biotechnology learning (NCBI). PubMed, works through searching in National Library of Medicine (NLMs) Web site, it helps the researchers to get full text of the articles from biomedical literature and helps to access throw out links to selected life sciences journals n ot in MEDLINE (National Center for Biotechnology Information, 2010). The search strategies were made by combining MeSH terms in PubMed and the result of this database search are shown in Table 1.In order to get relevant original articles to this literature review the authors have used Mesh term and restrict the research which published in the last 10 years between 2001-2011, English human and any age.Table 1. Database search in Pubmed.DatabaseKey wordIdentified articles (hits)Abstracts reviewedArticles examinedArticlesIncludedDate for searchPubmed22032011(Cardiopulmonary ResuscitationMesh) AND Education, Nursing, ContinuingMesh4141234Pubmed22032011Cardiopulmonary ResuscitationMesh nursing skill2221214Pubmed22032011(education Subheading) AND Cardiopulmonary ResuscitationMesh7255003011Key wordsIn this literature review the authors completed this research with the following key words(Cardiopulmonary Resuscitation AND Education, Nursing, ContinuingMesh,Cardiopulmonary ResuscitationMesh nursing skill and (Education Subheading) AND Cardiopulmonary ResuscitationMesh.Identified original articles had to be published in peer-reviewed journals with an available abstract and had to focus on cardiopulmonary resuscitation education in relation to the use of an automated external defibrillation in a cardiac arrest situation in a clinical setting. Furthermore studies on adult, children octonary years and older, SVT-VT patients and nurses were included. Non medical people and younger children (less than eight years), patients with pacemaker and refusal of informed consent were excluded, as were studies that did not involve health-care professionals in clinical settings.The primary search yielded 19 original articles of interest. In addition bibliographic searches revealed X articles. The articles are presented in the matrix (Appendix 1). The selected articles were assessed independently by the authors usingAppendix 1Sophiahemmet University College classification guide of aca demic articles and studies regarding quality in both quantitative and qualitative research (Appendix 2). The studies were classified as Randomised controlled trial (RCT), Clinical controlled trial (CCT), Non- controlled study (P), retro study (R) or Qualitative study (Q). Scientific quality of the studies was assessed on a three-grade scalehigh- (I), moderate- (II) or low- (III) quality. The authors intended to work systematically by bring out the similar words in the articles e.g., AED, clinical setting, skills and knowledge and discuss on regular basis to compare and discuss responses to the research questions.This literature review matter the cardiopulmonary resuscitation education in relation to acquired skills and knowledge in the use of an automated external defibrillation in resuscitation situation in hospitals for most of the medical professionals like doctors, technicians and nursing staff, but the authors will focus on nursing staff avoiding the vagueness of this litera ture review.Manual search can be defined as finding an original article which has been used in literature review (Polit Beck, 2008).ETHICAL CONSIDERATIONSThe ethical consideration which are so important in this literature review, include the authors must check who is the sponsor of the study because it includes the use of technology Furthermore the authors must assess if the participants in the reviewed studies were informed and consented before they participated, especially in case of patients are involved. Finally, the authors must clarify if these studies have got approval from the ethical committees (Spouse, 2003).RESULTS19 primary published articles have been reviewed by the authors in this study which have center on Teaching approaches used for cardiopulmonary resuscitation education when nurses use an automated external defibrillation in a cardiac arrest situation in a clinical setting and the Effect of cardiopulmonary resuscitation education on nurses skills knowledge in t heir use of an automated external defibrillation in a cardiac arrest situation in a clinical setting. Results from the studies are chosen which are relevant to this studys aim and research questions The selected results from the primary published articles have been categorized under the following headingsTeaching approaches used for cardiopulmonary resuscitation education when nurses use an automated external defibrillation in a cardiac arrest situation in a clinical settingPerkins, Hulme, Bion, (2002) stated in their article that , peer tuition is the one type of teaching approach which depends on peer of tutors with exceptional teaching background and experience by lecture-led CPR training. However, it pointed out that, in spite of cardiopulmonary resuscitation and AED skills performance enhance with peer tuition, knowledge remained the comparable over the participants.The quality of performance can be improved with audible feedback system (Noordergraaf, et al.2006). Furthermore , if audible feedback system has been used there is significant improvement in skill acquisition and skill retention has been reported that is available in automated external defibrillation (Handley Handley, 2003)Szgedi , Zrnyi , Betlehem, Ujvrin Tth(2010) defined problem-based learning as one of learning methods which organize the knowledge in clinical setting ,strengthens to motivate the students to learn, enhances clinical reasoning skills, and improve self-directed and continues education. Furthermore they concluded this method is better and more efficient method form the traditional method which is class room during cardiopulmonary education. Moreover this method can enhance and improve the issuance of cardiopulmonary education which can lead to better understanding and skill demonstrating during resuscitation in clinical setting.The other teaching approach which has been emphasized by Bjrshol, Lindner, Sreide , Moen Sunde(2009) is manikin and 24-min video instruction durin g cardiopulmonary resuscitation training. They made a study on hospital employees by distributing 5118 personal manikins.3466 responded to the first questionnaire the result can be seen in table 2Table 2. Questionnaire administered to all hospital employees before receiving their personal resuscitation manikin.QuestionAnswerNumber of repliesWhat is your age?43 (11) years3445What is your sexual urge?Female 87%3298Male 13%How long ago did you have training in basic life support (BLS)?15 (8-60) months3295Never 296How well do you feel that you are trained in BLS (1-5, 1=very bad and 5=very good)?3.1 (1.0)3412Have you been in a situation where you needed skills in BLS, whether at work or not?Yes, at work 1121 (33%)3425Yes, outside work 363 (11%)No 2071 (60%)Altogether 908 replied to second questionnaire which they attended the classroom training the result can seen in table 2Table 2. Questionnaire to all hospital employees nine months after receiving their personal resuscitation manikin .QuestionAnswerNumber of repliesWhere did you perform the BLS training with your MiniAnne manikin?Hospital meeting room 908 (65%)1397Own dept. 366 (26%)At home 73 (5%)Did not participate 120 (9%)How long ago did you train with your MiniAnne manikin?39 (26-48) weeks1184How well do you feel that you are trained in BLS (1-5, 1=very bad and 5=very good)?3.8 (0.8)1333How many persons, in addition to yourself, have trained on BLS with your MiniAnne manikin/self-instruction movie?1 (0-3)1165Have you experienced any discomfort using the manikin?Yes 49 (4%)1272No 1223 (96%)After receiving the participants their personal manikin by six month the result is displayed in table 3Table 3. Number of study subjects performing different BLS tasks before and six months after BLS training with a personal resuscitation manikin and video instruction (percentages in brackets). The number of correct chest compressions and mouth-to-mouth ventilations are calculated for 2min after initiation of BLS (interqu artile range in brackets).Before BLS training, n=59Six months after BLS training, n=39P abide byAssessed responsiveness42 (71)34 (87)0.02Opened airways before assessing respiration10 (17)17 (44)0.01Assessed respiration42 (71)28 (72)0.73Pulse check34 (58)13 (33)0.02Called for help before starting BLS45 (76)32 (82)0.61Correct telephone number for EMS activation56 (98)39 (100)NsCorrect compression ventilation (CV) ratio32 (54)36 (98)Number of correct chest compressions60 (5-102)119 (75-150)Number of correct mouth-to-mouth ventilations3 (0-8)4 (0-7)0.23After finalizing the result by Bjrshol , Lindner , Sreide , Moen Sunde(2009) they came to that cardiopulmonary resuscitation training with manikin and video instruction benefit and improve the staff self-confidence and clinical basic life support skill. In other hands using assessment of cardiopulmonary resuscitation defibrillation (CPR-D) nursing skills and informing the leaders is necessary to give information for kind of education th ey need seems to improve resuscitation performance (Mkinen, et al.2007).Spearpoint, Gruber Brett (2009) mentioned in their article that permanent cardiopulmonary education as one of the teaching approaches. Moreover they stated that , The simplicity, continuous and quality of the education on basic life support program are affected on CPR performance and hospitals cardiac arrest through increasing patient discharge and decrease the cardiac arrest. There was study done by Moule , Albarran , Bessant , Brownfield Pollock (2008) in united kingdom comparing two teaching met

Chapter Iv Shivaji The Great Guerrilla History Essay

Chapter Iv Shivaji The Great Guerrilla History Essay32. Shivaji practised more than three hundred years ago the tenets of freedom fighter war which guerrilla leaders have theorised today. It is unfortunate that no Indian author ever developed the objective and analytical style of writing history. If only Shivaji had a Sun Tzu or a Kautilya in his court or a chronicler like Edgar Snow or Payne to leave behind an account of how he be after his tactics and strategy in the hours of crisis and the words of wisdom he uttered in his directives to his commanders, we would have amassed such a huge mass of literature on guerrilla warfare.Early Life33. Shivaji belonged to the Bhosle clan of Marathas which claimed descent from the Sisodia ranas of Udaipur9. His father, Shahji was the first Maratha chief to defy the Mughal authorities, dodging and deluding their renowned generals. Shahji became a living example to his son, Shivaji, learning him how the infirm could wear out the strong.34. Shi vaji was born in the fort of Shivneri near Pune in 1627 AD.10It was a tumultuous period of bitter contest between the Mughals and Shahji, who was being17pursued by his own father in law , Lukhoji Jadhav. During this period , Shahji was in service of the Adilshah.11Shivaji stayed in Bijpur for a short period of time. He arouse the court by failing to observe the court etiquette and made a slight salaam instead of bowing to the ground.12His father and m separate, Jijabai advised him on matters of obeisance to elders and virtues of obedience and cooperation.Preparation to Meet his Destiny35. delinquent to years of suffering since her marriage, Jijabai had developed strong character and a spirit of dauntless courage and defiance, which she was contumacious to inculcate into her son. She had great moral and spiritual influence on him. If his father could defy the might of the mughals for years, why could not Shivaji continue and clear his work? speckle Jijabai moulded Shivaji to be a stern disciplinarian and far sighted, supervision of formal education was entrusted to Dadoji Kondev.1336. Dadoji Kondev was the manager of Shahjis Pune jagir. In 1642, he brought Jijabai and Shivaji from Karnataka to Pune and built Lal mahal for them to reside. He was a soulfulness of extraordinary integrity and devotion to his masters. But the greatest influence on Shivaji was of the unadorned nature and beauty of the fixs. He surveyed all inaccessible regions, studying routes of communication, bypaths and tracks and valleys. He appreciated that this terrain was best to oust the foreigners. While seeing his own countryside, he came in contact with his countrymen and developed long lasting friendships.141837. The news of Shivajis formulation for achieving swaraj reached the Bijapur court. All of sudden , Shahji was declared as a rebel by the Bijapur sultan. In 1645, at the age of sixteen, Shivaji took an oath to free his countrymen and establishing Hindavi Swaraj. By then he had collected a thousand mawlas under him. Outwardly he continued to profess full loyalty to the Bijapur sultan and urged that his own activities were intended to put carry out lawlessness and disorder in the hilly regions.Fort Based Tactics38. Shivaji developed fort based and fort centric tactics. His aim was to capture as many forts possible, that too without a fight. Most of the hills and mountains were neglected by the Muslim rulers and they failed to exploit the terrain . Shivaji active Torna, twenty miles south west of Pune. Torna fell in Shivajis turn everywhere with persuasion and guile and without a drop of blood in 1646. Till 1648, Shivaji captured numerous forts of strategic importance ie Kondana (later Sinhgarh), Raigad, Vishalgad, Purandar etc. By the end of 1648, Shivaji gained ascendancy over the parganas of Pune , Mawal and Supa. The numbers of his followers s healthyed in rank as days passed by.Clashes with Bijapur39. Shivajis first circularise clash with th e Bijapur sultan was in 1648, when he occupied Kondana fort. Till then he had avoided spread out conflict with the sultan, fucking fully well that he did not stand any chance in open combat. The sultan despatched Fateh caravansary, a well known general to teach Shivaji a lesson. Shivajis19meagre force of 5000 completely routed Fateh Khans forces by raiding parties unionised by Shivaji and his mawalas. Fateh Khan returned to Bijapur. Thus a shattering blow was delivered on the sultan.1540. In 1648, Shahji was arrested on false charges of conspiring with the Sultan of Golkonda. He was paraded as a mere nefarious in the streets of Bijapur. He was later reinstated in 1653, but was never allowed to leave Karnataka. Shahjis virtual house arrest in Karnataka put restrictions on Shivajis activities. Shahjis letter to Shivaji advising him to shit up Kondana, put Shivaji in a dilemma . Shivaji now, most tactfully displayed servile attitude towards the Mughal Emperor, invoking his patrona ge.Expansion41. Shivaji was a pragmatist, ethics of war had no blank in his philosophy he was fighting a war of liberation for his country and he was keen on securing his ends without bothering about morality of the means. But at that place were some basic precepts of human behaviour which did not flaunt even while dealing with the enemy. In his expansion, he soon captured Barmati, Indapur, Tikona, Lohgad, Rajmachi, Supa, Javli and Purandar. Javli was later renamed, Raigad in 1674.42. lento but surely , Shivaji was expanding his kingdom right under the watchful eye of the Bijapur sultan. Patronage of the mughal emperor paid good dividends. Shivaji had to arrest his wifes brother for not dynamic in the freedom struggle on his side. Following the tenets of guerrilla warfare, Shivaji did not relax and busied20himself in continuous activity. The recruitment ground of his mawla troops increase rapidly. Two miles west of Javli, he constructed fort Pratapgad, which control eight passes crossing the ranges into Konkan from Mahabaleshwar and Wai. Shivaji now eyed the fertile fields of Konkan. When in 1656, Mohd Adilshah of Bijapur died, Shivajis activities increased considerably.Confrontation with the Mughals43. In November 1656, Aurangzeb obtained permission from Shah Jahan to invade Bijapur. Mir Jumla and Shahistakhan joined him on this adventure. Shivaji assessed that taking on the Mughals alone was impossible, therefore he raided Dabhol in Bijapur territory and captured it. He pleaded with Aurangzeb, that he be allowed to go forward his spoils of the Bijapur territory. Aurngazeb , happy that Shivaji was on his side, permitted that. Aurangzeb was decimating Bijapur and was capturing territory after territory. Shivaji knew that with the Bijapur sultan gone, Aurangzeb would turn against him. He therefore launched several raids in the mughal governed areas. Shivaji captured Junnar in Mughal territory and marched against Ahmednagar and gained a lot in terms of horse s and money. The news of Shivajis raids annoyed Aurangzeb and ordered revenge.44. Shivajis possessions in Pune and Chakan were utterly ruined. Fortunately, Shah Jahan fell ill and Aurangzeb rushed back to Delhi to participate in the war for succession. While he was away, he sent a message to Adil Shah to expel Shivaji. With astuteness, Shivaji too sent ambassadors to Aurangzeb and accepted his21overlordship and demanded that Kokan be given to him as a jagir. Aurangzeb granted the jagir of Konkan to Shivaji. He consolidated his gains in Konkan by building sea forts and raising a navy under Kanhoji Angre. In the Konkan, he got into conflict with the Siddis,16English and the Portuguese over the control of the sea ports. He finally defeated the Siddis and forged a treaty with the English and the Portuguese.Challenge to Bijapur45. By the end of 1657, Shivajis small Maratha kingdom was organised on solid foundations. He had 10,000 mawal infantry and 10,000 horsed cavalry. He as well had a substantial navy. In 1656 , Adilshah died and there was a nineteen year old son on the throne. To punish Shivaji, it was decided to despatch Afzal Khan, a general of high repute who had valiantly fought the mughals recently. By Sep 1659, he marched against Shivaji with 10,000 cavalry and foot detachments of mountain guns and rockets carried on camel backs. He tried to win over the Deshmukhs to his side, but to no avail. They remained loyal to Shivaji. He caused plunder enroute to Wai and desecrated many temples. A meeting was consistent between Shivaji and Afzal Khan on 10 Nov 1659. As Shivaji bowed to Afzal Khan, he embraced Shivaji in a death grip. Shivaji having worn body armour, was not affected. Shivaji tore open Khans bowels as he thrust his dagger deep inside him.1722Battle of Pratapgarh46. Shivaji hastened back to Pratapgad and a cannon was fired to signal the infantry which was positioned at critical passes to cut off the fleeing Khan army . In the battle, Khans army los t over 3,000 men. Immense booty fell in the hands of the Marathas 4,000 horses,1,200 camels , 65 elephants and lots of cash and jewellery.47. The battle of Pratapgad is an excellent to demonstrate how a guerrilla commander is initially compelled to fight a defensive battle. The enemys superiority in blazonry and numbers had to blunted before converting the defensive tactics into offensive. Shivaji suspected treachery and was ready to meet the Khan. Shivaji lured Afzal Khan into the interior of the hilly region and annihilated his forces. This well executed operation was the final nail in the Bijapur coffin.18Second Front by the Mughals48. Shivaji challenged the mughal authority by raiding Junnar and Ahmednagar and exacting taxes from them. The mughal emperor sent Shahitskhan to teach him a lesson. Shahistakhan was beaten back with his fingers cut.19Then Aurangzeb sent Mirza Raje Jaisingh against Shivaji.20Jai Singh was a great soldier, he cast his net far and wide and invited the Siddis , Adilshah and the English to join him against Shivaji. Due to the triple alliance, Shivaji had to enter into a treaty with Jai Singh i.e. Treaty of Purandar. According to the treaty, Shivaji was to surrender 23 forts of the 35 held by him and his son Sambhaji was to proceed to Delhi as a courtier in Aurangazebs court.21Shivaji agreed and himself proceeded to Agra to meet the23mughal emperor. He was kept under house arrest, from where he escaped. This caused a major embarrassment to Aurangzeb. Shivaji came back to Deccan and reconquered all the lost forts.Shivaji a Top Guerrilla Leader49. Shivaji believed in the tenets of guerrilla warfare. He was a voracious reader and an ardent follower of Kautilyas Kut Niti. He learnt the importance of terrain in guerrilla war in his early years and never confronted the enemy in open combat. Few of his Guerrilla tactics can be summarised as beneath-(a) Use terrain to own advantage. Shivaji as a boy travelled all over the Mawal region and found the terrain was suitable for resisting Adilshah and the Mughals. The western ghats from Junnar in the north to Mahabaleshwar in the south have been cut by nature into valleys and each valley is fed by a separate river .These valleys are called mawals. High hills tower over these valleys where forts were constructed.(b) Be kind to people. Shivaji knew that his greatest strength was the people of his land. He won over the loyalty of his people by being one of them. He also won over his opponents by his forthrightness and good conduct.(c) Intelligence is the essence of all operations. Shivaji very early realised the importance of intelligence . He had a full fledged department of24spies who provided vital learning of political, military and social nature. He had a well oiled system of horsemen and runners to disseminate information at the earliest.(d) Treat women folk with respect. Shivaji was especially harsh on his soldiers who didnt respect women. He treated the women folk o f Surat22with respect , when he raided the city. He expected the resembling from his men. Any digression in this aspect was met with harsh punishment.(e) Religious tolerance. Shivaji was a devout Hindu, but was far from fanaticism. He was highly tolerant and respectful of other religions. He was never actuated by a feeling of hatred towards the Muslims as a people or the religion itself. The people of his kingdom had complete religious freedom His chief naval commanders were Muslims.(f) Fort based tactics. Shivaji developed and devised a techinique of defence and offence through a hundreds of forts as a necessary adjunct of guerrilla methods adopted by him. There are three lines of distinct forts in Maharashtra which can be recognised even in posture day. The main forts are on the top of the Sahayadri range then there are two main lines of them, one on the eastern and other on the western spurs of the mountain ranges. In addition, some sea forts were constructed by Shivaji on ina ccessible rocks near the sea coast as a counter to foreign maritime powers. Sindhudurg, Vijaydurg, Kolaba and Suvarnadurg are some of his major sea forts.25(g) Strict discipline. Shivaji maintined a high standard of discipline in his army. Whatever booty was obtained by the army during the campaigns had to be deposited in the treasury. Khafi Khan, a critic of Shivaji writes, He made it a rule, that whenever his followers went plundering, they should do no harm to mosques, Book of God or women of any one. Whenever a copy of Quran fell into his hands, he treated it with respect and gave it to some of his Muslim followers.23(h) Guile. Shivaji was a master mind in bluffing his enemies. Afzal Khan fell into his trap and paid with his life. At the siege of Panhala, Siddi Jauhar was lulled into inactivity by a promise of surrendering the fort.24Bahadur Khan was befooled by him as he was convinced of a submission of a petition seeking negotiations and pardon by the emperor(j) Speed, Surpris e and Audacity. Shivaji was a man of terrific speed and mobility, which helped him to gain surprise. Nobody could know where he would be the next day. He was always on the move, avoiding engagement with the better equipped and numerically superior enemy. He followed the principle of surprise to nark the enemy, when he was not prepared to meet him. Shivaji was bold and fearless and led his men personally on distant and perilous campaigns.26Conclusion50. Shivaji was a benevolent ruler, a liberal and a constructive administrator. If out of nothing he could carve out an independent kingdom against formidable enemies, it was because of his single-minded candor of purpose, dauntless courage, persistent pursuit of a high objective , military foresight and astute diplomacy . It is unfortunate that, he was always at a state of war and died in the prime of his glory. Ramdas called him Sarvadnya lord of all sciences.

The Essence Of The Marketing Concept

The Essence Of The Marketing ConceptMarket break complicate female genital organ be defined as the process of breaking down the entire market for a product or service into distinct sub-groups or divisions where for severally one part may conceivably represent a separate only whent market to be reached with a distinctive market mix. class and the subsequent strategies of branding and positioning start by recognizing that increasingly, within the total demand/market for a product, precise tastes, needs and demand may differ. It breaks down the total market for a product or service into somebody clusters of clients, or segments. Here, clients who sh atomic number 18 alike(p) demand preferences ar grouped together within each segment.Effective class is achieved when customers sharing similar patterns of demand be grouped together and where each group or segment differs in the pattern of demand from differentwise segments in the market. In most markets, be they consume r or industrial, some kind of partition can be accomplished on this background.2 Targeted selling effortsMost companies satisfyingise that they cannot effectively serve all the segments in a market, and must alternatively target their merchandising efforts. For example, in developing a new car, the manufacturing firm will have to assume a decision on many issues, much(prenominal) as should it be a two-, four-, or five-seater model, with a 1000, 2000 or 3000cc engine? Should it have leather, fabric or vinyl seats? The everywhere-riding factor when deciding these issues is customer demand. Some customers (segments) may want a five-seater 2000cc model with leather upholstery, while others may prefer a four-seater with a 1000cc engine and fabric seats. A result would be to compromise and produce a four-seater 1500cc model with leather seats and fabric trim. Clearly, such a model would go some guidance to clashing the requirements of both groups of procureers, but there is a d anger that because the needs of neither market segment are precisely met, most potential customers would purchase from other suppliers who could cater for their specific requirements. Ironically, one of the biggest post-war car failures was the much heralded and much hyped American Ford Edsel car. This is a car that was produced following extensive marketing research, the results of which were aggregated, and the complete product was a car that satisfied the true needs of precise few buyers making it the most spectacular flop in modern motor history.Target marketing is thus defined as the identification of the market segments that are identified as being the most likely purchasers of a companys products.Specifically, the advant jump ons of target marketing areMarketing opportunities and unfilled gaps in a market may be more than accurately appraised and identified. Such gaps can be real (e.g. sweet, strong, harsh or mild) or they can be illusionary in hurt of the way people wan t to view the product (e.g. happy, aloof, silly or moody). In the case of the former, product attributes can fulfil these criteria whereas for the latter these attributes susceptibility sound have to be implanted in the oral sexs of customers through an appropriate denote mess bestride.Market and product appeals through manipulation of the marketing mix can be more delicately tuned to the needs of the potential customer.Marketing effort can be concentrated on the market segment(s) which offer the greatest potential for the company to achieve its goals be they goals to maximise profit potential or to promise the best long-term position for the product or any other appropriate goal.3 Effective partitioningTheoretically, the base(s) used for segmentation should lead to segments that areMeasurable/identifiable Here, the base(s) used should preferably lead to ease of identification in terms of who is in each segment. It should also be capable of meter in terms of the potential c ustomers in each segment.Accessible Here, the base(s) used should ideally lead to the company being able to reach haveed market targets with their psyche marketing efforts.Meaningful The base(s) used must lead to segments which have unalike preferences or needs and show clear variations in market behaviour and answer to individually designed marketing mixes.Substantial The base(s) used should lead to segments which are sufficiently large to be economically and practically worthwhile serving as discrete market targets with a distinctive marketing mix.The third criterion is finickyly important for effective segmentation, as it is an essential prerequisite when attempting to identify and select market targets.In segmentation, targeting and positioning, a company must identify distinct subsets of customers in the total market for a product where any subset might ultimately be selected as a market target, and for which a distinctive marketing mix will be developed. The following re presents the sequential steps in conducting a segmentation, targeting and positioning exercise for any given product market. claim base(s) for segmentation and identify appropriate market segments.Evaluate and appraise the market segments resulting from the first step.Select an overall market targeting strategy.Select specific target segments.Develop a product positioning strategy for each target segment.6. Develop an appropriate marketing mix for each chosen target segment in order to support the product positioning strategy.4 Segmentation bases in consumer product marketsgeographic segmentation consists of dividing a country into regions that normally represent an individual sales persons territory. In bigger companies, these larger regions are then broken down into areas with individual regional manager controlling salespeople in distinct areas. In international marketing, different countries may be deemed to constitute different market segments.Demographic segmentation consists of a wide variety of bases for subdividing markets, and each of these is now discussedAge is a good segmentation variable for such items as clothes where the fashion-conscious young are more susceptible to regular changes in style and older segments are perhaps more concerned with such factors as quality and comfort.Sex is a strong segment in terms of goods that are specifically targeted towards males or females and again an obvious example is clothing. Here, fashion is a powerful element when acquire, and a whole industry surrounds this criterion.Income as a segmentation base is more popular in certain countries like the USA than others who regard such matters very esotericly.Social class is possibly the single most used variable for research intentions. It is universally used. The National Readership Survey divides everybody into the following categories as shown in get a line 1A Upper middle class (higher managerial, administrative or professional) which comprises virtually 3 per cent of the raceB Middle class (intermediate managerial, administrative or professional) which comprises just about 10 per cent of the universeC1 Lower middle class (supervisory, clerical, junior administrative or professional) containing around 25 per cent of the populationC2 Skilled working clsass (skilled manual workers) who comprise around 30 per cent of the population.D Working class (semi- and unskilled manual workers) or around 27 per cent of the populationE Lowest levels of subsistence (state pensioners with no other income, widows, casual and lowest grade earners) who form the remaining 5 per cent, or thereabouts, of the population.Figure 1 Social class and grade structureEducation is often related to social class, because, as a generalisation, the transgress educated tend to get the better jobs. It is principally acknowledged that a persons media habits are related to education. Accordingly, newspapers design to aim their news and newspaper content towards the upp er or lower ends of the social spectrum, and support advertisers to target their advertising appropriately, depending upon whether an advertisers product has an up-market or down-market appeal. In fact they realityise their readership profile of the percentage of ABC1, etc groups that truly read their newspapers or magazines and this information is ascertained through independent auditors. This is done principally to alert advertising agencies who will place their clients advertising according to the social classes towards at whom their products are targeted.Nationality or ethnic play down now constitutes a growing and distinctive segment for potential target marketing. Food products, clothing and hair care products are obvious examples of products that fit into this segmentation variable.Political is perhaps a less obvious segmentation base. An individuals political leanings might well influence the way he or she behaves in terms of purchases made. Such purchases are of course contriveed in the types of newspaper and other media that is read, and this, in turn, contains advertising which is aimed at people who read such media, so political leanings might be more significant than it initially seems.Family size will have an effect on the amount or size of purchases, so this is certainly a meaningful segmentation variable.Family animateness cycle is a logical follow on to the above and this will tend to determine the purchase of many consumer immutable products. This is based on the imprint that consumers pass through a series of quite distinct phases in their lives, each phase giving rise to different purchasing patterns and needs. For example, an unmarried person living at home will probably have very different purchasing patterns from someone of the same age who has left home and is recently married. Wells and Gubar have put forward what is now an internationally recognised classification musical arrangement in relation to life cycle and these stages are shown in Figure 2Bachelor stage young single people not living with parents (which gave rise to the category of YUPPIES or young, upwardly-mobile persons)Newly marrieds no children (sometimes referred to as DINKIES meaning double income no kids)Full draw near I with the youngest child being under six years of age (sometimes referred to as ORCHIDS meaning one recent child, heavily in debt)Full nest II is where the youngest child is six or overFull nest III is an older married couple with dependent children living at homeEmpty nest I with no children living at home, but the family head is in work (sometimes referred to as WOOPIES meaning well off older persons)Empty nest II where the family head is retiredSolitary survivor in workSolitary survivor retired (unkindly referred to as COCOON meaning cheap old child-minder, operating on nothing)Figure 2 Family life cycle segmentation baseSAGACITY is a refinement of the family life cycle grouping system. This is a system that be lieves that people have different behavioural patterns and aspirations as they glide by through life. Four main stages of life cycle are defined asDependent (mainly under 24 living at home)Pre-family (under 35s who have open their own household, but without children)Family (couples under 65 with one or more children in the household)Late (adults whose children have left home or who are over 35 and childless)Income groups are then defined as being in categories better off and worse offOccupation groups are defined as white (collar) or the A, B and C1 social groups and blue (collar) or the C2, D and E social groupsThe system works as shown in Figure 3 life sentence cycle Dependent Pre-family Family LateIncome Better off Worse off Better off Worse offOccupation White no-account White Blue White Blue White Blue White Blue White BlueApprox % 7 7 5 5 11.5 10.5 2.5 7.5 10 7.5 9 18 adults UK (NB Because of rounding, total figure does not add to 100%)Source Research Services LimitedFigu re 3 Sagacity Life Cycle GroupingsType of neighbourhood and dwelling (ACORN) is a relatively new segmentation base. Its underlying philosophy the fact that the type of dwelling and area a person lives in is a good predictor of likely purchasing behaviour including the types of products and brands which might be purchased. This classification analyses homes, rather than individuals, as a basis for segmentation. It is termed the ACORN system (A Classification of Residential Neighbourhoods). The source of this is the 10-yearly population census that is undertaken during every year ending with one the next being due in 2001. The system was developed by Richard Webber for Consolidated Analysis Centres Incorporated (CACI). It breaks down the census of population into various categories of homes as shown in Figure 4.Acorn Type of dwelling Approx % UK population GroupA Agricultural areas 3B Modern family housing, higher incomes 18C Older housing of intermediate status 17D Poor quality ol der terraced housing 4E Better-off council estates 13F Less well-off council estates 9G Poorest council estates 7H Multi-racial areas 4I High status non-family areas 4J Affluent suburban housing 16K Better-off retirement areas 4U Unclassified 1(Source CACI)Figure 4 ACORN Classification systemThese ACORN classifications are further sub-divided into yet smaller groupings. For instance, Group C which refers to Older housing of intermediate status, is broken down intoC8 Mixed owner-occupied and council estatesC9 Small town centres and flats above shopsC10 Villages with non-farm employmentC11 Older private shousing skilled workersMosaic system This system is an extension of the ACORN system overlook that this is based upon individual postal codes (or zip codes). Each postal code in the UK consists of up to seven letters and figures. An individual postal code represents approximately ten dwellings and each of these groups of dwellings is given an individual Mosaic categorisation, of whic h there are 58 categories. The idea of mosaic comes from the notion that if a different colour was ascribed to each category and superimposed on a map of the UK the resulting pattern would resemble a mosaic. The full Mosaic listing is not reproduced here, but by way of illustration some of these are describe belowM1 High status retirement areas with many single pensioners 1.0% of populationM15 Lower income older terraced housing 1.5% M25 promising inner city plats, company lets, very few children 1.5% M33 Council estates, often Scottish flats, with worst overcrowding 1.3% M46 Post 1981 housing in areas of highest income and status 0.2% M50 Newly built private estates, factory workers, young families 3.3% M57 Hamlets and scattered farms 0.7% Taken together, the demographic bases described constitute the most popular bases for segmentation in consumer product markets, since they are often associated with differences in consumer demand. As such, they are meaningful to advertisers. For instance, occupation and social class are linked because of the way that occupation is used to define social class. It is, therefore, relatively flaccid to reach the different social classes through their different media and shopping habits, although boundaries amongst the purchasing power of different classes become blurred when, for example, skilled manual workers are able to earn higher incomes than their counterparts in lower or intermediate management.Direct or behavioural segmentation appeals to marketing people as it takes customer purchasing behaviour as the starting point for segmentation. Such bases includeUsage status when a distinction might be made between say light, medium and heavy users.Brand loyalty status where customers can be divided into a number of groups according to their loyalty, or their propensity to salvation the brand again. Status categories areHard core loyals who purchase the same brand every timeSoft core loyals who have divided loyalties between two or more brands and purchase any of these on a random basisShifting loyals who are sometimes called brand switchers in that they buy one brand, and stay with it for a certain period, and then purchase another brand and stay with it for a certain period. They may then return to the accepted brandSwitchers who show no particular preference or loyalty to one particular brand, so their purchasing pattern cannot be clearly determined.Benefits desire is a segmentation base that determines the principal expectation(s) that a purchaser is seeking from the product. For instance, in the case of an automobile oil, purchasers might be looking for cheapness, a well known brand, its viscosity or its engine protection reputation.Occasions for purchase also falls under this category. An example here relates to the purchase of holidays.Lifestyle or psychographic segmentation is based on the idea that individuals have characteristic patterns of living that may be reflected in the products and b rands which they purchase. The advertising agency, Young Rubican, has come up with a classification system called Four Cs where C stands for consumers. These categories areMainstreamers or the largest group who do not want to stand out from the crowd. They are the biggest segment (over 40 per cent of the population) and tend to purchase branded products over supermarket brands.Reformers are people who tend to be creative and caring, many doing charitable work. They are largely responsible for the purchase of supermarket brands.Aspirers are usually younger people who are ambitious and keen to get on at all costs. Their purchases tend to reflect the latest models and designs.Succeeders are those who have made it and do not see the need for status symbols that aspirers seek. They like to be in control of what they are doing and this includes their purchases where they generally have very clear and firm ideas of what they see as a good product and what they see as being a less servic eable product.5 Segmentation bases in industrial product marketsSegmenting an industrial product market introduces a number of additional bases, uses similar bases and also precludes some of the ones more frequently used for consumer product markets. Such bases areType of application/end use e.g. adhesives for home, office and industrial useGeographical e.g. North, South, East and double-u regions or by countryBenefits sought Closely related to the above, but in terms of what the product actually does for the buying company e.g. detergents for general alter or detergents that are actually used in the production processType of customer e.g. banks or insurance companies or people who purchase for public authoritiesProduct/technology e.g. fibres for the carpet industry or the clothing industry usanceer size e.g. larger customers might receive different sermon to smaller customers and this is called key account selling whereby the sales manager deals directly with major accountsUsage rate e.g. light users or heavy users regular or sporadic usersLoyalty of customer e.g. regular purchasers of the companys products and sporadic purchasers. The treatment accorded to loyal customers might differ to that given to occasional customersPurchasing procedures e.g. centralized versus decentralized purchasing (which can affect the buyer/seller kindred) the extent to which purchasing is carried out by tightly defined, or more flexible, specifications which allows the seller more latitude in terms of making suggestions, the extent to which purchasing is by tender (i.e. by some kind of closed bidding system) or by open negotiationSituational factors considers the tactical role of the purchasing circumstances. In some purchasing situations it requires a more detailed knowledge of the customer whereas in others the buyer/seller relationship is kept strictly to commercial mattersPersonal characteristics relate to the people who make purchasing decisionsAs with consumer markets, industrial market segmentation may be on an indirect (associative) or a direct (behavioural) basis. A variety of bases may be also be used in conjunction with each other in order to obtain successively smaller sub-segments of the market. The essential criteria given earlier for bases of consumer market segmentation being identifiable, accessible, substantial and, most important, meaningful are equally applicable to bases for industrial market segmentation. A nested approach has been suggested on the basis of a hierarchy from the broad to the specific (See Figure 5).DEMOGRAPHICSOPERATING VARIABLES acquire APPROACHSITUATIONALPERSONALCHARAC-TERISTICSFigure 5 A nested approach to segmentation in industrial marketsAt the centre we have people who actually make buying decisions and their personalities must be considered. Then come situational factors that look at the tactical role of the purchasing situation. This demands customer knowledge. Purchasing approaches examines customer purch asing practices (e.g. who actually makes buying decisions, or the decision making unit). Operating variables allow a more exact pinpointing of potential and existing customers within the final category that is demographic variables, or the broad description of the segments related to customer needs and patterns of usage.6 Effective segmentationOnce market segments have been identified, the marketers task is to assess these various market segments. This appraisal should be in relation to sales and profit potential, or in the case of a non-profit organization, their ability to add to organisational aims. This means that each segment should be viewed in terms of its overall size, projected rate of growth, actual and potential competition, nature of competitive strategies and customer needs. Companies that decide to follow a concentrated or a differentiated targeting strategy must decide which of the segments in the market they wish to serve. Such a decision to select specific target ma rkets must be based on some of the factors outlined earlier, including resources, competition, segment potential and company quarrys.There are four characteristics that make a market segment particularly attractiveIt has sufficient current profit and sales potential to meet the organisations aims and objectivesCompetition in the segment is not as well intenseThere is good potential for future growthThe segment has some previously unidentified requirements that the company has recognised and is now in a position to serve especially well7 Product positioningA company has to develop a positioning strategy for each segment it chooses to serve. This relates to the task of ensuring that a particular companys products occupy a planned for place in chosen target markets, pertinent to opposing competition in the marketplace. The notion of product/brand positioning is applicable to both industrial and consumer markets, and the key aspects of this approach are based upon the following supposi tions.All products and brands have both objective attributes (e.g. sweet/sour dark/light fast/slow) and subjective attributes (e.g. modern/unfashionable happy/sad youthful/elderly).Potential purchasers might think about one or more of these attributes when deliberating which product and/or brand to purchase.That potential customers have their own thoughts about how the various competing products or brands rate for each of these particular attributes. In other words, the positioning of the brand along the parameters of these attributes (eg entertaining on the one hand to mundane at the other extreme) takes place in the mind of the customer.Once this is done, it is possible to appoint important attributes in choosing between different brands or products, together with the customers perception of the position of competitors products in relation to these characteristics, and then establish the most advantageous position for the company within this particular segment of the market.The f inal step in the appraisal of segmentation, targeting and positioning is developing appropriate marketing mixes. This involves the design of marketing programmes that will support the chosen positional strategy in the selected target markets. The company must therefore determine the 4 Ps of its marketing mix, i.e. what price, product, distribution (place) and promotional strategies will be necessary to achieve the desired position in the market.There are four acknowledged strategic options for target marketingUndifferentiated marketing where there is one single marketing mix for every potential customer in the market.Differentiated marketing where there are many marketing mixes for different segments of the market.Concentrated marketing which has a single marketing mix for a segment of the total market.Custom marketing which attempts to satisfy each individual customers requirements with a separate marketing mix.8 SummaryWe can now appreciate how marketing begins to work. Having def ined the purpose of segmentation we have looked at the obvious and the less obvious bases for segmentation in both consumer and industrial markets. We have also ascertained that used well, the techniques and concepts described in this chapter can contribute significantly to overall company marketing success. Market segmentation, targeting and positioning decisions are thus more strategic than they are tactical.Segmentation variables should be examined in detail, especially new segments. These should then be authenticated in terms of viability and potential profit.Targeting investigates specific segments in terms of how they should be approached. place relates to how the product is perceived in the minds of consumers and a suitable marketing mix should then be designed.

We Must Have the Right to Choose Euthanasia :: Free Euthanasia Essay

We Must Have the Right to Choose Euthanasia           There are many sides to the dilemma of whether or not mercy killing should be carried give away.  There is the question of morality, the question of active versus passive euthanasia and the question of when euthanasia should be put into use.  None of these questions are alone cut and dry.  There seem to be more gray areas within this issue than there are black and white.    Yet when you look at the line of work on a personal level with the actual individuals involved, some of those gray areas almost disappear.  People are put on this earth to live.  When it gets to the point where the flavour of a persons biography gets so bad that they can no longer function in the world, there is no reason to force that person to run alive.  Euthanasia is therefore a  necessary evil for those whose practical life is in effect over due to a terminal illness or otherwise life devastating condition.           If a person is in unbearable pain and close to death or is in a vegetable democracy and no longer able to function, their life is by all practical means over.  There is no reason to keep them alive.  The only way to culmination their physical life is by euthanasia.  The question is whether to do this by way of active euthanasia or passive euthanasia.  Many are against active euthanasia because in this case you actually kill the person rather than letting them die.  But both methods are used for the same end which is to end someones life without further pain for the patient as well as for the family.  The only choice to make after this fact is established is which of these means better carries out the end. James Rachels, a philosophy professor, says that, if one simply withholds treatment in the way of passive euthanasia, it whitethorn take the patient longer to die, and so he may suffer more than he would if more direct action were taken and a lethal injection given. (Rachels, p.111)  This defeats the purpose of euthanasia which is to end suffering.  Therefore, in cases where euthanasia is going to be carried out, active euthanasia is the better choice.

Bombings of Hiroshima and Nagasaki Essay -- essays research papers

Hiroshima. Nagasaki. From the bombing of Pearl Harbor to D-day, the bombings of Hiroshima and Nagasaki will be a triumph for the US by nuclear achievements and finis a war, but a tragedy for the all of the innocent Japanese victims. I decided to research this topic because I was interested in what happened in World War Two and wanted to learn more about this special occurrence. I believe this topic is important in history because when we expect to make a decision of war, where thousands maybe millions of lives are at risk to prevent even more from being ended or even destroy from the effects of it, we may look at this event and make a decision that will change history forever. The war in Europe short affected Asia. Although it was not part of the European war Japan was an ally of the Nazi-Germany and Italy. The three countries had signed an agreement in 1936, called the Anti-Communist International Treaty. By 1949, the Japanese judicature was largely dominated by militarists, ex tremists in the army and navy and their supporters who wanted the armed forces to control Japan and organize Japanese society along phalanx principles. They believed Japan had a sacred mission to conquer new territory to provide the natural resources that Japan lacked. In May 1941, the United States extended its conduce Lease program to chinaware. In effect, this meant that China could buy arms and supplies from the United States on long-term credit. By doing this, the United States was confirming that it would continue to support China in its war against Japan. At the same time, talks between Japan and the United States began in Washington, D.C they continued for months. Most historians agree that the negotiations never had any take a chance of success because ea... ...econd speck bomb, Fat Man, was sped up, and on August 9 it was ready to be dropped. Bad weather over the primary target of Kokura forced major(ip) Charles W. Sweeney, the pilot of Bocks Car, which was carrying the atom bomb, to divert the secondary target of Nagasaki. Clouds also obscured Nagasaki, but at the last minute, the clouds broke open and the second atom bomb known as Fat Man was dropped on Japan. Fat man exploded 1,600 feet above the city with an estimated force of 22,00 tons. The target seen through the clouds was some(prenominal) miles upriver from the original aiming point. Although the damage at Hiroshima, an estimated 50% of the population, died from the bomb in the next five years. Early in the morning of August 9, the Japanese was council met at a time again to discuss the possibility of surrender. The war council was evenly split over surrender. The war was over.4