Case Study Essay Example | Topics and Well Written Essays - 500 words - 39

How The Internet Got Started :: essays research papers

How The Internet Got Started      Some thirty years prior , the Rand partnership , America's formost cold war think tank, confronted an abnormal straegic issue. How could the US authrieties succesfully convey after an atomic war?      Postnuclear America would require a comand-and-control arrange, connected from city to city , state to state, base to base . In any case, regardless of how throughly that arrange was defensively covered or secured , its switches and wiring would consistently be defenseless against the effect of nuclear bombs. An atomic assault would lessen any possible system to wears out. Furthermore, how might the system itself be directed furthermore, controlled ? Any focal position, any system focal fortification, would be an undeniable and prompt objective for man adversary missle. The focal point of the system would be the absolute ahead of everyone else to go.      RAND thought about this bleak riddle in profound military mystery, and showed up at a challenging arrangement made in 1964.The standards were straightforward . The system itself would be thought to be problematic consistently . It would be structured as it so happens to tyranscend its all occasions . It would be structured from the get-go to rise above its own unrreliability. All the hubs from PCs in the system would be equivalent in status to every single other hub , every hub with its own position to start , pass , and recieve messages. The messages would be partitioned into parcels, every bundle seperatly tended to. Every parcel would start at some predefined source hub , and end at some other determined goal hub . Every bundle would wind its way through the system on a person basis.In fall 1969, the primary such hub was insalled in UCLA. By December 1969, there were 4 hubs on the newborn child arrange, which was named arpanet, after its Pentagon support. The four PCs could even be programed remotely from different hubs. on account of ARPANET researchers and specialists could share each other's PC offices by long - separation . This was an extremely helpful assistance , for PC time was valuable in the early ‘70s. In 1971 ther were fifteen hubs in Arpanet; by 1972, thirty-seven hubs. What's more, it was acceptable. As ahead of schedule as 1977, TCP/IP was being utilized by different systems to connection to ARPANET. ARPANET itself remained decently firmly controlled,at least until 1983,when its military fragment severed and became MILNET. TCP/IP turned out to be more common,entire different systems fell into the computerized grasp of the Internet,and messily followed. Since the product called TCP/IP was open area and he essential innovation was decentralized and somewhat anarchic by its very nature,it as hard to prevent individuals from jumping in connecting up some place or other.

Understanding the Free Rider Problem

Understanding the Free Rider Problem Have you ever been in a situation where you have felt like you pull more than your weight in a project, at work, in your neighborhood or even in your own home?Have you somehow ended up doing (almost) everything while others are slacking off?Imagine this: you are preparing a meal for your family. Everybody is eating the delicious dinner that you made, bought ingredients for, set up the table, and did all the dishes. Everybody enjoys it, but they did nothing to contribute to the experience.Or this other, very well-known scenario to even younger children: There are five of your classmates in your assignment group. You and Tom research and gather information; Kate ends up typing the entire project, but what about Bill and Jane? Jane makes a suggestion every now and then, and Bill says that this assignment is well beyond his knowledge and/or interests, and decides to stay on the sidelines and not help at all.Now, at the end of the day, all five of you get an A from your teacher, regardles s of how much you contributed to the overall success of the project.Do you feel okay about this? How do Bill and Jane feel? Would you do it again in the same way? Would you do it at all or would you take note from Bills handbook?What these examples illustrate is the instinct of all the people, in general, to get as much as they can out of a certain situation with investing as little resources (energy, time, money, and so on) as possible.In the Social and Economic science, it is called the Free Rider Problem.WHO IS A FREE RIDER, AND WHAT IS THE FREE RIDER PROBLEM?A free rider is a person who uses a certain good, resource or service without actually paying for it, or if they are contributing in some way, they are not contributing enough.This leads to the overconsumption or underproduction of that good, which eventually leads to either partial or complete market failure. From our example, we can deduce that both Bill-who does not contribute to the project, and Jane-who contributes rath er insufficiently are free riders in this scenario. The other three Tom, Kate, and you are contributing to the project.On a more global scale, the contribution can be made in several ways, depending on the type of a good or a service that is in question.If you are thinking about services like free healthcare- you can either contribute by paying taxes, donating money or even time, by volunteering, for example. In other cases, such as national defense, all you can do is pay the allocated taxes.The free rider problem happens mostly with public goods like national defense, access to clean air and water, flood protection, free knowledge (public schools, libraries, and online educational content), roads, bridges, sanitation regulations and so on.The problem with Public goods is that they are non-excludable and non-rival. What does that mean?A good is non-excludable if people who do not pay for it cannot be easily prevented from using that particular good.Lets take a look at an example: C lothes are an example of excludable goods because it is easy to prevent people who do not pay for clothes from using them (note: think about purchasing clothes, not donations for the underprivileged).However, national defense is a non-excludable good, since it is hard, no, not hard- it is impossible to prevent people who did not pay taxes for national defense from benefiting from it.They are protected the same way as those members of the society who do pay for national defense.A service or a good is non-rival if when one persons use of the goods does not reduce the ability of another person to use the good.Clothes are a rival good since if one person is using them; another person cannot use those same clothes at the same time.On the other hand, if a person is protected by national defense from, lets say, bombing; that does not prevent other people, even those who do not pay, to benefit from the protection.And, additionally, the people who do pay for it do not get the extra protectio n just because they have paid.Since it is really hard to exclude the non-payers, there is an incentive not to pay and try to free ride.Rational individuals would never want to contribute to the allocation of public goods because a rational individual knows that as soon as they make a payment for it, other people are going to benefit from it.So, then they are thinking: Why should I do that? Surely I would have to let other people pay for it and then I free ride on somebody elses payment.But if everyone decides not to pay and free ride, the public good does not get provided as there are not enough funds to sustain the market.The final consequence in the example of national defense is that there is none and that in the unfortunate case of a war, the country will not have the resources to defend itself and all of its people, regardless of whether they paid for it or not.Because of that, there is a missing market for public goods; private companies do not want to produce them as there is no profit to it.Take street lights, or lighthouses, or bridges, for example, although they are socially desirable by all, they are not provided for willingly. So, who pays for those? Well, the government does.It is interesting to note that the free rider problem occurs as an issue of the mixed economic system (free market economy combined with command economy), which is the newest and most common in this day and age.WHY DO PEOPLE CHOOSE TO FREE RIDE? As we already mentioned and illustrated in the above examples, it seems nonsensical for the people to pay for something if others are going to use it for free.Why would they pay for it if they think that they can benefit from it anyway-somebody else will make that contribution?There are two illustrations that can further explain the free rider problem and the sociological or rather behavioral aspect of it, and those are The Tragedy of the Commons and the Prisoners Dilemma Game.I.  Free Rider Problem and the Tragedy of the Commons With all of our examples, if you decide not to contribute to the public good, you are expressing the innate tendency to reap as many benefits as possible with as little work possible.In such cases, the benefits are larger for you in the short term; however, the consequences for society are far greater in the long term.Those actions are selfish, but people are wired this way- to take care of themselves and disregard the wellbeing of others, and themselves as a part of society as the end result.This is illustrated in grabbing more than your share of resources that should be equally used by all and equally distributed among all the members of the society.“What is common to the greatest number gets the least amount of care.”   Aristotle, PoliticsThe incentive to do what is best for you rather than what is best for everyone is the root cause of something that economists call the Tragedy of the Commons.This term is used to illustrate economic and social situations in which every person has the same access to the same good as any other individual- like street lighting, or a public park, for example.The idea in this theory is that those common goods that everyone has access to are often misused or exploited.It explains most of our environmental problems like air pollution, deforestation, the killing of many endangered species, and overfishing.The term was coined way back in 1833 by William Forster Lloyd, a British economist, who wrote a pamphlet on a hypothetical situation of the British farmers over-consuming the grazing areas by letting more than the allocated number of cows feed on the areas.As a result, the individual benefits were greater in the short term, but the grazing area was eventually destroyed.Garrett Hardin, an ecologist, popularized the term more than a century later by raising attention to overusing natural resources that can cause issues that could be catastrophic in the long run, arguing for the importance of the public good rather than individuals a lone.In many places in the world, there are more fish being pulled out of rivers, lakes, and oceans than the fish that are being born.Now, this is not just bad for the fish, and the entire ecosystem that will suffer if an entire species would be removed from it, but for the fishermen as well. As the resources are depleted, fishermen find themselves without the job.Isnt it more beneficial for more of them to work for a little less profit, but keep their jobs for the rest of their working lives, rather than have larger profit for a short period of time?So why are they not conserving, allowing fish to reproduce and generate more resources for the future?Take a look at the incentives. If a few environmentally conscious fishermen decide to give the fish the time to spawn, then some other fisherman will harvest them instead. If you cannot prevent other people from exploiting the resource, then you have an incentive to exploit it yourself and take as much as you can and as quickly as you c an. But with everyone following that logic, the finite resource gets pillaged.There is an entire subfield of economics that is focused on addressing and solving issues like this, and it is called environmental economics.However, the principles of the Tragedy of the Commons can be successfully used to illustrate the social causes and motivation for free riding.When we take street lightning into consideration, the consequences are not as far-reaching as with destroying entire ecosystems, but lets explain how the Tragedy of Commons applies to this problem.If you pay for the street light you are safe to wonder about your neighborhood at night, knowing that you will be less likely to stumble and fall. But so will your neighbor who did not pay for the street light.If you decide not to pay, and your neighbor still does not pay, you will both have a larger chance of injuring yourselves; it will be harder to notice a potential robber, you will be stressed and potentially develop a health co ndition related to stress.This is just a hypothetical and highly unlikely situation.However, stop and think for a moment how much you would hurt yourself, the others and all future generations by being socially and economically unconscious and selfish, especially when you decide to free ride on issues that are beneficial to all members of society.II.  The Free Rider Problem and the Prisoners Dilemma GameThe Prisoners Dilemma Game is a part of game theory (studies how mathematical models can show the process of rational decision-making).The idea came from Flood and Dresher in 195o and was named and shaped up to what it is today by A.W. Tucker.The main idea behind the game is to show that, given a choice to either cooperate or not cooperate, the majority of rational people opt not to cooperate regardless of how this might not be in their best interest. The original prisoners dilemma game includes two people with a rather short possible sentence with the option to lower the sentence ti me if they cooperate and betray another.If one betrays and the other one does not, the one who betrayed goes free and the other one gets a bigger sentence.So, why does it then happen that in most cases, both prisoners decide not to betray?The dilemma occurs because, from a personal standpoint, it is clear that they can only gain if they are betraying the other, regardless of the fact that the mutual benefit is larger if they both cooperate.This comes as a result of not knowing what the other prisoner would do, and having no control over it.So how does this apply to the free rider problem?We stated that the free rider problem occurs that the public goods, resources or services are divided equally among all the members of the society regardless of how much, or even whether the members of the society pay/contribute to the use of a certain public good.Let us imagine the next scenario:There are two people- Jake and Kim who are thinking about paying for public service. Lets say that the l ocal community has decided to open up a new library, and each of the members of the community is asked to contribute by paying 6$ to help build the library which will be available for everyone to use.The government has taken into account how much money people spend on buying books on average and came to the conclusion that the benefit of a 6$ contribution will be 10$.This is great since the benefit is larger than the cost. How does it happen that each member of the community is motivated to free ride rather than pay the 6$ and enjoy the new library?Let us examine how Jake and Kim rationalize the free riding on this occasion.If both Jake and Kim pay the required amount of money, they will each gain 10$, and the individual net gain is $4, and the complete gain for the society is 20$.If Jake contributes and Kim does not, the total gain is only 10$, and since the public goods are distributed evenly, Kim will get her 5$ in net gain with no contribution whatsoever, while Jake will have th e -1$ net gain since he paid the 6$ cost and gained only 5$. The same process goes for the situation that Kim contributes and Jake does not.If both Jake and Kim decide not to contribute there will be no cost but subsequently no gain either.This is where rationalizing and the incentive to free ride comes to action.Since Jake does not know for sure if Kim will contribute, he is worried that only he would pay for the library which would be available for Kim to use as well, he will lose 1$, and she will gain 5$.Kim is thinking n the same way. Since we assumed that both of them are rational people, they will most surely decide not to contribute at all as it will diminish their chance at a loss, regardless of the benefit they would have if they actually do contribute to the building of the library.If the majority of the people in this hypothetic community thought in this way, there would be insufficient or no funds at all for the government to build the public library so the community wil l be left without one, and possibly spend more money on buying books in the long run, than if they did contribute without thinking about their individual needs that are more beneficial, short term.ARE THERE SOLUTIONS TO THE FREE RIDER PROBLEM?Since most of the public goods are government funded, it is up to the government to find a way to eliminate the free riders.There are several ways in which the government can do that.1. TaxationIf the government finds that the fire department in your community costs X amount of dollars, they should divide the cost to the entire number of the contributing individuals and require them to pay the taxes.In that case, the fire department will be sustained, and everybody will be able to use this public service in the time of need. Since the taxes are mandatory, the free rider problem is eliminated.Both the cost and the benefits are evenly shared among all the members of the community.Sometimes, the need for taxation feels like a punishment to people who initially did not want to pay for a certain good, but it seems like the only certain way to fix the free-riding problem.Again, people are acting on their best individual interest by paying what is required of them and not risking the additional fees if they do not.2. PrivatizationIf a government makes a public good a private one, it addresses the problem of non-excludability.If they put a toll on a bridge, you have to pay to use it, so some funds for more bridges and roads, and repair of the existed ones come through that money. If you do not want to pay the toll, you will have to find another way to travel where you need to.3. DonationsFor public goods that are not as expensive as sanitation infrastructure, roads or national defense and healthcare, soliciting donations may be the way to make up for the free riders.The act of donating small amounts of money to public parks, libraries or museums will not completely eliminate free riders, but it appeals to peoples altruism and mor ale.Those donations can be used books, clothes, canned goods and so on, not just money.FINAL WORDThe free rider problem occurs as a consequence of peoples inherent need to work/pay as little as possible and gain as much as possible.We will always look for what is best for us at the moment, rather than looking at a bigger picture and doing something beneficial for the community whether it be a local animal shelter, a states defense system, or worlds environmental problems.What we should get from this text is that it is in our nature to look for an easy way out and rationalize when we are tempted to free ride, however, it is better to focus on the long term well-being of our entire community, since it is an investment in the future of this world and the generations that are to come.It is up to us to become more socially, economically, and environmentally conscious, and evade our impulse to free ride, and it is up to the government to implement means that will ensure the well-being of all.

The Vietnam War During The 20th Century Essay - 2391 Words

Vietnam War occurred in the 20th century was the longest war in the American history, aimed to stop the spread of the Communism of South East Asian . The United States had involved in the conflict in Vietnam as the global superpower following it triumph over the Axis forces in the Second World War, but left Vietnam with a mortifying lost, with a high level of casualty . The perennial and most grievous war created long-term aftermath and impacts on most perspectives of the American life from military, domestic politics, diplomacy, economy and cultures, some of which remain to the present . The Vietnam War spurred the change of the attitudes in an American generation, created a split in the American society that had not existed in the past . American public lost the faith in government, as well as in the sincerity and competence of the authority. The humiliating loss in Vietnam War was a valuable lesson for the United States. It also sabotaged American confidence in the superiority of the nation and the commitment to internationalism, as well as destroyed the American prestige . The Vietnam War occurred in 1954 and ended in 1975, which was a long-running and traumatic conflict between the communist forces in the Northern Vietnam back by China and Soviet Union against a South Vietnamese non-communist government supported by the United States . The war caused 3 million people dead, including more than 50,000 Americans and at least 1 million of Vietnamese civilians . TheShow MoreRelatedThe Battle Of Dien Bien Phu1256 Words   |  6 PagesBien Phu To Vietnam War â€Å"It will be a war between an elephant and a tiger. If the tiger stand still, the elephant will crush him. But the tiger will never stand still. It will leap upon the elephant’s back, ripping out huge chunks of flesh and then will disappear back again into the dark jungle and slowly the elephant will blead to death† (PeriscopeFilm, 1962). After World War II, the world experiences one of the longest wars that have ever occurred in the twentieth century, Vietnam War which lastedRead MoreDomestic Political State Of The Nation, Technological Advances, And Doctrinal Changes1511 Words   |  7 PagesThe Evolution of the Cost of War Analyzed through the Domestic Political State of the Nation, Technological Advances, and Doctrinal Changes Politics can be defined as the practice of influencing people through the exercise of power. The main way to control a person or a group of people is to control their finances. This is why the economy of the United States is so important. Without control of its finances, the nation is unable to exercise control internally or over other nations. There have beenRead MoreUnited States Experience During Wars897 Words   |  4 PagesUnited States Experience during wars The history of the United States is riddled with military engagements and warfare. To the present day, the world knows the United States as a militaristic power. During the 20th the century the United States participated in many military specially the World War I, World War II, and the Vietnam War. World War I created a national state with unprecedented powers and a sharply increased presence in American’s everyday lives. During the war, wages rose, working conditionsRead MoreCivil War And The 1960s1631 Words   |  7 PagesA History of Protest Music – Revolutionary War to the 1960s Protest music in the United States dates back to the 19th century. This protest music focused around subjects that were topical for the time period. Among these topics were the Civil War. Another topic was slavery, and its abolition. A final topic was women’s suffrage. A famous group of protest singers was the Hutchinson Family Singers. Their notoriety, which spanned the mid-19th century, began in 1839. Their songs about abolition wereRead MoreEssay on Nightfather by Carl Friedman834 Words   |  4 Pagesand realize the impact of history on fictional literature. This book takes place sometime during the 1960s after the Second World War. Some Germans would rather forget it ever happened than acknowledge the disgraceful events that took place during World War II â€Å"Adolf Eichmanns trial began on April 11, 1961 in Jerusalem, Israel. Eichmann was charged with 15 counts of crimes against the Jewish people, war crimes, crimes against humanity, and membership in a hostile organization† (â€Å"Eichmann Trial†)Read More The Vietnam War Essay1721 Words   |  7 PagesThe Vietnam War The Vietnam War was caused by many factors that contributed to the warfare in Vietnam during the years of 1959 to 1975. Most factors were the beliefs held by people who wanted to change or to prevent Vietnam becoming an Independent Country. Many people suffered due to these beliefs and policies and that the Vietnam War is now considered as one of the most distressing moments in the 20th Century. So why did the US become involved in the Vietnam War? What was Ho Chi Minh thinkingRead MoreRepresentations Of Disability During The 20th Century1727 Words   |  7 PagesAmita Wanar HSPB W3950 James Colgrove 10/22/15 Representations of Disability in Military Veterans During the 20th Century At the end of the Civil War, Andrew Johnson alleged our nation s supposed investment in our veterans by claiming that â€Å" a grateful people will not hesitate to sanction any measures having for their relief of soldiers mutilated...in an effort to preserve our national existence.† Since then, our changing perception of disabled veterans of military service has affected the successRead MoreThe Vietnam War Was The Biggest Failure Of The 20th Century1628 Words   |  7 PagesThe Vietnam War The Vietnam War is one of the most controversial wars the United States participated in. Communism in the 20th century, was a huge threat to the U.S. It become a priority of the U.S. to stop the spread of Communism. In the late 1940s, the French struggled to control its colonies in Indochina - Vietnam, Cambodia, and Laos (history.state.gov). The U.S. saw that the French were struggling in south Vietnam so they decided to come and help France. They tried to support France and theRead MoreVietnamese Immigration into the United States1664 Words   |  7 PagesAccording to the 2010 United States Census, California has the largest Vietnamese population of 581,946 in the United States. Before 1975 there were very few Vietnamese living in the United States. After the Vietnam War and the fall of Saigon in 1975, many Vietnamese refugees fled Vietnam resulting in three major waves of immigration. The first and second waves of immigration played a major role in Vietnamese refugees resettling in California. The last wave in the 1990s centered on family reunificationRead MoreEssay on French Colonialism and Vietnam894 Words   |  4 Pagestheir power through trade, the French first began interactions with the region as early as the 17th century. Alexandre De Rhodes began an expedition to the Southeast Asia region with the desire to expand the Jesuit missionaries throughout the region to further their belief. For many years until the 18th century, the Jesuits expanded and created many missionaries throughout the region. The 18th century had brought an astronomical expansion in the trading markets throughout Europe and Asia as all the

Death of a Salesman An Ending More Familiar Than Strange ...

Arthur Miller (1915-2005) born in Manhattan, but lived in Brooklyn when he was a teenager. He lived with his father during, the depression. This play â€Å" Death of a salesman† makes me think that growing up in such an eventful time has a lot to do with how the elements of his drama revolves around life. His drama portrays the gloom and the sadness with some happy moments. Life brings out the elements, where the author stages the event and the characters play them out. The drama of this play includes several elements such as plot, characters, dialogue, stage setting, and theme. The author seemed to manage it all in this masterpiece. The main focus in this essay will be on the stage setting, character and plot. The stage†¦show more content†¦Tells his parents he is going to settle down but doesn’t. Biff the second son is more likeable than Happy. He has been working on farms and at times comes home for a visit. They both act as though their still boys. The fath er seems to be the best character in this play. His past is very complicated. Willy represents a very common person so Miller thought tragedy could be for a person like him. He had a chance at several jobs but he always declined them and never explained why. He doesn’t seem to want to pursue a new life for himself. As time goes on he chooses suicide. His wife never understood why he took his own life. Seems his wife and children never helped him. Willy, just fails to realize his personal failure of the sales profession. He never really understood himself. Willy makes a sacrifice to leave an inheritance so Biff could fulfill the American Dream. Through all his advice and appointments you end up worth nothing. Biff tries to break the lies in the Lowman family in order to be realistic to himself. Happy never shares none of his poetry. Happy lacks self-knowledge and finds no escape from lies. Linda seems to be a very tough person and is very realistic. The American West and Alask a is where Willy’s father found success, and his brother Ben became rich in Africa. Not like where Willy lived in the Brooklyn neighborhood. This commercial world of the city trapped him in a poor reality. Alaska and the American jungle were his failures. TheShow MoreRelatedEssay on Silent Spring - Rachel Carson30092 Words   |  121 Pages.......11 Chapter 1 A Fable for Tomorrow.........................................................................12 Chapter 2 The Obligation to Endure....................................................................14 Chapter 3 Elixirs of Death.....................................................................................16 Chapter 4 Surface Waters and Underground Seas.............................................18 Chapter 5 Realms of the Soil..................................Read MoreEssay about The Results of Children in Fatherless Homes16087 Words   |  65 Pagesharmful to children and to society. The children of single paren ts are more likely to do poorly in school, commit crimes, and become single parents themselves. In addition, the increase in single-parent families contributes to such social problems as poverty, crime, and a decline in the quality of public education. Divorce and out-of-wedlock childbirth are transforming the lives of American children. In the postwar generation more than 80 percent of children grew up in a family with two biological parentsRead MoreLogical Reasoning189930 Words   |  760 Pages...................................................................................... 200 The Middle ...................................................................................................................................... 202 The Ending ...................................................................................................................................... 203 Digressions ..............................................................................................Read MoreDeveloping Management Skills404131 Words   |  1617 PagesBehavior that helps you actively study and prepare material for class. Chapter-by-chapter activities, including built-in pretests and posttests, focus on what you need to learn and to review in order to succeed. Visit www.mymanagementlab.com to learn more. DEVELOPING MANAGEMENT SKILLS EIGHTH EDITION David A. Whetten BRIGHAM YOUNG UNIVERSITY Kim S. Cameron UNIVERSITY OF MICHIGAN Prentice Hall Boston Columbus Indianapolis New York San Francisco Upper Saddle River Amsterdam Cape Town DubaiRead MoreCoaching Salespeople Into Sales Champions110684 Words   |  443 PagesCoaching Salespeople into Sales Champions A Tactical Playbook for Managers and Executives Keith Rosen, MCC John Wiley Sons, Inc. Praise for Coaching Salespeople into Sales Champions ‘‘Winning in sales is no different than winning in life. As someone who has done a lot of personal and professional coaching over the years, I see tremendous value for anyone who reads this book. If the reader will embrace Keith’s philosophy around coaching, they can certainly expect to win in all areasRead MoreMarketing Mistakes and Successes175322 Words   |  702 Pagesgeneration of entrepreneurs. A fair number of the older cases have faced significant changes in the last few years, for better or for worse, and these we have captured to add to learning insights. After so many years of investigating mistakes, and more recently successes also, it might seem a challenge to keep these new editions fresh and interesting. The joy of the chase has made this an intriguing endeavor through the decades. Still, it is always difficult to abandon interesting cases that haveRead MoreManaging Information Technology (7th Edition)239873 Words   |  960 Pagesprovide secure, electronic linkages with suppliers and customers, and the Internet has become a mainstream channel for communications and business transactions. As a result, decision making about information technology resources has also become even more visible as the roles and accountabilities of the IS function have become important not only operationally but also strategically. The overall objectives and targeted audience for this edition remain the same as for the prior sixth edition: to provideRead MoreProject Managment Case Studies214937 Words   |  860 PagesUnited States at (800) 762-2974, outside the United States at (317) 572-3993 or fax (317) 572-4002. Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books. For more information about Wiley products, visit our Web site at www.wiley.com. Library of Congress Cataloging-in-Publication Data: Kerzner, Harold. Project management : case studies I Harold Kerzner. -- 2nd ed. p. cm. Includes bibliographical references andRead MoreStrategic Marketing Management337596 Words   |  1351 Pages‘the new competition’. This new consumer is typically far more demanding, far more discriminating, much less loyal and more willing to complain than in the past, whilst xii P R E FA C E the new competition is frequently far less predictable and often more desperate than previously. At the same time, the marketing environment has also been affected by a series of unpredictable events (SARS and the Iraq war are just two of the more recent of these), and by the emergence of new technologies

Genetic Testing For Haemophilia Health And Social Care Essay Free Essays

string(98) " attend meetings where negotiations are given to educate parents on caring for haemophiliac kids\." MFA presented to the day care of the Paediatric section with left mortise joint swelling for one twenty-four hours after hitting his mortise joint on a rock while playing in the flushing one twenty-four hours prior to admittance. There was hurting and bruising seen at the mortise joint articulation after the injury. The swelling increased in size and became more painful throughout the dark. We will write a custom essay sample on Genetic Testing For Haemophilia Health And Social Care Essay or any similar topic only for you Order Now His parents so brought him to the day care early the following forenoon. Physical scrutiny revealed swelling and tenderness at the left ankle joint every bit good as decreased scope of motion on both inactive and active motion due to trouble. There were besides multiple ecchymosis in different phases seen at the upper and lower limbs. A diagnosing of haemarthroses of the left mortise joint articulation was made. MFA was transfused with 200IU of Factor VIII. The hurting and puffiness were reduced in badness but persisted throughout the twenty-four hours. MFA returned to the day care the following twenty-four hours for more Factor VIII. He was given Factor VIII transfusion 200 IU twice daily for the following two yearss. The hurting and puffiness subsided after 3 yearss. MFA was diagnosed with terrible Haemophilia Angstrom when he was eight months of age. The diagnosing was made at the national blood bank. Familial testing besides done at the national blood bank revealed that his female parent was a haemophilia cistron bearer. MFA receives transfusion of Factor VIII when he develops haemarthroses or shed blooding due to trauma. He requires factor transfusion on an norm of one time every three months. He has had repeated hospital admittances with an mean continuance of stay for three to four yearss. MFA has good household support and is a member of the haemophilia society. He and his household have adapted good to his unwellness. Student Name: Tan Hai Liang ID NO: M0409146 Name OF SUPERVISOR: Dr Kyin ROTATION: Pediatricss PATIENT ‘S DETAILS I/C NUMBER: ( B ) 630902-01-6092 Age: 9 old ages old Sexual activity: Male DATE OF ADMISSION: 23/04/09 R/N NUMBER: N/A 2 ) CLINICAL HISTORY Chief ailment: MFA is a nine twelvemonth old male child who was diagnosed with haemophilia A since eight months old. He presented with swelling in the left mortise joint for one twenty-four hours. History of present unwellness: MFA was running in the field at school when he knocked his mortise joint against a big rock in the land on the eventide of the twenty-four hours prior to showing at the day care. There was hurting after he hit his mortise joint but he was able to bear weight and walk. There was some bruising but no hemorrhage at the site of hurt. The joint became more painful towards the dark and there was some puffiness, heat and inflammation which increasingly increased. The hurting increased in badness so much so that MFA was unable to bear weight and used a wheelchair belonging to his brother to travel about the house. The hurting caused him some uncomfortableness but he was able to kip. He did non take any analgesia for the hurting. The following twenty-four hours, MFA ‘s parents brought him to the day care of the pediatric section for a factor transfusion. Systemic reappraisal was everyday. MFA was foremost diagnosed with haemophilia A when he was 8 months of age. His parents noticed that he developed contusions at his custodies and articulatio genuss. This occurred when he was tilting to creep. A blood trial was done in the national blood bank, and his parents were told that MFA had terrible hemophilia A. His immediate household underwent testing and his female parent was found to be a bearer of the haemophilia cistron. MFA receives factor VIII transfusion on an norm of one time every three months. The transfusions are required when he develops haemarthroses or gum hemorrhage due to tooth decay. The joint most normally affected is his right articulatio genus articulation. He has non developed any contractures. He does non normally seek medical intervention for contusions which are a common happening. He has non had mucosal shed blooding as nosebleed or hematuria. MFA would sometimes necessitate hospital admittance for factor VIII transfusion. This is normally when he has hemorrhage or terrible hurting due to a haemarthroses or a hematoma. At other times he would have the transfusion at the day care and return place. His parents would convey him once more to the infirmary for the following dosage till the hurting and puffiness in the joint resolutenesss. If a transfusion were required at dark when the day care is non unfastened, MFA would travel to the pediatric ward where the medical officer would be able to administrate the factor VIII. His symptoms would better with the factor VIII transfusion. MFA is an active male child who likes playing and running about. However his instructors in school restrict his physical activity to non-contact athleticss such as badminton and running. He is besides discouraged from unsmooth drama with his classmates. He wears elastic guards around his cubituss and articulatio genuss to protect them from hurt. However the elastic guards do non assist much as he still develops haemarthroses at those articulations. MFA is presently casting his decidual dentition. As such he requires factor VIII transfusion screen prior to tooth extraction. MFA is under followup at the pediatric clinic of Batu Pahat. He has defaulted the followup as his parents feel that nil much was done during the visits. He merely presents to the day care when necessitating factor VIII transfusion. MFA has besides been referred for physical therapy after episodes of haemarthroses which limit motion in the articulations. He has attended a few Sessionss of physical therapy in order to forestall contracture at articulations which have haemarthroses. He does non hold regular assignments. MFA is a member of the haemophilia society. His parents on a regular basis attend meetings where negotiations are given to educate parents on caring for haemophiliac kids. You read "Genetic Testing For Haemophilia Health And Social Care Essay" in category "Essay examples" The members besides relate their experiences and promote one another. MFA has a medic qui vive necklace which says that he has haemophilia A. However, he rarely wears the medic qui vive. Past medical history MFA has non had any other infirmary admittances other than those due to haemophilia. Family history MFA is the youngest of three siblings. His senior sister is twenty old ages old and is good. His senior brother is 15 old ages old and has a bone cyst. He has undergone eight surgeries to mend the bone cyst every bit good as due to complications such as refractures. The wheelchair which MFA used at place was bought for his brother ‘s usage. MFA ‘s parents are good. There is no household history of hemophilia on his maternal side even though she is a bearer. MFA ‘s female parent has 3 brothers but all of them are good and do non hold hemophilias. There is no history of shed blooding upsets in the household. Social history MFA ‘s parents are both instructors. However they have to lose traveling to work frequently due to MFA ‘s status which necessitates frequent visits to the infirmary. As such, MFA ‘s female parent has a particular agreement with her schoolmaster which allows her to learn from 11 to 4 autopsy. As such, she is free in the forenoon to convey MFA to the infirmary when he needs it. His parents besides provide good support for MFA in that they frequently attend haemophilia meetings to update themselves on agencies to outdo attention for their kid. Birth history MFA was born at term in Hospital Batu Pahat. He was delivered through an elected cesarean delivery subdivision due to a breech presentation. There were no prenatal abnormalcies detected during everyday prenatal medical examination. There were no perinatal or station natal complications. He was nursed with his female parent after birth and discharged uneventfully. Developmental history MFA is presently in primary three of a spiritual school. He is an above mean pupil who finishes in the top 10 of his category. His instructors have no ailments about his school assignment. Developmental mileposts prior to this were all achieved at the appropriate times. Dietary history MFA is on an grownup diet now. He eats balanced repasts which are normally prepared by his female parent. He was breastfed till the age of seven months. Weaning was with porridge at the age of five months. Immunization history MFA has been immunized harmonizing to the immunisation agenda. After he was diagnosed with hemophilia A, his immunisations were done at the pediatric clinic under factor VIII screen. His last immunisation was at seven old ages of age. Student Name: Tan Hai Liang ID NO: M0409146 Name OF SUPERVISOR: Dr Kyin ROTATION: Pediatricss 3 ) Findings ON CLINICAL EXAMINATION On general scrutiny, MFA was friendly and communicative. He was sitting in a wheelchair with a patch around his left mortise joint. There were some ecchymosis seen at his weaponries and thighs. He looked good nourished. He was non in terrible hurting. Anthropometric measurings: Weight: 24kg ( 10th to 25th centile ) Height:130cm ( 25th to 50th centile ) His critical marks were normal: Pulsation: 82 beats per minute Respiratory rate: 18 breaths per minute Blood force per unit area: 108/72 Temperature: 37 grades Celsius Examination of the lower limbs: There were ecchymosis seen on both lower limbs at the thigh every bit good as at the shin and calf. The left mortise joint was swollen and there was a contusion seen on it. It was stamp on tactual exploration but there was no addition in temperature. There was reduced motion of the left mortise joint articulation due to trouble. The right mortise joint articulation every bit good as both the left and right articulatio genus articulations were normal. There were no contractures seen. Examination of the upper limbs: There was besides some contusions seen on both the upper limbs. The cubitus and wrist articulations were normal on both custodies. The scope of motion for all the articulations on both upper limbs were normal. Examination of the cardiovascular and respiratory systems every bit good as scrutiny of the venters was normal. Student Name: Tan Hai Liang ID NO: M0409146 Name OF SUPERVISOR: Dr Kyin ROTATION: Pediatricss 4 ) PROVISIONAL AND DIFFERENTIAL DIAGNOSES WITH REASONING Probationary diagnosing: Haemarthroses of the left mortise joint articulation — — Evidence for: MFA has been diagnosed with hemophilia since the age of eight months. The articulations are a common site of shed blooding for hemophiliac. In add-on, MFA has had anterior episodes of hurting and puffiness in the joint similar to this episode. The hurting reduced when he was given factor VIII transfusion which farther supports this diagnosing. He besides has multiple contusions on his weaponries and legs which indicate that he has a hemorrhage upset. Differential diagnosing: 1 ) Juvenile Rheumatoid Arthritis The pauciarticular type of juvenile rheumatoid arthritis nowadayss with hurting and puffiness in the big articulations such as articulatio genuss, mortise joints and carpuss. It may show as symmetrical arthralgia or may merely impact one articulation. Evidence against: Juvenile rheumatoid arthritis normally nowadayss during childhood while MFA has been holding episodes of joint hurting and puffiness since he was an baby at eight months of age. Juvenile arthritic arthritis is besides associated with forenoon stiffness which MFA does non hold. MFA besides has easy contusing which is non a characteristic of juvenile rheumatoid arthritis 2 ) Septic arthritis Patients with damaged articulations are predisposed to infected arthritis. As such, a haemophiliac patient who has repeated haemarthroses may hold damaged articulations which are susceptible to infection. Evidence against: Patients with infected arthritis normally have fever while MFA did non. They are besides more common in patients who are immunocompromised. On physical scrutiny, there was no increased heat in the joint which would be more declarative of infected arthritis. 3 ) Ankle ligament hurt A sudden turn of the mortise joint may do a wrenching of the soft tissue and ligaments around the mortise joint doing hurting and puffiness. Evidence against: Master of fine arts did non writhe his mortise joint while playing. He simply knocked it against a stone. As such the mechanism of hurt does non propose that the ligaments were strained. He was besides able to bear weight after hitting his mortise joint and the puffiness and hurting bit by bit developed. This is contrary to what is expected in a sprained mortise joint where there would be immediate puffiness and hurting around the mortise joint. Student Name: Tan Hai Liang ID NO: M0409146 Name OF SUPERVISOR: Dr Kyin ROTATION: Pediatricss 5 ) IDENTIFY AND PRIORITISE THE PROBLEMS 1. Swelling at the left mortise joint MFA has hurting and puffiness at the left mortise joint articulation. He was in moderate hurting which he rates as 6 out of 10 on the hurting mark. Analgesics such as acetylsalicylic acid and NSAIDS are non recommended for him as they cause shed blooding in hemophiliac. As such the best agencies for rapid alleviation of the hurting and the swelling would be Factor VIII transfusion. 2. Hazard of joint devastation MFA is presently eight old ages old and is an active male child who enjoys playing with his friends. As such he is prone to injury from even mild injury. He has developed haemarthroses on an norm of every 3 months. Perennial haemarthroses at the same articulation could do devastation of his articulations taking to osteoarthritis, restriction in motion and development of contractures. A hold in intervention could besides do harm to the joint. As such, prompt and equal factor VIII transfusion is indispensable for MFA. He should besides be referred to the physical therapy section when the hurting has subsided. Physiotherapy would assist in forestalling the development of joint contractures 3. Hazard of shed blooding Due to his active nature, MFA is besides at hazard of terrible hemorrhage if he injures himself. He was last admitted to the infirmary for one hebdomad due to shed blooding when he fell while playing. There was terrible hemorrhage from his oral cavity and gums when he hit his face on a tabular array. MFA is besides presently casting his decidual dentition. As such, he is at hazard of gum hemorrhage from the site of tooth extraction. The most unsafe hazard is that of an intracranial bleeding 4. Hazard of perennial factor transfusions MFA requires frequent factor transfusion. As the factor VIII used in Batu Pahat is derived from human plasma, there is a hazard that MFA may acquire Hepatitis B, Hepatitis C or HIV infections. In add-on, MFA has non been screened for any of these infections. As such it is necessary for MFA to be screened as recommended by the Malaysian protocol for the direction of hemophilia. 5. Consequence of unwellness on school assignment and day-to-day activity MFA misses school for about a hebdomad on an norm of one time every three months. This may impact his public presentation in school. In add-on there is an addition demand for him to acquire good academic consequences as he would necessitate to believe about a hereafter with a calling that does non necessitate heavy physical activity due to his status. Trouble faced by caretakers MFA ‘s male parent and female parent are both working and frequently are forced to lose work in order to take attention of MFA when he develops episodes of hemorrhage. Both the parents are instructors who have understanding schoolmasters who sympathize with them and give them much leeway in order to care for their kid. However the uninterrupted emphasis of taking attention of a inveterate sick kid demands to be addressed. Support groups such as the haemophillia society would be able to assist the parents by giving them entree to other parents who face similar troubles. These parents would be able to promote one another and portion tips on caring for haemophilliac kids Student Name: Tan Hai Liang ID NO: M0409146 Name OF SUPERVISOR: Dr Kyin ROTATION: Pediatricss 6 ) Plan OF INVESTIGATION, JUSTIFICATIONS FOR THE SELECTION OF TESTS OR PROCEDURES, AND INTERPRETATION OF RESULTS Probes done at 8 months of age by the national blood bank: 1. Curdling profile Justification: MFA presented with peliosis at his limbs which indicates that might hold a hemorrhage upset. As such a curdling profile would be utile to see if the curdling tracts are affected. Consequences: APTT prolonged. More than 90 seconds Interpretation: The drawn-out APTT indicates that the intrinsic tract is affected and that one of the factors in the intrinsic tract may be deficient. 2. Serum factor VIII degree Justification: To determine which specific factor that is lacking doing the hemorrhage upset. Consequences: Factor VIII degree: 0.6 % ( No inhibitors detected ) Interpretation: MFA has severe haemophilia A due to his Factor VIII degree being less than 1 % . He will react to factor VIII transfusion as there are no inhibitors to factor VIII detected. No probes were done for this presentation at the day care. I would propose the undermentioned probes: 1 ) A field radiogram of the ankle articulation AP and sidelong position Justification: In order to govern out other causes of the joint hurting such as infected arthritis or break at the joint. Possible grounds why it was non done: The clinical presentation of the patient did non propose that he has infected arthritis as he did non hold a febrility and the articulation was non ruddy. As the clinical image was typically implicative of a haemarthroses given that he is a hemophiliac, it would be unjust to the patient to subject him to an ten beam as this would intend he would be exposed to radiation every three months. 2 ) Full blood count Justification: A full blood count would be utile to see if there is an increased white cell count which may bespeak an infection. Possible grounds why it was non done: MFA is clinically good with no symptoms of infection such as febrility. As such a full blood count may non be necessary as it would likely be normal. There is besides a hazard of shed blooding or hematoma from venepuncture. Student Name: Tan Hai Liang ID NO: M0409146 Name OF SUPERVISOR: Dr Kyin ROTATION: Pediatricss 7 ) Working DIAGNOSIS AND PLAN OF MANAGEMENT ON ADMISSION Working diagnosing: Haemarthroses of the left mortise joint due to Haemophilia A My proposed program of direction: I ) Factor VIII transfusion with a mark serum factor degree of 30 % eight hourly till the puffiness and hurting resolutenesss two ) Elastic patch and ice battalion around the left mortise joint three ) To rest the mortise joint articulation by non-weight bearing boulder clay swelling and hurting reduces four ) To analyze patient for joint malformation or contractures prior to dispatch from day care V ) Refer the patient to physiotherapy for joint rehabilitation of the affected articulation. six ) To educate the parents on attention for their kid and protective steps to forestall hurt. Student Name: Tan Hai Liang ID NO: M0409146 Name OF SUPERVISOR: Dr Kyin ROTATION: Pediatricss 8 ) Summary OF INPATIENT PROGRESS ( INCLUDING MAJOR EVENTS, CHANGE OF DIAGNOSIS OR MANAGEMENT AND OUTCOMES ) MFA was given 200 IU of Factor VIII transfusion. He was so asked to return the following twenty-four hours to be reviewed by the medical officer in charge. Merely one transfusion was deficient for the puffiness and MFA had to digest much uncomfortableness and hurting throughout the dark. This is despite the Malayan Paediatrics protocol recommendation that factor VIII is given every 8 to 12 hours. The ground for this could be the prohibitory cost of the factor. The following twenty-four hours MFA was given another 200 IU of Factor VIII transfusion in the forenoon and once more in the eventide, 12 hours apart. He was given two more transfusions on the 3rd twenty-four hours. The transfusions were given at the day care in the forenoons and at the pediatric ward at dark by the medical officer who was on call. The hurting and swelling resolved on the 4th twenty-four hours post hurt. He was examined by the medical officer and was told to merely return to the day care if he had another episode of joint puffiness or open hemorrhage. Student Name: Tan Hai Liang ID NO: M0409146 Name OF SUPERVISOR: Dr Kyin ROTATION: Pediatricss 9 ) DISCHARGE PLAN, COUNSELLING AND MOCK PRESCRIPTION Discharge program: I ) MFA was asked to rest him left mortise joint and to partly bear weight till it was wholly pain free. two ) Referral to the physical therapist for joint rehabilitation to be done Guidance: I ) MFA was advised to avoid athleticss which involve physical contact as the even minimum injury may do a bleed. two ) MFA ‘s parents were told to convey him back to the day care if there were any longer episodes of shed blooding into the articulations or self-generated hemorrhage. They were given a eventuality program to travel straight to the pediatric ward and see the medical officer on call if any hemorrhage were to go on when the day care is closed. three ) MFA and his parents were besides educated on complications that they need to look out for such as intracranial bleeding. They were taught about the marks and symptoms that they should be wary of. four ) MFA was encouraged to travel for physical therapy which he had antecedently defaulted. He was told about the dangers of joint devastation due to recurrent haemarthroses and how physical therapy may help in forestalling contractures. Student Name: Tan Hai Liang ID NO: M0409146 Name OF SUPERVISOR: Dr Kyin ROTATION: Pediatricss 10 ) REFERRAL LETTER ( MANDATORY ) Dr Tan Hai Liang, Paediatric Department, Hospital Batu Pahat Physical therapist, Physiotherapy section, Hospital Batu Pahat 27 May 2009 Dear sir, Patient ‘s name: Mohammad Faiz Affizuddin Patient ‘s I/c figure: ( B ) 630902-01-6092 Problem: Haemarthroses of the left mortise joint articulation Thank you for seeing this nine twelvemonth old male child who was diagnosed with Haemophilia A for the past eight old ages. He has had recurrent episodes of shed blooding into the articulations. The articulations most normally affected are the articulatio genus articulations and elbow articulations. His current presentation is for a haemarthroses of the left mortise joint articulation. Physical scrutiny: Inflammation and puffiness of the left mortise joint articulation. Tenderness on tactual exploration. Reduced scope of motion both active and inactive. He has been given Factor VIII transfusion which has reduced the puffiness and hurting. Kindly reexamine the patient and execute joint rehabilitation for him. He has good household support and his household could besides be taught exercisings to forestall joint contractures that can be done at place in position of his recurrent shed blooding into the articulations. Thank you. Yours genuinely, ______________ ( Dr Tan Hai Liang ) Student Name: Tan Hai Liang ID NO: M0409146 Name OF SUPERVISOR: Dr Kyin ROTATION: Pediatricss 11 ) Learning ISSUES IN THE 8 IMU OUTCOMES 1 ) Family and community issues in health care How are parents affected by holding a hemophiliac kid? I had the chance to speak to MFA ‘s parents and inquire them about the challenges faced when caring for him. They related many of their experiences and confided that many alterations to the life style of the household were done in order to accommodate to populating with and caring for a hemophiliac. Both parents have had to lose work on a regular basis due to MFA ‘s frequent infirmary admittances. Family activities besides are limited to light physical activity with minimum hazard of hurt. Furthermore MFA ‘s female parent admitted to ab initio experiencing guilty as she was the bearer of the cistron that leads to his status. As such, I wondered if hemophilia had an impact on parent ‘s quality of life in visible radiation of the many accommodations that they had to do to their life style. A survey by Beeton et al [ 1 ] involved 12 parents of kids with hemophilias whose age ranged from 18 months to 16 old ages of age. The parents were interviewed and qualitatively assessed on their experiences in caring for a kid with hemophilia. It found that medical direction often focused on assisting the hemophiliac adjust to his or her status with small accent on the wider household web. The early old ages of the kid ‘s life after diagnosing were characterized by the parents missing experience and feeling uncertain. This is coupled with the frequent demand of factor transfusion and the associated trouble in venous entree in babies and immature kids. Quality of life at the early old ages post diagnosing was found to be hapless due to parents experiencing ‘out of control ‘ . Parents caring for a hemophiliac kid besides reported that the manner in which they engaged with the people around them had changed. There was a necessity in being more self-asserting in order to protect their kid. This was confirmed by MFA ‘s female parent who relates that she had statements with the infirmary manager and schoolmaster of MFA ‘s school in order to take a firm stand on particular steps to be put into topographic point to better MFA ‘s quality of life. The survey besides found that female parents normally took up a greater duty in caring for the kid. Fathers who were at work during the twenty-four hours did non hold the same degree of experience and this could be a beginning of struggle between parents. Parents were besides found to hold higher degrees of emphasis and anxiousness. However the degree of the emphasis and anxiousness was dependent upon on the phase that parents had achieved in pull offing the status every bit good as successful version. Another survey by Bullinger et al [ 2 ] showed that the quality of life for patients and households with hemophilia was higher when compared to patients with other chronic unwellnesss such as asthma. This shows that households with hemophiliac are able to populate a comparatively normal life with good quality of life if certain stairss were taken to accomplish successful version. The survey found that betterment in quality of life can be attained by supplying an environment in which patients and parents experience understood and good informed. In decision, I learned that hemophilia has a profound consequence, non merely on the kid who has the disease but besides on his primary caretakers which are his parents. As such I need to besides ask about how parents are get bying and offer professional aid such as reding if necessary. 2 ) Critical thought and research Is coagulating factor dressed ore prophylaxis effectual in the direction of patients with hemophilias? A paper by Ljung [ 3 ] proposed that direction of a patient with hemophilia should travel off from concentrating on the upset itself and alternatively look towards keeping a healthy kid. This means that patient ‘s should non be repeatedly managed with factor transfusions when they present with shed blooding but alternatively be kept healthy by forestalling the hemorrhage from go oning in the first topographic point. As such the writer proposed that primary contraceptive therapy should be the gilded criterion in the direction of patients with hemophilias. However is coagulating factor dressed ore prophylaxis effectual in pull offing patients with hemophilias, and what are the associated factors which prevent this direction from being a practical option? I looked at a Cochranre reappraisal by Stobart et Al [ 4 ] which analysed four separate surveies affecting 37 patients. The consequences of the reappraisal showed that there was a statistically important difference in the decrease of shed blooding episodes in patients who were given standard prophylaxis when compared to a placebo. It besides found that secondary results such as clip loss to school and employment due to the unwellness was statistically significantly reduced among those having primary prophylaxis compared to a placebo. The reappraisal besides quoted one survey which showed that a twice hebdomadal extract of higher dosage of factor dressed ore had a statistically important advantage in cut downing the figure of bleeds a twelvemonth when compared to a lower dosage and less frequent disposal of transfusion. However the writers concluded that there was deficient grounds from randomized control tests to urge the usage of primary contraceptive factor extract in the direction of patients with hemophilias. An independent retrospective survey by Khoriaty [ 5 ] showed that primary prophylaxis has some promise. The survey recruited 133 patients with Haemophilia A and B with a average age of 27.93. It compared the 91 patients who were on primary prophylaxis and the staying 42 patients having on-demand intervention when they developed shed blooding. The survey found that there was a statistically important decrease in the figure of self-generated shed blooding per twelvemonth. Patients on primary prophylaxis were found to hold 3.2 bleeds per twelvemonth while those who received on-demand therapy bled 5.7 times per twelvemonth. It found no statistical difference between the two groups in footings of hemorrhage after injury. However the consequences for this survey needs to be read with attention due to the big age scope. Further surveies need to be done for the pediatric age group due to differences such as a higher leaning for injury and hurt in active kids compared to grownups who are better at caring for themselves. One ground why primary prophylaxis is non used in the intervention of haemophiliacs despite its promise is the high cost of the factor VIII. One phial of 200 IU costs in the part of RM 800. As such it may non be cost effectual for primary prophylaxis to be carried out particularly in the context of the Malaysian health care system with its limited budget. A cost effectivity analysis by Miners et al [ 6 ] in England showed that it would be amp ; lb ; 547 to forestall one episode of shed blooding from go oning. This cost is mostly prohibitory in the Malayan context. In decision I found that there is grounds that primary prophylaxis has much promise in the bar of shed blooding among haemophilia patients but extra surveies need to be carried out particularly in the local environment in order to determine the cost-effectiveness of primary prophylaxis. 3 ) Self directed life long larning What is the hereafter in footings of direction of hemophilia? The direction of hemophilia is presently with factor transfusions which aim to halt hemorrhage when it has already happened. The other option is primary prophylaxis with regular factor extracts to forestall hemorrhage. However this attack is dearly-won and does non cover with the job of patients developing inhibitors which make transfusions uneffective. As such, research workers are looking into a agency for a remedy of hemophilia. This remedy is by utilizing cistron therapy. The aim of cistron therapy is to redact a faulty cistron sequence to accomplish complete reversion of disease phenotype in the life-time of the patient. Haemophilia is seen as the ideal campaigner for cistron transportation therapy as foremost there are many cell types which are able to synthesise biologically active coagulating factor. Second, there is a broad remedy window which makes it unneeded to hold rigorous cistron look. Third there are big and little animate being theoretical accounts that permit the survey of safety and efficaciousness prior to induction of human tests. [ 7 ] Phase 1 clinical tests are presently being done utilizing largely viral vectors to infix the cistron. Retroviruss have shown promise in this therapy. The cistrons are inserted via developing hepatocytes or hematopoietic root cells. Presently safe long term look of coagulating factors has been successfully achieved in big carnal theoretical accounts of hemophilias utilizing multiple cistron transportations. [ 8 ] Gene transportation therapy nevertheless still faces many obstructions before it can be seen as a feasible therapy for hemophilia. There is hazard of experimentation in worlds in order to formalize this therapy. Many inquiries besides remain unreciprocated such as inhibitor development after the interpolation of the cistron and besides the transmittal of the extra cistron to the kids of the patient who receives the cistron therapy. One paper suggested a generous timeline of at least 20 to 30 old ages before the potency of cistron therapy can even be considered. These issues are ‘merely medical ‘ issues. Religious and ethical issues besides have to be taken into consideration before prosecuting this direction. In decision, I learned that though there is much potency in this field of cistron therapy, much research still has to be undertaken to determine its safety every bit good as efficaciousness. However it has been a valuable experience in larning about new modes of intervention and to catch a glance of what the hereafter holds. This has taught me to go on larning as there are ever new sentiments and therapies available in the direction of any unwellness. 4 ) Professionalism, moralss and personal development What are the ethical deductions of familial proving for haemophilia? After MFA was diagnosed with haemophilia, his immediate household underwent familial testing. The proving revealed that his female parent was a bearer and that his senior brother and senior sister were normal. The familial testing was done voluntarily. There is no recommendation in the Malayan Paediatric protocol for familial testing to be done. Familial testing is normally done in patients with no clear household history in order to determine which parent is a bearer so that farther stairss of direction can be carried out. These farther stairss may include offering familial testing to the siblings of the bearer parent and besides reding about hazard of holding extra kids. However familial testing besides raises many ethical inquiries. First there is guilt, heartache and ego incrimination when a female parent with no known household history of hemophilia discoveries that she was the cistron bearer that passed it on to her kid. A paper by Thomas et al [ 9 ] on attitudes towards familial proving in an Australian community found that female parents who were ‘sporadic ‘ bearers ( no known household history of hemophilia ) were had feelings of guilt. Performing familial testing to determine that a female parent of a haemophiliac kid is a bearer would merely be of value if extra stairss were taken such as offering familial testing to the female parent ‘s siblings. This in itself would raise inquiries of confidentiality and revelation since offering the testing would necessitate the physician to unwrap to the other household members that the female parent is a bearer. This revelation could so take to stigmatisation. In this specific instance, MFA ‘s female parent was found to be a bearer. She related that she felt anguished at ‘causing ‘ her boy to endure much hurting. The cognition that the female parent was the bearer who had passed on the cistron to her boy did non change the direction of MFA. As such there was small virtue in executing the familial testing in this instance. A 2nd consideration of familial testing is the deductions that it has on a individual ‘s determination of whether or non to hold kids. This is once more more relevant for female bearers. Carriers should be counseled that there is a 50 per centum opportunity that their kid would hold hemophilias if he were a male child. However the ethical issue arises when there is no agency of correlating between the genotype and phenotype. [ 10 ] Just because the kid may hold hemophilia does non foretell the grade of badness of the hemophilia. The lone means to cognize for certain about the position of a foetus in footings of whether he would hold hemophilias and the grade of badness is by making antenatal familial proving such as chorionic villi sampling. Prenatal familial proving itself is associated with many ethical issues such as the deductions of transporting out such a trial. Would the foetus be terminated? There is legal leeway for expiration if it can be proven that the kid ‘s unwellness would convey about mental hurt to the female parent. Where do we pull the line to make up one’s mind that such a foetus has excessively terrible a haemophilia so as to justify expiration? Who makes the determination? In the instance of MFA, the parents decided non to hold any more kids due to the hazard of holding another hemophiliac kid. It ca be seen that the familial testing had a profound impact on their determination. However proper and thorough familial guidance was non given to the parents. In decision I learned that familial proving for hemophilia is fraught with many ethical considerations. It should merely be offered when proper followup such as guidance, support and options can be offered to those undergoing the trial. In the absence of proper model of support, it may be better to keep back familial testing. How to cite Genetic Testing For Haemophilia Health And Social Care Essay, Essay examples

Unknown Lab Report Essay Example

Unknown Lab Report Paper Results Unknown #25 had the following morphology on a streak plate: medium sized buyouts cream colored colony. Grandstanding was utilized as a first step to differentiate between gram-positive and gram-negative. After determining that t was a Gram negative single bacillus, biochemical tests performed and their purpose and results are shown in table and flow chart form. Table 1: biochemical Test Results Test purpose I Reagents Observations I Results I Gram stain I To determine the Gram reaction tooth bacterium Crystal violet, Iodine, Alcohol, Sarnia Pink rod Cram-negative rods I Carbohydrate (Glucose) fermentation To determine the ability of a bacterium to ferment a carbohydrate, make acid or gas Durham tube Color change from red to yellow, bubble in Durham tube Positive carbohydrate fermentation, acid reduction and gas production Thyrotrophic digestion I To determine the ability of an organism to split indolence from thyrotrophic I Kavas drop added to Trenton broth I Kind of colorless and list green ring at top of broth Negative thyrotrophic digestion Sistine digestion I To determine the ability of an organism to catabolic certain amino acids I Iron ions I Color didnt changed remained creamy Negative Sistine digestion Citrate Utilization To determine the organism is able to utilize citrate as a carbon source I Citrate slant (green) Biorhythms blue I Color changed from green to deep blue I Positive for titrate utilization urea digestion To determine the ability of an organism to catabolic ammonia Phenol Color didnt change stayed bright orange Negative for urea digestion I Flowchart Gram stain Gram-negative Rod Glucose fermentation (positive) Positive Unknown# 25 Negative Escherichia coli Pseudonymous organisms Interrogator arrogates Pseudonymous fluorescent Salmonella enteritis Seriate mercenaries Protests vulgarism Gelatin drowsily (positive) Positive Negative Seriate mercenaries Salmonella enteritis Motility test (negative) Escherichia coli Interrogator arrogates Unknown# 3 Protests vulgarism Discussion/ Conclusion After several differential tests, it was concluded that unknown# 25 was Protests vulgarism. Tater performing the Gram stain to determine that the unknown was a Gram negative rod, the organism grown on slant for use in inoculating the rest of the biochemical tests. All of the biochemical tests worked well except for the motility, cytosine digestion and urea digestion. We will write a custom essay sample on Unknown Lab Report specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Unknown Lab Report specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Unknown Lab Report specifically for you FOR ONLY $16.38 $13.9/page Hire Writer According to chart it should be positive but because of the human error, not appropriate temperature, and too old culture, etc it gave a false negative result. For example: the culture that seed it might be too old, or when was inoculating the culture to the urea it might be hot, leaded to kill the bacterium _ That is Why got false negative result. Other than this everything (data) was great and into the conclusion the unknown was Protests vulgarism. P. vulgarism is in the Intercontinental family and opportunistic pathogen of humans. Colonies of Protests inhabits the intestinal tracts Of humans and animals. It can be found in soil, water and fecal matter.