Girl Interrupted Movie Review Example | Topics and Well Written Essays - 500 words

Young lady Interrupted - Movie Review Example As the story advances, Susanna got appended to Lisa who impacted her to cause issues with different patients. There was even a point where Susanna dismissed that she wasn't wiped out as what her beau had advised her since she depended much on Lisa. Susanna just came to acknowledge how risky Lisa's character was after Daisy murdered herself and Lisa demonstrated no kindness. Lisa even assaulted Susanna and took steps to slaughter herself, as well. Toward the finish of the film, Susanna was discharged from the organization. She left an astounding line Insane isn't tied in with being broken, or gulping a dull mystery. It's you, or me, amplified.... As per an examination directed by World Health Organization (2010) sorrow, tension, mental pain, sexual brutality, aggressive behavior at home and heightening paces of substance use influence ladies to a more prominent degree than men across various nations and various settings.

Marriot Being a Marketer Case Study Example | Topics and Well Written Essays - 1250 words

Marriot Being a Marketer - Case Study Example The advertiser offers phenomenal situating and division to the worldwide business element. The advertiser uses a few promoting techniques for his objective market and offers the perfect division for all the business endeavors far and wide. The advertiser gives more fixation on the buyer than some other component to make the business a triumph. He uses advertise looks into too get criticism that is generally used in the arrangement of the best administrations inside the worldwide business. Key promoting Issues Market look into Marriott uses statistical surveying to manage certain advertising issues or make upper hands towards its rivals. The worldwide uses various strategies to gather data for showcase assessments. Guaging strategies Marriott uses divergent determining methods for various brands offered inside its business domain. Markets-Marriott is a business-to-shopper advertise since it includes buyers and buyers of items without the goal of increasing any benefits from the offere d types of assistance. Market focusing on Marriott uses three systems in showcase focusing for its items. The three techniques are concentrated, separated and undifferentiated objective systems. Market situating Marriott has effectively situated its items in the contemplations of its purchasers by giving items that adequately address their wants. Situating has likewise helped Marriott in promoting division in a few different ways. Market division Marriott sections its market in like manner to suit all buyers visiting its inns everywhere throughout the globe. Division has broadly done to gather buyers as indicated by their requirements and inclinations. Individual Case Analysis Marriot case presents the fundamental and most basic ideas in the market systems. The case presents the challenges that an advertiser experiences to keep the business running. Market focusing on, division, and situating offer the advertiser with the best techniques to maintain the business. Marriott acquires a gigantic piece of the overall industry by working on unique nations around the world. Case Questions 1. How is Marriott sectioning the market for inn administrations? Promoting division offers extraordinary or unmistakable gatherings of purchasers with homogenous requirements and qualities (Shoba 1). Marriott has successfully sectioned the market into Marriott and Renaissance purchasers who bear divergent inclinations. Renaissance clients introduced the inclination to open the windows up and look outside upon appearance in their introduced rooms. The clients who invested their energy inside the Marriott’s property demonstrated enthusiasm for undertaking different cutting edge exercises, for example, video conferencing. Marriott has reacted to this call through the organization of hardware, for example, the latest account and correspondence devices inside the gathering places. The property has made an alliance with AT&T just as Cisco to give virtual gathering offices. Mar riott has likewise introduced another section inside its brands that comprise of clients and trade voyagers cognizant about the earth. Marriott has reacted to this portion through the advancement of model green inns. The lodging brands bearing these green inns are intended to hold mutual spaces, and visitor’s room that are increasingly situated towards protecting water, and vitality than the previous variants. Marriott brand with the green lodgings targets working in biological system amicable environs. The inns in this portion offer cushions produced from reused paper and key cards created out of reused plastics. The achievers fill in as one more of the numerous portions that Marriott has created.

Language Assessment Project Example

Language Assessment Project Example Language Assessment Project â€" Essay Example > The language Assessment Project RevisitedTeaching and testing: Most of the language teachers have little trust to both the tests and testers probably because they think that most of the types of language testing are usually of poor quality. They always harbor harmful effects on both learning and teaching respectively and fails short of accurately gauging their intended purpose. Backwash is known as the process of the effects of testing on teaching and learning. This process can either be beneficial or harmful. A good language test is very necessary and equally important judgment tool for the performance of the language learning student. Most often, language learning and testing are administered in the scenarios where is English is practiced, applied or used as second language (Read, 2000, p. 66). Grammar test are advisable to be administered by the writer in areas where English is used as a second language purposely to make it more original and real. In our case of in this paper, we are going to discuss English as second language in Saudi Arabian population learning English. We are going to investigate the English as a second language in the Saudi Arabian Background. The Handbook for the Teaching Staff, Test Takers and Users: Handbooks care written with different contents depending on the audience, and they are expected to contain the following contents: The test rationaleComplete sample tests as the sample contentsThe development and validation methods of the testsExplanations of how the tests scores are to be interpretedTest descriptions i. e. specifications version. Materials for training i. e. for raters and interviewers. Test administration training. The Testing ContextA design test was designed for the Saudi Arabia students in general since Saudi Arabia as a country speaks English as a second language. The assessment was carried out on what they had learnt on the grammar language thought their semester studies. The target groups were the students in their elementary level of educations of the ages between 14 â€" 16 years old and whose English aptitude level was transitional. The students who were selected for our study ranged on the same age group and had the same proficiency and skills in English. Examples of what the Saudi Arabia students learnt in grammar lessons and that were looked into included nouns, pronouns and verbs. We also based and conducted our achievement test on the Saudi Arabia first year students taking their grammar lessons as part of their syllabus. The details of these tests were broadly broken down on Appendix A. The students who normally take English as a second language always have a burning desire to learn more. The achievement tests in Saudi Arabia secondary schools platform are always of high stakes and the achievement motivation notwithstanding. And therefore this makes the achievement test a priority in the Saudi Arabian schools. The good results achieved from the scores of achievements tests did determined the promotions of the students to another level in their education, and so it was upon them to perform better on the design tests. The Test Features

The Los Angeles Of Anaheim - 929 Words

With the Los Angeles Angeles of Anaheim (you should only be allowed to represent one city) currently visiting the Bronx for a four-game series, the inevitable Mike Trout to Yankees trade rumors began to sprout up. So much in so, that Trout’s own family and friends began to pester him with questions about the possibility of one day soon, coming home to play. For those who don’t know, Trout grew up in nearby Millville, N.J., less than a two-and-a-half-hour drive to â€Å"the stadium.† When asked by N.J. Advance Media about the possibility of a trade to the Yankees, before the start of the series on Monday night, Trout replied, â€Å"I just say that I’m happy where I am right now.† Well, well, well, that doesn’t exactly sound like a ringing endorsement of staying in O.C. for the long haul, now does it? Maybe Trout has become weary of spending his baseball prime stuck in a situation that is more doom than gloom. The Angels finished the 2015 campaign in third place, while currently wallowing in fourth, already nine games behind division leader Texas. Saddled with a mixed roster of overpaid, injury prone players and unproven below-average talent; then combined with a minor league system that ranks dead last according to Baseball America, it would make sense now, more than ever that this Angels franchise cashes in on arguably the most complete player currently in the game. Trading ‘Mike from Millville’ is easier said than done. And obviously, if and when he is made available, there willShow MoreRelatedFBI Uniform Crime Report1064 Words   |  5 Pageskeeping in the last 20 years (Measures, n.d.). Calculating rates of crime (generally, per 1000 people or 100,000 people) requires that the number of offenses be divided by an accurate count of the population (Measures, n.d.). 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Reconsider Planting Leyland Cypress in Your Yard

The rapidly-growing Leyland cypress tree, or  Cupressocyparis leylandii,  quickly outgrows its space in a typical yard, unless properly and regularly trimmed. These trees have the potential to grow to 60 feet tall. They are not a practical tree to plant as a small yard hedge on tight, six- to eight-foot  centers. Tight spacing of the plant means that you must commit major time and effort to constant pruning. Leyland cypress is a  short-lived conifer, with a typical lifespan of 20 to 25 years, and will eventually have to be removed. Even properly-spaced trees left to grow may have limited root support, and are subject to being blown down during high winds if planted on wet soils. Consider the work needed to maintain a Leyland cypress before planting one. Why Not Plant Leyland Cypress? A study of Leyland cypress done at the University of Tennessee indicated that a lot of damage on these trees is simply environmental, and not always directly caused by a disease or insect. The study indicated that stress from a harsh winter can cause sporadic limb die off among Leyland cypress trees. Leyland cypresses grow into large, mature trees at 60-plus feet tall with a potential 20-plus foot spread. When they are planted as hedges on tight centers less of than 10 feet, there will be a major competitive  struggle for nutrients and shading. When needles turn brown or drop, the tree is reacting to environmental stresses. Leyland cypress trees do not tolerate many diseases and insects well, especially when environmental stressors are present. Spacing and soil may create an environment that can cause future stress on these trees. Planting Leyland cypress too close together or too close to other trees and structures that shade them can decrease vigor and increase pest damage. Caring for an Existing Tree Eliminating moisture stress on Leyland cypress through watering techniques can help lessen the occurrence of canker diseases. In particular, Leyland cypress is susceptible to Seiridium canker. There is no control for this disease other than to prune out the infected plant part. Watering is a long-term commitment for the Leyland cypress owner. These trees should be watered during any period of dry weather and should receive at least 1 inch of water per week. Pour the water at the base of the tree, and do not spray water on the foliage with sprinklers or watering techniques that can cause various  tree disease. As these tree age and lose lower foliage, consider removing Leyland cypress individually as they deteriorate, and replace each with a deciduous evergreen tree like wax myrtle.

De-icing operations at Minnesota Saint Paul Free Essays

string(104) " consequences the squad would travel one or multiple phases back in order to polish their old purposes\." Executive Summary This study explains the consequences of research into how de-icing operations at Minnesota Saint Paul could be improved. The findings were that this airdrome should utilize a combination of infrared warming and antifreeze crop-dusting in order to defrost aircraft in a fast, safe, cost effectual and environmentally friendly manner. The de-icing procedure is called the â€Å" thrust through method † and this study has backed up its probe through elaborate computations and the usage of a determination matrix to compare the benefits of the thrust through method against utilizing others. We will write a custom essay sample on De-icing operations at Minnesota Saint Paul or any similar topic only for you Order Now Although there are some jobs such as its comparatively long payback clip of 2.5 old ages, plus risk the airdrome may hold to pay license fees due to patents on the engineering, the benefits of the thrust through method outweigh these drawbacks. One ground for this is that after the payback period the airdrome will do an one-year economy of about $ 7,080,000 Introduction Rationale for the research The procedure of taking ice, hoar or snow from the surface of an aircraft is known as aircraft de-icing. This is an indispensable process because if these substances accumulate on an aeroplane they will magnify the retarding force force that the plane experiences. This will cut down the ability of its wings to bring forth adequate lift force to let it to take-off or tactic whilst in flight. Besides, harm could be caused if a big piece of ice dislodges from the plane and hits sensitive constituents like its engine. This could take to riders losing their lives in a clang and others losing their belongingss. The Federal Aviation Administration, FAA, modulate all major civil air power operations in America. One of their regulations is that aircraft must be free of ice before takeoff and during flight. Background This study uses Minneapolis Saint Paul ( MSP ) airdrome, Minnesota, as its primary instance survey. This is because aircraft at this airdrome often needs to undergo make up one’s minding as a consequence of the cold clime before, during and after winter in that part. MSP airdrome spans 3,400 estates, has five tracks, five de-icing tablets and â€Å" served more than 32 million travelers in 2009 doing it 15th in the United States andA 30th in the universe in footings of figure of riders served yearly. † ( MSP Airport, 2010 ) De-icing is presently carried out at MSP airdrome by operators who spray an ethylene-glycol based aircraft de-icing fluid onto planes. Storm H2O drains to roll up the waste fluid, before it is transported by a truck to a recycling installation to be treated. It needs intervention because its high Biochemical Oxygen Demand ( BOD ) makes it harmful to the environment. Research Aims and Aims This probe aims to happen a method and chemical to utilize for de-icing planes which is more environmentally friendly, cheaper and faster than that which is presently used in MSP airdrome. It should be a â€Å" entire solution engineering † which eliminates/reduces all the jobs that the current de-icing method causes without bring forthing damaging side effects. These purposes will be achieved by finishing the undermentioned aims: Identify a replacement de-icing fluid which has the same/better de-icing functionality but costs less and is safer than the one presently used in MSP airdrome. Find a better manner to recycle the waste de-icing fluid Ensure that the new utility chemical allow de-icing fluid to be recycled Find another manner to take snow from aircraft GENERIC DESIGN PROCESS Administrations frequently use a generic design procedure as they turn a merchandise thought into a manufactured point. Using a systematic, good organised designed procedure helps to cut down the research and development clip that a fresh merchandise experiences. The design squad for this undertaking used a generic design procedure and the actions that they took at each phase are detailed below: Merchandise Planning – First the squad used merchandise planning to assist do that dependable and valid research was carried out directly off. This started this by keep backing a treatment in which they clarified the purpose and aims of the undertaking. Then they identified their strengths and failings in relation to these aims to assist them take which responsibilities they were responsible for. Finally they agreed upon timescales in which to accomplish each aim. Designation of Customer Needs – Customers demands guided the squad ‘s merchandise inventions that were found. The squad held interviews with a representative from each major stakeholder group in the air hose industry, such as the air hose director and spray operator, to let them to voice their demands. This made it easier for the squad to put merchandise specifications and design a merchandise that they would O.K. . Constitution of Product Specifications – The client demands were ranked in order of their importance. The rank of each demand was relative to a weighting, tungsten, which was later used in a determination matrix. This information was used to bring forth merchandise specifications which were further defined utilizing prosodies. Coevals of merchandise thoughts – A insight was held to bring forth merchandise thoughts. This was utile because it encouraged the squad to construct thoughts on top of one another. From this they saw similarities between thoughts and linked some of them to specify a entire solution engineering. Choice of merchandise thoughts – A determination matrix was used to quantitatively compare the importance of each client demand in relation to the merchandise thoughts. The merchandise with the highest mark was selected for proving. Testing – The entire solution engineering was further evaluated in footings of its public presentation and economic viability. Because it was really good its specifications were was sent to industries so that they could construct a paradigm. Figure 1 – An illustration of the generic design procedure Figure 1 illustrates the merchandise design methodological analysis which begins with merchandise planning and ends with proving and industry. The flecked lines show that if one phase of the design procedure did non give advantageous consequences the squad would travel one or multiple phases back in order to polish their old purposes. You read "De-icing operations at Minnesota Saint Paul" in category "Essay examples" Then they would progress through each phase of the procedure once more until they reached the concluding testing and fabrication phase. This process of measuring and re-assessing merchandise developments ensured that hapless designs were eliminated or improved before they reached the testing and industries phase. Need Assorted clients have an involvement in aircraft de-icing operations ; these persons are referred to as stakeholders. The success of this venture will depend on how good it meets the demands of these persons. Hence, the squad evaluated each stakeholder ‘s demand utilizing an interview and ranked it harmonizing to its importance. Information Gathering The stakeholders were identified on the footing on who will pay for, sell, usage and run the de-icing engineering, these included air hose pilots and riders etc. They were interviewed and their responses are summarised below. Spray operator Q1: How do you defrost a plane? â€Å" A container on a truck is filled with de-icing fluid which is assorted with H2O to a 50 % concentration by volume. I sit in an enclosed cabin and heat the fluid onboard the truck to 70oC before I spray it onto the plane until all the ice thaws. † Airport director Q2: How of import is the BOD of a de-icing fluid? â€Å" Very of import, we pay the intervention works about $ 0.35 per US gallon and the monetary value goes up if the BOD additions. Our airdrome is fined if the BOD5 discharged to the environment exceeds 900 metric tons per twelvemonth. Q3: How long would you anticipate to wait for a return on your investing? â€Å" 1.5-2 old ages † Q4: How much does ethylene glycol cost? â€Å" The norm is $ 5-7 per gallon. † Q5: What safeguards were taken since your last incident? â€Å" We thought of retraining staff, but now operations are run by an outsourced concern. De-icing tablets and a drainage system were installed. † Aircraft director Q6: What do you believe of incorporating a warming system onto aircraft? â€Å" Not ideal for commercial planes because it ‘s expensive † Air traffic accountant Q7: How severe is the break caused by aircraft de-icing? â€Å" During the extremum of the winter season there are regular holds. Aircraft must be de-iced once more if they exceed a holdover clip of 5 proceedingss. † Ranking of demands and ‘sanity check ‘ The squad identified the most of import stakeholder demands and ranked them as listed below. Each demand was given a weighting, tungsten, harmonizing to its rank as portion of a ‘sanity cheque ‘ . Table 1 – The rank of each stakeholder demand and its weighting Need Weight-ing, tungsten Reasons 1 ) Safety 4 Safety was the top concern of every stakeholder. Aircraft at MSP airdrome can merely transport riders if they obey safety ordinances set by the FAA. 2 ) Life Cost 3 Some stakeholders disagreed on fiscal issues sing how much hard currency should be spent on certain points. e.g most spray operators would wish luxury de-icing cabins whereas airdrome directors would instead put the money. However, all stakeholders agreed that no de-icer with a high life-time cost would be acceptable. 3 ) Speed 2 Slow de-icing can do net income losingss due to detain flights. 4 ) Environmental impact 1 Although the airdrome will be fined for doing inordinate pollution these costs are usually absorbed by clients. Constitution OF PRODUCT SPECIFICATIONS Most of the demands highlighted by stakeholders were expressed in a qualitative mode. They needed to be converted into specifications in order to avoid fiddling yet expensive betterments being made to MSP airdrome. To make this the worst instance de-icing conditions that could potentially take topographic point at MSP airdrome were defined and as portion of saneness cheque. Following prosodies were used set up specifications for merchandise and procedure design methods that could get by with the worst instance de-icing scenarios at the airdrome. Specification 1 – Annual length of operation The day of the months in which the planes will necessitate to be de-iced scopes from November to early April because on these day of the months the temperature in Minneapolis Saint Paul is below stop deading. Therefore, any new de-icing method must be able to run through this period of 5 months and 1 hebdomad ( 157 yearss ) every twelvemonth. ( Figure 2 ) Figure 2- The mean last temperature in MSP every twelvemonth from 1971-2000 Specifications 2 – The instance survey aircraft and its ice coverage The mass of ice on a plane was calculated utilizing a worst instance scenario, which was that one of the biggest commercial rider planes ; the Boeing-747 ( BBC, 2007 ) needed to be de-iced. It was assumed that the top country of both its wings was covered by a 1cm thick bed of ice. Flying country ( Boeing-747 ) = 541.2 M2 ( Airliners, 2010 ) Ice Thickness = 0.01m Ice Coverage 100 % i Volume of ice on wings, Volice = 5.412 M3 ( App. 1, Eqn 1 ) Density of ice, I?ice = 917kg/m3 ( Kotz, 2009 ) i Mass of ice, = 4962.8 kilogram ( App. 1, Eqn 2 ) Specifications 3- Heating Duty Latent heat of merger of ice= 333 kJ/Kg ( Bird, 2003 ) i Minimum warming responsibility = 1652.6 MJ ( App 1, Eqn 3 ) Specifications 4 – The utility de-icing fluid The atmospheric temperature in MSP airdrome during the de-icing season is 20oF ( -29oC ) therefore the replacement ADF stop deading point must be less than 20oC in order to keep its functionality. Additionally it must supply a freezing point depression of more than 20oC as a consequence of this ambient temperature. All the stakeholders agreed that merchandise safety is of topmost importance, so the replacement ADF should be less toxic than ethylene-glycol. Additionally they agree that the one-year natural stuff costs of the new cubing method should be less than that of the current method. Two ways to make this are to utilize less cubing fluid per plane in the first case ; this should be less than the 408 gallons per aircraft required by the current de-icing method ( App. 1, Eqn. 9 ) , or to recycle the de-icing fluid. GENERATION AND SCREENING OF IDEAS The squad worked separately and brainstormed together to assist maximize the figure of good thoughts that were generated. Whilst making so they reflected upon the merchandise specifications to and stakeholder demands to assist test thoughts. De-icing Ideas De-icing boots – Rubber boots are attached to the front borders of wings on the plane. The aircraft inflates these boots with air to do ice that take ice that has accumulated on them. An unacceptable hazard of utilizing this method in MSP is that the system must be activated every bit shortly as a before an big ice bed can organize and hit other parts of the plane when it dislodges. Bleed air- In this method hot air from the aircraft engines is blasted on to the ice to run it. Although this could run ice really rapidly the airdrome director at MSP airdromes commented that incorporating heating systems on to aircraft is â€Å" non ideal for commercial planes because it ‘s expensive † . Mechanical Scraping/Blowing Employees use coppices, or fabrics to physically force ice off the aircraft. This method would be really easy to set into pattern at MSP because the equipment the required is really inexpensive. But it is more likely that harm will be done to aeroplanes as the employees scrape ice so the resulting aircraft care cost is could be really high. A propene ethanediol based de-icing fluid – Propylene ethanediol is a popular de-icing fluid and is regarded as non-toxic, hence it was chosen for farther probe. Decision Matrix The interviews that were conducted with the stakeholders highlighted that some client demands are more of import than others. Although the importance of some specific demands differed in each stakeholder group four demands were systematically rated as indispensable. These standards were analysed in a determination matrix with weighing Markss taken from Table 1 Table 2- Decision Matrix which focuses on the alternate deinking methods Option Ethylene Glycol ( Benchmark ) A Propylene Glycol Infrared + Propylene-glycol Standards Burdening tungsten Rating Mark Rating Mark Rating Mark Safety A 5 2 10 4 20 7 35 Life Cost A 4 5 20 5 20 6 24 Speed A 3 A 5 15 A 4 16 6 18 Environmental impact A 2 A 1 2 A 5 10 6 14 Entire A 14 A 13 47 A 18 66 A 25 91 Harmonizing to this determination matrix the best de-icing solution should be based on a combination of infrared and propylene ethanediol de-icers is the best as this option has the highest sore. The 2nd best method would be to utilize an ADF which is based on propene ethanediol instead than ethylene ethanediol. SELECTION OF IDEAS A comparing of ethylene-glycol and propylene ethanediols based de-icing fluids The most freezing point sedatives in aircraft de-icing fluids in the US are ethylene ethanediol ( EG ) and propylene ethanediol ( PG ) . Because PG and EG have a similar life-time cost, in this chapter the chemicals will be compared at a 50 % concentration by volume in footings of their safety, de-icing velocity and environmental impact because these are three of the most of import needs the stakeholders. Safety Ethylene ethanediol has a comparatively high toxicity when compared to Propylene-Glycol. It has been classed by the US Congress as a risky air pollutant ( HAP ) , if 2268 kilogram or more flights into the environment within 24 hours users are obligated to describe the event under the Comprehensive Environmental Response Compensation and Liability Act ( CERCL ) . However propylene ethanediol is non classified as a HAP, and users are non required to inform CERCL if it is released. Both chemicals are said to be non-lethal if worlds if they are breathed in with air or adsorbed through tegument. However, unlike PG, EG is toxic to worlds and mammals if it is ingested straight. Even though PG it is regarded as non-toxic it is still a wellness jeopardy because it uses O as it biodegrades which could do some beings to smother. De-icing Speed The freezing point of Propylene-glycol is -34oC which is somewhat higher than ethylene-glycol which freezes at -37oC. This is one of the grounds why MSP airdrome still uses EG. Another is that a lower volume of antifreeze is required for EG to accomplish the same freeze point depression as PG. MSP airdrome suffers severe conditions extremes so it needs to utilize an ADF which is dependable, particularly in highly cold conditions as this is by and large when it takes longer to defrost aircraft Propylene-glycol ‘s boiling point is 106oC whereas ethene ethanediol has a boiling point of 102.2oC for ethene ethanediol. In this instance Propylene-glycol is the better pick because it can reassign heat to frost at a higher temperature than ethylene ethanediol. Discussion There are some drawbacks with respect to utilizing ethylene ethanediol as a de-icing fluid, particularly refering its environmental impact. But, overall EG and PG have a similar de-icing public presentation degree. The Rate of Melting due to Heat Conduction Entirely The ADF is heated to 70oC before it is sprayed onto the plane, this heat entirely will do the ice to run through heat conductivity. The rate of this warming was calculated utilizing equation 1a, 1a ) Where Q= is the heat flow rate in the X-direction in kJ/s, A is the country normal to the way of heat flow in M2, dT/dx is the temperature gradient and K is the thermic conduction of ice The thermic conduction of ice at -20oC is 2.39 W/mK, the country normal to the way of heat flow is equal to the flying country of the Boeing 747 =541.2m2, the temperature alteration that occurs is ( 70oC- -20oc ) =90oC and the thickness of the ice x is 0.01m. Therefore the rate of heat transportation by the temperature of the de-icing fluid alone is 2a ) The reasonable heat is kJ ( App. 1, Eqn 12 ) The latent heat of merger is 1652612.4 kJ, ( App.1, Eqn 3 ) Summarizing the above gives the sum of het required to run the ice on a Boeing 747 from a starting temperature of -20oC which is Hence minimal clip that it would take to run the ice on the plane by heat conductivity entirely is This is a really fast clip, particularly as harmonizing to the undertaking brief, de-icing at MSP airdrome usually takes 10 proceedingss per plane. One ground ground for this difference is due to the fact that the ADF fluid is non ever in full contact with ice, merely its bottom surface is. Additionally these computations assume that heat transportation occurs over the whole of each flying equally, which is non the instance in existent life because de-icing fluid is sprayed onto the wing in different locations consistently. A concluding cause of this difference could be due to the fact that snow has a lower heat conduction, K, than ice and so any snow on a plane would take down the rate of heat transportation from the ADF. Entire SOLUTION TECHNOLOGY Drive-Through De-icing Figure 3 – An illustration of the thrust through de-icing engineering The concluding design construct was to carry on de-icing operations as a thrust through system. First the aircraft enters the Infrared airdock where and warm air blows snow of its wings whilst they are heated by infrared radiation for a typical continuance of 5-10 proceedingss. Ice on the plane thaws onto an inclined incline and the effluent is channelled into the waste aggregation zone. Water is channelled through bing storm H2O pipes into substructure to the located under the floor of the crop-dusting and waste aggregation country. The effluent is pumped out and transferred by a truck into the airdrome ‘s detainment pools. When the effluent has been removed compaction stoppers are removed and the plane moves into the spraying country. Here it is sprayed with propene ethanediol for up to 5 proceedingss to assist forestall any ice forming on it before takeoff. The propene ethanediol drains into a separate country of the aggregation chamber and is pumped to a detainment pool until it is due to be recycled. Finally the compaction plus are reinstalled so the system is ready to defrost another plane. Recycling Solution Minneapolis presently uses three Glycol Recovery Vehicles to roll up effluent. Using the IR installation eliminates the demand to defrost aircraft utilizing ethanediol by around 90 % , so no more of these vehicles will necessitate to be bought if the new engineering is adopted. Besides the airdrome has saved capital costs by utilizing their bing storm H2O drains to roll up both ethanediol and storm H2O. These storm drains can and should go on to be used if MSP airdrome adopts the Drive-Through De-icing system to salvage hard currency and clip during the installing of the new system. Harmonizing to ( Big book ) â€Å" Careful direction of the keeping systems enables the airdrome to roll up adequate effluent with high ethanediol concentrations to do glycol recycling/recovery economically feasible. † The bulk of ethanediol which is recycled is sold to makers who use it in other glycol-based merchandises. Analysis OF ECONOMIC VIABLITY Rate of return on investing ( ROI ) 3a ) Payback Time 3b ) =2.5 old ages Unfortunately the payback clip on the thrust through de-icing method is non fast plenty to fulfill the Airport Directors at MSP who expect a payback clip of â€Å" 1.5-2 old ages † . A higher rate of return on investing would cut down the payback clip so it would be wise to look into extra ways to cut down the cost of de-icing utilizing this engineering, and ways to better its efficiency. Patent issues Because this entire solution engineering uses de-icing methods which have been used in industry antecedently, but it combines them in a alone manner it is hard to measure whether or non it can be patented. Furthermore, it is expected that it would take a long clip to patent the merchandise even if it were possible because of its complexness and usage of old de-icing thoughts. The writer has recommended that MSP airdrome consults a attorney sing these affairs if they do non necessitate to utilize the de-icing solution instantly. If MSP airdrome do necessitate to utilize the engineering instantly they might hold to pay licence fees to one or more patent proprietors. Decision The findings from this probe have shown that the solution engineering that MSP airdrome should utilize to better its aircraft de-icing solution involves utilizing infrared warming and a propene ethanediol as a utility chemical for ethylene-glycol. The procedure is called the â€Å" thrust through method † and the major advantages of this intercrossed solution are that it meets the demands of its stakeholders by being safe, holding a low life-time cost, fast aircraft de-icing rate and low environmental impact. Evidence of this has been provided through a determination matrix and several mathematical ratings. Unfortunately this solution has a payback clip of 2.5 old ages, so research should be carried out to uncover how to do the one-year rate of return on the investing higher. Finally, this intercrossed system uses patented engineering so MSP airdrome might hold to pay license fees for a figure of old ages if it used the thrust through method. However, after the payback period the one-year economy of $ 70,844,300 per twelvemonth outweighs any of these drawbacks. Further Recommendations Find ways to cut the operating cost of the Drive-Through De-icing system as this will raise the one-year rate of return that this engineering provides. If the rate of return is high plenty the payback clip will drop below 2 old ages and the airdrome directors in MSP will hold this demand fulfilled. Use hot air to blow snow off the aircraft in the IR airdock. This will assist to run the snow and ice excessively, nevertheless the cost of warmin+ 3.0g air may countervail the benefit of a faster de-icing clip. Nb, as shown by the weightings, tungsten, in Table 1, the life-time cost of the engineering is more of import that the de-icing velocity that it provides. Mentions Books and Diaries Bird J.O. , 2003, Science for technology, pp. 205, Newnes, 2003, UK Ketler P. , Mosher M. , Scott A. , 2008, Chemistry: The Practical Science, media enhanced edition, Cengage Learning, pp. 478, UK Kotz J.C. , Paul T. , Townsend R.J. , 2009, Chemistry and Chemical Reactivity, Cengage Learning, pp. 15, USA Tsokos K.A. , 2010, Cambridge Physics for the IB Diploma, pp. 172, Cambridge University Press, UK Sinnot R.K. , 2005, Coulson and Richardson ‘s Chemical Engineering Series: Chemical Engineering Design, pp. 439, Butterworth-Heinmann, UK Online Resources MSP Airport, 2010, About Us, hypertext transfer protocol: //www.mspairport.com/about-msp.aspx, 24/10/2010 RSS Weather, 2003, Minneapolis-St. Paul, hypertext transfer protocol: //www.rssweather.com/climate/Minnesota/Minneapolis-St.Paul, 23/10/10 Airliners.Net, 2010, The Boeing 747-400, hypertext transfer protocol: //www.airliners.net/aircraft-data/stats.main? id=100, 20/10/2010 BBC, 25/10/2007, A380 superjumbo lands in Sydney, hypertext transfer protocol: //news.bbc.co.uk/1/hi/world/asia-pacific/7061164.stm, 19/10/2010 Energy Information Administration, October 2010, Electric Power Monthly, hypertext transfer protocol: //www.eia.doe.gov/cneaf/electricity/epm/epm.pdf, 15/10/2010 Wingss Magazine, 2007, Infrared De-icing: Giving glycol a tally for its money, hypertext transfer protocol: //www.wingsmagazine.com/content/view/1325/38/ , 23/10/10 APPENDICIES Appendix 1 Specifications 2 -The instance survey aircraft and its ice coverage The mass of ice on a plane was calculated utilizing a worst instance scenario, which was that one of the biggest commercial rider planes ; the Boeing-747 ( BBC, 2007 ) needed to be de-iced. It was assumed that the top country of both its wings was covered by a 1cm thick bed of ice. Flying country ( Boeing-747 ) = 541.2 M2 Ice Thickness = 0.01m Ice Coverage 100 % of flying country ( 1 ) Density of ice, I?ice = 917kg/m3 ( Kotz, 2009 ) ( 2 ) Specifications 3 -Heating Duty The ice on the aircraft needed to be provided with adequate energy to get the better of its 333kJ/Kglatent heat of merger, L, to run. The sum of heat energy, Q, required to accomplish this was calculated utilizing Equation 3 ( 3 ) ( Bird, 2003 ) Specifications 4 – The utility de-icing fluid In this subdivision the volume of ethene ethanediol and propene ethanediol needed to defrost a individual Boeing-747 will be calculated and compared. The prosodies are based upon a 50 % by volume solution of each chemical. Volume of Ethylene Glycol Required The freeze point depression of an ideal solution is given by the expression ( 5 ) Where a?† Tf represents the freeze point depression, m, is the solute concentration and Kf represents the freeze point depression invariable of H2O which is 1.86A °KA ·kg/mol ( Kilter P. , Mosher M. and Scott A. Andrew Scott, 2008 ) The coveted freeze point depression, a?† Tf is 20oC because winter temperatures in MSP autumn to that temperature, harmonizing to the undertaking brief. ( 6 ) The figure of moles of ethanediol required to accomplish the freeze point depression: ( 7 ) The chemical expression of ethylene-glycol is CH2OHCH2OH Mr Carbon = 12, Oxygen=16, Hydrogen=1 iMr ethene ethanediol = 2*16+2*12 + 1*6= 62 g/mol Therefore the mass of ethylene-glycol required per plane is: ( 8 ) The denseness of UCAR ADF at 20oC is 8.9 lb/gal ( US ) ( 1.07 kg/L ) ( SAE AMS 1424 Ethylene Glycol-Based Type I Fluids page 8 ) Therefore the volume of ethylene-glycol required is at least 408 US gallons ( 9 ) Because the de-icing fluid used in MSP airdrome is 50 % ethylene-glycol and about 50 % H2O, defrosting a individual plane would necessitate duplicate the sum of ADF which works out at 6,184 liters. The cost of ethene ethanediol per aircraft In general the chemical constituents in de-icing fluids, such as H2O, have a sum cost which is well less than that of ethylene-glycol. Hence the cost of these constituents in de-icing unstable solutions as deemed insignificant and ignored. Harmonizing to the airdrome director that was interviewed the minimal cost of a gallon of ethene ethanediol is $ 5 per US gallon ( 10 ) In MSP airdrome there is an norm of 293 takeoffs per twenty-four hours from 5 de-icing tablets ( MSP Airport, 2010 ) Assuming that during the de-icing season in MSP lasts 157 yearss and every plane needs to be de-iced the one-year cost of ADF is about ( 11 ) Reasonable heat required Harmonizing to the undertaking brief winter temperatures in Minneapolis Saint Paul autumn to-20oC. Ice must be brought to its runing point of 0oC before it can undergo a stage alteration from solid to liquid. Where Cp is the specific heat capacity of ice at -20oC which is 2 kJ/kg/K, ( Tsokos KA, 2010 ) , m is the mass of ice and a?† T is the temperature difference ( 12 ) Harmonizing to Wingsmagazine ( 2010 ) Ian Sharkey, the manager of de-icing services, with Radiant Aviation Services stated that during an ice storm on March 15-16, 2007 his squad had an â€Å" norm aircraft â€Å" block † clip ( aircraft brakes on to brakes off ) of less than 43 proceedingss for big aircraft † hence it was assumed that the Boeing 747 could be de-iced in this timeframe every bit good. This information was used to gauge the power that the IR deice would necessitate to convey the ice on an aircraft from -15oC to 0oC in 43 proceedingss, ( 13 ) Latent heat required Next was calculated which is the power needed to run the ice on the aircraft at 0oC in 47 proceedingss. ( 14 ) Therefore the entire power needed to run ice on the aircraft in 43 proceedingss by utilizing infrared deink engineering, QIR is ( 15 ) To do the value of QIR more realistic some premises refering the sum of energy loss, between the heat beginning and the wing were added. From this the excess power that the optical maser will necessitate to give out in order to get the better of the inferred energy lost as between the beginning and its finish ( transport efficiency ) and the energy lost due to contemplation by the ice on the surface of the wing ( absorption efficiency ) was calculated. Laser device efficiency, I ·laser=0.33, Transport efficiency, I ·transport = 0.75 Absorption efficiency, I ·absorbtion =0.75 The optical maser device, conveyance and soaking up efficiencies cut down the sum of energy that heats the ice. This is called the efficiency loss, 1-I ·i, and it was calculated as follows , ( 16 ) Hence, ( 17 ) Similarly, ( 18 ) Hence, the per centum excess energy, , required to cover for these energy losingss is ( 19 ) In existent footings ( 20 ) From this the entire IR power required to run ice from ice from its initial temperature of -20oC ( 21 ) = 586kW+227.9kW +1090.5kW= 1904.4 kilowatt Cost of de-icing utilizing IR energy Convert to kWh, The entire IR energy demand was converted into kWh as the de-icing clip of about 43 proceedingss for a Boeing 747 in highly rough conditions ( wingsmagazine, 2010 ) ( 22 ) In Minnesota during 2010 the â€Å" Average Retail Monetary value of Electricity to Ultimate clients † within was $ 0.068 per kWh ( Electric power monthly, 2010 ) Therefore the estimated the cost of defrosting a Boeing 747, by IR radiation in 43 proceedingss is: ( 23 ) We must account for the cost of anti-icing fluid ; this 10 % of the normal sum of ethanediol ( 24 ) Hence, ( 25 ) This system runs for 157days, with 293 takeoffs per twenty-four hours which gives an one-year running cost of approximately $ 26.8 million per tablet. ( 26 ) The capital cost of the IR de-icing tablets The JFK airdrome is a hub airdrome runs commercial rider flights in a similar manner to the the MSP airdrome. The JFK airdrome cost â€Å" $ 9.5-million † and can keep big aircraft such as the Boeing 747, which this study focuses on. Due to these similarities it can be assumed that the cost of the IR installation in 2010 will be around US $ 9.5 million every bit good. However a cost index should be used because the IR installation in JFK airdrome was commissioned in 2006 ( Wingsmagazine, 2010 ) The cost of the hanger was scaled up utilizing the CEPCI, so that it would be accurate for 2010. The latest information available to us was the CEPCI for 2008, it was 575.4 so and as of April 2010 it is 55.3 ( Access Intelligence, LLC 2010 ) . Taking this into history an estimation of the cost of the hanger in 2010 was made. ( Eqn 27 ) ( 27 ) There are five IR de-icing tablets so the entire capital cost is $ 49,219,345 Fixed cost – Staff fees The IR airdock, spray country and aggregation country will each hold a supervisor and operator, working an 8 hr, 9AM-5PM displacement for 5 yearss per hebdomad. Their wages will be ?18,000 ( technician ) and ?24,000 ( supervisor ) . The senior director for each de-icing tablet will hold a wage of $ 30,000. MSP will necessitate 5 new IR de-icing tablets to replace the 5 EG de-icing tablets that they presently use. How to cite De-icing operations at Minnesota Saint Paul, Essay examples

Family Law Dynamics in South Africa free essay sample

Moreover there are significant consequences on families such as child-headed households and foster care. Additionally the constitutional era’s bringing of the Bill of Rights guaranteeing sex equality has additionally changed the dynamics of South African marriages. This paper will investigate and discuss the dynamics of families and family law in South Africa and determine the extent to which they have transformed over time due to socio-legal and socio-political influences. Social, political and legal influences on South African family-law and their initial consequences From a socio-political point of view South Africa has transformed dramatically due to many influences but none more so than the Apartheid regime. The discriminatory nature of the Apartheid left many consequences on South African families. Firstly the original Black Administration Act did not hold customary marriages in the same esteem as civil marriages and heavily restricted the proprietary rights of women and children. Paternal power was unfairly exercised as the father being the head of the household had total influence over household possessions. Furthermore law did not formally recognize customary marriages of polygamy. Possibly equaling the dramatic effect that the Apartheid has had on South Africa is the HIV/AIDS pandemic. It is estimated that South Africa has a higher number of AIDS orphans than any other country. This has brought about many changes in the dynamics of South African families as a growing number of child-headed households are being formed as well as uncertainty created pertaining to care of the orphans. Due to factors such as an increasing crime rate and uneven education availability, in the case of divorce spouses have been forced to relocate from their original homes causing breakups in families and harsh custody battles. Considering the harsh affects that custody change and HIV/AIDS has on children, the Child Care Act 74/1983 has come under scrutiny for the way in which it has handled the care of children under troubled conditions. The narrow nature of this act has a primary goal of removal of an affected child from its original home and placement into alternative care, however it does not provide for prevention, nor for early intervention services and programs in terms of targeting child-abuse and neglect, contributing to building unstable families and homes fostering domestic violence. Finally before the new democratic era of South Africa, the women in families were extremely disadvantaged as in the past husbands enjoyed marital power under the two co-existing systems of the common-law community of profit and loss as well as the separation of goods established by antenuptial contract. This meant that as the head of the family, the husband had the final say in all matters concerning the common life of the spouses and he had power over the person of his wife and his wife’s property Another important example of previous discrimination is the past denial of homosexual unions. Because these unions were not recognized, not only were gay couples restricted of equal property and companionship rights and pleasures that heterosexual couples enjoyed, but they were additionally denied the rights to adoption. The Child Care Act and the Guardianship Act respectively declared that unmarried couples cannot jointly adopt and mothers and fathers have equal rights of guardianship in respect of legitimate children, thus denying the rights to homosexual couples of adoption and hence building a family. Consequential change on family dynamics from new legislation and social, political and legal influences In order to eradicate the discriminatory legal remnants of the Apartheid there were many legislative enactments that emanated to protect the rights of previously disadvantaged people in South Africa. One of the most significant of these enactments is the Recognition of Customary Marriages Act. This Act came into operation on the 15th of November 2000 and consequently brought an end to the doubtful nature of customary marriage, furthermore legally providing for monogamous and polygamous marriages. This impacts massively on family dynamics as because polygamy allows a husband to have more than one wife, his family has massive potential for growth allowing economic stability and furthermore it enabled wives to share the burdens of household labor, child-bearing and child-rearing Further accommodating the rights of women and additionally children is the abolishment of Section 23 of the Black Administration Act which administered an intestate estate of the deceased through primogeniture, a system in which in the absence of a will only a male relative may inherit. The case of Bhe amp; Others v Magistrate, Khayelitsha, amp; Others helped render this section unconstitutional, reflecting the democratic nature of the Recognition of Customary Marriages Act in that a wife in a customary marriage has full equality with her husband and is subject to the matrimonial property system pertaining to marriage, full status and capacity to litigate, enter into contracts and acquire and dispose of assets. This again drastically changes the dynamic of families buy way of allowing for a power balance in the household, and moreover restricting paternal dominance. In order to contribute where the Child Care Act was lacking, the Children’s Act 38 of 2005 was enacted. Firstly according to section 9 of the Children’s Act, â€Å"in all matters concerning the care, protection and well being of a child, the standard of the child’s best interest is of paramount importance must be applied†. This can be applied where in savior of children orphaned at the hands of HIV/AIDS, the Children’s Act has formally recognized child-headed households. This recognition provides specially tailored welfare services to the children and allows them to remain with pre-existing families instead of undergoing removals into expensive and frequently ineffective Western-style alternative care. Other than child headed households, the Children’s Act additionally strengthens family and in-community-care of children who may come from broken homes and be subject to domestic violence. The Act provides for ‘shared care’, ‘partial care order’ and cluster foster care schemes as well as family services orders such as anger management, rehabilitation and parenting skills courses. Finally with regard to custody disputes, the law always accommodates the best interests of the child as in the case of HG v CG the court found that according to the Children’s Act not only do children have rights but they additionally have the opportunity to participate in any decision affecting him or her. The revolution of South African children laws have changed family dynamics by ways of liberating children to lead their households and make decisions independently, while being awarded extensive care ensuring positive and constructive futures for families. Just as the Children’s Act helped uphold the rights of children, so too does the Matrimonial Property Act 88 of 1984 protect the rights of women in abolishing marital power. Women now have equal property rights especially enforced by the accrual system in which the net increases in the respective estates of the spouses during the subsistence of their marriage are equally divided upon its dissolution. In addition to this wives are now also allowed locus standi, meaning that they can, independently of their husbands, conduct civil legal proceedings. The Matrimonial Property Act brings a clear shift towards equality in power balance in the household, contributing critically to the change in family dynamics. After wives had been allowed equal household power, dynamics of South African families were further transformed as the enactment of the Civil Unions Act 17 of 2006 gave recognition to homosexual unions, or ‘gay marriages’. Moreover one of the most significant cases in terms of these unions was Du Toit and Another v Minister of Welfare and Population Development and Others where same sex couples were officially granted the ability to adopt children.

Medicinal Drug Addiction Essay Example

Medicinal Drug Addiction Essay Ethical criteria for medicinal drug promotion World Health Organization Geneva 1988 ISBN 92 4 154239X O World Health Oganbatian, 1988 Publications of the World Health Organization enjoy copytight protection in accordance wiVl t e provisions of Protocol 2 of the Universal C o r n Convention. For rights of h reproduction or translation of W O publications, in part or in tom, application should H be made to the Gffice of Publications, World Health Organization, Geneva, S w i a n d .The World Heam Organization welcomes such applications. The designations employed and te presentation of the material in this publication do h not imply the expression of any opinion whatsoever on the part of t e Secretariat of the h World Health Organization concerningthe legal status of any country, territory, cky or area or of its authorities, or concerningthe delimitation of its frontiers or boundaries.The mention of specific companies or of certain manufacturers productsdoes not imply that they are endor sed or recommendedby the World Health Organhation in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. Typeset and printed in Switzerland 88/7708-WHO/Gloor43WO Ethical criteria f6r medicinal drug promoW~ Resolution WHA41. 17 Introduction Objective Ethical criteria Applicability and implementation of criteriaPromotion Advertising Medical representatives Free samples of prescription drugs for promotional purposes Free samples of nomprescription drugs to the general public for promotional purposes Symposia and other scientific meetings Postmarketing scientific studies, surveillance and dissemination of information Packaging and labelling Information for patients: package inserts, leaflets and booklets Promotion of exported drugs Appendix: Sample drug information sheet Ethical criteria for medicinal drug promotion Resolution WHA41. 7 adopted by the Forty-first Wo rld Health Assembly, 13 May 1988 Ethicalcriteriafor medicinal drugpromotion The Forty-first World Health Assembly, Recalling resolutions WHA21. 41 and WHA39. 27; Having considered the report of the Executive Board concerning the ethical criteria for medicinal drug promotion based on a draft prepared by an international group of experts; Convinced that observance of ethical criteria for medicinal l drug promotion by al parties concerned will contribute to a more rational use of drugs; 1. THANKS the international group of experts for its work; . ENDORSES the ethical criteria for medicinal drug promotion that are annexed to this resolution, on the understanding that they constitute general principles that could be adapted by governments to countries circircumstances as appropriate to their political, economic, cultural, social, educational, scientific and technical situation, their national laws and regulations, disease profile, therapeutic traditions, and the level of development of t heir health system, and that they do not constitute legal obligations; 3.URGES Member States: (1) to take account of these ethical criteria in developing their own appropriate measures to ensure that Ethical criteria for medicinal drug promotion medicinal drug promotion supports the aim of improving health care through the rational use of drugs; (2) to monitor and enforce, where appropriate, the implementation of the measures they have developed; 4. APPEALS to pharmaceutical manufacturers and distributors, the promotion industry, ealth personnel involved in the prescription, dispensing, supply and distribution of drugs, universities and other teaching institutions, professional associations, patient and consumer groups, the professional and general media (including publishers and editors of medical journals and related publications), and the public: (1) to use these criteria as appropriate to their spheres of competence, activity and responsibility; (2) to adopt measures based on th ese criteria as appropriate, and monitor and enforce their standards; 5.REQUESTS the Director-General: (1) to ensure the wide dissemination of these criteria in all official languages; (2) to follow the practice of these criteria and to report to the Executive Board from time to time as appropriate. Ethical criteria. for medicinal drug promotion Introduction 1. Following the WHO Conference of Experts on the Rational Use of Drugs held in Nairobi in November 1985, WHO prepared a revised drug strategy which was endorsed by the Thnty-ninth World Health Assembly in May 1986 in resolution WHA39. 27.This strategy includes, among other components, the establishment of ethical criteria for drug promotion based on the updating and extension of the ethical and scientific criteria established in 1968 by the Twenty-first World Health Assembly in resolution WHA21. 41. The criteria that follow have been prepared in compliance with the above on the basis of a draft elaborated by an international gr oup of experts. Objective 2. The main objective of ethical criteria for medicinal drug promotion is to support and encouragethe improvement of health care through the rational use of medicinal drugs.Ethical criteria 3. The interpretation of what is ethical varies in different parts of the world and in different societies. The issue in all societies is what is proper behaviour. Ethical criteria Ethical criteria for medicinal drug promotion for drug promotion should lay the foundationfor proper behaviour concerning the promotion of medicinal drugs, consistent with the search for truthfulnessand righteousness. The criteria should thus assist in judging if promotional practices related to medicinal drugs are in keeping with acceptable ethical standards. Applicability and implementation of criteria . These criteria constitute general principles for ethical standards which could be adapted by governments to national circumstances as appropriate to their political, economic, cultural, soci al, educational, scientific and technical situation, laws and regulations, disease profile, therapeutic traditions and the level of development of their health system. They apply to prescription and nonprescription medicinal drugs (over-the-counter drugs). They also apply generally to traditional medicines as appropriate, and to any other product promoted l as a medicine.The criteria could be used by people in al walks of life; by governments; the pharmaceutical industry (manufacturers and distributors); the promotion industry (advertising agencies, market research organizations and the like); health personnel involved in the prescription, dispensing, supply and distribution of drugs; universities and other teaching institutions; professional associations; patients and consumer groups; and the professional and general media (including publishers and editors of medical journals and related 4 -Ethical criteria for medicinal drug promotion publications). Al these are encouraged to use the cril teria as appropriate to their spheres of competence, activity and responsibility. They are also encouraged to take the criteria into account in developing their own sets of ethical standards in their own field relating to medicinal drug promotion. 5. The criteria do not constitute legal obligations; governments may adopt legislation or other measures based on , them as they deem fit. S ~ l yother groups may adopt l self-regulatory measures based on them.Al these bodies should monitor and enforce their standards. Promotion 6. In this context, promotion refers to all informational and persuasive activitiesby manufadurers and distributors, the effect of which is to induce the prescription, supply, purchase and/or use of medicinal drugs. Active promotion within a country should take place only with respect to drugs legally available in the country. Promotion should be in keeping with national health policies and in compliance with national regulations, as well as with voluntar y standards where they exist.All promotion-making claims concerning medicinal drugs should be reliable, accurate, truthfulI informative, balanced, up-to-date, capable of substantiationand in good taste. They should not contain misleading or unverifhble statements or omissions likely to induce medically Ethical criteria for medicinal drug promotion unjustifiable drug use or to give rise to undue risks. The word safe should only be used if properly qualified. Comparison of products should be factual, fair and capable of substantiation.Promotional material should not be designed so as to disguise its real nature. 8. Scientific data in the public domain should be made available to prescribers and any other person entitled to receive it, on request, as appropriate to their requirements. Promotion in the form of financial or material benefits should not be offered to or sought by health care practitioners to influence them in the prescription of drugs. 9. Scientific and educational activi ties should not be deliberately used for promotional purposes.Advertising (a) Advertisements in all forms to physicians and health-related professionals 10. The wording and illustrations in advertisements to physicians and related health professionals should be fully consistent with the approved scientific data sheet for the drug concerned or other source of information with similar content. The text should be fully legible. 11. Some countries require that advertisements should contain full product information, as defined by the 6 Ethical criteria for medicinal drug promotion pproved scientific data sheet or similar document, for a given period from the date of first promotion or for the full product life. Advertisements that make a promotional claim should at least contain summary scientific information. 12. The following list, based on the sample drug information sheet contained in the second report of the WHO Expert Committee on the Use of Essential Drugs1and appended for ease of reference, can serve as an illustration of the type of information that such advertisements should usually contain, among others: he name($ of the active [emailprotected](s) using either international nonproprietary names (INN) or the approved generic name of the drug; the brand name; content of active ingredient(s) per dosage form or regimen; name of other ingredients known to cause problems; approved therapeutic uses; dosage form or regimen; side-effectsand major adverse drug reactions; precautions, contra-indications and warnings; major interactions; name and address of manufacturer or distributor; reference to scientific literature as appropriate. WHO Technical Report Series, No. 722,1985,p. 43.Ethical criteria for medicinal drug pronotion 13. Where advertisements are permitted without claims (reminder advertisements),they ought to include at least the brand name, the international nonproprietary name or approved generic name, the name of each active ingredient, and the name an d address of the manufacturer or distributor for the purpose of receiving further information. (b) Advertisements in all forms to the general public 14. Advertisementsto the general public should help people to make rational decisions on the use of drugs determined to be legally available without a prescription.While they should take account of peoples legitimate desire for information regarding their health, they should not take undue advantage of peoples concern for their health. They should not generally be permitted for prescription drugs or to promote drugs for certain serious conditions that can be treated only by qualified health practitioners, for which certain countries have established lists. To fight drug addiction and dependency, scheduled narcotic and psychotropic drugs should not be advertised to the general public.While health education aimed at children is highly desirable, drug advertisements should not be directed at children. Advertisementsmay claim that a drug ca n cure, prevent, hs or relieve an ailment only if t i can be substantiated. They should also indicate, where applicable, appropriate limitations to the use of the drug. 15. When lay language is used,the information should be consistent with the approved scientific data sheet or 8 Ethical criteria for medicinal drug promotion other legally determined scientific basis for approval. Language which brings about fear or distress should not be used. 6. The following list serves as an illustration of the type of information advertisements to the general public should contain, taking into account the media employed: the name(s) of the active [emailprotected](s) using either international nonproprietary names (INN) or the approved generic name o the drug; f the brand name; major indication(s) for use; major precautions, contra-indications and warnings; name and address of manufacturer or distributor. Information on price to the consumer should be accurately and honestly portrayed. Medical re presentatives 17.Medical representatives should have an appropriate educational background. They should be adequately trained. They should possess sufficient medical and technical knowledge and integrity to present information on products and carry out other promotional activities in an accurate and responsible manner. Employers are responsible for the basic and continuing training of their representatives. Such training should include instruction regarding appropriate ethical conduct taking Ethical criteria for medicinal drug promotion into consideration the WHO criteria.In this context, exposure of medical representatives and trainees to feedback from the medical and allied professions and from independent members of the public, particularly regarding risks, can be salutary. 18. Medical representatives should make available to prescribers and dispensers complete and unbiased information for each product discussed, such as an approved scientific data sheet or other source of inform ation with similar content. 19. Employers should be responsible for the statements and activities of their medical representatives.Medical r e p resentatives should not offer inducements to prescribers and dispensers. Prescribers and dispensers should not solicit such inducements. In order to avoid overpromotion, the main part of the remuneration of medical representatives should not be directly related to the volume of sales they generate. Free samples of prescription drugs for promotional purposes 20. Free samples of legally available prescription drugs may be provided in modest quantities to prescribers, generally on request. 10 Ethical criteria for medicinal drug promotionFree samples of mmpresdption chugs to the general puWi for promotional purposes 21. Countries vary in their practices regarding the provision of free samples of non-prescription drugs to the general public, some countries permitting it, some not. Also, a distinction has to be made between provision of free drug s by health agencies for the care of certain groups and the provision of free samples to the general public for promotional purposes. The provision of free samples of non-prescription drugs to the general public for promotional purposes is difficult to justdy from a health hs perspective.If ti practice is legally permitted in any country, it should be handled with great restraint. Symposia and other seientiic meetings 22. Symposia are useful for disseminating information. The objective scientific content of such meetings should be paramount, and presentations by independent scientists and health professionals are helpful to this end. Their educational value may be enhanced if they are organized by scientific or professional bodies. 23. The fad of sponsorship by a pharmaceutical manufacturer or distributor should be clearly stated in advance, at the meeting and in any proceedings.The latter should accurately reflect the presentations and discussions. Entertainment or other hospitalit y, and any #S offered Ethical criteria for medicinal drug promotion to members of the medical and allied professions, should be secondary to the main purpose of the meeting and should be kept to a modest level. 24. Any support to individual health practitioners to participate in any domestic or international symposia should not be conditional upon any obligation to promote any medicinal product. Post+nadcet~ng scientific studies, suweiC ance and dissemination of information 25. Post-marketing clinical trials for approved medicinal drugs are important to ensure their rational use. It is recommended that appropriate national health authorities be made aware of any such studies and that relevant scientific and ethical committees confirm the validity of the research. Intercountry and regional cooperation in such studies may be useful. Substantiated information on such studies should be reported to the appropriate national health authorities and disseminated as soon as possible. 26.Post- marketing scientific studies and surveillance should not be misused as a disguised form of promotion. 27. Substantiated information on hazards associated with medicinal drugs should be reported to the appropriate national health authority as a priority, and should be disseminated internationally as soon as possible. 12 Ethical criteria for medicinal drug promotion Packaging and labelling 28. Appropriate information being important to ensure the rational use of drugs, all packaging and labelling material should provide information consistent with that approved by the countrys drug regulatory authority.Where one does not exist or is rudimentary, such material should provide information consistent with that approved by the drug regulatory authority of the country from which the drug is imported or other reliable sources of information with similar content. Any wording and illustration on the package and label should conform to the principles of ethical criteria enunciated in this docum ent. lrrfonnation for patients= package inserts, leaflets and booklets 29. Adequate information on the use of medicinal drugs should be made available to patients. Such information should be provided by physicians or pharmacists whenever possible.When package inserts or leaflets are required by governments, manufacturers or distributors should ensure that they refled only the information that has been approved by the countrys drug regulatory authority. If package inserts or leaflets are used for promotional purposes, they should comply with the ethical criteria enunciated i this document. The wording of the n package inserts or leaflets, if prepared specifically for patients, should be in lay language on condition that the medical and scientific content is properly reflected. Ethical criteria for medicinal drug promotion 30.In addition to approved package inserts and leaflets wherever available, the preparation and distribution of booklets and other informational material for patien ts and consumers should be encouraged as appropriate. Such material should also comply with the ethical criteria enunciated in this document. 31. Ethical criteria for the promotion of exported drugs should be identical with those relating to drugs for domestic use. It is desirable that exporting and importing countries that have not already done so should use the WHO Certification Scheme on the Quality of Pharmaceutical Products Moving in International Commerce.Ethical criteria for medicinal drug promotion Appendix Sample Drug Information Sheet1 Various types of information are needed by prescribem and consumers to ensure the safe and effective use of drugs. The following list is a sample that should be adjusted to meet the needs and abilities of the prescriber. (1) International Nonproprietary Name (INN) of each active substance. (2) Pharmacological data: a brief description o pharmacolf o i a effects and mechanism of action. gcl (3) Clinical information: (a) Indications: whenever appropriate, simple diagnostic criteria should be provided. b) Dosage regimen and relevant pharmacokinetic data: average and range for adults and children; dosing interval; average duration of treatment; special situations, e. g. , renal, hepatic, cardiac, or nutritional insufficiencies that require either ineased or reduced dosage. (c) Contra-indications. (d) Precautions and warnings (reference to pregnancy, lactation, etc. ). Reproduced from The use of essential dnrgs: s m n d report of the WHO fipert Committee on the Use of EssentialD ~ g (WHO Technical Report Series, No. 722, s %, P. 43). Ethical criteria f r medicinal drug promotion o e) Adverse effects (quanbfy by category, if possible). (f) Drug interadions (includeonly if clinically relevant; drugs used for self-medication should be included). (g) Overdosage: brief clinical description of symptoms; non-drug treatment and supportive therapy; specific antidotes. (4) Pharmaceutical information: (a) Dosage f o m . (b) Strength o f dosage form. (C) Excipients. (d) Storage conditions and shelf-life (expiry date). (e) Pack sizes. (f) Description of the product and package. (g) Legal category (narcotic or other controlled drug, prescription or non-prescription). (h) Name and address of manufacturerb) and importer(s).

Team Communication

Team Communication Free Online Research Papers As companies find that sharing ideas creates a more productive work environment, they are encouraging their employees to work as a team. Effective communication is a key element to build among team members. Once a team is formed, communication processes are integrated. The team becomes familiar with each other’s actions and collectively uses these actions to their advantage. Past experiences are discussed and the knowledge of each member’s strength and weaknesses begins to develop. The strengths and weaknesses that have been identified can help the team to learn from each other and grow together. This will create a positive atmosphere in which individuals can feel more comfortable to share their ideas with their team. Conflicts will arise from time to time. They occur for different reasons such as an influence from another team member. For example, an individual may try to persuade the leader into going along with a suggestion that he/she has made. The member continues to bargain with the leader until the leader can reach a solution to compromise. Other members may not be satisfied with the new change. Problem solving begins among the group to try to overcome any obstacles. The group must discuss the conflicts and try to empathize with the current situation in order to resolve it efficiently. Depending on the obstacle, a tremendous amount of understanding may be required. Often times, people pass judgment too quickly. This tends to happen because the team is still in the process of developing and trust has not yet been fully established. Lack of communication will occur when an individual feels that they can not put their trust into another team member. They are no longer willing to share their ideas. They also become afraid to disagree with others. A team project will only be successful if the team is open to considering all ideas that have been given. After decisions have been made, they must reach a consensus as a team. Effective communication is extremely important when working as a team. A strong bond is formed. Once a relationship has been established, the results are endless. Research Papers on Team CommunicationThe Project Managment Office SystemResearch Process Part OneThe Hockey GameMarketing of Lifeboy Soap A Unilever ProductIncorporating Risk and Uncertainty Factor in CapitalHip-Hop is ArtThree Concepts of PsychodynamicBionic Assembly System: A New Concept of SelfOpen Architechture a white paperInfluences of Socio-Economic Status of Married Males

Brooklyn in the 1950's Essay Example | Topics and Well Written Essays - 1500 words

Brooklyn in the 1950's - Essay Example Among these displays, some of the very best include those on 83rd and 84th streets. For the tourists nowadays a 3.5 hours tour shuttle is also offered whose name is â€Å"Tony Muia† This is what Brooklyn looks like at present times but in this article we’ll try to have a look about the outlook of Brooklyn as it was in 1950s. The main reference to the history of Brooklyn is a beautiful book by Colm Toibin named â€Å"Brooklyn†, it is basically a novel based on the life of Brooklyn in 50s. This novel basically depicts a sad life and gives an overview about the pattern of life in Brooklyn at that time. Geographical Location: In 1950s, Brooklyn had the same boundaries as of the Kings County which is now the 2nd most densely populated county of United States after the Manhattan County, if we go far behind in the past then Brooklyn was an independent city until it was included in New York in 1898, but still in 1950s, despite of the merger into New York., Brooklyn maint ained its individuality in culture, art and its architecture and it has harbor different cultures in different areas. Downfall of Brooklyn: In the post war years, Brooklyn was the main supplier of the industrial goods to the whole of the country but by 1950 these industrial supplies began to diminish pertaining to the fact that the major industrial manufacturers started to move to other cities which appeared cheaper to them as well as the Brooklyn port also started to decline as larger ships came into scene which required larger ports having deep harbors which was deficient factor in the port of Brooklyn, at that time, economy was unstable and banks were providing loans for building houses on easy conditions so a large number of white middle class community left their native homes in Brooklyn and moved to other localities which appeared to have more prosperous future for them such as Staten Island and New Jersey. Whole of the Jewish community left their homes in Brooklyn and moved t o other places such as Flatbush, Borough Park, Eastern Parkway and Brighton Beach. Most of the Italians also moved from Brooklyn and what could be regarded as a major blow was the incidence of Brooklyn Dodgers moving to Los Angeles in 1957. This was quite significant as Dodgers symbolized Brooklyn for a very long time so it was a big setback for the residents of Brooklyn and the dodgers wee the unifying factor for the whole diverse ethnic groups residing in the Brooklyn. So everyone in Brooklyn in some way or the other was related to each other through the Dodgers. One such incidence which showed the significance of Dodgers was the defeat of New York Yankees by the Dodgers in 1955 which made their loyal fans felt proud and when this team suddenly became the Los Angeles Dodgers then it was also taken as a sign of the decline of the golden era of Brooklyn. Once all the colors of Brooklyn faded, the manufacturing power of Brooklyn also declined drastically and this can be shown by the fact that the Brooklyn Navy yard was closed in 1966. The Brighter Side: Despite of a large number of people migrating to other areas from Brooklyn, in 1950s there was an influx of a large number of Italians to this area resulting in the predominance of Italians in these neighborhoods and this dominance of Italians still persists in some areas of Brooklyn such as Bensonhurst which is also known as the â€Å"Little Italy† of Brooklyn. In 1950, one major event was the arrival of New York aquarium into the Coney Island. Though the abrupt voting of the Dodgers to join Los Angeles was the significant dilemma for the Brooklyn residents but event after that there were some leaders in Brooklyn like Galamison and Reverend Milton who continued the traditions of the activists to raise their voices against any injustice or

Domestic Dogs Essay Example | Topics and Well Written Essays - 1000 words

Domestic Dogs - Essay Example Domestic dog is morphologically distinct from all other canids except its close relatives, the wolf-like canids. The earliest burial remains of a domestic dog are 14,000 years old and were found in Bonn-Oberkassel, Germany. Despite their many shapes and sizes all domestic dogs, from Newfoundlands to pugs, are members of the same species-Canis familiaris. Although they have domestic temperaments, these dogs are related to wolves, foxes, and jackals. Many of the behavior traits and body movements or positioning can be applied universally to all canids for example ear positioning, tail positioning, raised hackles, etc. There is considerable similarity between dogs and wild canid species; many wolf-like canids cannot be distinguished from domestic dogs of equivalent size. However, all dogs are consistently separated from fox-sized, wild canids by subtle but evolutionarily significant differences in olecranon, metapodial, and scapula morphology. Second, in domestic dogs the pattern of sta tic allometry is nearly identical to that of ontogenetic allometry. This finding can be attributed to simple heterochronic alterations of postnatal growth rates. Talking about wolves, they have a fairly sophisticated communication system--in both body language and verbal language. They use their whole bodies when communicating. North American Wolves are extremely social animals and live in groups called packs. The packs can vary in size, usually according to the abundance or dearth of prey. For example, the wolf packs of Alaska's Denali National Park preying primarily on moose can number into the twenties; but in Minnesota, wolf packs typically number under ten. In some packs, there is one male or female wolf called the "omega". This wolf lives on the fringes of the wolf society and is usually the last to eat, sometimes going without if food is scarce. The link between the Domestic Dog and the Wolf is therefore a matter of scientific classification in Zoology. Interestingly the recl assification of the dog in 1993 meant the inclusion of Lupus to the scientific classification and therefore signifying the link between the dog and the wolf. Domestic Dogs share many of their characteristics with their wild relatives. Pack animals eat meat. Dogs too are able to eat raw meat if given to them and it's called the raw diet, territory issues marking their scent, communicating using physicality, play fighting etc. Essential difference between Domestic Dogs and their wild relatives is that of genetic information. Some other trivial differences are that dogs tend to howl less and bark more. Dogs are also domesticated as they are friendly towards people. A domestic dog when subject to wild environment will get acclimated and become wolf-like. As far as physicality is concerned, some of the attributes are tail & ear carriage, vocal communication - barking, howling, hunting, pack mentality & hierarchy, mating & litter rearing. Dogs were probably the first tame animals. They ha ve accompanied humans for some 10,000 years. During this time we have, in some respects, genetically engineered (by selective breeding) so that they can become useful as working dogs. For Example the Bernese mountain dog was bred for draft work, the Boxer for bear fighting and the Mastiff as a war dog. Apart for the

Haemolytic Disease of the Fetus and Newborn (HDFN)

Haemolytic Disease of the Fetus and Newborn (HDFN) List and briefly describe three clinical signs for Haemolytic Disease of the Fetus and Newborn (HDFN) Haemolytic disease of the fetus and newborn (HDFN) is a rare disease that occurs when maternal alloantibodies cross the placenta during pregnancy and cause the destruction of fetal red blood cells (RBCs) (Delaney and Matthews, 2015; Haas et al., 2015). HDFN can result in fetal anaemia with progression to severe morbidities, such as ascites, hydrops fetalis, heart failure, kernicterus, and death (Delaney and Matthews, 2015). The clinical presentation of HDFN is variable, in which there are several manifestations that may occur (Murray and Roberts, 2007). Three of the most prevalent clinical signs that allows for neonatal paediatricians to suspect HDFN includes splenomegaly, oedema, and jaundice. HDFN is characterised by the accelerated destruction of RBCs, which results in differing rates of haemolysis and fetal anaemia (Urbaniak and Greiss, 2000). The continuous and rapid process of haemolysis causes extramedullary haematopoiesis, a result of erythropoiesis failing in the bone marrow, in the fetal liver and spleen (Dean, 2005). Organs, such as the liver and spleen, that are involved in the synthesis of RBCs increase the production to combat the rate of destruction and counteract the overall loss (Dean, 2005). The increased workload of the spleen results in its enlargement, termed splenomegaly (Bowman, 1997; Dunn, 1963).          Oedema is an important clinical sign of HDFN that is also associated with the degree of haemolysis and anaemia (Delaney and Matthews, 2015). Oedema can occur due to low levels of serum albumin through a decrease in osmotic pressure (Dean, 2005). Moreover, as the body compensates for fetal anaemia, the fetus can develop a hyperdynamic circulation (Haas et al., 2015). This can result in hydrops fetalis, a severe and life-threatening condition in which there is widespread oedema in the fetal and skin and serous cavities (Haas et al., 2015). A further clinical sign of HDFN is jaundice. Jaunice may occur as a result of haemolysis, in which there is an increase in the level of bilirubin within the body (Urbaniak and Greiss, 2000). Throughout pregnancy, bilirubin is removed via the maternal circulation by the placenta (Dean, 2005). Therefore, a high level of haemolysis may be present with a low level of bilirubin (Murray and Roberts, 2007). However, after birth the haemolytic process continues. At this stage of development, the liver of the neonate is immature and unable to conjugate the excess bilirubin (Urbaniak and Greiss, 2000). The unconjugated bilirubin begins to build and accumulate in the blood of the neonate, causing the skin and whites of the eyes to turn yellow (Dean, 2005). Within 24 to 48 hours after delivery, the level of bilirubin may increase substantially (Urbaniak and Greiss, 2000). Left untreated, this can lead to the development of kernicterus, a condition in which bilirubin deposits form in the basal ga nglia and brain stem nuclei (Haas et al., 2015). Describe the progression of HDFN, from sensitisation to fetal red cell destruction, in a D negative mother carrying a D positive fetus that has not received RhIg. Throughout pregnancy, antibodies from the maternal circulation play a vital role in providing protection for neonates; crossing the placenta from the maternal to the fetal circulation (Dean, 2005). This is essential for the fetus, as by delivery newborns have a relatively immature immune system (Murray and Roberts, 2007). Although the presence of maternal antibodies provides protection, the active transporting of antibodies across the placenta can result in HDFN (Dean, 2005). HDFN is triggered by a sensitisation event. This most often occurs during the first pregnancy; however, it can also arise from a blood transfusion or organ transplant (Delaney and Matthews, 2015). During the course of pregnancy, the maternal and fetal circulations gradually mix with each trimester (Delaney and Matthews, 2015). This results in maternal alloimmunisation, as the maternal circulation has been exposed to foreign RBCs (Haas et al., 2015). Despite the relatively small amount of fetal blood that passes into the maternal circulation, only a small amount is needed for sensitisation to occur (Dean, 2005). This is typical for an RhD negative mother carrying an RhD positive fetus. Sensitisation frequently transpires during the birth of the firstborn RhD positive child, where fetal maternal haemorrhage (FMH) is common (Delaney and Matthews, 2015). However, the risk of sensitisation increases in complicated and extensive labours (Dean, 2005). Sensitisation can also occur through earlier  events in pregnancy, such as a prenatal bleed, trauma, termination of pregnancy, chronic villus sampling, and miscarriage (Sebring and Polesky, 1990). The greatest risk of developing FMH is during the process of labour (Murray and Roberts, 2007). Subsequently, alloantibodies are most likely to form after delivery (Delaney and Matthews, 2015). After sensitisation of an RhD negative mother carrying an RhD positive fetus, the mothers serum will contain anti-D (Dean, 2005). Importantly, the maternal anti-D that is formed is of the IgM class and unable to effectively cross the placenta (Delaney and Matthews, 2015). As a result, HDFN is rare in first-born children and unlikely to have any clinical consequence or significance (Dean, 2005). However, once the maternal circulation has been exposed to the fetal circulation the maternal immune system has the potential to respond to foreign red cell antigens (Delaney and Matthews, 2015). Through extensive research and cohort studies, it has been established that HDFN is most likely to effect subsequent pregnancies (Dean, 2005). Maternal alloantibodies of the IgG1 and IgG class cause significant haemolysis, thus the most clinically significant forms of HDFN (Roberts, 2008). In the event that an RhD negative mother becomes pregnant for a second time, interaction with the RhD antigen stimulates the production of IgG type anti-D, which can be transported across the placenta into the fetal circulation (Delaney and Matthews, 2015). Once anti-D has entered the fetal circulation, it binds to the RhD antigens found on fetal RBCs and labels them to be destroyed (Delaney and Matthews, 2015). From here, the pathophysiology of the disease ensues, as illustrated in figure 4. Explain the action of RhIg in a D negative mother that has a D positive fetal bleed. Rh immunoglobulin (RhIg) is routinely used in clinical practice to prevent HDFN. RhIg is prepared from human plasma that has been immunised to the D antigen and functions by targeting RBCs that are positive for the D antigen (Brinc and Lazarus, 2009). The use of prophylactic anti-D remains the gold standard approach of antibody-mediated immunosuppression, having been used for several decades (Giancarlo et al., 2010). However, the mechanism of action of RhIg is not fully understood and there are three key hypotheses that have been proposed to explain its method of action. Antigen Clearance Hypothesis The first hypothesis is the antigen clearance hypothesis and is considered the main mechanism of action. Here, IgG is understood to prevent an antibody response by increasing the rate of phagocytosis and the removal of RBCs from circulation via the mononuclear phagocytic system, prior to recognition by the immune system (Brinc and Lazarus, 2009). IgG opsonised RBCs are believed to engage in the activation of IgG receptors (FcÃŽÂ ³Rs) on effector cells, stimulating phagocytosis. IgG is also suspected to increase the clearance of RBCs through the stimulation of complement activation on the RBC surface. Anti-D does not activate complement and therefore it is believed that FcÃŽÂ ³R-mediated phagocytosis is the mechanism by which anti-D is cleared (Brinc and Lazarus, 2009). FcÃŽÂ ³RIIB mediated B-cell inhibition hypothesis This mechanism is the most recently proposed and came about through the discovery of increased levels of transforming growth factor-ÃŽÂ ² and prostaglandin E2 in a number of pregnant women who were given RhIG. This mechanism proposes that RBCs and IgG form a complex in which a negative signal is delivered to inactivate antigen-specific B cells. However, mice models deficient in FcÃŽÂ ³RIIBhave shown that the involvement of FcÃŽÂ ³RIIB is not needed to induce antibody-mediated immune suppression. Furthermore, FcR-like molecules have been discovered in both mice and humans. It is believed that the FCRLs mediate the B-cell inhibition, however, this has yet to be demonstrated (Brinc and Lazarus, 2009). Steric Hindrance Hypothesis The Steric hindrance hypothesis proposes IgG binds the antigen, preventing the B-cell receptor from recognising the corresponding epitopes. Most anti-D epitopes are not blocked by RhIg. This allows free D epitopes to be detected after administration of RhIg. Monoclonal anti-D has been shown to prevent antibody responses by binding 10-15% of epitopes. This pathway has not been studied in detail and therefore knowledge of the immunobiology is limited. However, it is believed that IgG binding of D epitopes allows a formation between RBCs and B cells, in which this prevents B-cell activation (Brinc and Lazarus, 2009). The established methodology in the UK for the Quantification of a D positive fetal bleed is via flow cytometry with FITC-anti-D (FITC-BRAD3). Name and describe 3 alternative methods used worldwide to detect fetal bleeds In addition to the use of flow cytometry, several alternative screening methods are available to determine and quantify FMH (Kim and Makar, 2011). Three screening methods that are used worldwide include the rosette screen, Kleihauer-Betke acid elution test, and flow cytometry using anti-fetal haemoglobin antibodies. The rosette test is a screening method that is used to qualitatively detect fetal bleeds equal to or greater than 10 mL and 0.2% of fetal cells present in the maternal circulation (Kim and Makar, 2011). The rosette test works by indirectly identifying the presence of D positive fetal RBCs in D negative mothers (Solomonia et al., 2012). To perform this test, a maternal blood sample is collected, incubated with exogenous anti-D, and washed. D positive RBCs are added and are key as they act as an indicator. The sample is examined using a light microscope. In the presence of fetal D positive cells, the indicator RBCs form aggregates or rosettes around the coated fetal RBCs (Solomonia et al., 2012). A positive result is indicative of an FMH greater than 10 mL and requires quantification by Kleihauer-Betke acid elution test or flow cytometry to determine the dose of RhIg to administer (Kim and Makar, 2011). This test can encounter and produce false-positive results. This largely occurs if the mother of fetus is weak D. Furthermore, in the presence of a direct antiglobulin test (DAT), the rosette test may produce a false-negative result. This can be attributed to crosslinking and agglutination of the mothers antibody coated cells (Kim and Makar, 2011). The Kleihauer-Betke acid elution test is a screening method that differentiates between fetal haemoglobin (HbF) RBCs and adult Hb (Bromilow and Duguid, 1997). The underlying notion of this test is fetal RBCs largely contain HbF and are resistant to acid elution, whereas in contrast, adult Hb is acid-sensitive (Kim and Makar, 2011). To perform this test, a maternal blood sample is taken to prepare a thin peripheral smear. The peripheral smear is dried, immersed in fixative, exposed to and incubated with an acid buffer, and stained with eosin. Under a microscope, the test reveals fetal cells to be stained a dark pink-red colour, whilst adult red cells appear pale or as uncoloured ghost outlines (Kim and Makar, 2011). Under a microscope, the fetal cells are counted and reported as a percentage of adult cells (Kim and Makar, 2011). Flow cytometry using anti-fetal haemoglobin antibodies is a variant of flow cytometry that detects RhD positive fetal cells (Kim and Makar, 2011). In this method, monoclonal antibodies are directed against HbF (Davis, 2007). A maternal blood sample is collected and an RBC count is performed (Davis, 2007). Cells are then fixed and permeabilised with detergent to enable antibodies to enter the cellular membrane and bind HbF (Davis, 2007). A flow cytometer is used to analysed the antibody stained cells (Davis, 2007). This method uses positive and negative controls simultaneously to differentiation between fluorescence from fetal RBCs and non-specific background staining (Kim and Makar, 2011). The positive control is also highly important in setting out the parameters for gating a sample (Kim and Makar, 2011). Rosette test Kleihauer-Betke acid elution test Flow cytometry using anti-fetal haemoglobin antibodies Advantages: Commercial kits Widley available Simple to use Fast Inexpensive Advantages: Not dependent on presence of RhD antigen Requires only basic laboratory equipment Inexpensive Can be used to assess fetal welfare in RhD positive patients Advantages: Quantitative Automated good precisions, sensitivity, accuracy, and reproducibility Cost-effective Less labour intense Disadvantages: Only applicable to RhD negative mothers carrying RhD positive fetus Qualitative only not quantitative Disadvantages: Laborious to perform Accuracy and precision limited due to variation in test characteristics Poor reproducibility Subjective Disadvantages: If mother and fetus have the same RhD type or mother is RhD positive cannot be used to determine FMH False positives due to hereditary persistence of fetal Hb, increased levels of Hb in pregnancy and certain disease states a) A >2mL bleed is detected via acid elution test in a sample taken from a D negative mother. Quantification via anti-D flow cytometry results in a zero bleed. Explain two possible reasons for the opposing results. The differing results of the acid elution test and anti-D flow cytometry may be explained by the RhD status of the mother and fetus. If the mother is not RhD negative and is carrying an RhD positive fetus, this test would not reproduce the results of the acid elution test. Additionally, if the fetus has an RhD negative status, this would also cause the test to fail and detect a zero bleed. Furthermore, flow cytometry cannot accurately detect weak and partial D variants, resulting in a false negative result. Therefore, if the mother or fetus has either of these D variants, FMH would not be detected via flow cytometry. An alternative reason for the differing results between the two tests could be attributed to haemoglobinopathies, in which the flow cytometer detects HbF. Lastly, there could be a mistake in the tube, such that the antibody was not detected, causing an incorrect result. b) Suggest a suitable test alternative to those already conducted to investigate the sample further and explain your reasoning for the alternative test. The use of flow cytometry using anti-fetal haemoglobin antibodies would be a beneficial test to implement in order to clarify the results and detect if a bleed is present. This is important to ensure the appropriate and correct dose of RhIg is administered. Testing the sample using HbF flow cytometry would be useful as flow cytometry using anti-D failed to reproduce the results of the acid elution test. There is a possibility that the acid-elution test produced a false positive result. The acid-elution test is limited in that is has poor accuracy and is prone to variations. The false positive may arise as a result of adult hereditary persistence of HbF, which is known in 1 to 2% of the population. Furthermore, during pregnancy the level of HbF rises by 25%. Therefore, the use of HbF flow cytometry would be able to detect if this is what caused the result. The following bleeds were detected via anti-D flow cytometry in a D negative woman. Using the Mollison calculation work out: The bleed volume in mL The total RhIg dose in each case to the nearest 500 IU The top up RhIg dose required in each case to the nearest 500 IU The Mollison calculation is used to calculate the volume of bleed. To do this, the background of the isotope matched control is subtracted from the number of events obtained in the D positive region, as recommended in the BCSH guidelines. The Mollison equation is as follows: D (+) events D (-) events1800FMH = X -ml X 1.22 Total number of events 1 The equation can be simplified to the following: FMH = % of D positive events x 18 x 1.22 0.81% x 18 x 1.22 = 17.79 mL 18 ml bleed* = 18 x 125 = 2250 IU Rounded to nearest 500 = 2500 IU 2500 IU 500 IU = 2000 IU 0.45 x 18 x 1.22 = 9.88 mL 10 mL bleed = 10 x 125 = 1250 IU Rounded to nearest 500 = 1500 IU 1500 IU 500 IU = 1000 IU 0.091 x 18 x 1.22 = 1.99 mL 2 mL bleed = 2 x 125 = 250 IU Rounded to nearest 500 = 500 IU 500 IU 500 IU = 0 IU This bleed is under 4 mL and therefore no top up is required as 500 IU is routinely administered for a bleed of up to 4 mL. 1.09 x 18 x 1.22 = 23.94 mL 24 mL bleed = 24 x 125 = 3000 IU Rounded to nearest 500 = 3500 IU 3500 IU 500 IU = 3000 IU 0.02 x 18 x 1.2 = 0.43 1 mL bleed = 1 x 125 = 125 IU Rounded to nearest 500 = 500 IU 500 IU 500 IU = 0 IU This bleed is under 4 mL and therefore no top up is required as 500 IU is routinely administered for a bleed of up to 4 mL. References Brinc, D. and Lazarus, A. (2009). Mechanisms of anti-D action in the prevention of hemolytic disease of the fetus and newborn. Hematology, [online] 2009(1), pp.185-191. Available at: http://asheducationbook.hematologylibrary.org/content/2009/1/185.long [Accessed 6 Mar. 2017]. de Haas, M., Thurik, F., Koelewijn, J. and van der Schoot, C. (2015). Haemolytic disease of the fetus and newborn. Vox Sanguinis, [online] 109(2), pp.99-113. Available at: https://www.ncbi.nlm.nih.gov/pubmed/25899660 [Accessed 6 Mar. 2017]. Dean, L. (2005). Blood groups and red cell antigens. 1st ed. [Bethesda, Md.]: NCBI. Delaney, M. and Matthews, D. (2015). Hemolytic disease of the fetus and newborn: managing the mother, fetus, and newborn. Hematology, [online] 2015(1), pp.146-151. Available at: https://www.ncbi.nlm.nih.gov/pubmed/26637714 [Accessed 6 Mar. 2017]. Giancarlo Maria Liumbruno, Angelo DAlessandro, Federica Rea, Vanessa Piccinini, Liviana Catalano, Gabriele Calizzani, Simonetta Pupella, Giuliano Grazzini (2010). Blood Transfus. 2010 Jan; 8(1): 8-16. doi: 10.2450/2009.0108-09 Kim, Y. and Makar, R. (2012). Detection of fetomaternal hemorrhage. American Journal of Hematology, [online] 87(4), pp.417-423. Available at: https://www.ncbi.nlm.nih.gov/pubmed/22231030 [Accessed 6 Mar. 2017]. Murray, N. and Roberts, I. (2007). Haemolytic disease of the newborn. Archives of Disease in Childhood Fetal and Neonatal Edition, [online] 92(2), pp.F83-F88. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2675453/ [Accessed 6 Mar. 2017]. Roberts, I. (2008). The changing face of haemolytic disease of the newborn. Early Human Development, [online] 84(8), pp.515-523. Available at: https://www.ncbi.nlm.nih.gov/pubmed/18621490 [Accessed 6 Mar. 2017]. Urbaniak, S. and Greiss, M. (2000). RhD haemolytic disease of the fetus and the newborn. Blood Reviews, [online] 14(1), pp.44-61. Available at: https://www.ncbi.nlm.nih.gov/pubmed/10805260 [Accessed 6 Mar. 2017].      Ã‚