Module 6 Essay Example | Topics and Well Written Essays - 500 words - 1

Module 6 - Essay Example It is believed that there are certain places considered as sacred spaces where the kami communicate with people. These places are usually located near waterfalls, trees and mountains, rivers, and other unusual natural formations. In these places, shrines are built to house the kami where the sacred space separates them from the ordinary world. Sacred spaces also exist in the homes where the kamidana or home shrine is designated. The shrine and the home shrine are therefore treated with the utmost respect, and this is evident in the architecture of the edifice. A large gate called tori, with a distinctive design fronts kami shrines, exhibiting two upright bars and two crossbars that indicate the separation of the sacred from the common space. Aside from this several real and symbolic barriers mark the sacred space, such as statutes of protection, ropes and fences. The shrines have distinctive parts such as the public hall of worship (haiden), the hall of offerings (heiden), and the innermost portion which comprises the worship hall reserved for the high priest (honden). It is in the honden where the symbol of the enshrined kami is situated. http://it.spcollege.edu/flashapplications/accessibleYouTubePlayer/index.htm?swfWidth=480&swfHeight=358&videoWidth=480&videoHeight=270&srtFile=http://it.spcollege.edu/srt/HUM2270_KevinMorgan/Hum2270_Mod6_EarlJapArtCult_TradJapArch.srt&youtubeURL=http://www.youtube.com/watch?v=VVnQvhS4vRs The video chosen for review describes how Japanese dwellings are constructed. It is interesting to note that the traditional Japanese home is constructed of wood and light materials and seldom have solid walls. There are also no permanent partitions, only temporary dividers, typically free-standing folding screens made of paper that are set up when the need to segregate spaces arises. Occasionally, there are also sliding doors which are installed along wooden

Application Architecture Case Study Example | Topics and Well Written Essays - 1000 words

Application Architecture - Case Study Example This is done using special Internet addresses that have been reserved for this purpose. These special addresses are invalid in the Internet itself. The hosts using these addresses may communicate among themselves, but they cannot access the Internet directly†. NAT In order to make it easy for the network administrator, the NAT translates all the personal and confidential IP addresses into inclusive IP addresses. This will require an incremental change devoid of host and routers modification. Furthermore, the NAT has its own drawbacks for instance; its performance is slow since each packet is processed before translating it. Therefore the ‘IP traceability’ also becomes complicated because data packets are hard to trace. 3 Tunneling Tunneling is also referred as port forwarding. Port forwarding is often used for establishing a secure data channel from head office to the remote office corporate network by utilizing the Internet. One of the methods for deploying a tunn eling protocol is to configure the WAN connection with port number along with allocation of the required service. For example, for accessing remote desktop for a payroll application, port number 3389 will be used with the service named as ‘RDP service’ along with the specific IP address of the computer. As discussed earlier, PPTP developed by Microsoft. Likewise, PPTP is required for transmitting encrypted data over the VPN. Besides, no data encryption is available on port forwarding configuration as compare to tunneling because every tunneling route needs to be defined. This may create complex configurations that are difficult to manage. 4 Access Control List In a router, firewall, multi-layer switches etc.; the Access Control List is characterized. If a data packet attempts to pass through a router, it will take in security rules and policies. In the same way, the user’s rights on the files and directories are identified related to the ACL operating system. In order to check quality, the files and folders are read, write and executed. Thus, the ACL offers security for the network data administration, system files and folders. 5 Sub Netting Sub netting is described in â€Å"document RFC 950, originally referred to the subdivision of a class-based network into sub networks, but now refers more generally to the subdivision of a CIDR block into smaller CIDR blocks† (Subnetting, n.d). In IPv4, a single subnet only encloses 254 assignable IP addresses. The issues related to the broadcast are always triggered, generating network congestion and disruption in services. Therefore, these IP addresses should be managed properly in order to control congestion. However, o overcome the above mentioned issues, the IP addresses are divided into smaller class C networks for better performance related to network management and security. In addition, to operate a corporate network, sub netting is needed in order to allocate private IP addresses to inb ound networks as the global IP addresses are limited. The global IP addresses can be configured on the bases of WAN (Wide Area Network) devices. 6 Virtual Local Area Network (VLAN) The Virtual Local Are

Degrees Of Carpal Tunnel Syndrome Health And Social Care Essay

Degrees Of Carpal Tunnel Syndrome Health And Social Care Essay Carpal tunnel syndrome is a most common compression neuropathy of the upper extremity. It is caused by compression of median nerve in the carpal tunnel. Women are more commonly affected than men. It is commonly seen in age group between 30 and 60 years. Carpal tunnel syndrome usually occurs due to excessive use of the hands and occupational exposure to repeated trauma. Average cross sectional area of the carpal tunnel is 1.7 cm2 with the wrist in neutral position. Passive flexion and extension of the wrist has been increased the carpal tunnel pressure. Wrist extension increases carpal tunnel pressure more than the wrist flexion. Any space occupying mass or swelling of the structures in the tunnel also causes pressure on the median nerve. Mostly, the cause of carpal tunnel syndrome is unknown. Any condition which causes pressure on median nerve at the wrist will result in carpal tunnel syndrome. Obesity, pregnancy, hypothyroidism, arthritis, diabetes and trauma are the common conditions that lead to carpal tunnel syndrome. Repetitive work such as uninterrupted typing which result in tendon inflammation can also cause carpal tunnel symptoms. Carpal tunnel syndrome due to repetitive activities has referred to one of the repetitive stress injuries. In some rare diseases such as amyloidosis, leukemia, multiple myeloma, and sarcoidosis, deposition of abnormal substances in and around the carpal tunnel leads to nerve irritation. Prolonged flexion or extension of the wrists under the patients head or pillow during sleep is believed to contribute to the prevalence of nocturnal symptoms. Usually patient complaints pain, numbness and tingling sensation in the hand and fingers. Symptoms worsening at night typically awakening the patient or occurring on bunching up the hand for tasks such as writing. Carpal tunnel syndrome is the most common cause of acroparaesthesiae often pain and paraesthesiae may be the only symptoms for many months or years. The syndrome is essentially a sensory one; the loss or impairment of superficial sensation affects the thumb, index and middle fingers and may be or may not split the ring finger. There may be wasting and weakness of the thenar muscles. Weakness and atrophy of the abductor pollicis brevis and other muscles supplied by median nerve occur in only the most advanced cases of compression. Degrees of carpal tunnel syndrome are classified as dynamic, mild, moderate and severe. The pathophysiology of carpal tunnel syndrome is typically demyelination. Secondary axon loss may present in more severe cases. With 20 to 30 mm hg compression, the initial insult is a reduction in epineural blood flow. With wrist extension, intracarpal pressures routinely measure atleast 33 mm hg and often upto 110 mm hg in patients with carpal tunnel syndrome. Edema in the epineurium and endoneurium is caused by continued or increased pressure. Carpal tunnel syndrome diagnosed by detailed history collection, phalen maneuver, percussion test, two point discrimination test, vibrometry, monofilament test, distal sensory latency and conduction velocity, distal motor latency conduction, upper limb tension tests. X-ray is taken to check for arthritis and fracture. If there is a suspected medical condition that is associated with carpal tunnel syndrome, laboratory tests may be done. This condition could be mistaken for a brachial neuritis due to cervical intervertebral disc prolapse at C5 C7 level. Nerve conduction tests on the median nerve help to localize the lesion in the tunnel. Both conservative and surgical management options are available in order to reduce pressure over median nerve. The current conservative treatments include non steroidal anti inflammatory drugs, sometimes rest, local injection of corticosteroids, activity modification, ultrasound therapy, carpal bone mobilization, magnetic therapy, night and/or daytime wrist splint positioned at 0 to 15 degrees of extension, nerve and tendon gliding exercises. Anyone of the measures alone or in combination can be effective in treating early carpal tunnel syndrome. Tendon gliding exercises are performed to lubricate and increase gliding of the flexor pollicis longus, flexor digitorum superficialis and flexor digitorum profundus tendons. They are best performed with the hand elevated to concurrently control local edema. Median nerve gliding exercises and the upper limb tension test with median nerve bias can be used as treatment techniques. Modality treatment can also control symptoms and enhance the therapeutic exercise program. Exercise intervention for carpal tunnel syndrome focuses on mobility and strengthening without producing an exacerbation. Stretches for the extrinsic and intrinsic muscles are prescribed for several times each day. If working, a patient should perform them before work. They should be performed slowly and gently; the patient feel only a gentle stretching sensation. In workplace, modification of the job site or complete ergonomic redesign is typically the most helpful approach. In addition yoga, chiropractics, laser treatment have been advocated. Surgery is indicated in advanced cases with objective sensory loss and /or weakness or atrophy of the abductor pollicis brevis. In severe cases surgical division of the transverse carpal ligament relieves the condition. Surgical management includes open carpal tunnel release and endoscopic release. It aims to decompress nerve, to improve excursion and to prevent flexor damage. Splinting is the most popular method of conservative management of carpal tunnel syndrome. Splints are recommended by the American Academy of Neurology for the Carpal tunnel syndrome with light and moderate pathology. Immobilization of the wrist joint in a neutral position with splint will increase the carpal tunnel volume and minimize the median nerve pressure. Wrist Splinting in a neutral position will help reduce and may even completely relieve Carpal tunnel syndrome (Slater RR et al 1999). Ultrasound therapy is more useful in the management of Carpal tunnel syndrome. It has the potential to accelerate normal resolution of inflammation. Ultrasound therapy elicit anti inflammatory and tissue stimulating effects. Ultrasound therapy accelerates the healing process in damaged tissues. Pulsed Ultrasound therapy with the intensity of 1.0 w/cm2, 1:4 for fifteen minutes per session has significantly improved subjective symptoms in patients with carpal tunnel syndrome (Ebenbichler GR et al). Nerve and tendon gliding exercises are used in conservative treatment of carpal tunnel syndrome to decrease adhesions and to regulate venous return in nerve bundles (Rozmaryn et al). Nerve and tendon gliding exercises may maximize the relative movement of the median nerve within the Carpal tunnel and the excursion of flexor tendon relative to one another (Rempel D, Manojlovic R et al). Wrist splint along with nerve and tendon gliding exercises showed significant improvement in reducing symptoms in Carpal tunnel syndrome. (Akalin et al) NEED FOR THE STUDY: Ultra sound therapy, splints, nerve and tendon gliding exercises are significantly effective in reducing symptoms in the treatment of Carpal tunnel syndrome. Combination of various treatments is also useful in reducing symptoms in Carpal tunnel syndrome. Ultrasound therapy helps to increase healing process in damaged tissue. This study aimed to find out the effect of Ultrasound therapy in reducing pain in patients with Carpal tunnel syndrome. STATEMENT OF THE PROBLEM Effect of Ultrasound Therapy in reducing pain in patients with Carpal tunnel syndrome. KEY WORDS: Carpal tunnel syndrome Ultrasound therapy Splint Exercises Pain Visual analogue scale (VAS) AIM: To find out the Effect of Ultrasound Therapy in reducing pain in patients with Carpal Tunnel Syndrome. OBJECTIVE: To study the Effect of Ultrasound Therapy in reducing pain in patients with Carpal Tunnel Syndrome. HYPOTHESIS: 1.6.1. NULL HYPOTHESIS There is no significant effect of Ultrasound Therapy, Splint and Exercises in reducing pain in patients with Carpal Tunnel Syndrome. There is no significant effect of Splint and Exercises in reducing pain in patients with Carpal Tunnel Syndrome. There is no significant difference between the effect of Ultrasound Therapy, Splint and Exercises and Splint and Exercises in reducing pain in patients with Carpal Tunnel Syndrome. 1.6.2. ALTERNATE HYPOTHESIS There is significant effect of Ultrasound Therapy, Splint and Exercises in reducing pain in patients with Carpal Tunnel Syndrome. There is significant effect of Splint and Exercises in reducing pain in patients with Carpal Tunnel Syndrome. There is significant difference between the effect of Ultrasound Therapy, Splint and Exercises and Splint and Exercises in reducing pain in patients with Carpal Tunnel Syndrome. II.REVIEW OF LITERATURE CARPAL TUNNEL SYNDROME DAVID A FULLER, MD, et al (2010) Stated that carpal tunnel syndrome is the most common entrapment neuropathy. The syndrome is characterised by pain, paraesthesia, and weakness in the median nerve distribution of the hand. The etiology of carpal tunnel syndrome is multifactorial which is contributed by various degrees of local and systemic factors. Symptoms of carpal tunnel syndrome are due to ischemia and impaired axonal transport of the median nerve which results from median nerve compression at the wrist. (Lunborg G, Dahlin LB 1992). Elevated pressure inside the carpal tunnel leads to compression. HARVEY SIMON, MD et al, (2009) Stated that carpal tunnel syndrome is considered as an inflammatory disorder caused by medical conditions, physical injury or repetitive stress. JEFFREY G NORVELL, MD et al (2009) Stated that carpal tunnel syndrome (CTS) is caused predominantly by median nerve compression at the wrist because of hypertrophy or oedema of the flexor synovium. Pain is thought to be secondary to nerve ischemia rather than direct physical damage of the nerve. S.BRENT BROTZMAN, MD (2003) Explained that degree of the carpal tunnel syndrome as dynamic, mild moderate and severe. In mild cases, patients has intermittent symptoms, decreased light touch, positive digital compression test and positive tinel sign or phalen test may or may not be present. In moderate cases, patients have frequent symptoms, decreased vibratory sense, muscle weakness, positive tinel sign, phalen test and digital compression test. GERRITSEN AA, DE KROM MC, STRUIJS MA, ET AL (2002) Stated that carpal tunnel syndrome (CTS) is caused by median nerve compression at the wrist and is considered to be the more common entrapment neuropathy. Symptoms of carpal tunnel syndrome include pain, numbness or tingling sensation, paraesthesia, involving the fingers innervated by the median nerve. (Bakhtiary AH, Rashidy Pour AR et al 2004) GELBERMAN RH, HERGENROEDER PT, HARGENS AR, RYDEVIK B, LUNDBORG G, BAGGE U (1981) Fracture callus, osteophytes, anomalous muscle bodies, tumours, hypertrophic synovium, and infection as well as gout and other inflammatory conditions can produce increased pressure within the carpal tunnel. Extremes of wrist flexion and extension also elevate pressure within the carpal tunnel. Intraneural blood flow is affected by compression on nerve. Venular blood flow in a nerve is reduced by pressure as low as twenty to thirty mm Hg. At level of thirty mm Hg, axonal transport is impaired. At forty mm Hg, neurophysiologic changes manifested as sensory and motor dysfunctions are present. Any further increase in pressure will produce sensory and motor block. At level of sixty to eighty mm Hg, complete cessation of intraneural blood flow is seen. In one study, the carpal tunnel pressure in patients with carpal tunnel syndrome averaged thirty two mm Hg, compared with only about two mm Hg in control subjects. RH GELBERMAN, AR HARGENS, GN LUNDBORG, PT HERGENROEDER et al, (1981) Measured intra carpal canal pressures with the wick catheter in 15 patients with carpal tunnel syndrome and in 12 control subjects. The average pressure in the carpal tunnel was raised significantly in the patients with carpal tunnel syndrome. When the wrist was in neutral position, the mean pressure was 32 millimeters of mercury. With ninety degrees of wrist flexion the pressure raised to 94 millimeters of mercury. While with ninety degrees of wrist extension the average pressure was 110 millimeters of mercury. The pressure of carpal canal in the control subjects with the neutral position of wrist was 2.5 millimeters of mercury; with wrist flexion the carpal canal pressure rise to 31 millimeters of mercury, and with wrist extension it increased to 30 millimeters of mercury.  ­Ã‚ ­Ã‚ ­Ã‚ ­Ã‚ ­Ã‚ ­Ã‚ ­Ã‚ ­GEORGE S. PHALEN M.D, et al (1966) Stated that diagnosed Carpal tunnel syndrome has been made in 654 hands of 439 patients during the last seventeen years. The typical patient with this syndrome is a middle-aged housewife with numbness and tingling in the thumb and index, long, and ring fingers, which is worse at night and worse after excessive activity of the hands. The sensory disturbances both objective and subjective must be directly related to the sensory distribution of the median nerve distal to the wrist but pain may be referred proximal to the wrist as high as the shoulder. There is usually a positive tinel sign over the median nerve at the wrist, and the wrist flexion test is also usually positive. About half of the patients also have some degree of thenar atrophy. In clinical practice, Carpal tunnel syndrome is the most commonly seen entrapment mononeuropathy which is caused by median nerve compression at the wrist (PHALEN 1966, GELBERMAN et al 1998). Usually patients show one or more symptoms of hand weakness, pain, numbness or tingling in the hand, especially in the thumb, index and middle fingers (SIMOVIC and WEINBERG 2000). Symptoms are worst during night time and often wakeup the patient. WILLIAM C. SHIEL JR., MD.FACP, FACR, et al Stated that the cause of the carpal tunnel syndrome is unknown. Any condition which causes pressure on the median nerve at the wrist will result in carpal tunnel syndrome. Common conditions such as obesity, pregnancy, hypothyroidism, arthritis, diabetes, and trauma can lead to carpal tunnel syndrome. Repetitive work such as uninterrupted typing result in tendon inflammation can also cause Carpal tunnel symptoms. In some rare diseases such as amyloidosis, leukemia, multiple myeloma, and sarcoidosis, deposition of abnormal substances in and around the carpal tunnel leads to nerve irritation. MEDIAN NERVE LUNDBORG G, DAHLIN LB, et al (1996) Stated that throughout the extremity movement, mobility of the peripheral nerve changes and longitudinal movement of the median nerve mostly occur in the carpal tunnel. In Carpal tunnel syndrome, this physiologic mobility of the median nerve disappears. REMPEL D, MANOJLOVIC R, LEVINSOHN DG, et al (1994) Stated that during the exercise there may be redistribution of the point of maximal compression on the median nerve. This milking effect would promote venous return from the median nerve, thus decreasing the pressure inside the perineurium. NAKAMICHI AND S. TACHIBANA et al Conducted a study the motion of median nerve in patients with carpal tunnel syndrome and normal subjects. Median nerve motion was assessed by axial ultrasonographic imaging the mid carpal tunnel. They concluded that wrist of patients with Carpal tunnel syndrome showed less sliding which indicates that physiological motion of the nerve is restricted. This decrease in nerve mobility may be of significance in the pathophysiology of carpal tunnel syndrome. ULTRASOUND THERAPY BAKHTIARY AH, RASHIDY-POUR A et al (2004) Conducted a study to compare the effect of Ultrasound and laser therapy in patients with mild to moderate idiopathic carpal tunnel syndrome. By electromyography findings, 90 hands in 50 consecutive patients with carpal tunnel syndrome were confirmed and allocated randomly in two groups. One group received low level laser therapy and the other group received ultrasound therapy. Ultrasound treatment (pulsed 1:4, 1.0 W/cm2, 1 MHz, 15 min/session) and low level laser therapy (infrared laser, 830nm, 9 Joules, at five points) were given to the carpal tunnel for fifteen daily treatment sessions. Ultrasound group showed more significant improvement than low level laser therapy group in motor latency, motor action potential amplitude, finger pinch strength, and pain reduction. Effects were also sustained in the follow-up period. They concluded that ultrasound therapy was more effective than laser therapy in the management of carpal tunnel syndrome. EBENBICHLER GR, RESCH KL et al (1998) Studied the efficacy of Ultrasound therapy in patients with mild to moderate idiopathic Carpal tunnel syndrome. Ultrasound with parameters 1MHZ, 1.0 W/cm2 pulsed mode 1:4, 15 minutes per session was applied over the carpal tunnel and compared with Sham Ultrasound. Actively treated ultrasound group showed significant improvement than sham treated wrists in both subjective symptoms and electroneurographic variables. To confirm the usefulness of ultrasound therapy for Carpal tunnel syndrome, more studies are needed. Additional randomized trials comparing conservative therapies for Carpal tunnel syndrome would be useful in selecting appropriate treatments for individual patients. EL HAG M, COGHLAN K, CHRISMAS P et al (1985) Stated that Ultrasound could elicit anti-inflammatory and tissue-stimulating effects as already shown in clinical trials and experimentally (Byl et al 1992, Young and Dyson 1990). In this way, Ultrasound has the potential to accelerate normal resolution of inflammation (Dyson 1989). The results of these studies confirm that Ultrasound may accelerate the healing process in damaged tissues. In mild to moderate carpal tunnel syndrome patients, these mechanisms may explain their findings including pain relief, increased grip and pinch strength, and changed electrophysiological parameters toward normal values better than Laser therapy. WRIST SPLINT Wrist splints help to keep the wrist straight and reduce pressure on the compressed nerve. Doctor may recommend the patients to wear wrist splints either at night, or both day and night, although patient may find that they get in the way when they are doing their daily activities. Some research indicates that ultrasound treatment may help to reduce the symptoms of carpal tunnel syndrome. (BUPAS health information team 2010) BRININGER TL, ROGERS JC et al (2007) Fabricated customized neutral splint and nerve and tendon gliding exercises is more effective than wrist cock up splint and nerve and tendon gliding exercises in reducing symptoms and improving functional status in the treatment of Carpal tunnel syndrome. GERRITSEN AA, DE KROM MC, STRUIJS MA, et al (2002) Immobilization of the wrist joint in a neutral position with a splint will maximizes carpal tunnel volume and minimize the pressure acting on median nerve. AKALIN E, EL O, SENOCAK O, et al (2002) Compared the effect of wrist splint alone to wrist splint with nerve and tendon gliding exercises in the treatment of carpal tunnel syndrome. In their study, both groups showed significant improvement in clinical parameters, functional status scale and symptom severity scale. They also reported significant improvement only in pinch strength in the group with wrist splint in combination with exercises compared with the wrist splint group. MANENTE G, TORRIERI F, et al (2001) Stated that wearing a specially designed wrist splint at night time for four weeks was more effective than no treatment in reducing the symptoms of Carpal tunnel syndrome. SLATER RR, et al (1999) Stated that splinting the wrist in a neutral position will help to reduce and may even completely relieve carpal tunnel syndrome symptoms. SAILER SM, et al (1996) Stated that the optimal splinting regimen depends on the patients symptoms and preferences. To prevent prolonged wrist flexion or extension, night splint use is recommended. BURKE DT, STEWRT GW, CAMBER A, et Al (1994) Stated that carpal tunnel syndrome is the commonest compression neuropathy in the upper limb. Several studies have demonstrated the effect of wrist splint in reducing the symptoms of carpal tunnel syndrome. But the chosen angle of immobilization has varied in the management of carpal tunnel syndrome. Wick catheter measurements of carpal tunnel pressures suggest that the neural position has less pressure and, therefore, greater potential to provide relief from symptoms. KRUGER VL, KRAFT GH, et al (1991) Stated that wrist splint at a neutral angle helps to decrease repetitive flexion and rotation, thereby relieving mild soft tissue swelling or tenosynovitis. Splinting is most effective when it is applied within three months of the onset of symptoms. NERVE AND TENDON GLIDING EXERCISES BAYSAL O, ERTEMK, YOLOGLUS, ALTAY Z, KAYHANA et al (2006) Stated that combination of ultrasound therapy, splinting and exercises is a preferable and an efficacious treatment for patients with carpal tunnel syndrome. ROZMARYN LM, et al (1998) Used nerve and tendon gliding exercises in conservative treatment models to decrease adhesions developed in the carpal tunnel and regulate venous return in the nerve bundles. They reviewed more than 200 hands under consideration for carpal tunnel decompression. Altogether 71% of the patients who were not offered gliding exercises went forward to surgery; only 43% of the gliding exercise group was felt to require surgery. SERADGE et al (1995) Stated that intermittent active wrist and finger flexion-extension exercises reduce the pressure in the carpal tunnel. SZABO et al (1994) Showed that the relationship between median nerve and flexor tendon excursion was consistently linear. They suggested active finger motion of the median nerve and flexor tendons in the vicinity of the wrist to prevent adhesion formation even if the wrist is immobilized. REMPEL D, MANOJLOVIC R, LEVINSOHN DG, et al (1994) Stated that the median nerve movement is increased by nerve and tendon gliding exercises in the carpal tunnel and the flexor tendons excursion is increased in relative to one another. TOTTEN AND HUNTER, et al (1991) Proposed a series of exercises enhancing the gliding of the median nerve and tendon at the carpal tunnel for management of postoperative Carpal tunnel syndrome. They also suggested these exercises for non-operative Carpal tunnel syndrome. LAMINA PINAR, SAIT ADA AND NEVIN GUNGOR ET AL Stated that nerve and tendon gliding exercises included in conservative therapy approaches showed more rapid pain reduction and greater functional improvement in grip strength. HANNAH RICE MYERS, et al Stated that carpal tunnel exercises reduce the tension on the tendons in the tunnel and strengthen the weakened muscles of wrist and forearms. Even though nerve and tendon gliding exercises are effective when used alone, they have a greater effect when used along with other intervention such as splint. For people who are involving jobs with keeping their hands in a fixed position throughout the day such as typing secretaries, these exercises may help to prevent carpal tunnel syndrome from developing. VISUAL ANALOGUE SCALE POLLY E. BIJUR PHD, WENDY SILVER MA, E. JOHN GALLAGHER MD et al (2008) Conducted to study to assess the reliability of the visual analogue scale (VAS) for acute pain measurement as assessed by the intraclass correlation coefficients (ICC) appears to be high. The results showed that the Visual analogue scale (VAS) is sufficiently reliable to be used to assess acute pain. PAUL S. MYLES, MBBS, MPH, MD, FFARCSI, et al (1999) Stated Visual analog scale (VAS) is a tool widely used to measure pain. A patient is asked to indicate his/her perceived pain intensity (most commonly) along a 100 mm horizontal line, and this rating is then measured from the left edge (VAS score). The visual analogue scale score correlates well with acute pain. JOYCE, et al Suggested that visual analogue scale and another scales have been compared in terms of sensitivity, distribution of responses and preferences. Results of these studies appear equal. The visual analogue scale has been described as superior in one study because it was more sensitivity than any other scale. III. METHODOLOGY 3.1 STUDY DESIGN: Pretest and Posttest Experimental group study design. 3.2 STUDY SETTING: The study was conducted at Department of Physiotherapy, K.G.Hospital, Coimbatore. 3.3 STUDY DURATION: 3 weeks for each individual subject and the total duration was one year. 3.4 STUDY POPULATION: Patients with Carpal tunnel syndrome referred to the Department of physiotherapy, K.G.Hospital, Coimbatore. 3.5 STUDY SAMPLE: All patients with carpal tunnel syndrome who referred to Department of Physiotherapy, K.G. Hospital were selected. Among all patients, 20 patients who satisfied inclusive and exclusive criteria were selected and assigned into two groups, 10 of each by using Purposive Sampling method. 3.6 CRITERIA FOR SELECTION: INCLUSIVE CRITERIA: Age group above 30 years. Both sexes. Patients with mild to moderate unilateral carpal tunnel syndrome. Patients with Positive Tinel sign, Phalens test and Digital compression test. EXCLUSIVE CRITERIA: Patients with severe carpal tunnel syndrome Patients having thenar atrophy or denervation on electromyographic findings Patients with a neuropathy other than carpal tunnel syndrome in the past year Patient with history of steroid injection in carpal tunnel in the past 3 months Patients had a prior carpal tunnel release Cervical disc prolapse Degenerative changes of cervical spine Acute upper limb fractures Wrist and fingers stiffness Recent hand surgeries Deqeurains disease Pregnancy Acute Infections of Wrist and Hand 3.7 Variables: Dependent variable Pain. Independent variable Visual analogue scale. 3.8 Orientation of subjects: Before treatment all the patients were explained about the study and procedure to be applied and were asked to inform if they feel any discomfort during the course of the treatment. All the willing patients were asked to sign the consent form before the treatment. 3.9 OUTCOME MEASURES: Pain. 3.10 OPERATIONAL TOOLS: Visual analogue scale 3.11 STUDY PROCEDURE: 20 Patients with carpal tunnel syndrome were selected for this study after due consideration of inclusive and exclusive criteria. 20 patients were divided into 2 groups of 10 each. Group A: 10 patients received ultrasound therapy, splint and exercises. Ultrasound therapy with parameters of 1 MHz pulsed mode, 1:4, 1 w/cm2 is given 15 minutes per day, five times per week. Custom made neutral volar splint is given at night and during day time. Exercises are nerve and tendon gliding exercises. During tendon-gliding exercises, the fingers are placed in five discrete positions. Those were straight, hook, fist, table top, and straight fist. During the median nerve-gliding exercise the median nerve was mobilized by putting the hand and wrist in six different positions. During these exercises the neck and the shoulder were in a neutral position and the elbow was in supination and 90 degrees of flexion. Each position was maintained for 5 seconds. Each exercise is repeated 10 times at each session, 5 sessions per day. The total treatment duration is 3 weeks. Group B: 10 patients received only Splint and Exercises. Custom made neutral volar splint is given at night and during day time. Exercises are nerve and tendon gliding exercises. During tendon-gliding exercises, the fingers are placed in five discrete positions. Those were straight, hook, fist, table top, and straight fist. During the median nerve-gliding exercise the median nerve was mobilized by putting the hand and wrist in six different positions. During these exercises the neck and the shoulder were in a neutral position and the elbow was in supination and 90 degrees of flexion. Each position was maintained for 5 seconds. Each exercise is repeated 10 times at each session, 5 sessions per day. The total treatment duration is 3 weeks. 3.12 STATISTICAL TOOLS: Statistical analysis was done using Student t-test. Paired t test Where, n = Total number of subjects SD = Standard deviation d = Difference between initial and final value = Mean difference between initial and final value. (ii) Unpairedt test: To compare the pre test, post test values of both groups independentt test is used. Where, n1 = Number of subjects in Group A. n2 = Number of subjects in Group B. = Mean of Group A = Mean of Group B s1 = Standard deviation of Group A. s2 = Standard deviation of Group B. S = Combined standard deviation IV.DATA ANALYSIS AND INTERPRETATION TABLE-1 VISUAL ANALOGUE SCALE FOR PAIN GROUP A PAIREDt TEST Mean values, mean differences, standard deviation andt values of Visual Analogue Scale for Group A who underwent Ultrasound therapy, Splint, Nerve and Tendon gliding exercises. S. NO VAS Improvement t value Mean Mean difference Standard deviation 1. Pre test 5.60 3.90 0.70 39.0 2. Post test 1.70 0.67 FIGURE-1 GRAPHICAL REPRESENTATION OF MEAN VISUAL ANALOGUE SCALE FOR GROUP A TABLE-2 VISUAL ANALOGUE SCALE FOR PAIN FOR GROUP B PAIREDt TEST Mean values, mean differences, standard deviation andt values of Visual Analogue Scale for Group B who underwent to Splint, Nerve and Tendon gliding exercises. S. NO VAS Improvement t value Mean Mean difference Standard deviation 1. Pre test 5.40 3.0 0.70 20.12 2. Post test 2.40 0.52 FIGURE-2 GRAPHICAL REPRESENTATION OF MEAN VISUAL ANALOGUE SCALE FOR GROUP B TABLE-3 VISUAL ANALOGUE SCALE FOR PAIN PRETEST VALUES OF GROUP A VERSUS GROUP B UNPAIREDt TEST Mean, mean difference, standard deviation and unpairedt test of pre test v

Critique of a Study; Muscle Dysmorphia - excellent paper :: essays research papers

  Ã‚  Ã‚  Ã‚  Ã‚  Last year a study was performed to examine a model for the development of muscle dysmorhpia among male college athletes. The model is known as the Lantz, Rhea, and Mayhew Model and it describes the relationship between pre-disposing factors for the development of muscle dysmorphia and the negative consequences paired with the disorder. The study concentrated on male college athletes falling into three different categories: weight lifters, non-contact sports athletes, and contact sport athletes. The study was to determine which of the expected negative behaviors, if any, prevailed among the separate categories.   Ã‚  Ã‚  Ã‚  Ã‚  Over the past decades the media has been the primary blame of creating body image disorders among both females and males. â€Å"Similar to females, men have been inundated with distorted pictures representing the ideal male physique from TV, fitness magazines, and the toy industry (e.g., bulging superhero, G. I. Joe). While most researchers suggest that a multitude of factors may play a role in creating body image disorders (Pike & Striegel-Moore, 1997), Levine and Smolak (1998) are among a growing number of researchers who blame the media's glamorized body blueprint messages for men and women unrealistically judging themselves. (Page 120)† Men with body image disorders are usually afraid of being too small rather than too large. They tend to have the desire to gain muscle mass at the same time as cutting down the waist line. Along with this desire, an obsession can occur to compulsively lift weights as a way of life. The compulsive weight lifting and consumption of dietary supplements describes the term â€Å"muscle dysmorphia†. This disorder is more mental than physical and may also be a type of obsessive-compulsive disorder. â€Å"In a manner similar to MD, OCD is manifested by obsessions (e.g., constant thoughts about being too small) and compulsions (e.g., repeated behaviors of weight-lifting). (Page 120)† Muscle dysmorphia can also create other mental disorders. It may actually be genetically impossible for some to reach their ideal body. This creates an individual who obsesses over a goal which is non-existent, creating possible depression and perhaps impairing social and occupational functioning. The model of muscle dysmorphia has yet to be tested and this study is to determine if the psycho-behavioral characteristics proposed by the model are present, and to what degree, in the selected weight lifters compared to other athletes. A sample student body of 106 students was selected as the participants. This group contained 29 weight lifters, 24 non-contact sport athletes, and 53 contact sport athletes.

Protestant Reformation

Before his death at the Second Battle of Kappel (Capel) on October 1 1, 1531, at the age of 47, Zwingli had accomplished much in the way of developing the theology of the growing Protestant faith. While Zwingli and Luther may have agreed on many points of the faith one area of profound division was over the presence of Christ's body in the Communion. Luther held to the belief that when one partook of the bread and wine that, while the bread and wine did not change into the body and blood of Christ, the body and blood were present with them to nourish the believer. Zwingli, on the other hand firmly believed that that bread and the wine and the actions accompanying them in the Communion were strictly symbolic of a more spiritual reality. 6 According to Lindsay, the Fourth thesis at the Bern Disputation of 1 528 states that, † it cannot be proved from the Scripture that the Body and Blood of Christ are substantially and corporeally received in the Eucharist. 7 With this, Zwingli w ould agree. While Zwingli was not willing to part ways entirely with the Catholic Church in regards to infant baptism he was an ardent advocate of allowing the clergy to marry.In a meeting in which Zwingli had composed sixty-seven theses to be presented and debated he said, † I know of no greater nor graver scandal than that which forbids lawful marriage to priests, and yet permits them on payment of money to have concubines and harlots. Fie for shame! â€Å"8 There were many area of disagreement between the Reformers and the established Church, such as who should rule and ake laws governing botn church and state. Zwingli upheld the right ot the state to make laws and govern religion but also allowed the people to rise up and rebel against the ruling parties if necessary.This was in great contrast to the stand taken by the Anabaptist in later years. Though changes were slow in coming and in many cases were hard won, major changes were taking place in regards to how the church was to be governed, who was to receive the cup and bread, whether or not priests were allowed to marry, as well as many other theological issues. One group that came about as a process of Zwingli's teachings, though they did ot feel that Zwingli had carried scripture or the reform of the church to its logical conclusion, was the Anabaptists.Though often referred to as â€Å"rebaptizers† due to their unwillingness to accept infant baptism or baptisms performed by the Catholic Church, they would â€Å"re-baptize† those individuals. The Anabaptists themselves did not believe they were re-baptizing people because they had not been scripturally baptized in the first place. 9 Wanting to restore the church to what they believed it was in the first century, adherents were more accurately â€Å"restorationists† than reformationists. Called Radical Reformers they were considered heretical and seditious by the Catholic Church as well as other Protestant groups for their r ejection of the established churches. Believing that all other faiths had corrupted the Word of God and the practices established in Scripture Anabaptists broke from fellowship with other believers. One of the main forces of the Anabaptist movement was Thomas Muntzer. He wrote several scathing attacks against Luther, in one tract calling Luther, † the unspiritual soft-living flesh in Wittenberg, whose robbery and distortion of Scripture has so grievously polluted our wretched Christian Church. In he same tract he called Luther â€Å"Father Pussyfoot,† â€Å"Dr. Liar† and â€Å"the Pope of Wittenberg. â€Å"11 thus reinforcing the discontent and separation between the Anabaptists and other groups of Protestants. Change was occurring over many parts of Europe. Men like Luther, Calvin, and Zwingli were attempting to right what they believed were the wrongs and atrocities being forced on the people by a corrupt Church and nation. The Catholic Church and the Emperor s or kings throughout the time of the Reformation continued to resist the teaching of reformed theology, even to the point of executing those who would not recant their â€Å"unacceptable† views.Occasionally meetings (Diets) were called in an attempt to resolve many of the issues between the established church, the king , and the reformers. In response to Luther's posting of his 95 theses, in which he publically challenged and condemn many of the practices of the Catholic Church, on the door of Wittenberg church, a papal bull was issued excommunicating Luther from the Catholic Church. Luther publically burned the papal bull on a bonfire, in essence defying the authority of the Pope himself. A diet was called by Emperor Charles V.Held, April 16- May 25, 1521 in Worms, Germany it was intended to determine if Luther was a heretic. Luther was under the impression that it was a hearing to discuss or debate his beliefs, to his surprise he was presented some of his writings and comm and to recant. In Luther's response that he could not unless he was convinced that he was wrong. One result of this Diet was the issuing of the Edict of Worms, which condemned Luther as a, â€Å"heretic and an outlaw,† and commanded that he be arrested and his books burned. 2 While Luther struggled in the tight tor the truth in Germany, Zwingli was having more success in Zurich. In the first of four meetings, known as the Zurich Disputation in 529, Zwingli presented his 67 theses which condemned many of limitations and practices of the clergy. He believed that the Bible was its own authority and the Church did not give it power and truth. Jesus was the one and only way to get to God the Father, the Pope did not possess ultimate power over all spiritual matters, and works cannot achieve merit, for salvation, through their good works. 3 His writings were well received and the Council would put into practices some of his recommendations. Other notable events, though there are ma ny, would be the Augsburg Confession, and The St. Bartholomew's Day Massacre on August 24, 1572. The first was written by Melanchthon, which laid out the fundamental beliefs of faith for the reformers. Presented at the Diet of Augsburg in 1530 it was rejected by the Catholic emperor but adopted by the Lutheran church as their foundational document of faith. 14 St.Bartholomew's massacre was an attempt by Catherine de' Medici to cover up an assassination of Admiral Coligny by Catherine and the Duke of Guise. Fearful that an investigation would reveal her part in the plan and that the Huguenots increasing violence, she ordered a massacre of the Huguenots gathered in Paris at the time. 15 Before the conflict was over thousands of Huguenots had been murdered or died from starvation. As has already been mentioned, some of the more well known writings of the reformation include the sixty-seven theses by Zwingli.https://global.oup.com/academic/product/zwingli-9780198263630?cc=ua&lang=en&htt ps://books.google.com/https://www.liberty.edu/online/ Protestant Reformation The Protestant Reformation was considered as the ultimate revolutionary incident in the 16th century. This was the period when the Church occupied the seat of power. Because of the authoritative control over their constituents and their questionable practices, many people became discounted with the situation. As a consequence, they were forced to choose between the traditional Catholic Church or the new concept of Protestant Reformation. Their dissatisfaction was rooted from many flaws of the Church. First, the Church focused on the conduct of rituals which many perceived as an evasion from the Church's original objective of helping their devotees to attain personal salvation. The Church sacraments became highly ritualized that they were no longer connected with the Europeans. Its meaning and significance have become senseless. Another major reason that induced the Protestant Reformation was the dispossession of the spiritual influence of the Church officials over their people which was caused by the manifestation of secularization. More criticisms commenced when popes and other high church officials adapted a king-like lifestyle wherein they lived in luxurious houses and palaces. More so, because of the acquired fortune of the Church, it instigated numerous forms of abuses which was unfortunately executed by representatives of the Church. As a result from all of these, many people have been driven to initiate changes in the doctrines and rituals of the Catholic Church( Kreis, 2006, â€Å"Protestant Reformation†). During the reformation, one man was bold enough to reveal the truth about the misconducts of the Church, he was Martin Luther. His incessant struggle to tell the truth amid constant intimidations and threat from the Church gave him leverage in gaining the interest and trust of the people. Also, he was able to capitalize on the brewing discontent of the Europeans that made it more difficult for the Church to manage and to put a stop on the dissension of the people (cited in everythingimportant. org, â€Å"What started the Protestant Reformation? †).

My initial regional marketing strategy Essay

In pricing, most of my pricing strategies were just following my competitors, because I have the faith that their prices are the results from the competition in that market. It is true that we should put an eye upon our main competitors, because they have the important information we need. For example, in Brazil, when I found the main competitor of me spent 35 million dollars on the promotion on Family & Healthy products, I realized that I could not I Ignore the promotion on this kind of product any more. So I invested about 5 million dollars on it immediately.Furthermore, I found that a big number of the competitors produced the medium toothbrushes and few of them put their heart into producing small and large products. And more people in all of the markets choose medium toothbrushes than other products. Therefore, I focused upon the medium products from the 1st period to the 6th period. What’s more, once I entered a new market, I chose only several medium products to produce because the data told me that the medium toothbrushes are the most popular products and the most profitable products. After I ran the actions I prepared, I got positive net contribution finally. In promotion, I always consulted the strategy from my competitors, because I believed they could survive in the market, meaning that their promotions were not bad. I usually was the second or third in promotion among all the companies. In addition, I arranged the promotion by the sales force after I arranged the sale force by the shopping habits of the customers in the native market. In pricing, I chose almost all the medium products because I thought the medium is the most practical. And I chose some small and large products, in order to collocate with the medium ones. In advertising, I also consulted from my competitors. However, I put all of my advertising into a continued advertisement. Especially in large market, such as Brazil and Mexico, I focus on the Family/Economy products, because I think the family is the group, who has the biggest buying power. 2. Changes and Rationale My first steps were 1st Brazil in period 1, 2nd Argentina in period 2, 3rd Mexico in period 4, 4th Chile in period 5, 5th Peru in period 7, 6th Venezuela in period 9. And the 10th period is the remaining period for me to do some adjustments to make a better result of the simulation. In order to  get a better performance, I rearranged the steps into 1st Brazil in period 1, 2nd Argentina in period 3, 3rd Mexico in period 4, 4th Venezuela in period 6. The reasons why I changed the order is that when I entered Brazil, I got the top market share immediately. After that I set a plant in Brazil, but I need time to improve the capability of the plant to support that markets I am going to enter later (we can only add 100 units of production in Brazil every year). As a result, I stayed at Brazil for another year. At the third year, I entered Argentina instead of the second year. As for the fourth market I entered. I used to enter Chile at the 5th period. However, at this time, when I entered Mexico at the 4th period, it needs some time for me to enlarge the market in Mexico. Consequently, I chose to enter into the 4th market at the 6th period, which is actually the requirement from the MBA 558 professor, corresponding to the class syllabus. What’s more, when I chose Chile, who was my first choice for the 4th market, I found that the work-force in that country was really high and the advertising cost was also too expensive. I abandoned it because I believe I didn’t have enough money to support this strange market at that time. And then I chose Venezuela to replace it because it was a little country and it was easy for me to handle. Moreover, its work force cost is low and market is normal, unlike Chile. 3. Performance Objectives VS Actual Performance After I ran the period 1 and period 2, I got a negative net contribution. That is inevitable and reasonable, because when I entered Brazil, I started the plant immediately and invested huge money on the promotion and advertisements. Moreover, I arranged nearly 100 people working on the sales and the price was also not too high. As a result, the cost of products sold was really high, which is why the net contribution was negative. However, as I invested huge money on the promotion and sales, and the price was not too high. I got lots of unit sales totally. It means that, I already have a relatively big mark share with the competitors. Because the market share is truly important especially for the new comers, I still felt optimistic about my wonderful future in Brazil. That is to say we must bear the negative net contribution at first and try to get positive net contribution later, which needs us have the enough support of finance. Every time I entered a new market, I got a negative contribution in the first period. However when I  enlarged my productivity and raised my price, I got a positive contribution in the following periods. I didn’t have a specific objective in every market, but the actual performance was that I have the biggest market share in Brazil, which is my most important market. And in other markets, I was always top 3 company in market share. I have the overall biggest market share. It seems like my strategy was not bad but need to be improved if I want to have the biggest market in every country. 4. Key Strategy Entry Steps Important markets first, Largest markets first. Sale force, Promotion, Pricing, Allowance and Advertising According to the shopping habits of the customers, rich status of the countries and competition situation. SKU  When I entered a new market, I focus on several medium products, because medium ones are the most practical and popular. After I occupied some market share, I developed some other products. In rich countries, I focus on healthy ones. By contrast, in poor counties, I drew attention into the economy ones. Among the children, I only sold medium products, because the children don’t have so many different requirements 5. Company Position for the future After the 10 periods, I have the biggest market share in Brazil, which is my most important market. And in other markets, I was always one of the top 3 companies in market share. In total, I have the overall biggest market share. It seems like my strategy was not bad but need to be improved if I want to have the biggest market in every country. In the future, I will try to enlarge my market share in the other countries, except for Brazil, in order to get the biggest market in every country. After that, my company should find a good way to get more net contribution, as my company was not the one who has the largest net contribution. 6. Lessons from the simulation experience The entry steps when my company want to expand  I should find a most important and large country to enter first and then expand step by step. In every new market, what I need to do step by step.  At first, I should focus on the specific product or some specific products, instead of kinds of ones. After I occupy some market share, I will try to produce other kinds of popular products How to arrange sales force and promotion upon it I would search the information about the shopping habits of the customers at first and then analyze it. After that, I arrange the sales force and the promotion. How to price the products and make the allowance Before I price my products, I should consult my competitors, because their prices represent the market supply and demand. As for the allowance, I will make it based on my price. When my price is raised, I would also raise my allowance. How to advertise Before I invest my money into the advertisements, I should find my target market and then try to consult my competitors in that specific market. And then I will make a advertisement corresponding to my competitors and my steps to enlarge my market share. What’s more, I would still stick on a advertisement if I have it for many years, because I believe I have a competitive advantage in it. How to arrange the plants I chose Brazil as the location of the plant because I thought Brazil has the sufficient work force, a big market and also the central location. Nevertheless, I made a mistake upon the production in the plant that I added its capability by 100 million units every year, making the depreciation so high. If I restart the simulation, I would control the power of the plant according to the sales. 7. Conclusion From the simulation, I learned how to do the streamlined global expansion with working as the country-manager and how to use different strategies in different periods, which are the vital things that I learned from this course.

Free Essays on Comparing Thomas Volgy And Scott Putnam

The issue of decline in political participation of the population of the United States has never been so vital. Numerous sociological surveys indicate that people’s participation in various social activities is not as active as it used to be in the past. The population of the United States represents a disintegrating group that is more than ever influenced by individualism. People no longer care about other members of the society because for many people personal independence has been of primary importance. Many sociologists have noticed this trend and conducted numerous studied on the issue. Robert Putnam’s book â€Å"Bowling Alone† and another work â€Å"Politics in the Trenches† written by Thomas Volgy can give one much insight into the current social trends that are dubbed â€Å"the loss of social capital†. Robert Putnam's book "Bowling Alone" argues that "the quality of public life and the performance of social institutions . . . are powerfully influenced by norms and networks of civic engagement." Political activity, social and economic cooperation, and neighborhood comity are all promoted, on this view, by the interactions of individuals in their clubs, leagues, organizations, and families. However, the contemporary accounts of civil society's importance are marked by anxiety as much as celebration. "Bowling Alone," as its title suggests, portrays a significant decline in our associational habits. Citing surveys that track levels of political participation, group membership, and even informal socializing over the past quarter century, Putnam argues that "Americans who came of age during the Depression and World War II have been far more deeply engaged in the lives of their communities than the generations that have followed them." His diagnosis of civic decline has become a subject o f vigorous debate, not all of which is accessible or comprehensible to non-sociologists. If Putnam's diagnosis is sound, we must be concerned about ... Free Essays on Comparing Thomas Volgy And Scott Putnam Free Essays on Comparing Thomas Volgy And Scott Putnam The issue of decline in political participation of the population of the United States has never been so vital. Numerous sociological surveys indicate that people’s participation in various social activities is not as active as it used to be in the past. The population of the United States represents a disintegrating group that is more than ever influenced by individualism. People no longer care about other members of the society because for many people personal independence has been of primary importance. Many sociologists have noticed this trend and conducted numerous studied on the issue. Robert Putnam’s book â€Å"Bowling Alone† and another work â€Å"Politics in the Trenches† written by Thomas Volgy can give one much insight into the current social trends that are dubbed â€Å"the loss of social capital†. Robert Putnam's book "Bowling Alone" argues that "the quality of public life and the performance of social institutions . . . are powerfully influenced by norms and networks of civic engagement." Political activity, social and economic cooperation, and neighborhood comity are all promoted, on this view, by the interactions of individuals in their clubs, leagues, organizations, and families. However, the contemporary accounts of civil society's importance are marked by anxiety as much as celebration. "Bowling Alone," as its title suggests, portrays a significant decline in our associational habits. Citing surveys that track levels of political participation, group membership, and even informal socializing over the past quarter century, Putnam argues that "Americans who came of age during the Depression and World War II have been far more deeply engaged in the lives of their communities than the generations that have followed them." His diagnosis of civic decline has become a subject o f vigorous debate, not all of which is accessible or comprehensible to non-sociologists. If Putnam's diagnosis is sound, we must be concerned about ...