Accreditation Audit Essay Example for Free

Accreditation Audit Essay With all of the possible problems that could occur during surgery, a wrong-site, wrong-patient mistake is one that should never arise. Nightingale Community Hospital (NCH) fully understands the importance of doing away with these errors and has set up protocol to work towards this goal. While the protocol is in place, it is not fully compliant with Joint Commission (JC) standards. Standard: UP.01.01.01: Conduct a preprocedure verification process. Nightingale Community Hospital has a Site Identification and Verification policy and procedure. Within this policy, and Preoperative/Preprocedure Verification Process is addressed. There is also a Preprocedure Hand-Off form present. This form is a bit misleading as it is essentially a hand-off form in general with a few extra boxes possible for check-off. To prepare for inspection and audit, NCH should create and implement a form for use within the Operating Theater or wherever procedures are performed, such as bedside procedures. This form needs to be more specific in addressing at least the minimum requirements by JC. The form needs to cite that all relevant documentation is present, such as signed consent form, nursing assessment, preanesthesia assessment, history and physical. The form also needs to specify that the necessary diagnostic and radiology test results, rather they be images and scans, or biopsy reports, and properly displayed and labeled. Finally, to fulfill the minimum requirements by JC, any and all required blood products, implants, devices, and special equipment needs to be labeled and matched to the patient. Standard: UP.01.02.01: Mark the procedure site. NCH covers the procedure site marking standard fairly well within their Site Identification and Verification Policy. It mentions that site marking is needed for those cases involving laterality, multiple structures, or levels. Several times in their policy NCH mentions that it is best to have the patient involved, if at all possible. If the patient is unable to mark the site, the policy states that the physician will be called to mark the site. The policy states that the mark shall be made in permanent black marker so it will remain visible after skin preparation, and also in a location that will remain visible after sterile draping is in place. The policy also  includes circumstances in which the marking will be unable to be performed based on the location of the surgery being in an area that is unable to be marked. Standard: UP.01.03.01: A time-out is performed before the procedure. Nightingale Community Hospital has an adequate procedure in place for the time-out performance. Within the Site Identification and Verification Policy, the Time-Out Procedure complies with JC standards. A time-out is to be conducted immediately prior to performance of the procedure, it is initiated by the nurse or technologist, it involves all personnel involved in the procedure, the team members agree to a minimum of patient identity, correct site, and correct procedure to be performed, and all of this information is documented in the record, including those involved and the duration of the time-out. The only issue not addressed fully is the possibility of multiple procedures occurring on the same patient by different practitioners, and in that case, an additional time-out needs to be done for every new procedure. The Communication priority focus area is an extremely important area for any hospital. This is a common sense area that should be able to reach complete compliance. A wrong-patient, wrong-site issue should never arise and is completely avoidable. In 2010, Joint Commission reported that wrong-patient/site surgeries continued to be the most frequently reported sentinel event(Spath 2011).Jay Arthur states that JC reports between four and six wrong-site surgeries per day(2011). The World Health Organization believes that at least 500,000 deaths per year could be prevented if the WHO Surgical Safety Checklist was correctly implemented. These numbers, when compared with the possibility of 100% compliance, are astounding and completely avoidable. Nightingale Community Hospital is well on their way to avoiding these types of sentinel events through usages of proper protocol, procedures, and policy as is seen by the upward trend from their last year of self-checks. With continued diligence and appropriate modifications made, this can be an area that NCH, and any other hospital can be fully compliant in. References Arthur, J. (2011). Lean six sigma for hospitals: Simple steps to fast, affordable, flawless healthcare. New York, NY: McGraw-Hill. Spath, P. L. (2011). Error reduction in health care: A systems approach to improving patient safety (2nd ed.). Hoboken, NJ: Jossy-Bass. WHO (2013). WHO | Safe surgery saves lives. Retrieved from http://www.who.int/patientsafety/safesurgery/en/ [Last Accessed November 5, 2013].

How To Do Gram Staining

How To Do Gram Staining Observation of microorganism under microscope can be improved by using certain processes and techniques such as the staining. Staining is an important step to observe microorganisms more clearly, to differentiate between microorganisms as well as to differentiate parts in microorganism (Bagyaraj et al, 2005). The identification, morphology, some extracellular and intracellular components of microorganisms can be determined and detected through the staining. Many microorganisms difficult to be observed under microscope due to their colourless appearance and semitransparent properties as their refractive index almost same as surroundings (Patil et al, 2008). The stain improves contrast for visualizing microorganisms. Staining process can be explained either as physical, chemical reaction or combination of the both reaction. There are different types of staining such as the simple stain, differential stain and special stain. Simple stain can be used for observing certain basic structures as well as the shape of microorganisms. Differential stain while can be used in distinguishing between different types of microorganisms. Special stain on the other hand can be used for identifying specific structures in the microorganisms such as the flagella (Frey Price, 2003). Gram-stain is one of the commonly used differential stains. The Gram-staining process discovered in 1882 (published 1884) by Hans Christian Gram, a Danish bacteriologist and plays an important role in the classifying the bacteria. Gram-staining is usually the first step in identification bacteria and can be used in characterizing bacteria. Bacteria species can be separated into two large groups, which are the Gram-positive and Gram-negative groups through the Gram-staining (Sridhar Rao, n.d.). This process also important in clinical laboratory such as to examine and identify bacteria responsible for certain diseases. Staining process requires the preparation of smear that contains a thin layer of bacteria. The preparation of smear involves spreading and fixing of microorganisms on the microscope slide. Use of smear prevents microorganisms from being washing away with stain (Vasanthakumari, 2009). Besides the smear, there are four important components in the Gram stain process, which are the primary stain, mordant, decolourizing agent as well as the counterstain that used in sequences. The primary stains usually basic dye such as crystal violet that reacts with acidic component of cell and causes all the bacteria to be stained with the crystal violet or purple. The other dye like the methyl violet can also be used. The other component, mordant in the Gram stain refers to iodine. Mordant is chemical that increases affinity of the stain to the microorganisms and also their coating, making certain structures thicker for easier observation under microscope. The decolorizing agent decolorizes dye from cell that already being stained (Rajan, 2005). The degree of decolorization different in bacteria depends on their chemical components. Decolourization agent commonly refers to ethanol or other solution like acetone or mixture of acetone and ethyl alcohol. Counterstain while is another basic dye that important in giving new colour for cells that decolourized. Counterstain can be the safranin (used in this practical) or the carbon fuchsin. The Gram stain (differential stains) gives different colour for different types of bacteria. The colour is the one that determine whether the bacterium is Gram positive or Gram negative. The Gram positive bacteria resist decolourization and give result of crystal violet or purple colour (primary stain). Gram-negative bacteria decolorize and give red or pink colour as it takes up counterstain (Ananthanarayan Paniker, 2006). The difference in result is due to the differences in the cell wall structure or composition of bacteria that causes the different in the reaction with the series of reagents in Gram staining (Talaro, 2007). Preparation of Staining Reagents: Crystal violet Solution A: Crystal violet 2.0g Ethanol, 95% (v/v) 20 ml Solution B: Ammonium oxalate 0.8g Distilled water 80 ml Solution A and B mixed. Mordant Iodine 1.0 g Potassium iodide 2.0 g Distilled water 300 ml Iodine and potassium blended with mortar, distilled water added during blending until iodine dissolved. Decolorization solvent Ethanol, 95% (v/v) Counterstain Safranin 0.25 g [2.5 %(w/v)] Ethanol 10 ml [9.5% (v/v)] Distilled water 90 ml Materials: Glass slide Escherichia coli in broth culture Escherichia coli in agar culture Bacillus sp. in broth culture Bacillus sp. in agar culture Staphylococcus aureus in broth culture Actinomycetes sp. in broth culture Actinomycetes sp. in agar culture Kimwipe Bunsen burner Dropper Distilled water Inoculation loop Procedure: Preparation of smear: For culture taken from liquid medium (broth), 1 drop of culture to be examined was transferred by using inoculation loop onto a slide and spread to from circular smear. For culture taken from solid medium (agar), one drop of distilled water first dispensed on the slide. The single colony then spread on the water to form circular smear. The slide was heat-fixed with flame. Gram-staining The slide was placed on the rack. 1-2 drops of crystal violet was dropped on the smear and left for 2 minutes. The crystal violet was rinsed off with distilled water for 2 seconds. Iodine solution was dropped and left for 2 minutes. The iodine solution was rinsed off with distilled water for 2 seconds. The smear was decolorized by washing with ethanol (95%v/v) for less than 10 seconds. The ethanol then rinsed off with distilled water for 10 seconds. Safranin solution was dropped on the smear for 10 seconds. The red-coloured safranin was rinsed-off with distilled water. The side was dried using Kimwipe or air-dry. The slide was observed under the microscope. Results: (A)Escherichia coli G:DCIM101NIKONDSCN1773.JPG 1(a) Broth culture (zoom in). 1(b) Agar plate (zoom in). Figure 1: Microscopic image of Escherichia coli under total magnification of 400ÃÆ'- from different culture (B) Bacillus species G:DCIM101NIKONDSCN1745.JPG G:DCIM101NIKONDSCN1738.JPG 2(a) Broth culture (zoom in). 2(b) Agar plate (zoom in). Figure 2: Microscopic image of Bacillus sp. under total magnification of 400ÃÆ'- from different cultures. (C) Staphylococcus Aureus G:DCIM101NIKONDSCN1767.JPG Figure 3: Microscopic image of Staphylococcus aureus under total magnification of 400ÃÆ'- from broth culture (zoom in). (D) Actinomycetes species C:UsersmichelleDocumentsUMS MICROBIOLOGYPHOTOSS1.JPG G:DCIM101NIKONDSCN1760.JPG 4(a) Broth culture (zoom in) under total magnification of 400ÃÆ'-. 4(b) Agar plate (zoom in) under total magnification of 400ÃÆ'-. Figure 3: Microscopic image of Actinomycetes sp. under different magnification from different culture. Table 1: The result of Gram stain on different microorganism Type of microorganisms Shape of the microorganisms Colour stained on microorganisms Gram positive or Gram negative Escherichia coli (broth culture) Bacillus or Rod-shaped Pink Gram negative Escherichia coli (agar plate) Bacillus or Rod-shaped Pink Gram negative Bacillus sp. (broth culture) Bacillus or Rod-shaped Purple Gram positive Bacillus sp. (agar plate) Bacillus or Rod-shaped Purple Gram positive Staphylococcus aureus Coccus or round-shaped Purple Gram positive Actinomycetes sp. (broth culture) Mycelial Purple Gram positive Actinomycetes sp. (agar plate) Mycelial Purple Gram positive Discussion: For every bacterium studied, a smear is first prepared as the smear enables Gram staining to be done without washing away bacteria together with stain. The spreading process (for both broth and agar culture) enables the distribution of bacteria on slides so that suitable density of bacteria can be found on the slide. This increases chance of individual bacteria to be observed under microscope (Port, 2009). The microorganisms from agar first suspended in distilled water before spreading. Without spreading, bacteria may be too concentrated, crowded and overlapped (in clumps), making the observation to be difficult. The slide was heat fixed after drying. Heating enables coagulation and precipitation of protein of bacteria to occurs, hence fix the bacteria on slide. The bacteria killed and adhere to the surface. Fixation makes the bacteria rigid, immobile, increased permeability and affinity to staining. This also prevents the autolysis process of bacteria (Aneja, 2003). During the fixat ion process, slides not be placed directly above the heat or passed through too many times as overheat may causes changes in the shape and hence cause the distortion of the microorganisms. At the same time, less heat supplied may cause the microorganisms do not fix firmly. Before heat fix, the slide is allowed to dry completely as wet bacterial suspension may create aerosol (Shimeld, 1999).The presence of water may also cause over heating. The crystal violet added as the primary stain. Crystal violet is basic dye and has affinity for cell structures that are acidic such as the protoplasm. Crystal violet is added to stain everything on slide or to stain all bacteria (Gram positive or Gram negative). This is same for all the seven samples. Crystal violet dye enters the cells and stained with crystal violet colour. It was suggested that the aqueous dye dissociated into CV+ ion and chloride, Cl- ion (Hussey Smith, n.d.). The positively charged ion binds to the negatively charged components in cell after penetrating the cell wall and cell membrane, hence giving the purple colour. The extra crystal violet dye that not binds to cell is cleared by distilled water. Addition of iodine in next step enables the crystal violet dye to further fix and adhere to organisms (Medical Education Division, 2006). This is due to the formation of complex between iodine and dye ion (CV-I complex) as the negatively charged iodine ion (I- or I3 - ion) binds to the positively charged ion of dye (CV+ ion) in cytoplasm and hence bacteria appeared as violet colour (Vasanthakumari, 2009). The solubility of the dye decreased during the process as the ions bind to organisms. Iodine acts as mordant as it increases affinity of crystal violet stain to organisms. The addition of 95% ethanol as decolourizer enables the lipid to be extracted or dissolved from the cell wall for the Gram negative bacteria like the Escherichia coli. Gram negative bacteria have an outer membrane that constitutes most of the cell wall, also known as lipopolysaccharide layer (LPS) in cell wall (Clark et al, 2009). This is a lipid bilayer structure that differs from cytoplasmic membrane. This layer not only made up of phospholipids and protein, but also polysaccharides that not commonly found in cytoplasmic membrane. Polysaccharide portion made up of core polysaccharides and O-polysaccharides while the lipid portion made up of lipid A which then bind to the core polysaccharides. This LPS layer is located outside a thin layer of peptidoglycan. The outer membrane gives rises to high lipid composition in the cell wall. Decolourizer dissolve off lipid, hence increases the permeability of cell wall which eventually enables the crystal violet-iodine complex to be lost toget her with the lipid. The cell wall (murein layer) of Gram positive layer while has no outer membrane but have thick, cross-linked and multi-layered peptidoglycan. Teichoic acids, the phosphorylated polyalcohol can be found embedded in peptidoglycan layers. These acids can be found bonded to muramic acid residues in peptidoglycan. Lipoteichoic acid which refers to the teichoic acids that binds to the lipids of membrane can also be found in Gram positive bacterial cell wall. In certain actinobacteria, structure called mycolic acids also can be found. The lack of outer membrane gives rises to low lipid composition in cell wall. Hence, the action of decolorizer on Gram positive bacteria (Bacillus sp., Staphylococcus aureus and Actinomycetes sp.) causes dehydration of cell wall due to the thick peptidoglycan and the composition of lipid available to be dissolved is low. This eventually decreases cell wall permeability, closing pores on cell wall and hence retain the crystal violet-iodine complex inside (Diffe rential staining: The Gram Stain, n.d.). As the cell shrinks, the complex trapped in the thick peptidoglycan and hence cells do not decolourized. After this process, E. coli is in colourless as the crystal-violet iodine complex loses while Bacillus sp., Staphylococcus aureus and Actinomycetes sp. still in purple colour. Ethanol was not added for more than 30 seconds. Over decolourization can cause the stain of Gram positive bacteria to decolourize and appears as Gram negative (Betts et al, 2003). Under decolourization (too short) also avoided as it can cause dye to be removed incompletely from Gram negative bacteria. Both situations can give false results. After decolorization, smear was washed with distilled water for 15 second to completely stop the decolourization process. The counterstain, safranin solution then stained the E. coli that is colourless with the red colour. Safranin is basic dye (cationic ion) carry the positive dye ion, chromophore that attached to acidic cell structures (negatively charged) such as the protoplasm. Basic dye also attached to other negatively charged macromolecules like proteins and nucleic acid (Archunan, 2004). Both the Gram positive and Gram negative bacteria took up the counterstain but the colour of Gram Positive do not change much as it already stained with p urple. For every dye, there is different period of time for staining. This is to prevent over or under stain that may results in inaccurate result. From the observation, Escherichia coli stained red and give accurate result of Gram negative. The shape of E. coli can be observed as rod shape. Bacillus sp., Staphylococcus aureus and Actinomycetes sp. while shows results of Gram positive as all are stained with purple colour. The shapes observed are respectively rod-shaped, round-shaped and in mycelial. For Staphylococcus aureus, the cocci shape is sticked together in clumps or amorphous sheet and not separated. For E. coli, bacillus sp. and staphylococcus aureus, two samples are taken, one from the broth and one from the agar. Both the samples show the same results. The difference is on the amount of microorganisms observed. Bacillus sp., for example, that taken from agar plate is very crowded. This is because the each colony taken contains a number of microorganisms. It is more difficult to be observed the shape of the organisms. However, the colour stained can be observed clearly. For the broth culture, individual organisms and the shape as well as the colour can be observed more clearly. Conclusion: Gram staining is important in differentiating Gram positive and Gram negative bacteria in which the Gram positive bacteria stained purple colour while Gram negative organisms stained pink. Escherichia coli is Gram negative while bacillus sp., staphylococcus aureus and actinomycetes are Gram positive bacteria.

Psychological and Sociological Aspects :: essays papers

Psychological and Sociological Aspects In the beginning of my freshman semester in college I decided to major in secondary education with a minor in psychology. I made the decision just recently to change my major to sociology for many reasons that relate to research during this course. I am currently enrolled in an educational psychology course as well as an introduction to sociology class. As the semester has progressed, I have gotten deeper into my research for this project. One of the main things that I have taken note of is that much of what I am learning in this course through research is being enhanced by studies we discuss in sociology. The topic â€Å"Students at Risk† is a very broad topic. In psychology class we study the behavioral and mental aspects of dealing with students who have difficulty performing in a structured classroom setting. However, in my sociology class, we touch more upon the environmental and societal effects that are common influences amongst students at risk. I have found th at sociological theories are the basis for labeling those students who have been set up for failure. The study of sociology as it relates to this topic is that environmental and societal negativities can be credited for student failure. With psychology, you are attempting to find reasons within one-self that have caused a delay in ones academic success. It becomes a main issue when dealing with these types of situations to find someone or something to blame for the student’s level of progression. Through research I have found that instead of directing our attention to the cause of the problem, we must exert more energy to finding a solution. â€Å"Learning Disabled?† or â€Å"Slow Learner?† When first approaching this subject I began to explore different behavioral disorders and learning disabilities that would cause a student to be considered â€Å"at risk†. However, before beginning to explore these sub topics in detail I thought it would be helpful to find some information on determining the difference between someone who is just a slow learner, verses someone who has trouble learning because of disability. I came across an article by author Margaret Shepherd that is titled â€Å"Learning Disabled or Slow Learner†? This article details the differences between the learning disabled child and the slow learner, and it is also a plea for caution in the use of the diagnostic term learning disabilities.

History of Television Essay -- TV Television Historical Essays

History of Television   Ã‚  Ã‚  Ã‚  Ã‚  Television has become a major industry all over the world, especially in the industrialized nations, and a major medium of communication and source of home entertainment. Television is used in many industries. A few examples are for surveillance in places inaccessible to or dangerous for human beings, in science for tissue microscopy, and in education. Today you can find a television in almost every home. This is why I decided to research the history of the television.   Ã‚  Ã‚  Ã‚  Ã‚  The first television devices were based on an 1884 invention called the scanning disk, patented by Paul Nipkow. This device was a large disk with holes on it, which spun in front of an object while a photoelectric cell recorded changes in light. Depending on the electricity transmitted by the photoelectric cell, an array of light bulbs would glow or remain dark. But Nipkow’s mechanical system could not scan and deliver a clear, live-action image. Many inventors hoped to perfect this.   Ã‚  Ã‚  Ã‚  Ã‚  In 1921, a 14-year-old Mormon from Idaho named Philo Farnsworth came up with an idea. While mowing hay in rows, Philo realized an electron beam could scan a picture in horizontal lines, reproducing the image almost instantaneously. Philo was not the only one with this idea. At the same time, Russian immigrant Vladimir Zworykin had also designed a camera that focused an image through a lens onto an array of photoelectric cells coating the end of a tube. The electrical image formed by ...

Ecstasy Abuse :: essays research papers fc

Ecstasy Abuse For many people the drug of choice would be marijuana, but in recent years that trend has been changing. The drug of choice for today’s young adults is MDMA or ecstasy. Unlike marijuana which has long term affects, ecstasy can kill a person with one hit. It is a very dangerous drug, and is spreading like wildfire in the United States. Most teenagers take the drug without knowing the side affects such as depression and brain damage (theantidrug.com). With more people trying the drug everyday, it is becoming harder for law enforcement to keep up with them. Law enforcement, parents and kids need to do something about this rising drug problem before it is too late. There are numerous solutions that can curb the use of this drug, and other solutions that can put the drug to good use.   Ã‚  Ã‚  Ã‚  Ã‚  Ecstasy first became popular in European countries such as Belgium and the Netherlands. A large portion of the ecstasy that is sold in the U.S. comes from these two countries (www.dea.gov). Although efforts have been made to stop the flow of this drug to America, large amounts are still coming into the U.S. America needs to take stronger measures to stop this epidemic sweeping our nation. A measure that can be taken to stop this drug from spreading would be to form an international organization that would fight to keep ecstasy and other drugs off the streets. America would have to work together with countries such as Canada and Mexico. International control of this drug would benefit greatly, but local law enforcement could help stop this drug as well. The police can take part by educating kids about the harmful affects of ecstasy and how kids can say no to drugs. These measures and others can help America curb this drug in the years to come. But preventing the us e of this drug doesn’t stop at the law enforcement level, parents and kids can take part in stopping the use of this drug. According to the DARE program, the best way to keep kids from doing drugs is to monitor them (dare.com). Monitoring kids can allow parents to assure the safety of their child. Parents also have to know who their child’s friends are and what their plans are. If a child says they are going to a rave, there is a high possibility that they will try or will be offered ecstasy.

The Background Of Metabolic Syndrome Health And Social Care Essay

Harmonizing to recent worldwide estimations, 1.7 billion people are classified as either corpulence or corpulent, more than 1 billion have high blood pressure, and more than 500 million have either diabetes or the pre-diabetes position, impaired glucose tolerance ( IGT ) [ Hossain et Al. 2007 ] . Metabolic syndrome ( MetS ) A is a complex and multivariate disease thought to be when a figure ofA coincident metabolicA abnormalcies occur in the same person with a frequence higher than it could be expected by opportunity, foremost coined â€Å" syndrome Ten † in 1988 by ( Reaven 1998 ) . The first formal definition of the MetS was put away in 1998 by the World Health Organization ( WHO ) . The International Diabetes Federation ( IDF ) described a syndrome as â€Å" a recognizable composite of symptoms and physical or biochemical findings for which a direct cause is non understoodaˆÂ ¦the constituents coexist more often than would be expected by opportunity entirely. When causal mechanisms are identified, the syndrome becomes a disease. † MetS is so a composite of complecting hazard factors for cardiovascular disease ( CVD ) , diabetes and shot. The bunch of hazard factors encompasses dysglycemia ( unnatural glucose degrees ) , raised blood force per unit area ( high blood pressure ) , hyperglycemia, elevated triglyceride degrees, low high-density lipoprotein cholesterin degrees, and cardinal adiposeness tissue degrees ( fleshiness ) . Metabolic syndrome has been assigned its ain ICD-9 diagnostic codification: 277.7, but there is ongoing contention about whether metabolic syndrome is a homogenous upset or disease, and whether it merits acknowledgment as a syndrome ( Huang 2009 ) . MetS has many factors involved ; most surveies agree that the underlying pathology of abnormalcies seems to be related to insulin opposition ( IR ) and fleshiness. The job and confusion comes from the differences in standards for the diagnosing of MetS by the ( WHO, 1998 ) , the European Group for survey on insulin Resistance ( EGIR ) in 1999, the National Cholesterol Education Program Adult Treatment Panel III ( NCEP-ATP III ) in 2001, the American Heart Association/National Heart, Lung and Blood Institute and the ( IDF ) 2005. Regardless of which standard is used for diagnosing, all major bureaus agree to an extent that the cardinal factors include fleshiness and waist perimeter ( WC ) , insulin opposition, dyslipidemia, and high blood pressure ( Alberti et al 2006 ) Multiple diagnostic standards from several beginnings have given rise to confusion and incompatibilities. Because of the different threshold degrees and how they they are combined to name, there may be fluctuations within in the same population at analysis of informations, taking to skewed hazard schemes and the prioritization of patients and their preventative intervention. One individual may be diagnosed and intervention on the footing of one set of standards, but so be ineligible utilizing another. The purpose of this instance survey is to place and foregrounding the most relevant and up to day of the month facets of the epidemiology, pathophysiology, experimental theoretical accounts, and related clinical and population informations in relation to MetS. The World Health Organization ( WHO ) estimates that more than 1 billion people are overweight globally, and if the current tendency continues, that figure will increase to 1.5 billion by 20154. It is estimated that over 1.7 billion individuals worldwide are fleshy, more than 300 million of whom are clinically corpulent. This addition is a multifactor with deficiency of exercising, aging, familial sensitivity and hormonal alterations being cited. This addition in fleshiness and fleshy people is associated with the addition in prevalence of Mets and diabetes ( Wild et al 2011 ) . Abdominal fleshiness is linked with the opposition effects of insulin on peripheral glucose and fatty acid metamorphosis, which can consequences in type 2 diabetes mellitus. With fleshiness comes Insulin opposition and that can take to hyperinsulinemia, hyperglycaemia, and increased adipocyte cytokines that contribute to endothelial disfunction, altered lipid profile, high blood pressure, and systemic redness. This procedure of harm can advance the development of atherosclerotic cardiovascular disease ( CVD ) . Therefore Mets has several possible aetiologic classs, upsets of adipose tissue ; insulin opposition ; and the grouping of independent factors of hepatic, vascular, and immunologic beginning involved in different constituents of the MetS. When the single constituents of Mets cluster together and this is associated with both the addition hazard of Diabetes and CVD ( Wild et al 2011 ) With many hazard factors for CVD included within the MetS assorted definition and standard ‘s, the purpose is provide utile early diagnosing of MetS that in bend identifies persons with cardinal fleshiness and cardio-metabolic hazard factors. ( Wild et Al 2011 ) . These persons are at increased hazard of type 2 diabetes, CVD, non-alcoholic fatso liver disease ( NAFLD ) and sleep apnoeas. These hazard factors like abdominal fat degrees can frequently be left untreated as separately they do non justify intercession. Not all fleshy people are at high hazard degrees of vascular disease, type 2 diabetes and NADFL. The Mets definition is aimed at placing the subgroups of these fleshy and corpulent persons that are at a high hazard of the effects of inordinate abdominal fat and Insulin Resistance ( IR ) . As mentioned above, several organisations have established their ain diagnostic standards for MetS, NCEP ATP III, AHA/ NHLBI, WHO, IDF, EGIR, and ACE. With In there diagnostic standards of the MetS, different combinations of predating pathological factors are required, including: Iridium, dysglycemia, low HDL-C, hypertriglyceridemia, fleshiness or increased waist perimeter, high blood pressure, impaired glucose tolerance ( IGT ) or DM, microalbuminuria and hyperinsulinemia. ( See Table 1 ) . The prevalence of the MetS is increasing throughout the universe ( who ) the many different estimations are nevertheless dependent on the definition used and the topic ( e.g. , sex, age, race, and ethnicity ) . The WHO and NCEP: ATPIII definitions are similar for fleshiness, high blood pressure, and dyslipidemia. The inclusion of requirements, IR, IGT, and type 2 diabetes of the WHO definition are more tapered. The estimations reached by the assorted definitions in a individual population are frequently really similar across surveies ; the rates are variable in subpopulations with MetS and besides between cultural groups. Therefore the planetary prevalence estimations of MetS vary and are unsure. Statistically, the incidence of metabolic syndrome is reported from assorted beginnings over the decennary is variable between the populations. It was estimated that 20-30 % European population is affected ( Vosatkova et al 2012 ) . The consequences of a wide-spread epidemiological survey carried out among the US population show metabolic syndrome prevalence of 23.9 % as defined by the standards of the National Cholesterol Education Program Adult Treatment Panel III and 25.1 % harmonizing to WHO standards ( Ford and Giles, 2003 ) . Most surveies used the NCEP-ATP III definition and showed an elevated prevalence of MS in different parts of the universe. Harmonizing to ( NHANES ) 2003-2006, about 34 % of people studied met the NCEP: ATPIII revised standards for MetS. ( Appendix Table 2 ) A reappraisal of current prevalence tendencies and statistics was carried out in by ( Marjani 2012 ) identified the following planetary incidence and epidemiological findings from assorted equal reviewed beginnings: The undermentioned information is taken from ( Marjani 2012 ) : The prevalence of MetS was found to increase with age with 20 % of males and 16 % of females under 40 old ages of age, 41 % of males and 37 % of females between 40-59 old ages, and 52 % of males and 54 % of females 60 old ages and over by and large. Incidence of metabolic syndrome additions as age progresses. In a survey in Turkey, the prevalence of the metabolic syndrome was 15.3 % , 23.1 % , 28.0 % , 26.0 % , and 20.5 % among people aged from 30 to 39, 40 to 49, 50 to 59, 60 to 69, 70 to 79 and a†°? 80 old ages old, severally. Study of Ford showed that the prevalence in the US was16.5 % and 46.4 % for males aged 20 to 60, and 19.1 % to 56.0 % , for females with additions in MetS prevalence with increased age [ 19 ] . World Health organisation predicts the prevalence of fleshiness to be 4.8 % in developed states, 17.1 % in developing and 20 % in less developed. Cardiovascular disease is one of the chief grounds of decease among adult females in the universe. .women aged more than 55 have a higher incidence of cardiovascular disease than younger adult females. In several surveies, the incidences of metabolic syndrome among postmenopausal adult females were found to be increased in the universe. The prevalence of metabolic syndrome ( utilizing the WHO definition ) in Ireland was 21 % . The prevalence was higher in males ( 24.6 % ) than in females ( 17.8 % ) . The Botnia survey † ( utilizing the WHO definition ) found the prevalence in Finland was 84 % and 78 % in male and female topics with type-2 diabetes, severally. In the United States, the prevalence of metabolic syndrome was 21.8 % utilizing the ATP III definition. Mexican Americans had the highest prevalence of metabolic syndrome ( 31.9 % ) . The prevalence was similar for male ( 24.0 % ) and female ( 23.4 % ) subjects. The prevalence in Isfahan ( Iran ) was 65.0 % with higher rate in females than males ( 71.7 % female and 55.8 % male ) . The prevalence in Karachi ( Pakistan ) was 79.7 % in type 2 diabetics, ( 45.5 % females and 34.3 % males ) . The overall prevalence of metabolic syndrome in type 2 diabetics in Japan was 168 ( 26.37 % ) out of 637 type 2 diabetic patients. The prevalence was higher in males ( 45.9 % ) than females ( 28.0 % ) . A survey done in Korean estimates the overall prevalence was 32.6 % . The prevalence was found to be 46.9 % and 65.1 % among males and females severally. The overall prevalence among Saudis with type 2 diabetes was 22.64 % ( 19.49 % male, 25.17 % female ) . The prevalence of metabolic syndrome in type 2 diabetic patients is higher in females ( 53.27 % ) than males ( 48.71 % ) , and that the prevalence of metabolic syndrome in Gorgan is appreciably higher compared with that in some other states. One of the latest and up to day of the month documents by ( Craig and Turner 2012 ) made a systematic reappraisal of 85 surveies. They found the average prevalence of MetS in whole populations was 3.3 % , in fleshy kids was 11.9 % , and in corpulent populations was 29.2 % . Although prevalence rates are varied throughout the universe it is clear that metabolic syndrome has developed into epidemic degrees and farther research is needed as the mechanisms of MetS are non to the full known ( Cornier et al 2008 ) . As described above, the general hypothesis to depict the pathophysiology of MetS is insulin opposition and abdominal fleshiness ( Cornier et al 2008 ) . Visceral fleshiness is the chief cause of the metabolic syndrome, and is associated with development of high blood pressure in the metabolic syndrome via a assortment of pathwaysA ( Figure1 ) . Metabolic Syndrome and its related upsets Insulin opposition Cardinal fleshiness Glucose intolerance Dyslipidemia with elevated triglycerides Low HDL-cholesterol Microalbuminuria Predominance of little heavy LDL-cholesterol atoms High blood pressure Endothelial disfunction Oxidative emphasis Inflammation Related upsets of polycystic ovarian syndrome, fatty liver disease ( NASH ) , and urarthritis A major subscriber is an surfeit of go arounding fatty acids, released from an expanded abdominal adipose tissue. Free Fatty Acids ( FFA ) cut down insulin sensitiveness in musculus by suppressing insulin-mediated glucose consumption. Increased degree of go arounding glucose additions pancreatic insulin secernment ensuing in hyperinsulinemia. In the liver, FFA increase the production of glucose, triglycerides and secernment of really low denseness lipoproteins ( VLDL ) . The effect is the decrease in glucose transmutation to glycogen and increased lipid accretion in triglyceride ( TG ) . Insulin is an of import antilipolytic endocrine. In the instance of insulin opposition, the increased sum of lipolysis of stored triacylglycerol molecules in adipose tissue produces more fatty acids, which could farther suppress the antilipolytic consequence of insulin, making extra lipolysis and more FFA. This build up of FFA from increased the volume of adipocytes lead to IR through the look of assorted proinflammatory cytokines. These cytokines, tumour mortification factor ( TNF ) -I ± , interleukin ( IL ) -1 and IL-6 are increased in adipose tissue but the production of anti-inflammatory adipokine adiponectin is reduced, this look is linked to systemic redness. The instability of pro- and anti-inflammatory adipokines, induces insulin opposition by impairing the insulin signalling procedure. ( acquire ref ) . This addition in cytokines promote lipolysis and increase Free fatty acids ( FFAs ) so causes endothelial disfunction and increased coronary artery disease hazard ( Wieser et al 2013 ) See ( Appendix Figure 2 ) Inflammatory cytokines have been reported in the development of high blood pressure. ( Grundy 2003 ) suggests a important association among redness, high blood pressure, and the metabolic syndrome. TNF-I ± stimulates the production of endothelin-1 and angiotensinogen. interleukin-6 ( IL-6 ) is a multifunctional cytokine which mediates inflammatory responses and stimulates the cardinal nervous system and sympathetic nervous system. This mediates an addition in plasma angiotensinogen and angiotonin II, and hence high blood pressure. ( Sarafidis and Bakris 2007 ) show that IR increases leptin and NEFA degrees thereby augmenting sympathetic nervous activation. The survey besides showed NEFA to raise blood force per unit area, bosom rate, and I ±1-adrenoceptor vasoreactivity, while cut downing baroreflex sensitiveness, endothelium-dependent vasodilatation, and vascular conformity. Insulin has anti-natriuretic and stimulates nephritic Na re-absorption. Insulin opposition and the ensuing hyperinsulinemia induce blood force per unit area lift by the activation of sympathetic nervous system and renin-angiotensin-aldosterone system ( RAAS ) causes sodium keeping and volume enlargement, endothelial disfunction and change in nephritic map. The subsequent hyperinsulinemia promotes the addition in sodium soaking up by the kidneys, which can impair force per unit area natriuresis, thereby doing high blood pressure in salt-sensitive persons. Hyperinsulinemia increases the sympathetic activity, taking to arterial high blood pressure. 1475-2891-7-10-1 ( 1 ) .jpg ( Figure 2 ) IR proposed tracts. YanaiA et al.A Nutrition JournalA 2008A 7:10 doi:10.1186/1475-2891-7-10 Insulin opposition is characterized by pathway-specific damage in phosphatidylinositol 3-kinase signalling. In the endothelium, this may do an instability between the production of azotic oxide and secernment of endothelin-1, taking to decreased blood flow. The accretion of splanchnic fat elevates the activity in the renin-angiotensin system, due to an increased production of angiotensinogen, which accordingly favours arterial high blood pressure. FFAs contribute to endothelial disfunction by a combination of lessened PI3K-Akt signalling, increased oxidative emphasis. And increased ET-1 production. Insulin opposition and splanchnic fleshiness are associated with atherogenic dyslipidemia ( Semenkovich, 2006 ) . Atherogenic dyslipidemia can develop from increased ( FFAs ) . They are known to assist the production of the lipoprotein ( apoB ) within ( VLDL ) atoms, ensuing in more VLDL production. Insulin usually breaks down apoB through PI3K-dependent tracts, therefore insulin opposition additions VLDL production. Hypertriglyceridemia in insulin opposition is the consequence of both an addition in VLDL production and a lessening in VLDL clearance. VLDL is metabolized to remnant lipoproteins and little dense LDL, both of which can advance atheroma formation. Insulin opposition besides causes endothelial disfunction by diminishing Akt kinase activity, ensuing in lessened eNOS phosphorylation and activity. Phosphorylation of eNOS is required for the hemodynamic actions of insulin, this consequences in lessened blood flow to skeletal musculus and endothelial disfunction that so worsens insulin opposition. The metabolic consequences of drawn-out insulin opposition produce Glucose intolerance. AS mentioned earlier, glucose consumption in adipocytes and skeletal musculus cells is decreased and can no longer be absorbed by the cells but remains in the blood, but hepatic glucose production is increased. Therefore an overrun insulin by beta cells to keep plasma glucose homeostasis. Once the pancreas is no longer able to bring forth adequate insulin to get the better of the insulin opposition, impaired glucose tolerance ( IGT ) develops. Harmonizing to the World Health Organization, IGT is a pre diabetic status in which serum glucose concentrations range between 140 and 200A mg/dL 2 H after a 75A g glucose burden ( WHO ) Persons with IGT have extended loss of first stage insulin secernment and a decreased 2nd stage, and persons with type 2 diabetes have small first stage insulin release at all. ( Mackie and Zafari 2006 ) Postprandial hyperglycaemia appears to bring forth oxidative emphasis, addition protein glycation, addition hypercoagulability, and damage endothelial cells, all of which promote coronary artery disease. Hyperglycemia is a well-known hazard factor for micro and macrovascular disease ( HutchesonA andA Rocic 2012 ) and is associated with increased morbidity and mortality via means an increased hazard of CVD and type 2 diabetes among others. Metabolic syndrome is associated with increased oxidative emphasis. Recent documents suggest that some of the implicit in pathologies contribute more entire oxidative emphasis than others ( HutchesonA andA Rocic 2012 ) ( huge grounds to see, more research needed ) Adipose tissue has been shown to lend to the production of reactive O species and proinflammatory cytokines, including TNF-I ± , IL-6, and IL-18. Previous surveies showing that fleshiness and MetS are independently associated with increased oxidative emphasis and inflammatory load. The presence of MetS exacerbates oxidative and inflammatory emphasis in corpulent grownups with higher systemic markers of oxidative emphasis and low-grade chronic redness in corpulent grownups with MetS compared with corpulent grownups free of MetS ( Guilder 2006 ) . Cross-sectional informations from 2,002 non-diabetic topics of the community-based Framingham Offspring Study has shown that systemic oxidative emphasis is associated with insulin opposition ( Meigs 2007 ) . There are besides negative effects of inordinate and deficient slumber on metabolic syndrome prevalence are described in ( Vosatkova et al 2012 ) . Despite a familial background of the upset, its outgrowth and development are strongly influenced by life manner. Therefore, intervention metabolic syndromeA by and large focuses onA diet and exercising. regularA physical activityA and a diet with aA restricted Calories intake, that is high inA whole grains, A monounsaturated fatsA and works nutrients ( such as theA Mediterranean diet ( Kastorini 2011 ) . The medical direction of metabolic syndrome includes CVD hazard, Blood force per unit area control WITH ( angiotension-converting enzyme ( ACE ) A inhibitors AND ORA angiotension receptor blockersA ( ARBs ) , drug therapy for Cholesterol withA lipid-lowering medicines ) , preventive Diabetes intervention and Exercise rehabilitation plans to help loss and mobility, In decision prevalence of metabolic syndrome is increasing steadily across assorted populations increasing hazards CVD and Diabetes related co-morbidities. Metabolic syndrome includes insulin opposition, splanchnic adiposeness, atherogenic dyslipidemia and endothelial disfunction and their ain related effects. The pathophysiological mechanisms of Mets are all interconnected. With changing planetary statistics and multiple universe definitions and standards a comprehensive cosmopolitan definition of the metabolic syndrome is needed for elucidation. The NCEP ATP III definition uses straightforward standards that are measured readily AND easiest to use clinically and epidemiologically. Metabolic syndrome and its different definitions do place the pathophysiological mechanisms that underline the procedure Insulin opposition and cardinal fleshiness are clearly cardinal constituents of the disease as they both cause glucose intolerance and dysplycemia. Metabolic syndrome is complex and there is new research on traveling. The best signifier of bar seem to be an easy hole for most MetS persons, lifestyle alterations and weightless.

Pest

Name: Kimberly Hodge 1. Using APA citations to support your statements, explain what a PEST table is and why it is important to an organization (1-2 paragraphs). Pest Analysis is a frame work that strategy consultants uses to scan the mirco environment in which the firm operates. (Value Based 2013) PEST is Political, Ecomonic, Social factor and Techonolgies factors. Companies will use this in workshops and it will make the managmenets brainstorm techniques using PEST for strategic plannings, marketing planning or development in the business or the production. (Value Based 2013) 2.Include an explanation of the organization and environment you are focusing on in the PEST table (3-5 sentences): I answer #4 before I answer this one. It is combine of both questions. The organization would be my bike shop. I would use this table to think how this would affct my employees and the consumers. Political section, with the Furlough going on and unemployment numbers are going up.. I need to be aw are that I will have good days and bad days with sales. The next couple months were be good month because income refunds are coming in and people want to buy and spend but then at the same time consumers may be saving as well.International trades will be affecting my bike shop because some of the bikes are shipped from France, Switzerland and other countries. I need to be aware this could affect my business as well.. Social is a huge impact for any business. And I think economic influences social a lot. Then Technologies, there are always new gadgets that are being added to the bikes or can be purchased to add to the bike. As a management, I have to be aware that when I promote new technology, I need to let them know what is new and how does it work. 3. 4. Identify 3-5 items in each category and post them in the PEST table below.Provide enough detail to explain your thoughts for each item. One or two lines will suffice for each item; please avoid using one-word, generic items within the table. Political1. Tax policies2. political stability3. safety regluations4. international trade regulations and restricitions5. contract enforcement law consumer protection| economic1. stage of the business cycle2. consumer confidence3. exchange rates/inflaction rates4. Interest rates and montery policies5. unemployment policy| SOCIAL1. income distriubiton2. labor/social mobility3. lifestyle changes4. health consciousness and welfare, feelings on saftey5. iving conditions| TECHOLOGY1. government research spending2. new inventions and development3. energy use and costs4. rate of technology transfer5. life cycle and speed of technological obsolescence| 5. If you were the leader of the organization used here, how would you utilize the information in the PEST graph, and what changes would you make based on your results? How would those changes affect the success of the business? (1-2 paragraphs) When I am leader of the organization, I will need to look each catergory and determine what are affecting our people in our country.People may be looking for changes or having trouble adapting to changes. Why are the changes happening like the example in the book talking about when the records were going out and the CD were coming in and it happened almost over night. This means people who had record players did not have CD players.. The customers had to buy CD players before they could buy the CD. This is what I need to look, what will happen if I change something, does this mean the consumers will have to spend money to make something adapt to something such as CD player. With the government changes laws, it affects our people.Like recent event, the Furlough, I know some people are losing two days of work per payperiod, this will affect their paychecks which will affect the social. So as a leader, we have to look how each category will affect the next. 6. References (please use proper APA set up as you construct the reference list): Valued Based Management. Net (Ja nuary 2, 2013) http://www. valuebasedmanagement. net/methods_PEST_analysis. html GRADING RUBRIC Item| Point Value| Assignment Content| | In depth responses to all questions| 40| General Writing and APA compliance| 10| Total| 50|