Four Software Development Methodologies

Student Name Student ID Student Signature Assessor Name Assessor's Signature Final Result / Grade Assessed By / Date Case Study Research (worth 20% of final grade)100 MarksSOF535: Application Design and DevelopmentVersion 1.1, Level 5, Credits 20New Zealand Diploma in Information Technology Technical Support Level 5Task 1: Requirement Gathering and Analysis(Total 40 Marks) comparison between four software development methodologies. Four Software Development MethodologiesWaterfall Development MethodologyThe Waterfall approach to systems analysis and design was the first established modern approach to building a system. This method was originally defined by Winston W. Royce in 1970, (â€Å"The Waterfall Development Methodology†, 2006). It quickly gained support from managers because everything flows logically from the beginning of a project through the end, (Jonasson, 2008). Sources differ when it comes to the specific steps in the Waterfall process.Rapid Application Development MethodologyRapid application development is a software development methodology that uses minimal planning in favor of rapid prototyping. A prototype is a working model that is functionally equivalent to a component of the product.In the RAD model, the functional modules are developed in parallel as prototypes and are integrated to make the complete product for faster product delivery. Since there is no detailed preplanning, it makes it easier to incorporate the changes within the development process.RAD projects follow iterative and incremental model and have small teams comprising of developers, domain experts, customer representatives and other IT resources working progressively on their component or prototype.The most important aspect for this model to be successful is to make sure that the prototypes developed are reusable.Agile Development MethodologyThere are many different forms of the  Agile development method  including: Scrum, Crystal, Extreme Programming (XP), and Feature-Driven Development (FDD).  Agile methods  attempt to minimize risk (such as bugs, cost overruns, and changing requirements) by developing the software in iterations that  are mini-increments of the new functionality. The benefit of multiple iterations is that it improves efficiency by finding and fixing defects and expectation mismatches early on.Agile methods rely on real-time communication, which fails to provide new users with documentation to get up to speed. They require a huge time commitment from the users, and is labor-intensive on the developers due to the need to fully complete each feature within each iteration for user approval. The benefits to the software are realized early on due to the incremental addition of the iterations. The Agile methods are similar to RAD, and  can be inefficient in large organizations. Programmers, management and organizations accustomed to the Waterfall Method may have difficulty adjusting to Agile, and often a hybrid approach works well for them.DevOps Deployment MethodologyDevOps deployment  is centered around organizational change that  enhances the collaboration between the departments responsible for different segments of the development life cycle, such as development, quality assurance and operations. It is focused on improving the time to market, lowering the failure rate of new releases, shortening the lead time between fixes, and prioritizing minimal disruption as well as maximum reliability. To achieve this, DevOps aims to automate its continuous deployment to ensure everything happens smoothly and reliably.Companies that use  DevOps  have benefitted by significantly reducing the time to market, improving customer satisfaction, improving product quality and improving productivity and efficiency of its employees. A few  drawbacks of DevOps includeappropriate methodology that is suitable for this project.It totally depends on the nature of the project. Many people might argue that Agile is the best methodology for software development and it does have significant advantages in most cases; however, saying â€Å"Agile is better than Waterfall† is like saying â€Å"A car is better than a boat†. They both have advantages and disadvantages depending on the environment.Agile/Scrum works best with projects that have high levels of uncertainty and require an adaptive approach. A plan-driven approach (what many people loosely call â€Å"Waterfall†) works best in situations where the requirements are fairly certain and there is some need for predictability of project costs and schedules. And, of course, that is not meant to imply that there is a binary and mutually-exclusive choice between two extremes. There are many ways to blend an adaptive (Agile) approach with a plan-driven approach in the right proportions to fit the situation.There is no â€Å"silver bullet† methodology that fits all possible projects and the right solution is to fit the methodology to the nature of the problem rather than force-fitting a project to some predefined methodology.https://blog.blackducksoftware.com/top-4-software-development-methodologiesTwo types of requirements1.Functional Requirements Functional requirements define the fundamental actions that system must perform.The functional requirements for the system are divided into three main categories, Reservation/Booking, Food, and Management. For further details, refer to the use cases.EXAMPLE 1.Reservation/BookingThe system shall record reservations.The system shall record the customer's first name.The system shall record the customer's last name. The system shall record the number of occupants.The system shall record the room number.The system shall display the default room rate.The system shall allow the default room rate to be changed.The system shall require a comment to be entered, describing the reason for changing the default room rate.The system shall record the customer's phone number.The system shall display whether or not the room is guaranteed. The system shall generate a unique confirmation number for each reservation.The system shall automatically cancel non-guaranteed reservations if the customer has not provided their credit card number by 6:00 pm on the check-in date.EXAMPLE 2FoodThe system shall track all meals purchased in the hotel (restaurant and room service). The system shall record payment and payment type for meals.The system shall bill the current room if payment is not made at time of service.The system shall accept reservations for the restaurant and room service.ManagementThe system shall display the hotel occupancy for a specified period of time (days; including past, present, and future dates).The system shall display projected occupancy for a period of time (days).The system shall display room revenue for a specified period of time (days).The system shall display food revenue for a specified period of time (days). The system shall display an exception report, showing where default room and food prices have been overridden.The system shall allow for the addition of information, regarding rooms, rates, menu items, prices, and user profiles.The system shall allow for the deletion of information, regarding rooms, rates, menu items, prices, and user profiles.The system shall allow for the modification of information, regarding rooms, rates, menu items, prices, and user profiles.The system shall allow managers to assign user passwords.

Djas

Successful adaptation to change Involves risk taking which means that the inevitability of unpredictable outcomes, both positive and negative leaves many individuals lost in fear and pain. While some find contentment in familiar family and friends, others find change confronting, causing feelings of fear and insecurity, while still others seek the thrill of exploration. In spite of these varying attitudes to change, change is a concept that is essential to the continuation of life. These varying concepts of change and Its Importance are represented through structural and language techniques.In the poem ‘Loch Arid Gorge' by John Fouler, a poem that refers to the thrill and dangers of naval exploration. The feature film ‘Rush' directed by Ron Howard, conveys the fear resulting from injury and the positive change that can come from suffering. Finally, the poem ‘Enter Without So Much as Knocking' by Bruce Dade tests the reader's own understanding of the negative effects of commercialism change on human life. Whilst the positive thrill of exploration and risk taking involves new worlds and perspectives, the negative aspects when disaster strikes well outweigh the positive effects.Such journeys may include other people such as the way that Australian poet John Fouler explores the notion of change via thrill of exploration, as well as the discovery of the past. Fouler creates a relationship between himself and the responder through the use of Inclusive language within the text. This Is conveyed In â€Å"We climb along a weathered cream precipice†¦ † The use of Inclusive language takes the responder on a dangerous journey along the cliff face with the author to the setting where the poem is taking place.The Journey Fouler shares with responders pens their eyes, revealing the tragic historical past and the violent events that had taken place along the Victorian coastline. With the realization of the shipwreck of the Lock Arid ‘a centu ry ago, the true strength and persistence of nature Is revealed as It simply goes on *clicking tufts of unconcern' Like the sheep and cattle', the unusual metaphor here together with the gravestones' that ‘hump the grass' reveal Just how much has changed physically at this tourist site since that terrible night.Moreover, nature's power to provide negative unpredictable outcomes reveals the risk of sea runners in the past. Change is perceived by the reader as both, positive and negative resulting in the responders Joining Fouler as he takes them on an exploration to discover the unfamiliar secrets of history. This idea of risk taking and unpredictable outcomes is also represented in the film ‘Rush' which involves the highly dangerous sport of Formula One in sass's. The protagonists cheat death and get thrill from it which is represented in the quote, â€Å"The closer you are to death, the more alive you feel.It's a wonderful way to live. † which describes risk taki ng with positive connotations. This is reinforced by the way the director capture the protagonists crash. The use of a long shot down the straight they are sitting on the straight watching the scene take place. The heavy rain droplets running down the screen emphasis the dangers and how heroic the drivers are. When the car flips many components from the vehicle fly off in every direction illustrating how dangerous the sport was, not only for the driver and the car but for the audience who are at risk of projectiles from crashing cars.This crash hanged the Fl culture forever, it encouraged drivers never to push racing to extreme limits where conditions are likely to result in great injury or death. Both of these texts demonstrate the thrill that some find in risk taking. However, this text also demonstrates the dangers in the exploration of new situations. Since change is unpredictable, individuals often experience pain and suffering which negatively affects their lives but also has the potential to encourage personal growth and understanding as they struggle to adapt.This is explored in ‘Rush' as Howard explores both change and the positive and negative thoughts of fear which arise from injury and suffering. Suffering forces individuals to take stock of their lives ,†Ã¢â‚¬ ¦ While in Hospital getting my lungs vacuumed I realized there was more than Just winning, I have a wife and want to live till a long age†¦. â€Å", the use of personal first person reflection and the black humor of' getting my lungs vacuumed' makes the character, Nikkei Laud, exaggerate his feelings towards the positive aspects of life and how much he values it.The use of the flashbacks to where Laud was in hospital unconnected to all the medical equipment show the true terror all bystanders experienced. A close up shot from the doctor pushing the vacuum down his throat as well as the strong sound of sludge being sucked from his lungs, turns the responder stomach to almost feeling the smallest of pain Laud experienced during his recovery. The director included the direct and confronting image in the film to express how the positive outcomes of change only become obvious after fear of injury and suffering. Enter without so much as knocking is a poem written by Bruce Dade in order to test he reader's opinion towards change and question the inevitability of change through the broad range of language techniques used. The parody of sass advertising slogans in the quote â€Å"†¦ Like every other well-equipped smoothly-run household, his included one economy size mum, one Anthony Squires-Cholesterol-summertime Dad†¦ † Enforces the influence of consumerism on society as it manipulates people to change without them being aware of it.This is seen through the use of caesura and tone to reinforce the thoughts of shallow commercialism and its strong influence on change. The overload of commercialism is perceived as topic but is only changing the world into a dyspepsia society as it large influences the actions and products of each and every individual. This tests the reader's thoughts of change and why they have changes. Throughout all three texts composers take their responders on a Journey to demonstrate their perspectives of change.In ‘Loch Arid Gorge' and ‘Rush' the composers express factual historical events. The composers take their responders on social, cultural and personal changes and the impact on human life. Those personae quire adaptation and often risk taking behavior in order to understand themselves better. By contrast, â€Å"Enter without so much of knocking reveals that change can be subtle as the persona is not aware of the changes until it is too late and he is faced with death.Intro: risk taking – different perspective unpredictable outcomes: positive and negative inevitability, no control expressed through engage and structural techniques ‘Loch Arid Gorge' by John Fouler: destr uction caused by nature ‘Rush' by Ron Howard: fear resulting from injury and the positive change that can come from offering ‘Enter Without So Much as Knocking by Bruce Dade: negative effects of commercialism on human life.

Dementia to Elderly in Uk

Abstract Dementia is characterized by evidence of short term and long term memory impairment with impaired abstract thinking, impaired judgment, disturbances of higher cortical thinking, and personality changes. It is basically a progressive decline of cerebral utility such as logic, remembrance, language, problem solving, or concentration. This disease greatly harms the day by day performance of a person and is seen more in older people, however, is not a normal part of aging. . INTRODUCTION 1. 1. Aim The aim of this dissertation is to analyze the effects of dementia in older people and to suggest possible solutions for its prevention and treatment. 1. 2. Objectives Primary objective of this research is to see how effective the health care management systems are for the diagnosis, treatment and prevention of dementia syndrome specially keeping in view the population of UK. 1. 3. Dementia defined The International Dictionary of Psychology (Sutherland, 1989) defines it as â€Å"an impairment or loss of mental ability, particularly of the capacity to remember, but also including impaired thought, speech, judgment, and personality. It occurs in senile dementia and in conditions involving widespread damage to the brain or narrowing of the blood vessels†. In the preceding definition, Sutherland introduced a different term, senile dementia. Senile is derived from the Latin adverb senex pertaining to age or growing old. This shows that some dementias occur at later or older ages for reasons not known. Definition of senile dementia as per The International Dictionary of Psychology is that it is â€Å"a progressive syndrome starting in old age with no clear cause, in which intellect, memory, and judgment are impaired; it is often accompanied by apathy or irritability† (Sutherland, 1989, p. 397). 1. 4. How common is dementia? In England only, there are approximately 570,000 people living with dementia. It is expected that this number would double in the coming 30 years (Barberger-Gateau, 2007). Generally dementia arises in people who are 65 years of age above. The chances of developing it are more as one gets old as compare to young people. Roughly, it is anticipated that dementia occurs in: †¢1. 4% of men and 1. 5% of women aged between 65 and 69, †¢3. 1% of men and 2. 2% of women aged between 70 and 74, †¢5. 6% of men and 7. 1% of women aged between 75 and 79, †¢10. 2 % of men and 14. 1% of women aged between 80 and 84, and †¢19. 6% of men and 27. 5% of women aged 85 or over. 2. LITERATURE REVIEW In the preceding paragraphs, we will discuss in detail the different kinds of dementia that occur to people at older age along with a number of causes that lead towards this syndrome. . 1. Types of dementia Following are the different types of dementia recognized so far (Davidson, 2005): †¢Alzheimer's disease, where tiny clusters of protein, known as plaques, start to build up around brain cells. This upsets the regular workings of the brain. †¢Vascular dementia, where troubles with blood distribution result in uneven supply of blood and oxygen to certain parts of the brain. †¢Dementia with Lewy bodies, where irregular structures, known as Lewy bodies, grow inside the brain. †¢Frontotemporal dementia, where the two parts of the brain, frontal and temporal lobes, start to shrink. Not like other types of dementia, frontotemporal dementia typically grows in people who are below 65 years of age and is very rare than other types of dementia. 2. 2. Different Kinds of Dementia Different kinds of dementing disorders exist. One way of classification is according to parts of the brain being affected. Some frequently used classifications are as follows: †¢Cortical dementia: This type of dementia damages the brain particularly affecting the brain's cortex, or outer layer. Problems such as memory, language, thinking, and social behavior results due to this disoder. Sub cortical dementia: It affects parts of the brain below the cortex and causes changes in emotions and movements along with damaging memory. †¢Progressive dementia: It gets worse with the passage of time, thus interfering more and more with cognitive abilities. †¢Primary dementia: This denotes to that form that does not result from any other disease such as AD. †¢Secondary dementia: This type of dementia occurs due to some physical disease or injury. †¢Treatable Dementia: About 10 percent of conditions that cause dementia are treatable. With treatment, the dementia can either be upturned or at least halted. Instances of conditions that cause treatable cases of dementia comprise of the following: ?Normal pressure hydrocephalus ?A brain tumor or brain cancer ?Hypothyroidism ?Vitamin B12 deficiency ?Neurosyphilis ?Reactions to medications ?Poisoning. †¢Non-Treatable Dementia: Types of dementia that currently have no cure include: †¢Lewy body dementia †¢Binswanger's disease †¢Frontotemporal dementia †¢Corticobasal degeneration †¢Certain conditions that can cause childhood dementia †¢HIV-associated dementia Other infections within the brain, such as Creutzfeldt-Jakob disease †¢Huntington's disease and other rare hereditary dementias †¢Head trauma, such as dementia pugilistica (also known as boxer's syndrome). Several types of dementia fit into more than one of these classifications. For instance, AD is considered both a cortical as well as progressive dementia. 2. 3Causes 2. 3 . 1Alzheimer's disease It is the most common cause of dementia, affecting around 417,000 people in the UK. German neurologist Alois Alzheimer first described Alzheimer's disease. According to him, it is a physical disease affecting the brain. All through the course of the disease, plaques and tangles develop in the brain, thus leading to the loss of brain cells. Shortage of some important chemicals in the brain also results due to this disease. These chemicals are concerned with the spread of messages within the brain. 2. 3. 2Vascular dementia Vascular dementia is the second most common form of dementia after Alzheimer's disease. It is caused by problems in the supply of blood to the brain. There are a number of conditions that can cause or increase damage to the vascular system. These include high blood pressure, heart problems, high cholesterol and diabetes. This means it is important that these conditions are identified and treated at the earliest opportunity. 2. 3. 3Dementia with Lewy bodies Dementia with Lewy bodies (DLB) is a form of dementia that has characteristics similar to both Alzheimer's and Parkinson's diseases. It makes around four per cent of all cases of dementia in older people. Lewy bodies, named after the doctor who first identified them in 1912, are tiny, spherical protein deposits found in nerve cells. Their presence in the brain disrupts the brain's normal functioning, interrupting the action of important chemical messengers, including acetylcholine and dopamine. Researchers have yet to understand fully why Lewy bodies occur in the brain and how they cause damage. 2. 3. 4Fronto-temporal dementia The term ‘fronto-temporal dementia' includes conditions such as Pick's disease, frontal lobe degeneration, and dementia associated with motor neurone disease. All these are due to damage to the frontal lobe and/or the temporal parts of the brain. These areas are responsible for our behaviour, emotional responses and language skills. . 3. 5Korsakoff's syndrome Korsakoff's syndrome is a brain disorder usually linked with heavy alcohol utilization over a long period. Sometimes it is referred to as ‘alcohol amnestic syndrome' ? ‘amnestic' meaning loss of memory ? although in rare cases alcohol is not the cause. Although Korsakoff's syndrome is not strictly speaking a dementia , people with the condition suffer loss of short-term memory. 2. 3. 6Creutzfeldt-Jakob disease Prions are contagious agents that onslaught the central nervous system and then occupy the brain, causing dementia. Known prion disease is Creutzfeldt-Jakob disease, or CJD. It was first reported by two German doctors (Creutzfeldt and Jakob) in 1920. 2. 3. 7Aids-related cognitive impairment Individuals with HIV and AIDS occasionally develop cognitive impairment – particularly in the later stages of their sickness. AIDS (acquired immune deficiency syndrome) is caused by the presence of the human immunodeficiency virus (HIV) in the body. HIV attacks the body's immune system, making the person affected more susceptible to infection. HIV-related cognitive impairment can be caused by: ? The direct impact of HIV on the brain Infections (called ‘opportunistic infections') that take advantage of the weakened immune system. 2. 3. 8Binswanger's disease Binswanger's disease is a unusual form of vascular dementia in which harm occurs to the blood vessels in the deep white matter of the brain. Symptoms of Binswanger's mostly occur in people over the age of 60 and it is usually linked with long-ter m hypertension. The disease chiefly affects memory and mental abilities such as thinking and learning. The individual may also experience mood swings, tremors, seizures and problems with walking. 2. 3. 9Huntington's disease Huntington's disease is a progressive inherited disease. It typically becomes obvious in adults in their 30s, even though it can occur earlier or later. There is also a puerile type of Huntington's, which affects children. The route of the disease varies for each person, and dementia can occur at any stage of the illness. 2. 4Diagnosis Diagnosis of dementia is based on the following: †¢History †¢Physical exam †¢Tests The process of identifying dementia is made only if two or more brain functions such as memory and language skills are extensively damaged without loss of consciousness. An early and precise dementia diagnosis can help in early treatment of dementia symptoms and maybe reversing the dementia or stopping its development, if the cause of dementia is reversible (such as normal pressure hydrocephalus, a brain tumor, or B12 deficiency). †¢Patient History History taking is a very important step in identifying dementia. It is important to know how and when symptoms developed and about the patient's overall medical condition. Is there any risk factor involved or there is any family history of similar symptoms along with any medication the person is taking. Physician also try to evaluate the patient's emotional state and the degree of day to day actions being affected in spite of of the fact that patients with dementia frequently are ignorant of or in denial about how their disease is affecting them. Typically the family members also deny the reality of the disease because they take this in the beginning as a usual procedure of aging. Therefore, additional steps are necessary to confirm or rule out a dementia diagnosis. †¢Physical Exam: A physical examination can help in the following: ?Rule out treatable causes of dementia Classify signs of stroke or other disorders that can add to dementia ? Identify indications of other illnesses, such as heart disease or kidney failure that can be related with dementia. A thorough neurological assessment is performed to evaluate the balance, sensory function, reflexes, and other functions of the patient and to spot signs of conditions that may have an effect on the diagnosis of dementia. †¢Tests Used in Diagnosing Dementia Tests that are used to diagnosis dementia include the following: ?Cognitive and neuropsychological tests (Mini-Mental State Examination (MMSE) ? Brain scans (MRI or CT scan) Laboratory tests ?Psychiatric evaluations ?Pre-symptomatic testing. †¢Cognitive and Neuropsychological Tests for Dementia Tests are done to measure memory, language skills, math skills, and other abilities associated to mental functioning to help them analyze a patient's condition precisely. A test called the Mini-Mental ® State Examination (MMSEâ„ ¢) is used to judge cognitive skills in people with assumed dementia. This test examines: ? Orientation ?Memory ?Attention Doctors also use a diversity of other tests and rating scales to categorize explicit types of cognitive problems and abilities. †¢Brain Scan Tests for Dementia Brain scans are carried out to recognize strokes, tumors, or other problems that can result dementia. A brain scan may also demonstrate cortical atrophy (the progressive loss of neurons causes the ridges to become thinner and the sulci to grow wider), which is the deterioration of the brain's cortex (outer layer) and is frequent in many forms of dementia. Brain scans can also spot changes in the brain's organization and function that would propose Alzheimer's disease. †¢Computed Tomography Scan or Magnetic Resonance Imaging The most general types of brain scans are computed tomography (CT) scans and magnetic resonance imaging (MRI). A CT scan of the brain frequently suggested in a patient with suspected dementia. These scans, which use x-rays to detect brain structures, can show evidence of: ?Brain atrophy ?Strokes and transient ischemic attacks (TIAs) ?Changes to the blood vessels ?Other problems (such as hydrocephalus and subdural hematomas). MRI scans use magnetic fields and focused radio waves to detect hydrogen atoms in tissues within the body. They can detect the same problems as CT scans but they are better for identifying certain conditions, such as brain atrophy and damage from small TIAs. †¢Electroencephalograms (EEGs) Electroencephalograms (EEGs) are another tool to assist in inspecting people with suspected dementia. In an EEG, electrodes are placed on the scalp over several parts of the brain in order to detect and record patterns of electrical activity and to check for abnormalities. This electrical activity can indicate cognitive dysfunction in part or all of the brain. Many patients with moderately severe to severe Alzheimer's disease have abnormal EEGs. An EEG may also be used to detect seizures, which occur in about 10 percent of people with Alzheimer's disease. It can also help diagnose Creutzfeldt-Jakob disease. †¢Other Brain Scan Tests Several other types of brain scans allow researchers to watch the brain as it functions. These scans, called functional brain imaging, are not often used as diagnostic tools, but they are important in research and they may ultimately help identify people with dementia earlier than is currently possible. Types of functional brain scans include: ?Functional MRI (fMRI): It uses radio waves and a strong magnetic field to measure the metabolic changes that take place in active parts of the brain. ?Single photon-emission computed tomography (SPECT): It shows the distribution of blood in the brain, which generally increases with brain activity. Positron emission tomography (PET): This scans can detect changes in glucose metabolism, oxygen metabolism, and blood flow, all of which can reveal abnormalities of brain function. ?Magneto encephalography (MEG): This can show the electromagnetic fields produced by the brain's neuronal activity. †¢Laboratory Tests for Dementia Doctors may use a variety of laboratory tests to help diagnose dementia or rule out other conditions, such as kidney failure, which can contribute to symptoms. A partial list of these tests includes: ?A complete blood count (CBC) Blood glucose test, which measures sugar levels in the blood ? Urinalysis ?Drug and alcohol tests (toxicology screen) ?Cerebrospinal fluid analysis (to rule out specific infections that can affect the brain) ? Analysis of thyroid and thyroid-stimulating hormone levels. ?A doctor will order only the tests that he or she feels are necessary to improve the accuracy of a diagnosis. †¢Psychiatric Evaluation The healthcare provider may recommend a psychiatric evaluation to determine if depression or another psychiatric disorder may be causing or contributing to a person's symptoms. Pre-Symptomatic Testing In most cases, testing people before symptoms begin in order to determine if they will develop dementia is not possible. However, in cases involving disorders such as Huntin gton's where a known gene defect is clearly linked to the risk of the disease, a genetic test can help identify people who are likely to develop the disease. Since this type of genetic information can be devastating, people should carefully consider whether they want to undergo such testing. 2. 5Treatment For about 10 percent of conditions that cause dementia, treatment is available that can help reverse or at least slow down its progression. Some examples of these treatable causes of dementia include: †¢A brain tumor †¢Normal pressure hydrocephalus †¢Hypothyroidism. For most cases, treatment does not exist to reverse or halt the disease's progression; however, this does not mean that nothing should be done. People with dementia can benefit to some extent from such things as medications and cognitive training. There are also options for the family to help them cope. 2. 6Risk Factors Scientists have found a number of risk factors for dementia that affect the likelihood of developing one or more kinds of dementia. While these are not causes of dementia, they may increase a person's chances of developing the symptoms referred to collectively as dementia. Some dementia risk factors can be treated or controlled and some cannot Some of these risk factors for dementia are modifiable, while others are not.. Also, certain risk factors are more likely to increase the risk for certain types of dementia. For example, the risk of vascular dementia is strongly correlated with risk factors for stroke. Finally, the more dementia risk factors you have, the greater your chances of having dementia. An example of risk factors for dementia that you cannot change involves getting older (the risk of dementia tends to increase with age). Other dementia risk factors you cannot control include having: †¢Age †¢A family history of dementia †¢Down syndrome †¢Mild cognitive impairment †¢History of a stroke. Dementia risk factors that you can control include: †¢Hypertension †¢hypercholesterolemia †¢Diabetes †¢Atherosclerosis †¢Smoking †¢Heavy alcohol use. †¢Homocysteine levels in the blood. There are also things that can be controlled that increase your risk for developing diabetes, atherosclerosis, and other conditions that may increase your risk of developing dementia. These include: †¢Being overweight or obese †¢Lack of physical activity †¢Unhealthy diet. ?Age Age is the utmost risk aspect for dementia. Dementia influences one in 14 people over the age of 65 and one in six over the age of 80. However, Alzheimer's is not limited to aged people: in the UK, there are 15,000 people under the age of 65 with dementia, although this figure is likely to be an underrated. ?Genetic inheritance Several people fear that they may become heir to Alzheimer's disease, and scientists are presently exploring the hereditary background to Alzheimer's. In most of the cases, the effect of inheritance appears to be minute. If a parent or other family member has Alzheimer's disease, probability of developing the disease is only a slight elevated than if there were no cases of Alzheimer's in the direct family. ?Environmental factors The ecological factors that may add to the onset of Alzheimer's disease have yet to be discovered. Not many years ago, there were concerns that revelation to aluminum might cause Alzheimer's disease. Nevertheless, these fears have largely been discounted. ?Other factors Because of the dissimilarity in their chromosomal structure, people with Down's disorder who live into their 50s and 60s may develop Alzheimer's disease. People who have had stern skull or whiplash wounds also come out to be at increased risk of developing dementia. Boxers who get frequent blows to the head are at risk too. Study has also revealed that people who smoke, and those who have elevated blood pressure or sky-scraping cholesterol levels, augment their risk of developing Alzheimer's. 2. 7 Care of people with dementia People with moderate and advanced dementia typically need round-the-clock care and supervision to prevent them from harming themselves or others. They may also need assistance with daily activities such as eating, bathing, and dressing. Meeting these needs requires patience, understanding, and careful thought from the person's caregivers. For people involved with dementia care, there are some important things to consider. These include such things as: †¢Making the home safe †¢Helping to reduce stressors †¢Providing mental stimulation. Good dementia care always involves the issue of driving. One of the hardest things to do is to take away a person's independence that comes with driving. However, for a number of reasons that we will explain later, people with dementia should not drive. 2. 7. 1Dementia Care and the Home A typical home environment can present many dangers and obstacles to people with dementia, but simple changes can overcome many of these problems. For example, sharp knives, dangerous chemicals, tools, and other hazards should be removed or locked away. Other safety precautions include: †¢Installing bed and bathroom safety rails †¢Removing locks from bedroom and bathroom doors Lowering the hot water temperature to 120 °F (48. 9 °C) or less to reduce the risk of accidental scalding. People with dementia should also wear some form of identification at all times in case they wander away or become lost. Caregivers can help prevent unsupervised wandering by adding locks or alarms to outside doors. 2. 7. 2Reducing Stressors People with dementia ofte n develop behavioral problems because of frustration with specific situations. Understanding and modifying or preventing the situations that trigger these behaviors may help to make life more pleasant for the person with dementia as well as his or her caregivers. For instance, the person may be confused or frustrated by the level of activity or noise in the surrounding environment. Reducing unnecessary activity and noise (such as by limiting the number of visitors and turning off the television when it's not in use) may make it easier for the person to understand requests and perform simple tasks. Caregivers may also reduce confusion in people with dementia by: †¢Simplifying home decorations †¢Removing clutter †¢Keeping familiar objects nearby †¢Following a predictable routine throughout the day. Calendars and clocks also may help patients orient themselves. . 7. 3Mental Stimulation as Part of Dementia Care Caregivers should encourage people with dementia to continue their normal leisure activities as long as they are safe and do not cause frustration. Activities such as crafts, games, and music can provide important mental stimulation and improve mood. Some studies have suggested that participating in exercise and intelle ctually stimulating activities may slow the decline of cognitive function in some people. 2. 7. 4Is Driving Safe? Many studies have found that driving is unsafe for people with dementia. They often get lost and they may have problems remembering or following the rules of the road. They may also have difficulty processing information quickly and dealing with unexpected circumstances. Even a second of confusion while driving can lead to an accident. Driving with impaired cognitive functions can also endanger others. Some experts have suggested that regular screening for changes in cognition might help to reduce the number of driving accidents among elderly people, and some states now require that doctors report people with Alzheimer's disease to their state motor vehicle department. However, in many cases, it is up to the person's family and friends to ensure that the person does not drive. 2. 7. 5How the local authority assesses need Local authority social services departments are the main providers of care and support services. If a person with dementia or their carer is in need of support, they should contact the local social services department to explain. The department will then carry out an assessment of the person's needs and identify what services would be appropriate to meet those needs. This is known as a community care assessment If the department assesses a person as being in need of certain services, it has a duty to provide the services that fall within their eligibility criteria (locally set rules on what type of needs the local authority will meet). The person may have to contribute towards the cost of these services. Local authorities can provide services directly themselves, or may make arrangements for private or voluntary-sector organizations to provide care on their behalf. Services ary from area to area, but range from those that allow someone to remain independent in their own home (such as meals on wheels, day care, equipment and home adaptations) to residential care. The views and preferences of the person receiving the service should always be taken into account. 2. 7. 6Care plans If, after assessing the person's care needs, the social services department agrees that certain services should be provided, it will give the person a written care plan out lining these services. This applies whether the person lives at home or in a care home. Care plans should be reviewed regularly and as needs change. If a review has not been carried out recently, or if one may be necessary, the person or their carer should contact social services and ask for a review. In addition, care homes must provide an individual care plan for each resident. This must be regularly reviewed to take account of changing needs. 2. 7. 7Thinking through the options Once the social services department has confirmed what services the person is eligible to receive, the person and their carer can begin to think through the options. Even if the assessment concludes that the person's needs are not yet urgent enough to receive help from social services, or if some services are not available under the local authority's eligibility criteria, an assessment will give everyone clearer information about the situation and the kinds of help available from other sources. The person or their family or carer could arrange services themselves, or through a voluntary organization or private agency. A key decision is whether the person can remain in their own home, or whether they would prefer to move into sheltered housing or a care home. If they stay in their own home, there are many additional support options available. It is also important to consider the financial implications of the options available. Social services should be able to give an idea of how much the person will have to pay towards the costs of the various services that are arranged through them. Services provided by the NHS, such as community nursing, are free. Anyone who is arranging services themselves, whether through a voluntary organisation or a private agency, will need to make their own enquiries. It is important not to rush into a decision. It might help to also talk to friends and relatives, other carers and your local Alzheimer's Society branch. Local voluntary organisations are a source of further information, advice and practical help. Below is some guidance about what to consider when you are thinking about the kind of care the person in question needs. 2. 7. 8Understanding and respecting the person with dementia It's very important that people with dementia are treated with respect. It is important to remember that a person with dementia is still a unique and valuable human being, despite their illness. If you can understand what the person is going through, it might be easier for you to realise why they behave in certain ways. When a person with dementia finds that their mental abilities are declining, they often feel vulnerable and in need of reassurance and support. The people closest to them – including their carers, health and social care professionals, friends and family – need to do everything they can to help the person to retain their sense of identity and feelings of self-worth. 2. 7. 9Helping the person feel valued The person with dementia needs to feel respected and valued for who they are now, as well as for who they were in the past. There are many things that the people around them can do to help, including: †¢trying to be flexible and tolerant †¢making time to listen, have regular chats, and enjoy being with the person †¢showing affection in a way they both feel comfortable with †¢finding things to do together. Our sense of who we are is closely connected to the names we call ourselves. It's important that people address the person with dementia in a way that the person recognises and prefers. Some people may be happy for anybody to call them by their first name or nickname. †¢Others may prefer younger people, or those who do not know them very well, to address them formally and to use courtesy titles, such as Mr or Mrs. Make sure you explain the person's cultural or religious background, and any rules and customs, to anyone from a different background so that they can behave accordingly. These may include: †¢respectful forms of address †¢what they can eat †¢religious observances, such as prayer and festivals particular clothing or jewellery that the person (or those in their presence) should or should not wear †¢any forms of touch or gestures that are considered disrespectful †¢ways of undressing †¢ways of dressing the hair †¢how the person washes or uses the toilet. Many people with dementia have a fragile sense of self-worth; it's especially important that people continue to treat them with courtesy, however advanced their dementia. †¢Be kind and reassuring to the person you're caring for without talking down to them. †¢Never talk over their head as if they are not there – especially if you're talking about them. Include them in conversations. †¢Avoid scolding or criticising them – this will make them feel small. †¢Look for the meaning behind their words, even if they don't seem to be making much sense. Whatever the detail of what they are saying, the person is usually trying to communicate how they feel. †¢Try to imagine how you would like to be spoken to if you were in their position. †¢Try to make sure that the person's right to privacy is respected. †¢Suggest to other people that they should always knock on the person's bedroom door before entering. If the person needs help with intimate personal activities, such as washing or using the toilet, do this sensitively and make sure the door is kept closed if other people are around. †¢Everyone involved – including the person's friends, family members, carers, and the person with dementia themselves – reacts to the experience of dementia in their own way. Dementia means different things to dif ferent people. There are lots of things you can do to help the person with dementia feel good about themselves. This factsheet offers some suggestions. When you spend time with someone with dementia, it is important to take account of their abilities, interests and preferences. These may change as the dementia progresses. It's not always easy, but try to respond flexibly and sensitively. Dementia affects people's thinking, reasoning and memory, but the person's feelings remain intact. A person with dementia will probably be sad or upset at times. In the earlier stages, the person may want to talk about their anxieties and the problems they are experiencing. †¢Try to understand how the person feels. Make time to offer them support, rather than ignoring them or ‘jollying them along'. †¢Don't brush their worries aside, however painful they may be, or however insignificant they may seem. Listen, and show the person that you are there for them. †¢Make sure that, whenever possible, you inform and consult the person about matters that concern them. Give them every opportunity to make their own choices. †¢Always ex plain what you are doing and why. You may be able to judge the person's reaction from their expression and body language. †¢People with dementia can find choice confusing, so keep it simple. Phrase questions so that they only need a ‘yes' or ‘no' answer, such as ‘Would you like to wear your blue jumper today? ‘ rather than ‘Which jumper would you like to wear today? ‘ †¢Avoid situations in which the person is bound to fail, as this can be humiliating. Look for tasks that they can still manage and activities they enjoy. ive plenty of encouragement. Let them do things at their own pace and in their own way. †¢Do things with the person, rather than for them, to help them retain their independence. †¢Break activities down into small steps so that they feel a sense of achievement, even if they can only manage part of a task. Our self-respect is often bound up with the way we look. Encourage the person to take pride in their appearance, and compliment them on how they look. Make sure that anyone involved in caring for the person has as much background information as possible, as well as information about their present situatio n. This will help them see the person they're caring for as a whole person rather than simply ‘someone with dementia'. It may also help them to feel more confident about finding conversation topics or suggesting activities that the person may enjoy. 2. 8How effective is heath care management? Health care management involves several techniques to cater the needs of the patient. It should be kept in mind that patient is not responsible for the disease and therefore should not be ignored or avoided. With the advancement in technology, different techniques can be used to look after the suffer of this disorder. However, these techniques and ways could only help the victim survive a bit since. Those kinds of dementia which are treatable and such patients have a different perspective and outlook of life as compared to those who are the victims of the untreatable ones. So the care also varies with these two kinds of patients. Effectiveness of the present day health care management system is satisfactory but as said earlier it cannot bring back the life of the victim, however could let him or her survive for few more days with a happy face. 3. DEMENTIA IN UK Following statistics give a clear cut idea about the ratio and proportion of dementia patients in UK: †¢There are currently 700,000 people with dementia in the UK. †¢There are currently 15,000 younger people with dementia in the UK. †¢There are over 11,500 people with dementia from black and minority ethnic groups in the UK. There will be over a million people with dementia by 2025. †¢Two thirds of people with dementia are women. †¢The proportion of people with dementia doubles for every 5 year age group. †¢One third of people over 95 have dementia. †¢60,000 deaths a year are directly attributable to dementia. †¢Delaying the onset of dementia by 5 years wo uld reduce deaths directly attributable to dementia by 30,000 a year. †¢The financial cost of dementia to the UK is over ? 17 billion a year. †¢Family carers of people with dementia save the UK over ? 6 billion a year. †¢64% of people living in care homes have a form of dementia. Two thirds of people with dementia live in the community while one third live in a care home. 4. LIVING WITH DEMENTIA People with dementia have become increasingly involved in the work of the Alzheimer's Society since 2000. Through a national programme called ‘Living with Dementia', people with dementia have been sharing their experiences and knowledge, and raising awareness of dementia at local and national levels. This contribution is crucial to ensure that the Alzheimer's Society develops appropriate information and support for people with dementia. It ensures that people with dementia can influence the work that the Society carries ut on their behalf. On a national level the Living with Dementia programme consults with people with dementia in support of the Alzheimer's Society's work of influencing government policy. †¢People with dementia in action People with dementia are involved in the Alzheimer's Society in a variety of ways: ? Giving presentations and raising public awareness. ?Organising the unique UK wide convention of people with dementia. ?Lobbying MPs and commenting on government legislation. ?Being interviewed by national press and television. ?Recruiting and inducting new staff at the Alzheimer's Society. ?Helping to make the website easier to use. Developing information for other people with dementia and their families. ?Participating in the national consultative body, the Living with Dementia Working group. These are just a few examples. There are many opportunities in the Living with Dementia programme †¢Living with Dementia Programme Various initiatives in the Alzheimer's Society have focused on ways of supporting people living with dementia. Many started as two year pilots in 2001 and 2002, but are now established as a core part of the Alzheimer's Society activity. Examples of current initiatives are listed below: †¢West Kent Computer project Started in 2001. It supports people with dementia using computer equipment, to find new ways of communicating, pursuing interests and have fun. †¢Living with Dementia presentation skills training For people with dementia. Everyone affected by dementia has their own unique story to tell. Personal experiences and views are a powerful way of raising awareness about dementia, making issues come alive. Training people with dementia to share their experience on TV, press and at meetings, helps to reduce the misunderstanding that surrounds dementia and offers hope to people facing the same situation. Providing key skills enables people to undertake publicity work with confidence. †¢Helpcard for people with dementia Developed in 2007 by people with dementia and piloted by people with dementia. The helpcard enables people with dementia to feel confident, not alone and able to ask for help at anytime. It is very useful in emergency situations, and is an effective communication tool that informs others of a person's circumstances. There are three different designs, with three different options for describing particular situations. †¢National conference for people with dementia The Alzheimer's Society has hosted three conferences for people with dementia in London, Newcastle and Birmingham (Thompson, Nanni & Schwankovsky, 1990). The latter two involved members from the Living with Dementia Working group and the Scottish Dementia Working Group, making them the only UK wide events for people with dementia. In Newcastle the ‘Improving Our Lives' feedback included: ?Get out and enjoy life ?Laugh! Confidence ?Remaining the same person after diagnosis ?Open positive communication ?Speak up – have your voice listened to ?Speak to your MP Being denied treatment – medication because of a ‘cost cutting' exercise – it's a disgrace ? Set up an email group ?Done more since having dementia – living my life to the full 5. RESEARCHES Currently, scientists are conducting research on many different aspects of dementia. This research promises to improve the lives of people affected by such symptoms and may eventually lead to ways of pre venting or curing the disorders that result in dementia. Some areas of focus for dementia research include: †¢Causes and prevention †¢Diagnosis †¢Treatment. Researching the Causes and Prevention of Dementia Research on the causes of Alzheimer's disease (and other disorders that are causes of dementia) includes studies of: †¢Genetic factors †¢Neurotransmitters †¢Inflammation †¢Factors that influence programmed cell death in the brain †¢The roles of tau, beta amyloid, and the associated neurofibrillary tangles and plaques in Alzheimer's disease. Some other dementia research scientists are trying to determine the possible roles of cholesterol metabolism, oxidative stress (chemical reactions that can damage proteins, DNA, and lipids inside cells), and microglia in the development of Alzheimer's disease. Current research on dementia prevention and causes includes the following: †¢Research to better understand the role of aging-related proteins (such as the enzyme telomerase) in the development of dementia. †¢Studies of abnormal clumps of proteins in cells. Researchers are trying to learn how abnormal clumps of protein in cells develop, how they affect cells, and how the clumping can be prevented. †¢Studies that examine whether changes in white matter — nerve fibers lined with myelin — may play a role in the onset of Alzheimer's disease. Myelin may erode in Alzheimer's disease patients before other changes occur. This may be due to a problem with oligodendrocytes, the cells that produce myelin. †¢Work being done by scientists to search for additional genes that may contribute to Alzheimer's disease. These researchers have identified a number of gene regions that may be involved in the development of Alzheimer's. Some researchers suggest that people will eventually be screened for a number of genes that contribute to Alzheimer's disease and that they will be able to receive treatments that specifically address their individual genetic risks. However, such individualized screening and treatment is still years away. †¢Studies on insulin resistance. Insulin resistance is common in people with Alzheimer's disease, but it is not clear whether the insulin resistance contributes to the development of the disease or if it is merely a side effect. †¢Several dementia research studies have found a reduced risk of dementia in people who take cholesterol-lowering drugs called statins. However, it is not yet clear if the apparent effect is due to the drugs or to other factors. Therefore, more research is being currently being done be better understand this possible relationship between statins and dementia. †¢ A 2003 dementia research study found that people with HIV-associated dementia have different levels of activity for more than 30 different proteins, compared to people who have HIV but no signs of dementia. The study suggests a possible way to screen HIV patients for the first signs of cognitive impairment, and it may lead to ways of intervening to prevent this form of dementia. Research in this area continues. Research Involving Diagnosis of Alzheimer's Disease Improving early diagnosis of Alzheimer's disease and other disorders that may cause dementia is important not only for patients and families, but also for researchers who seek to better understand the causes of dementia and find ways to reverse or halt them at early stages. Improved diagnosis can also reduce the risk that people will receive inappropriate treatments. †¢In some resea rch, scientists are investigating whether three-dimensional computer models of positron emission tomography (PET) and magnetic resonance imaging (MRI) can identify brain changes typical of early Alzheimer's disease, before any symptoms appear. This research may lead to ways of preventing the symptoms of Alzheimer's disease. †¢One study found that levels of beta amyloid and tau in spinal fluid could be used to diagnose Alzheimer's disease with an accuracy of 92 percent. If other studies confirm the validity of this test, it may allow doctors to identify people who are beginning to develop the disorder before they start to show dementia symptoms. †¢This would allow treatment at very early stages of the disorder, and may help in testing new treatments to prevent or delay symptoms of the disease. Other researchers have identified factors in the skin and blood of Alzheimer's disease patients that are different from those in healthy people. They are trying to determine if these factors can be used to diagnose the disease. Treatment Research †¢Researchers are continually working to develop new drugs for Alzheimer's disease and other causes of dementia. Many researchers believe a vaccine that reduces the number of amyloid plaques in the brain might ultimately prove to be the most effective treatment for Alzheimer's disease. In 2001, researchers began one clinical trial of a vaccine called AN-1792. The research study was halted after a number of people developed inflammation of the brain and spinal cord. †¢Despite these problems, one patient appeared to have reduced numbers of amyloid plaques in the brain. Other patients showed little or no cognitive decline during the course of the study, suggesting that the vaccine may slow or halt the disease. Researchers are now tryi ng to find safer and more effective vaccines for Alzheimer's disease. Researchers are also investigating possible methods of gene therapy for Alzheimer's disease. In one case, researchers used cells genetically engineered to produce nerve growth factor and transplanted them into monkeys' forebrains. The transplanted cells boosted the amount of nerve growth factors in the brain and seemed to prevent degeneration of acetylcholine-producing neurons in the animals. †¢This suggests that gene therapy might help to reduce or delay symptoms of the disease. Researchers are now testing a similar therapy in a small number of patients. Other researchers have experimented with gene therapy that adds a gene called neprilysin in a mouse model that produces human beta amyloid. They found that increasing the level of neprilysin greatly reduced the amount of beta amyloid in the mice and halted the amyloid-related brain degeneration. They are now trying to determine whether neprilysin gene therap y can improve cognition in mice. †¢Since many studies have found evidence of brain inflammation in people with Alzheimer's disease, some researchers have proposed that drugs that control inflammation, such as NSAIDs, might prevent the disease or slow its progression. Studies in mice have suggested that these drugs can limit production of amyloid plaques in the brain. Early studies of these drugs in humans have shown promising results. †¢However, a large NIH-funded clinical trial of two NSAIDs (naproxen and celecoxib) to prevent Alzheimer's disease was stopped in late 2004 because of an increase in stroke and heart attack in people taking naproxen (Aleve ®, Naprosyn ®, Anaprox ®, Naprelan ®), and an unrelated study that linked celecoxib (Celebrex ®) to an increased risk of heart attack. Some research studies on dementia have suggested that two drugs, pentoxifylline and propentofylline, may be useful in treating vascular dementia. Pentoxifylline improves blood flow, while propentofylline appears to interfere with some of the processes that cause cell death in the brain. †¢One research study is testing the safety and effectiveness of donepezil (Aricept ®) for treating mild dementia in patients with Parkinson's dementia, while a nother is investigating whether skin patches with the drug selegiline can improve mental function in patients with cognitive problems related to HIV. . CONCLUSION An appropriate cost effective workup of dementia includes a complete history, a complete physical examination (including a neuropsychiatric evaluation), a CBC, blood glucose, serum electrolytes, serum calcium, serum creatinine, and serum thyroid stimulating hormone (Whitlatch, Feinberg & Tucke, 2005). Other tests should be done only if there is a specific indication for e. g. vitamin B12 and folate if macrocytosis is present (Wilkinson & Lennox, 2005). A CT or MRI should be considered if the onset of dementia is before the age of 65 years, symptoms have occurred for less than 2 years, there is evidence of focal or asymmetrical neurological deficits, the clinical picture indicates normal pressure hydrocephalus, or there is a recent history of fall or other head trauma. If a patient has a history of cancer or is on anticoagulation therapy, then neuro imaging should also be considered. Thus to conclude, it is sufficient to say that dementia, though a dangerous disorder, having not much cures, can be prevented by undergoing certain precautionary measures as illustrated above.

Wind Turbine Design and Construction Lab Report

Wind Turbine Design and Construction - Lab Report Example In its very basic nature, the wind turbine consists of the rotating blades, a component that points the turbine to the wind, a system to convert the mechanical rotation of the blades into other forms of energy, the control system, as well as the start and stop mechanisms. There are two main wind turbine designs, the horizontal axis and the vertical axis designs (Spera, 2009). Specifications of the Wind Device For this project, the horizontal axis wind turbine (HAWT) is considered. The horizontal axis machine is preferred due to the fact that less cost is incurred in the foundation (as a fraction of the total cost) of the structure compared to its vertical axis counterpart (Veritas, 2001). This essentially makes HAWT cheaper in cost. The design is also preferred since it does not need to be pointed at the wind direction especially where the wind direction varies almost constantly. The wind turbine is expected to operate at room temperatures (between -200C to 400C). Operating beyond these temperatures may cause the wind turbine generator to work inefficiently or cause structural damage. Furthermore, at extremely low temperatures, the generator may need external power to internal heating. The wind turbine should be ale to work efficiently at different wind speeds and directions. Very high wind speeds (beyond the survival speed) often lead to wind turbine damages according to Veritas (2001). In order to reduce the speed of rotation, a mechanical (disc) braking system will be used. The design will take into consideration the three modes of operation of the turbine; beyond rated speed, around rated speed and below rated speed operations. In order to ensure that the wind turbine operates efficiently at different wind directions, a wind vane will be fitted at the rear of the devices. The vane which also forms the tail of the wind turbine is made of a thin steel plate welded to a slender metal strip. Steel is suitable for its strength and low cost. According to past studies, the mass of a wind turbine for the survivable wind speed is best proportional to the blade length cubed (Stiesdal, 1998). The square of the blade length is also proportional to the power of the wind tha t is intercepted by the turbine (Stiesdal, 1998). The Rotor Unit As a matter of fact, the most visible and most vital part of the wind turbine is the bladed rotor. The rotor is the part that transforms wind energy into mechanical energy. This energy in turn causes the rotation of the turbine’s main shaft. The turbine blade is designed in such a way as to allow the streamlined flow of wind, the material at best remaining inflexible. Considering this need, the blades will be made of steel sheets. The thickness, twist and width of the blade is a compromise between the need for strength and for the streamline flow of wind (Stiesdal, 1998). Considering that the more the number of blades the greater the aerodynamic efficiency but with reducing return, the turbine to be constructed will have three blades. The transmission system The transmission system of the wind turbines acts as the link between the rotor system and the generator. The transmission system of the wind turbine is bas ically presented in the following figure. Fig. Transmission system The hub is made of cast iron. The complicated shape of the hub makes casting the most appropriate method for its production according to Stiesdal (1998). The material for the hub is cast iron, the material’s desirable property being its high resistance to fatigue. For such a small turbine, normal cast iron, although the material is fragile and may fracture if exposed to extreme blasts. Fig: The Wind turbine hub The main shaft of the wind turbine is commonly made of hardened steel that is tempered. For this project, hardened steel will

Vendor Managed Inventory Essay Example | Topics and Well Written Essays - 1000 words

Vendor Managed Inventory - Essay Example It is therefore inevitable to discard inventory with low turnover rates because the above fixed costs will have to be paid for whether or not the product has been sold. Asset management is a very important concept in finance. Any businessman should practice better working capital management. The levels of stock, debtors and cash must be balanced appropriately. From the above, for instance, it is practicable to invest $2,500 compared to $10,000 because when the stock is converted into cash, it could have generated some interest. But even though by going with the last option i.e. buying $2500 worth of inventory would be preferable as the approach suffers from one setback. I.e. the purchaser will have to forgive quality discounts by virtue of buying in bulk. However, consistently, we may apply the inventory turnover formula, as its usefulness will depend on how we have cost/valued our inventory. Stock can be valued on FIFO, LIFO or weighted average method. To get a reliable rate, then we must be consistent on how we value of inventory as some methods will over cash them while others will under cash the stock making the resulting conclusions to be misleading. The inclusion of the cost of goods sent to branches is also tricky if those other branches are in foreign states and operate in foreign currencies and yet the financial operators need be reported in reporting entity. Translations will then have to be made for the foreign operation back to the reporting entity's currency. But despite the criticism to this technique, inventory turnover is a very instrumental tool for decision making. One will be able to gauge on where to invest and disinvest in case of a low inventory turnover rate. Ajax Chemical's Existing Inventory A problem would arise when the vendor gives the consumer some money in advance before the products are sold. The products would either fetch low returns or no returns at all. The customer's inventory would again require to be maintained, distinguishing them from the other stock. This would mean additional labor costs. The return on this investment would then be too low for the vendor. May be it could be advisable for the vendor to monitor the sales patterns and know which product have a higher turnover rate that can give full credit on them, for the others with a moderately fair or no turnover rate, he should apportion his credit accordingly. For example, by pegging is as a percentage of the turnover rate. For example, a credit of $2,000 of the product's turnover rate is 100% while on the other hand a credit of $1,400 of the product's turnover rate is 70%. Ignoring of critical stock (Repair Parts) To avoid stock-outs, and make Vendor managed inventory succeed, the vendor must in his premises maintain a buffer/safety stock. Running out of stock is costly and a considerable safety stock need be maintained. But important also is the fact that this buffer stock shouldn't be too high as this would consequently catapult the stockholding costs to higher levels.Vendor managed inventory is a situation whereby a customer enters into a contract/agreement with a vendor for the latter to procure and store goods for him in his premises so that the customer can continue buying from him frequently and a lower

Case 5.1 MERCK ACQUISITION OF MEDCO Research Paper

Case 5.1 MERCK ACQUISITION OF MEDCO - Research Paper Example avings, whereby a company paying higher taxes because of high income can acquire another firm with accumulated losses, which after the acquisition will reduce the overall taxable income and tax liability. The other advantage of acquisition is that it allows the company to achieve short term growth. The target would benefit from the predator since, in most cases, predators are well-established companies; thus fasten the growth of the target (Finkelstein, 2010). Asset backing is another merit behind the acquisition. For instance, Merck would benefit from the well-established database set up by Medco and would allow Merck to achieve its objectives by using these valuable resources, which would be acquired from the target company Medco. Therefore, the decision to buy Medco Containment Services by Merck, and Company should be driven by the above factors. One of the major forces driving the acquisition of Medco Containment Services by Merck and Company is the growth in the managed health care, which has been contracted by the managed health care organization to Medco Containment Services. Managed health care is a new phenomenon in the health care industry and the health expert (Kolassa & Greg, 2012) predicts that by the end of the current century, at least 90% of the Americans will have the cost of their drugs included in some managed health care plan. Besides, at least 60% of all the outpatient medicine will be able to be purchased by the managed health care programs (Merck and Company Inc., 2002). Therefore, the planned acquisition of Medco Containment Services by Merck and Company would be timely since it would allow the predator to benefit from these lucrative business deals being enjoyed by the Medco Containment Services. As such, a substantial beneficial synergy would be created since Merck and Company is the manufacturer of dr ugs and Medco Containment Services manages the insurance claims, hence will encourage patients to utilize cheap generic substitute drugs

Physics homework Math Problem Example | Topics and Well Written Essays - 500 words

Physics homework - Math Problem Example Thus as boat 1 is displacing more volume of water than boat 2, it has a higher buoyancy force subjected upon it. Clearly, this is evident from the fact that boat 1 is afloat whereas boat two is sunken. 2. The volume of the given ice cube of 10cm dimensions is 1000cm3. It is given that when the ice cube is floating in pure water, 1cm of it is sticking up above the surface of the water. This shows that the weight of the water displaced by the 9cm thick portion of water is equivalent to the weight of the ice cube. The 9cm thick portion has a volume of 9cm*10cm*10cm i.e. 900cm3. The weight of 900cm3 of pure water is equivalent to 1000cm3 of ice. If we suppose the density of liquid water to be 1g/cm3, then we have 900g of liquid water equivalent to 1000cm3 of ice. This gives us a density of ice as 0.9g/cm3, which is approximately equal to the real value of density of ice (~0.91g/cm3). When the excess 1cm thick part is cut off, the remaining portion of ice has a volume of 900cm3. The weigh t of 900cm3 of ice is 0.9g/cm3*900cm3 i.e. 810g. Now, for liquid water, the volume of water that needs to be displaced to have the same weight as that of the ice is 810cm3 (810cm3*1g/cm3 = 810g). This means that only 810cm3 of the total 900cm3 of the remaining ice will get immersed in water. The rest 90cm3 volume will remain above the water level.

Macro Economis - Essay Example | Topics and Well Written Essays - 2000 words

Macro Economis - - Essay Example Macroeconomics As noted above, this present paper is based on the concept of macroeconomics, which has been described by Bauman and Klein (2011) as the branch of economics that majorly deals with the wider perspective of the national economy rather than a single segment of the economy. With reference to the writings by Mankiw (2011, p23) macro-economic is stated as â€Å"a branch of economics that focus on the trends and movements in the entire economy,† and some of these movements and trends concern employment, inflation, price levels, rate of growth, national income, and gross domestic product of a particular country, or region/ economic block. In comparison to the other branch of economics, Chung et al. (2007) stated that microeconomics mainly focus on smaller aspects of the economy such as the behaviour of consumers and business organisations, and how this affects quantities and prices within a particular market. According to Buiter (2010), even thou the field of macroecon omics is broad, it largely focuses on two critical areas of studies, which include the study on the causes and repercussions of short-run business cycles on the national income and the study on determinants of long-run economic growth. Dale et al. (2010) stated that usually the central government as well as the large corporations, utilise macroeconomic forecasts and models primarily to develop and evaluate economic policies and business strategies. Macroeconomic objectives In the previous sub-section, it was stated that macroeconomics is simply a branch of economics that focuses on the wider aspect of the economy; however, Keynes (2011) further added that macroeconomics also concerns itself with the conscious and deliberate management of economic variables within an economy in order to attain certain objectives. It is of essence to note that macroeconomics relies on three critical policies to attain its objectives, and these policies include the monetary policies, fiscal policies an d supply-side policies. Monetary policies are defined by Krugman and Wells (2009), as measures that are adopted by the central government through the central bank in order to increase or decrease the supply of money in circulation while fiscal policies are the policies of the central government, which focus on the country’s budget and especially issues pertaining to borrowing and taxation. As for supply-side policies, they are mainly devised to ensure that the market works efficiently. According to the writings by Bauman and Klein (2011), they wrote that the top objectives of macroeconomics include price stability, exchange stability, full employment, growth of the economy, and the balance of payment equilibrium. a) Price stability According to Buiter (2010), the maintenance of price stability is crucial to the national economy because higher price levels contribute to various problems pertaining to consumption, distribution, exchange, and production. For example, inflation d istorts economic calculations as well as expectations and it generates varying problems in different sections of the economy. Moreover, Buiter (2010) stated that during inflation creditors lose while debtors gain. Furthermore, inflation strains the relationship between capital and labour, and the distribution of national income becomes

Wind Farm Development in the United Kingdom Essay

Wind Farm Development in the United Kingdom - Essay Example This research will begin with the history of wind farm development in the United Kingdom. Wind farm development in the United Kingdom owes its influence to a few litigations. Among them is the Kyoto Protocol, which legally binds, the United Kingdom to its treaty of reducing greenhouse gases emission. There are a number of recommendations the treaty offers to this effect, but the United Kingdom has made significant steps in energy harnessing from the sun, water and wind. By the beginning of 2012, United Kingdom had the capacity of producing close to 1000 mega watts worth of solar energy. Meanwhile, water mainly generates hydroelectric power with estimated potentials of 5000Gkh. The other factor is the situation in MENA countries. Fossil fuels are the most widely used sources of fuel even in the United Kingdom. The Middle East and Northern African countries are the greatest producers of oil in the world but at the same time prone to political and economic instability. In this regard, w hatever economic or civil situation purges MENA countries, affects the state of oil production. A good example of political instability is the recent rebellion of citizens against dictator leaders in Libya, Egypt and Tunisia. This makes relying on fossil fuels such as oil and biogas tricky. Then, there is the fact that use of fossil fuel leads to production of green house gases reducing the use of oil even further. The United Kingdom sees the need to find a source of fuel that is reliable – not dependant on factors such as political instability, non pollutant and easy to produce. ... Since there got some progress in wind farms establishment and subsequent production of wind energy, a lot had to be done (Mackay 2009, p. 79). The year 2009 saw the establishment of 211 of fully functional wind farms. There is a steady progress in wind farm development across the country. For the year 2012, the aim is to increase offshore wind production capability by building at least five wind farms with a potential capacity of producing 1300 mega watts of electricity. This will be a much welcomed addition to the current 6,580 megawatts produced by the 333 fully functional wind farms across the country. Examples of functional wind farms in the U.K include the Burbo Bank wind farm, Scroby Sands and the largest offshore wind farm in the world, Thanet wind farm at the coast of Kent. The government’s commitment to these projects is clear from the current budget allocation of over five hundred million pounds to offshore wind farms (Julia 2006, p. 103). Wind farm development has a large ecological impact both positively and negatively. Positive Ecological impact, of wind farm development in the U.K: Unlike other sources of energy, wind power does not require the use of another fuel or water for it to be produced. This ensures that when producing wind energy one does not require exploiting other sources of fuel (Dragoon 2010, p. 87). Wind power does not produce air pollution during production essentially making it a clean source of energy (Boyle 2004, p. 34). Building wind farms, therefore, means there will be less air pollution; this will give the environment ample time to disintegrate the already existing green house gases in the atmosphere. Studies indicate that, since the embrace of wind energy use, carbon dioxide emissions have reduced

An investigation of public health responses to diabetes Essay

An investigation of public health responses to diabetes - Essay Example This results in increased amounts of sugar in the blood, causing complications usually involving the heart and kidneys. (Wikipedia, 2011) There are three main types of Diabetes. Type 1 Diabetes, or insulin-dependent diabetes, occurs when the pancreas fails to secrete insulin, thus the glucose taken in from food cannot be broken down. The result is a buildup of sugar in the blood that causes complications like kidney failure, retinopathy, heart failure, and hypertension. A patient with this condition requires artificial insulin to be injected regularly in order to control the blood sugar levels. Type 2 Diabetes, or non-insulin dependent diabetes, is similar. In this case, the pancreas is able to secrete small amounts insulin, but the body’s cells cannot receive it. The result is identical. The sugar builds up in the bloodstream, and causes the above complications. The third type is Gestational Diabetes. This occurs in pregnant women only. During pregnancy, the overworked body o f the mother is unable to secrete the excess insulin required, leading to increased blood sugar levels. Women with gestational diabetes are most likely to have large babies. Diabetes is caused by different factors. Obesity is a big predisposing factor. In obese persons, insulin is less able to facilitate the entry of glucose into the liver and adipose tissues. In addition, fat buildup presents a suitable environment for circulatory overload. As sugar builds up in the blood, the density and concentration gradient increases, making the blood thick and viscous. This prevents it from properly circulating around the body. And because the hands and feet are the furthest from the pump center, the heart, they receive the least amount of blood. Lack of nutrients from the blood kills the tissue surrounding the area. Eventually, the hand or food necrotizes, or dies, leaving amputation as the only solution. Not surprisingly, most amputees are a result of Diabetes Mellitus. Heredity also plays a big role. If one of your ancestors or family members had a health history of diabetes, you have more chances of acquiring it, and as you age these chances increase. In spite of all these, the principal factor is a sedentary lifestyle. When your body lacks enough exercise, the heart pumps less blood to the extremities, causing tissue death. (Black, 2001) Classic signs and symptoms of Diabetes are increased thirst, increased hunger, and frequent urination. The thirst occurs when the body mistakes the concentration of sugar in the blood for lack of water, thus it triggers the thirst center in the brain, causing the person to drink more water, which in turn causes him to urinate more. The hunger occurs because the cells cannot utilize the sugar and nutrients, causing them to â€Å"starve†. The body interprets this as lack of food; hence, the person eats more and more. Increase of blood sugar also affects the eyes. Absorption of glucose causes the lens to change shape, resulting in vision changes. The heart usually suffers the most. Because of an increased workload, the heart muscles grow, causing cardiomegaly. As this progresses, the heart, out of exhaustion and overwork, eventually gives up and stops pumping, causing heart failure, and death. Heart attacks are common in chronic high blood pressure. Kidney failure also occurs. The main job of the kidneys is to remove waste from the blood and return the cleaned blood back to the body. In diabetes, the high levels of sugar damage the nephrons, the

HRD 495 Essay Example | Topics and Well Written Essays - 750 words - 1

HRD 495 - Essay Example Fourth is being a capacity builder in order to do culture and capability audits of the organization. Fifth is being a strategic positioner which involves constructing HR reactions that are in line with the external requirements (Jackson, Schuler & Werner, 2012). With the changes in the nature of business, there has been a refocusing and expanding in HR roles. In order to meet the expectations of organizations, senior HR leaders have to react by recognizing and acquiring the competencies necessary for their dynamic functions. The major additional competencies required by senior HR leaders are leading change, strategic thinking and effective communication. Strategic human resource management is formulated to aid companies in meeting the various needs of their employees while also promoting company goals. SHRM is a component that is valuable in ensuring organizational success as it helps in attaining a competitive edge as pertains to flexibility, cost and quality. It is therefore necessary for SHRM to include the individuals that the organization is involved in business with. It is through them that sustainability can be attained by creating values that could not be implemented by indirect and direct competitors. Organizational success could also be attained by continuous investment by an organization in its image or reputation, emphasizing on the need for sound HR practices and policies and adjusting them with the business strategies through SHRM. Therefore, SHRM is not merely a strategy that is centered on the organization’s human aspect but is a holistic approach which builds on the human asset as value-creating factors (Ivan cevich, 2010). It is an employer’s aim to hire the best person for a particular job irrespective of their age. There have been a lot of misconceptions regarding hiring older workers pertaining to productivity, health, up-skilling, and blocking

Googles Mission and Values, an Analysis Essay Example for Free

Googles Mission and Values, an Analysis Essay Google is a 21st century company even though it was founded in 1998 with a simple mission statement; Google’s mission is to organize the world‘s information and make it universally accessible and useful (Google Inc, Quick Profile, 2010,  ¶ 1). Google has one vision: to accomplish it mission by providing the best web based services to its end users. According to the Google on its corporate website, there are ten things they (Google) know to be true that are the keys to their success (Google Inc, Our Philosophy, 2010,  ¶ 4-17) 1.Focus on the user and all else will follow 2.Its the best to do one thing really, really well. 3.Fast is better than slow. 4.Democracy on the web works. 5.You dont need to be at your desk to need an answer. 6.You can make money without doing evil. 7.Theres always more information out there. 8.The need for information crosses all borders. 9.You can be serious without a suit. 10.Great just isnt good enough. What does all this mean in relation to the espoused values and vision of the company? This question requires a closer look. History What a grand endeavor founders Larry Page and Sergey Brin undertook when they founded Google. Googles mission statement seems almost untenable. Both the founders are brilliant engineers and in light of the advancement of technology and their pension for understanding algorithmic math, they built the first Google search engine. Little did they know how the grand ideals encapsulated in Googles mission statement could really change the face of the world in which we live, based on the computer coding to search the web more efficiently, but how did that happen? Before Google, from 1994 to 1997 web search was hit or miss using such services as MOSAIC, Wandex, Webcrawler, Infoseek, Lycos, Altavista, Magellan, Excite, Inktomi, Ask Jeeves, Northern Light Snap, Yahoo, and other smaller search engines. In 1998, that changed with the Google algorithm (Viney, 2008). Once Google was unleashed into the wild of the World Wide Web, it quickly took its place at the top of the search engine services as the best. To give credence to this fact the very name of the company has become a verb. Very few that live in a wired world have not heard the phrase Google it in relation to finding an answer on the internet. Google was so far ahead of its times even James Jenny, reviewer of the book by Jeff Jarvis What would Google Do? states I realized I was reading a glimpse of the future after gaining an understanding of Googles grand goal, its mission, organizing the worlds information (Penny, 2010, pg 810). Philosophy Googles founders simply had an understanding of what could be and found a means to try to accomplish it. They idealized that the world would be a better place if everyone, yes everyone, had access to the same information. A capitalism comparison seems appropriate here since it is based on the precept that the best minds can create the best product and that product will win the market. Google did just this in its creation and it has not only revolutionized the world of internet search, it has begun to see it mission statement to fruition. In the minds of the founders, free information leads to better ideas and actions for all of humanity. Better ideas that will lead overall to a better planet lead by the best thinkers that have the most influence over the direction of industry, politics, and other world opinions, all based on the precept of an unlimited worldview of information that is unlike the education systems in place today in most classrooms. Google espouses the possibility of an education that is not myopic from the point of view of a countrys agenda as can be seen in the teaching of Tiananmen Square in China where none of the textbooks and public media will show the atrocities that happened that day in 1989 as just one example (Richelson and Evans, 1999). Analysis So how has Google fulfilled its vision, mission, and the edicts of it companys culture? The answer is not simple and it would require a PHD dissertation to delve into Googles proposed failures, but even longer, to qualify and quantify its impact of the good it has brought to the world as a whole. It does seem prudent to quickly point out a few of it missteps. A couple of examples are: 1.Google Buzz a Twitter like clone had unintentional consequences for Gmail users because it shared personal information by default with everyone in the users contact list without the consent of the Gmail user. 2.Google Wave was an attempt to redefine email. However, recently Google decided not to continue development due to lack of interest by its end users. All of this has been possible due to Google’s corporate culture that encourages its employees to communicate freely, innovate constantly, and requires that 20% of every employee’s work week be spent working on personal projects without the direction or oversight of management. Gmail came from this directly as did Buzz and Wave. Even Google’s communication with the rest of the world is open and direct. In a recent blunder by Google’s street view project, individuals’ personal information was collected by Google which in some cases included entire emails, passwords, and other data that was inadvertently broadcast by individuals’ unsecured wifi routers. In response to this Google admitted in earnest that it had done so, but that it did not mean to do it and made every attempt to correct the problem. They were up front enough that even the FTC â€Å"forgave† Google for this unintended trespass after they investigated the issue (Forbes, 201 0). Conclusion Overall Google has lived up to its mission and values, both internally and externally. It allows its employees to spread their wings, work in an open environment that promotes ingenuity, and encourages open communication. Google also communicates openly with world governments and humanity as a whole. Even in the wake of Google becoming a public company, it has not lost sight of what makes it special. Google indeed lives up to the ideals it espouses in all respects.

Study Effectiveness Of Nebulization Improving Childrens Respiratory Status Nursing Essay

Study Effectiveness Of Nebulization Improving Childrens Respiratory Status Nursing Essay Data analysis is the systematic organization and synthesis of research data and testing of research hypothesis using those data. Interpretation is the process of making sense of the result and examining their implication (Polit, 2004). Analysis is the method of rendering qualitative data meaningful and providing intelligible information, so that the research problem can be studied and tested, including the relationship between the variables. The study was conducted among children with wheezing to compare the effectiveness of nebulization with oxygen and without oxygen in improving their respiratory status. The data was collected, assembled, analyzed and tested and the findings based on the analysis are presented in this chapter. 4.1 Demographic Variables of Children with Wheezing: The age of the children with wheezing ranged between one month to five years. Out of this, 8 (16%) children were between the age group of one month to one year, 17 (34%) were between 1-3 years and 25 (50%) were between the age group of 3-5 years. Majority of the children were males (62%) and female children were 38%. 34 (68%) children belonged to nuclear family whereas 16 (32%) children belonged to joint family. LPG was used as the cooking fuel in all (100%) the houses (Table 4.1). 4.2 Family History of Smoking Habits: In nebulization with oxygen group, 5(20%) children had the family history of smoking habit. For majority (4) of children, grandfather was the person who smokes and for one child father was the smoking person. In nebulization without oxygen group, fathers of 3(12%) children smoke in the family (Table 4.2). 4.3 Family History of Respiratory Diseases: 5 (20%) children in the nebulization with oxygen group had a family history of asthma, out of which one person is on regular treatment. In nebulization without oxygen group, 5(20%) children had a family history of asthma and 3(12%) had a family history of COPD, out of which one person is on regular treatment (Table4.3). 4.4 History of Respiratory Diseases in Children: With regard to previous history of respiratory diseases, majority (64%) of children had wheeze associated lower respiratory infection (WALRI) in nebulization with oxygen group whereas in nebulization without oxygen group, 15 (60%) children had WALRI, .6 (24%) children had hyper reactive airway disease (HRAD) and 3 (12%) children had asthma in nebulization with oxygen group , whereas in nebulization without oxygen group,7 (28%) children had asthma and 3 (12%) had HRAD (Table.4.4). About the onset of respiratory diseases, 14 (56%) children developed respiratory diseases before 1year of age and 5 (20%) children developed between the age group of 1-2 years in nebulization with oxygen group whereas in nebulization without oxygen group, 10 (40%) children developed before 1year of age and 7 (28%) children developed between 1-2 years of age (Table.4.4). Regarding the duration of the disease, 14 (56%) children had the duration of disease less than a year and 6 (24%) had the duration between1-2 years in nebulization with oxygen group whereas in nebulization without oxygen group, 11 (44%) children had duration of less than 1 year and 8 (32%) had the duration between 1-2 years (Table.4.4). With regard to the regularity of the treatment, 3(12%) children in the nebulization with oxygen group and 6 (24%) children in the nebulization without oxygen group were on regular treatment. All these children were using inhalers. Majority of the children (66.66%) were using a combination of salbutamol -fluticosone inhaler in both groups and the rest (33.33%) were using asthalin alone (Table.4.4). 4.5 Immunization History: All the children (100%) in both groups were completely immunized. 4.6 Pre assessment of Respiratory Parameters in Nebulization with Oxygen Group: The initial assessment of respiratory rate of children in nebulization with oxygen group showed that 6 (24%) children were in mild distress, 6 (24%) children were in moderate distress and 13 (52%) children were in severe distress. In the assessment of oxygen saturation, 20 (80%) children had mild desaturation (95-97% in room air) and 5 (20%) children had moderate desaturation (90-94%in room air).In the initial assessment of wheezing, 12 (48%) children were having wheezing on terminal expiration and 13 (52%) children were having wheezing on entire expiration.The assessment of retraction showed that 16 (64%) children were normal, 8(32%) children had intercostal retractions and 1 (4%) child had intercostal and substernal retractions..In the initial dyspnoea assessment, 5 (20%) children were having mild dyspnoea and 20 (80%) children were normal (Table 4.5). 4.7 Pre assessment of Respiratory Parameters in Nebulization without Oxygen Group: The initial respiratory rate assessment of children in nebulization without oxygen group showed that 10 (40%) children were in mild distress, 8 (32%) children were in moderate distress and 7 (28%) children were in severe distress. In the assessment of oxygen saturation, 22 (88%) children had mild desaturation (95-97% in room air) and 3 (12%) children had moderate desaturation (90-94%in room air). In the initial assessment of wheezing, 17 (68%) children were having wheezing on terminal expiration and 8 (32%) children were having wheezing on entire expiration. Initial retraction assessment showed that 18 (72%) children had intercostal retractions and 7 (28%) children had intercostal and substernal retractions. In the assessment of dyspnoea, 5 (20%) children were having mild dyspnoea and 20 (80%) children were normal (Table 4.6). 4.8 Implementation of Therapies among Children with Wheezing: 4.8.1 Administration of nebulization with oxygen: Nebulization with oxygen was provided to 25 children with wheezing who were prescribed for Combimist nebulization in the OPD. Nebulization was provided by the staff nurse for a period of 15-20 minutes. Children who were on treatment prior to the nebulization were not included in the study. Assessment was done before and after nebulization with oxygen. 4.8.2 Administration of nebulization without oxygen: Nebulization without oxygen was provided by the staff nurse to 25 children with wheezing who were prescribed with Combimist (Salbutamol+ Ipravent) nebulization in the OPD. Nebulization was provided for a period of 15-20 minutes. Children who were on treatment prior to the nebulization were not included in the study. Assessment was done before and after nebulization with oxygen. 4.9: Post assessment of Respiratory Parameters in Nebulization with Oxygen Group: 4.9.1 Post Assessment at 5 Minutes: In the post 5 minutes assessment of respiratory rate of children in nebulization with oxygen group,1 (4%) child reached normal ,7 (28%) children were in mild distress,5 (20%) children were in moderate distress and 12 (48%) were in severe distress. In the assessment of oxygen saturation, 4 (16%) children reached normal saturation, 17 (68%) children had mild desaturation (95-97% in room air) and 4 (16%) children had moderate desaturation (90-94%in room air). Wheeze assessment showed that 1 (4%) child became normal, 13 (52%) children were having wheezing on terminal expiration and 11 (44%) children were having wheezing on entire expiration. In the assessment of retraction, 16 (64%) children were normal, 8 (32%) children had intercostal retractions and 1 (4%) child had intercostal and substernal retractions.In the dyspnoea assessment, 5 (20%) children were having mild dyspnoea and 20 (80%) children were normal (Table 4.5). 4.9.2 Post Assessment at 10 Minutes: In the post 10 minutes assessment of respiratory rate of children,1 (4%) child reached normal ,8 (32%) children were in mild distress,7 (28%) children were in moderate distress and 9 (36%) were in severe distress. Assessment of oxygen saturation revealed that 13 (52%) children were having normal saturation, 11 (44%) children had mild desaturation (95-97% in room air) and 1 (4%) child had moderate desaturation (90-94%in room air). In the assessment of wheezing, 10 (40%) children were relieved from wheezing, 11 (44%) children were having wheezing on terminal expiration and 4 (16%) children were having wheezing on entire expiration. Assessment of retractions showed that 21 (84%) children became normal, 4 (16%) children had intercostal retractions.In the dyspnoea assessment, 22 (88%) children were having no dyspnoea and 3 (12%) children were having mild dyspnoea (Table 4.5). 4.9.3 Post Assessment at 15 Minutes: Post 15 minutes assessment of respiratory rate showed that 5 (20%) child reached normal ,5 (20%) children were in mild distress,9 (36%) children were in moderate distress and 6 (24%) were in severe distress. In the assessment of oxygen saturation, 17 (68%) children reached normal saturation, 8 (32%) children had mild desaturation (95-97% in room air). In the assessment of wheezing, 12 (48%) children were relieved from wheezing, 12 (48%) children were having wheezing on terminal expiration and 1(4%) child was having wheezing on entire expiration. The assessment of retractions revealed that 23 (92%) children became normal, 2 (8%) children had intercostal retractions.Dyspnoea assessment showed that 23 (92%) children became normal and 2 (8%) children were having mild dyspnoea (Table 4.5). 4.9.4 Post Assessment at 30 Minutes: Post 30 assessment of respiratory rate showed that 11 (44%) child reached normal, 7 (28%) children were in mild distress, and 4 (16%) children were in moderate distress and 3 (12%) were in severe distress. In the assessment of oxygen saturation, 19 (76%) children reached normal saturation, 5 (20%) children had mild desaturation (95-97% in room air) and 1 (4%) child had moderate desaturation. In the assessment of wheezing, 14 (56%) children were relieved from wheezing, 11 (44%) children were having wheezing on terminal expiration. The assessment of retractions showed that 24 (96%) children became normal, 1 (4%) children had intercostal retractions. Dyspnoea assessment revealed that 23 (92%) children reached normal and 2 (8%) children were having mild dyspnoea (Table 4.5). 4.10 Post assessment of Respiratory Parameters in Nebulization without Oxygen Group: 4.10.1 Post Assessment at 5 Minutes: Post assessment of respiratory rate showed that 11 (44%) children were in mild distress, 8 (32%) children were in moderate distress and 6 (24%) were in severe distress. In the assessment of oxygen saturation, 1 (4%) child reached normal, 21 (84%) children had mild desaturation (95-97% in room air) and 3 (12%) children had moderate desaturation (90-94%in room air).Assessment of wheezing showed that 2 (8%) children became normal, 15 (60%) children were having wheezing on terminal expiration and 8 (32%) children were having wheezing on entire expiration. In the assessment of retraction, 19 (76%) children had intercostal retractions and 6 (24%) children had intercostal and substernal retractions. Dyspnoea assessment showed that 5 (20%) children were having mild dyspnoea and 20 (80%) children were normal (Table 4.6). 4.10.2 Post Assessment at 10 Minutes: Post 10 minutes assessment of respiratory rate revealed that 4 (16%) children reached normal rate, 10 (40%) children were in mild distress,7 (28%) children were in moderate distress and 4 (16%) were in severe distress. In the assessment of oxygen saturation, 7 (28%) children reached normal, 15 (60%) children had mild desaturation (95-97% in room air) and 3 (12%) children had moderate desaturation (90-94%in room air). Assessment of wheezing showed that 16 (64%) children became normal, 4 (16%) children were having wheezing on terminal expiration and 5 (20%) children were having wheezing on entire expiration. In the assessment of retraction, 22 (88%) children became normal and 3 (12%) children had intercostal retractions. Dyspnoea assessment revealed that, 3 (12%) children were having mild dyspnoea and 22 (88%) children became normal (Table 4.6). 4.10.3 Post Assessment at 15 Minutes: In the post assessment of respiratory rate,9 (36%) children reached to normal rate, 7 (28%) children were in mild distress, 5 (20%) children were in moderate distress and 4 (16%) were in severe distress. The post assessment of oxygen saturation showed that 10 (40%) children reached normal, 13 (52%) children had mild desaturation (95-97% in room air) and 2 (8%) children had moderate desaturation (90-94%in room air). Wheeze assessment at 15 minutes showed that 19 (76%) children became normal, 6 (24%) children were having wheezing on terminal expiration. In the assessment of retraction, 24 (96%) children became normal, 1 (4%) children had intercostal retractions. Evaluation of dyspnoea revealed that 2 (8%) children were having mild dyspnoea and 23 (92%) children were normal (Table 4.6). 4.10.4 Post Assessment at 30 Minutes: Post assessment of respiratory rate showed that 13 (52%) children reached normal rate, 7 (28%) children were in mild distress, 2 (8%) children were in moderate distress and 3 (12%) were in severe distress. In the assessment of oxygen saturation, 10 (40%) child reached normal, 13 (52%) children had mild desaturation (95-97% in room air) and 2 (8%) children had moderate desaturation (90-94%in room air). In the assessment of wheezing, 19 (76%) children became normal, 6 (24%) children were having wheezing on terminal expiration. Assessment of retraction revealed that 24 (96%) children had no retractions, 1 (4%) children had intercostal retractions.Dyspnoea assessment showed that1 (4%) child was having mild dyspnoea and 24 (96%) children became normal (Table 4.6). 4.11 Comparison of Mean Difference of Pre and Post Assessment of Respiratory Parameters in Nebulization with Oxygen Group and Nebulization without Oxygen Group: 4.11.1 Mean Difference of Respiratory Rate in Nebulization with Oxygen Group and Nebulization without Oxygen Group: In nebulization with oxygen group, the pre mean values of respiratory rate was 41.68 and post mean value at 5 minutes was 40.4.Post mean values at 10 minutes was 37.76, at 15 minutes was 35.6 and at 30 minutes was 32.8. The mean difference between pre and post respiratory rate at 30 minutes was 8.88. This shows a significant reduction in respiratory rate after nebulization with oxygen. The pre mean value of respiratory rate in nebulization without oxygen group was 36.64 .The post mean value of respiratory rate at 5 minute was 36, at 10 minutes was 34.32, at 15 minutes was 32.48 and at 30 minutes was 30.96. The mean difference between pre and post respiratory rate at 30 minutes was 5.68. This shows a reduction in respiratory rate after nebulization without oxygen. Therefore, it can be inferred that the mean difference was high in nebulization with oxygen group comparing to nebulization without oxygen group. This showed that nebulization with oxygen is effective in reducing tachypnea among children with wheezing (Table 4.7). 4.11.2 Mean Difference of Oxygen Saturation in Nebulization with Oxygen Group and Nebulization without Oxygen Group: Oxygen saturation above 98% in room air is considered as the normal saturation level. The pre mean value of oxygen saturation in nebulization with oxygen group was 95.24. The post mean value of oxygen saturation at 5 minute was 96, at 10 minutes was 97.24, at 15 minutes was 98.08 and at 30 minutes was 98.32. The mean difference between pre and post oxygen saturation at 30 minutes was 3.08. This shows an improvement in oxygen saturation after nebulization with oxygen. The pre mean value of oxygen saturation in nebulization without oxygen group was 95.72 .The post mean value of oxygen saturation at 5 minute was 95.88, at 10 minutes was 96.68 at, 15 minutes was 97.36 and at 30 minutes was 97.08. The mean difference between pre and post respiratory rate at 30 minutes was 1.36. Therefore, it can be inferred that the mean difference was high in nebulization with oxygen group comparing to nebulization without oxygen group. This showed that nebulization with oxygen is effective in improving the oxygen saturation among children with wheezing (Table 4.7). 4.11.3 Mean Difference of Wheeze Score in Nebulization with Oxygen Group and Nebulization without Oxygen Group: Auscultation of normal vesicular breath sounds is considered as normal. The pre mean value of wheeze score in nebulization with oxygen group was 1.52. The post mean value of wheeze score at 5 minute was 1.4, at 10 minutes was 0.72, at 15 minutes was 0.56 and at 30 minutes was 0.44. The mean difference between pre and post wheeze score at 30 minutes was1.08. This showed an improvement in wheeze score after nebulization with oxygen. The pre mean value of wheeze score in nebulization without oxygen group was 1.32. The post mean value of wheeze score at 5 minute was 1.12, at 10 minutes was 0.56, at 15 minutes was 0.24 and at 30 minutes was 0.24. The mean difference between pre and post wheeze score at 30 minutes was 1.08. This showed that there was no mean difference in wheeze score in nebulization with oxygen group and nebulization without oxygen group. Hence, nebulization with oxygen and nebulization without oxygen has similar effect in reducing wheeze score among children with wheezing (Table 4.7). 4.11.4 Mean Difference of Retraction Score in Nebulization with Oxygen Group and Nebulization without Oxygen Group: Observation of normal chest movements is considered as normal. In nebulization with oxygen group, the pre mean value of retraction score was 0.4. The post mean value of retraction score at 5 minute were 0.4, at 10 minutes was 0.16, at 15 minutes was 0.08 and at 30 minutes was 0.04. The mean difference between pre and post wheeze score at 30 minutes was 0.36. This showed an improvement retraction score in nebulization with oxygen group. The pre mean value of retraction score in nebulization without oxygen group was 0.28. The post mean value of retraction score at 5 minute was 024, at 10 minutes was 0.12, at 15 minutes was 0.04 and at 30 minutes was 0.04. The mean difference between pre and post retraction score at 30 minutes was 0.24. This showed that there was no mean difference in retraction score in nebulization with oxygen group and nebulization without oxygen group. Hence, nebulization with oxygen and nebulization without oxygen has similar effect in reducing retraction score among children with wheezing (Table 4.7). 4.11.5 Mean Difference of Dyspnoea Grade in Nebulization with Oxygen Group and Nebulization without Oxygen Group: Grade 0 is regarded as absence of dyspnoea. In nebulization with oxygen group, the pre mean value of dyspnoea grade was 0.2. The post mean values of dyspnoea grade at 5 minute were 0.2, at 10 minutes was 0.12, at 15 minutes was 0.08 and at 30 minutes was 0.08. The mean difference between pre and post dyspnoea grade at 30 minutes was 0.12. This showed an improvement in dyspnoea grade in nebulization with oxygen group. The pre mean value of dyspnoea grade in nebulization without oxygen group was 0.2. The post mean values of dyspnoea grade at 5 minute was 0.2, at 10 minutes was 0.12 ,at 15 minutes was 0..08 and at 30 minutes was 0..04. The mean difference between pre and post dyspnoea grade at 30 minutes was 0.16. Hence the result highlighted that the mean difference was slightly higher in nebulization without oxygen comparing to nebulization with oxygen. This showed that nebulization with oxygen had similar effect in reducing dyspnoea grade among children with wheezing (Table 4.7). 4.12. Effectiveness of Nebulization with Oxygen in Improving the Respiratory Parameters among Children with Wheezing through Pairedt test Analysis: Paired t test was used to assess the differences in pre and post assessments of respiratory parameters among nebulization with oxygen group. (Table 4.8). 4.12.1 Comparison of Pre and Post 5 Minutes, 10 Minutes, 15 Minutes and 30 Minutes Assessment of Respiratory Rate in Nebulization with Oxygen Group: Hypothesis: There will be a significant difference in pre and post assessment of respiratory rate in nebulization with oxygen group. t = t5min = =2.67 t10min = =5 t15min = =7.89 t30min= =12.94 The calculated values of t at 5,10,15 and 30 minutes are 2.67, 5, 7.89 and 12.94 respectively which are greater than the tabulated value at p