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Wednesday, July 31, 2019

Bony Anatomy The Knee Joint Health And Social Care Essay

IntroductionThe undermentioned chapter intends to supply an overview of current literature pertinent to this survey. A brief lineation of related anatomy and biomechanics of the articulatio genus articulation will be discussed, every bit good as a theoretical association of articulatio genus degenerative arthritis and the lower kinetic concatenation. The clinical, aetiological and epidemiological facets of degenerative arthritis of the articulatio genus will be provided, along with the possible effects that assorted intervention option may hold on this disease.Anatomy2.2.1 Bony Anatomy of the Knee JointThe articulatio genus joint maps chiefly as a big hinge-type articulation, dwelling of three articulations ; two tibiofemoral articulations between the medial and sidelong femoral and tibial condyles, and one patellofemoral articulation between the posterior facet of the kneecap and thighbone ( Moore and Dalley, 1999 ) . Due to the comparative incongruence of the articulating surfaces, the articulatio genus articulation composite is inherently unstable, hence two fibrocartilage phonograph record ( semilunar cartilage ) exist in the infinite between the shinbone and thighbone, are attached to the intercondylar distinction of the shinbone, and farther addition the congruency of the joint every bit good as provide extra stableness ( Magee, 2008 ) . In add-on to the semilunar cartilage, legion environing ligaments play an of import function in stabilization of the articulatio genus. The name, location and specific map of these ligaments are outlined in the tabular array below.Table 2.1.1 Name Location and maps of articulatio genus ligamentsNameLocationFunctionMedial ( tibial ) collateral ligament ( MCL ) Anchored superiorly to the median femoral epicondyle, inferior to the adductor tubercle, and descends anteriorly to attach to the median border and median surface of the shinbone above and behind the fond regard of sartorius, gracilis, and semitendinosus sinews. Attaches by much of its deep surface to the underlying hempen membrane of the median semilunar cartilage. Stabilises the hinge-like gesture of the articulatio genus and prevents knee abduction Lateral ( fibular ) collateral ligament ( LCL ) Attaches superiorly to the sidelong femoral epicondyle, superior to the channel for the popliteus sinew. Inferiorly, it is attached to a depression on the sidelong surface of the fibular caput. It is separated from the hempen membrane by a Bursa Stabilises the hinge-like gesture of the articulatio genus and articulatio genus adduction. It is stronger than MCL Anterior cruciate ligament ( ACL ) Attaches to a aspect on the anterior portion of the intercondylar country of the shinbone and ascends posteriorly to attach to a aspect at the dorsum of the sidelong wall of the intercondylar pit of the thighbone Complect the thighbone and shinbone, stops tibia traveling frontward on thighbone, and prevents hyper-extension and inordinate internal rotary motion. ACL crosses sidelong to the PCL as they pass through the intercondylar part Articular capsule and the Bursa Articular capsule presents merely at the sides and posterior facets of the articulatio genus, where it covers the majority of the femoral and tibial condyles. It is stabilised and straighten by the joint ligaments and the musculus sinews. Bursa are extensions of the articulatio genus synovial pit and are filled with synovial fluid The capsule consists of an external hempen bed ( hempen capsule ) and an internal synovial membrane, which is uninterrupted with the synovial liner of the Bursa. They act to cut down clash between the sinews and implicit in castanetss ( hypertext transfer protocol: //andme26.hubpages.com/hub/Anatomy-of-the-knee-Bones-Muscles-Arteries-Veins-Nerves )2.2.2 Neurovascular StructuresTable 2.1.2 Neuravascular constructions of the articulatio genus2.2.3 Lower Limb MusculatureThe primary musculus groups responsible to making motion at the articulatio genus articulation are the quadriceps femoris ( extension ) and hamstrings ( flexure ) . The fond regards, excitation and action of the single musculuss within the quadriceps and hamstring are described in Table 2.1.3.1 and Table 2.1.3.2, severally.Table 2.1.3.1 Attachments, Innervation and Action of Quadriceps Femoris ComponentsMuscleProximal AttachmentDistal AttachmentExcitationActionRectus Femoris Anterior inferior iliac spinal column and Troy superior to acetabulum Via a common sinewy interpolation to the base of kneecap ; indirectly via patellar ligament to tibial tubercle Femoral Nerve ( L2, L3, L4 ) Extend leg at articulatio genus articulation ; rectus femur besides steadies hip articulation and helps iliopsoas musculus flex the thigh Vastus Lateralis Greater trochanter an sidelong lip of linea aspera of thighbone Vastus Medialis Intertrochanteric line and median lip of linea aspera of thighbone Vastus Intermedius Anterior and sidelong surfaces of shaft of thighbone ( Table abridged from Moore and Dalley, 1999 )Table 2.1.3.2 Attachments, Innervation and Action of Hamstrings ComponentsMuscleProximal AttachmentDistal AttachmentExcitationActionSemitendinosus Ischial tubercle Superior portion of shinbone on median surface Tibial division of sciatic nervus ( L5, S1, S2 ) Extend thigh ; flex leg and revolve it medially when articulatio genus is flexed Semimembranosus Ischial tubercle Posterior portion of shinbone on median condyle Bicepss Femoris Long caput: ischial tubercle Short caput: linea aspera and sidelong supracondylar line of thighbone Fibula on sidelong side of caput Long caput: Tibial division of sciatic nervus ( L5, S1, S2 ) Short caput: Common fibular division of sciatic nervus ( L5, S1, S2 ) Extend thigh ; flex leg and revolve it laterally when articulatio genus is flexed ( Table abridged from Moore and Dalley, 1999 )2.2.4 Lower Limb BiomechanicsThe primary motions of the articulatio genus are flexure and extension, with a smaller rotational constituent when the articulatio genus is flexed ( Moore and Dalley, 1999 ) . Table 2.1.4 outlines the chief motions of the articulatio genus articulation, every bit good as the name and action of the musculus bring forthing them.Table 2.1.4 Motions of the articulatio genusMotion and scope of motionNameActionKnee flexors 135A °-150A ° 1. Hamstrings ( semitendinosus, semimembranosus, biceps femoris ) 2. Popliteus Flexs and rotes leg medially, locks and unlocks the articulatio genus from beginnings of flexure Knee extensors 0A °-10A ° Quadricepss femoris ( rectus femur, vastus lateralis, vastus medialis, vastus intermedialis ) extends leg, ( but flexes thigh by action of rectus femur ) Medial rotary motion 0A °-10A ° Popliteus ( non-weight bearing articulatio genus extended ) , or semitendinosus and semimembranosus ( when knee flexed ) Weakly flexes articulatio genus, unlocks knee by revolving femur 5A ° laterally on fixed shinbone Lateral rotary motion 0A °-30A ° Bicepss femoris ( when knee flexed ) Weakly flexes articulatio genus, unlocks knee by revolving femur 5A ° medially on fixed shinbone ( hypertext transfer protocol: //andme26.hubpages.com/hub/Anatomy-of-the-knee-Bones-Muscles-Arteries-Veins-Nerves ) The comparative incongruence of the articular surface consequences in the articulatio genus being comparatively weak automatically, and a greater trust on the actions of environing musculuss, sinews and ligaments for strength and support ( Magee, 2008 ) . The anterior thigh musculuss are the most critical of these supports, with the quadriceps femoris musculuss being the most of import stabilizer of the articulatio genus articulation ( Moore and Dalley, 1999 ) . Because of the fond regard of the quadriceps femoris musculus across two articulations, it is capable of bring forthing action at both the hip and the articulatio genus ( Moore and Dalley, 1999 ) . The three vastus musculuss ( vastus intermedius, vastus medialis and vastus lateralis ) form the primary extensor musculus group of the articulatio genus ( Moore and Dalley, 1999, Magee, 2008 ) . The rectus femoris division of the quadriceps femoris musculus Acts of the Apostless, along with the iliopsoas, to flex the hip ( Moore and Dalley, 1999 ; Marieb, 2004 ) ; therefore its ability to widen the articulatio genus is compromised when the hip is flexed. As a consequence, the ability of the quadriceps femoris musculus group to bring forth knee extension is most effectual when the hip articulation is extended ( Moore and Dalley, 1999 ) . The hamstrings musculus group produces extension at the hip and flexure at the articulatio genus ( Moore and Dalley, 1999 ; Marieb, 2004 ) . These two actions of the hamstrings can non be performed maximally at the same clip, as full flexure of the articulatio genus requires so much shortening that the hamstrings can non supply the extra contraction needed for full extension of the hip, and frailty versa ( Moore and Dalley, 1999 ) . The hamstrings, nevertheless, demonstrate most activity when they are eccentrically undertaking to defy hip flexure and articulatio genus extension ( Moore and Dalley, 1999 ) . A survey by Wilson et Al ( 2011 ) aimed to look into the correlativity between articulatio genus articulation biomechanics and neuromuscular control and moderate articulatio genus degenerative arthritis radiographic and pain badness, higher articulatio genus adduction minutes ( during stance stage ) and lower articulatio genus flexure angles ( full pace rhythm ) were associated with higher RVAS. Higher hurting tonss were associated with lower pace velocities and reduced activation of the sidelong gastroc between early and late stance stage, which the writers suggested may be a mechanism to antagonize high median compartment articulation burden. Additionally, increased activation of the median hamstring between early stance stage and toe off may be declarative of higher coactivity of these musculuss in a guarding mechanism to increase joint stiffness and cut down the hurting, and perchance to compensate joint instability.2.2.4.1 Kinetic Chain TheoryThe kinetic concatenation is defined as â€Å" a combination of several in turn arranges myofascial, articular and nervous constituents, representing a complex unit † ( Bergmann & A ; Peterson, 2002 ) . In order for this system to map, it requires optimum alliance, mechanics and enlisting of these articulations. There are 3 sub-systems within a kinetic concatenation ( active, inactive and nervous ) , all of which contribute to the production of motion: In the lower limb there exists a functional relationship between the articulatio genus and the superior articulations in the hip and lumbopelvic spinal column, every bit good as the pes and mortise joint, inferiorly. When the pess are weight-bearing, the kinetic concatenation is closed and the links map interdependently, with a alteration in one articulation ensuing in an immediate consequence on the kinematics of other articulations in the concatenation. Therefore, a disfunction in the articulatio genus can hold a direct consequence on next articulation in the concatenation, and frailty versa. This highlights the importance of turn toing non merely the country of ailment, but besides next parts to rectify any potentially altered biomechanics of the kinetic concatenation in entirety.Overview of Osteoarthritis of the KneeEpidemiologyIncidence and PrevalenceBy the age of 60 old ages, about 100 % of the population will hold histologic alterations of devolution in their articulatio genus gristle, over 80 % will hold radiographic grounds of OA in at least one articulation, about 40 % will describe clinical symptoms of arthritis, and 10 % will see activity restriction ( Loeser 2000 ) .Hazard FactorsHarmonizing to the Framingham degenerative arthritis survey, the major hazard factors for KOA were age, female gender, fleshiness, non-smoking, occupational articulatio genus bending, physical labor, and chondrocalcinosis ( Felson 1993 ) . Other hazard factors identified are listed in the tabular array below.Table 2.2.1 Hazard factors and Protective factors for KOA harmonizing to the F ramingham OA surveyHazard factorsAge Female gender Geneticss Race Geographic Fleshiness Major articulation injury Occupational Immobilization High bone mineral denseness Joint hypermobility & A ; instability Insistent articulation usage Peripheral neuropathy Prior inflammatory articulation disease Congenital/developmental defects Crystal deposition in articulations Oestrogen surplus Diabetess, high blood pressure, hyperuricaemiaProtective factorsSmoking Osteoporosis Weight decrease Age: Age is the strongest hazard factor for OA, with an addition in prevalence of diagnostic OA from 7.0 % in those aged 63-69 old ages old to 11.2 % in those over the age of 80. Radiographic grounds of OA increased from 27.4 % amongst those in their 1960ss compared to 43.7 % prevalence in those in their 1880ss ( Felson 1987 ) . Gender: Age related increased in OA were found to be more evident in females ; non merely with respect to incidence, but besides in badness and rate of patterned advance ( grade 3/4 alterations increased in prevalence by 7.9 % from the 6th to eighth decennary of life ( Felson 1990 ) . Although there was small or no difference in gender prevalence of mild OA ( Roberts 1996 ) , females tended to hold more terrible OA, a greater figure of joint engagements, more symptoms, and a higher prevalence of manus and articulatio genus OA ( Kellgren-Lawrence 1963 ) ( Felson1995 ) . Recent surveies suggest that post-menopausal oestrogen lack may play a function in development of KOA in older adult females ( Nevitt 1996 ) . Males, nevertheless, had an increased prevalence of hip OA ( particularly in those aged 55 and supra ) ( Kellgren-Lawrence 1963 ) Fleshiness: Fleshiness is the strongest modifiable hazard factor for development of KOA, particularly in adult females ( Loeser 2000 ) . Harmonizing to the Framingham survey, higher organic structure mass index ( BMI ) was associated with an odds ratio of 1.6 per 5-unit addition in BMI. Similarly, a weight loss correlated to a 40 % lessening in hazard of KOA per 10-lb ( ~4.5kg ) weight loss ( Felson 1988/1997 ) . Hazard for development of KOA increased exponentially when fleshiness was present with an extra hazard factor, such as heavy physical activity. Aged patients in the upper tertile of BMI who performed at least 3 hours of physical activity daily had an odds ratio of 13 for development of KOA ( McAlindon 1999 ) . Major joint injury: The comparative hazard for development of radiographic KOA following meniscectomy for direction of stray meniscal cryings was 14 ( Roos 1998 ) . Surveies besides suggest that quadriceps failing increased the hazard of both radiographic and diagnostic OA ( Slemendra 1997 ) . Insistent articulation usage: While there is deficient informations to propose that featuring activities may take to generalised OA ( Lane 1993 ) , it has been shown that certain businesss may do the overexploitation of peculiar articulations, therefore increasing the hazard of development of localized OA ( Croft 1992 ) . For illustration, occupational articulatio genus bending is strongly associated with KOA and mineworkers frequently exhibit marks of spondylosis ( Felson 1990 ) . Muscle dysbalance & A ; wasting: Muscles play a major function in joint biomechanics as the green goods motions, absorb burden, and supply dynamic joint stableness. It is therefore possible that musculus failing due to aging or anterior injury my consequence in loss of the protective musculus control, inordinate joint motion and instability ( Slemendra 1997 ) . Ultimately this will do stress-induced microtrauma of the articular gristle due to the increased happening in physiological shear and extremum articulation forces. Over an drawn-out period of clip, this microtrauma will do gristle devolution, with pathological subchondral force per unit area addition and attendant subchondral induration, and joint prostration with axis maldeviation ( mention ) . Slemenda et Al. conducted a prospective survey in which reduced articulatio genus extensor strength was present in those topics who developed OA as compared to the unaffected participants ( Slemendra 1998 ) . Similar findings were seen in a survey by on patients with one-sided mortise joint OA, in which the affected side displayed reduced calf perimeter and decreased electromyography ( EMG ) frequences of lower leg musculuss ( Valdererrohano 2006 ) . In a healthy person, musculus biopsies have shown wasting of type-1 musculus fibers ( slow-twitch ) in the vastus lateralis following periods of articulatio genus immobilization. In KOA patients nevertheless, failing of the vastus lateralis was largely due to type-2 fiber wasting ( Nakamara and Suzuki 1992 ) . Fink et al so investigated the structural alterations in the vastus medialis and found type-2 fiber wasting in all specimens ( which was consistent with informations from Nakamara ) every bit good as extra type-1 fiber wasting in 32 % of patients ( Fink 2007 ) . Exercise preparation has been found to increase diameter of both type-1 and type-2 musculuss fibers ( Saltin 1977 ) , and was therefore the recommendation of the writers in order to antagonize the musculus wasting and therefore protract the oncoming of OA. As musculuss increase in size with exercising, it is suspected that wasting in creaky patients is non merely caused by neglect in the presence of joint stiffness and hurting, but besides by age-related sarcopenia ( generalized loss of skeletal musculus mass ) , physical immobilization and decreased physical activity ( Goodpaster 2006 ) . This musculus wasting, irrespective of its causative pathomechanism, has been found to be strongly correlated to the development of OA. Since exercising additions muscle mass and improves musculus map, it is likely to play an of import function in intervention and bar of OA.PathologyOA is characterised by focal loss of gristle with grounds of attach toing periarticular bone response. Clinically, it presents as joint hurting and crepitus in the aged age group, and is radiographically characterised by reduced joint infinite, osteophytes and a assortment of malformations that develop as the disease progresses.Pathogenesis and MorphologyNormal hyaline gr istle comprises chondrocytes ( 1-2 % ) embedded in extra-cellular matrix, which in bend is constituted by H2O, type-II collagen and proteoglycans. Articular gristle performs two chief maps: 1 ) along with synovial fluid, it provides virtually friction-free motion within the joint ; and 2 ) in weight-bearing articulations, it spreads the burden across the joint surface in a mode that allows the implicit in castanetss to absorb daze and weight. These maps require that gristle be elastic and have a high tensile strength. These properties are provided by proteoglycans and type II collagen, both of which are produced by chondrocytes. Articular gristle invariably undergoes matrix devolution and replacing. Any instability in normal chondrocytes ability to keep gristle synthesis and debasement can take to OA. Majority of the pathological alterations in OA occur in the gristle itself, nevertheless as the disease progresses, the organic structure and synovial constructions besides begin to de mo marks of devolution. ( Reference ) Cartilage Changes: Chondrocyte map can be affected by a assortment of influences, including mechanical emphasiss, aging, metabolic and familial factors, increased bone denseness and high oestrogen degrees. Regardless of the inciting stimulation, early OA is marked by the degenerating gristle incorporating more H2O and less proteoglycan ( mention ) . This occurs as a consequence of an enzymatic debasement of the major structural constituents, aggrecan and collagen, which causes reactive proliferation of chondrocytes to organize bunchs ( ringers ) with increased production of matrix constituents. Although the turnover of aggrecan constituents is increased, the concentration finally falls. The lessening in size of hydrophilic aggrecan molecules increases the H2O concentration and swelling force per unit area in gristle, farther interrupting the staying staging of type II collagen. Overall, gristle tensile strength and resiliency are compromised doing it susceptible to supporting hurts. ( BOON ET AL ) Progression of these alterations leads to transgress of surface unity, crevices, opposing, flaking of gristle and development of perpendicular clefts ( fibrillations ) , localised chondrocyte decease and lessening in gristle thickness. Cartilage loss is focal instead than widespread and normally restricted to the maximal supporting portion of the joint ( BOON ET AL ) . Gross scrutiny at this phase reveals a soft farinaceous articular gristle surface ( kumar et Al ) . Bone Changes: The bone instantly below the compromised gristle responds by increasing its trabecular thickness ( subchondral induration ) , which in some instances reflects healed trabeculate microfractures or countries of osteonecrosis caused by the increased force per unit area in bone as the gristle fails in its load-transmitting map. The break gaps allow synovial fluid to be forced into the subchondral parts, organizing hempen walled cysts. At the border of the joint there is formation of new fibrocartilage, which so undergoes endochondral ossification to organize osteophytes. Despite cardinal and fringy new bone formation, with terrible gristle loss, crevices may intensify and expose the subchondral bone to have on, with the unprotected bone ends going ivory-like due to inspissating and vascularization ( eburnation ) , frequently with deep linear furrows ( BOON ET AL ) . Small breaks can free pieces of gristle and subchondral bone into the joint, organizing loose organic structu res ( joint mice ) . Bone remodelling and gristle thinning easy alter the form of OA articulations, increasing their surface Other Changes: The synovial membrane undergoes variable grades of hyperplasia, sometimes as aureate although less widespread as RA ( In terrible disease, a hempen synovial pannus covers the peripheral parts of the articular surface ) . Osteochondral organic structures normally occur within the synovial membrane, reflecting chondroid mataplasia or secondary consumption and growing of damaged gristle fragments. The outer capsule besides thickens and contracts, normally retaining the stableness of the remodelling articulation. The musculuss that act over the joint normally show non-specific type-II fiber wasting ( BOON ET AL ) .Natural HistoryThe class of OA is extremely variable. Those patients with multiple affected articulations tend to hold a more rapid patterned advance of OA in their single articulations ( Felson 1993 ) . Advanced age ( Felson 1993 ) and fleshiness ( Felson 1993 ) are besides associated with more rapid patterned advance. Primary OA is regarded as by and large easy progressive, which is apparent in one 3rd to two tierces of radiographic OA instances ; while it has been known to brace for many old ages, betterments are rare ( kumar et Al ) . Diagnostic OA may come on, or better, or may even be arrested due to the fact that symptoms have been shown to be ill correlated to radiographic patterned advance ( Kellgren-Lawrence 1963 ) . Osteophye encroachments on spinal hiatuss are a common cause of nervus root entrapment, which may ensue in neurological shortages such as radicular hurting, musculus wasting or cramp, and centripetal loss. With clip, entire articulation prostration may happen, but unlike Rheumatoid arthritis, does non ensue in joint anchylosis ( merger ) . ( kumar et Al )Subsets of OAPrimary OA can be categorised into three major subsets, although it may non be easy to find an exact differentiation between the subsets ( Doherty 1994 ) . Nodal Generalised OA: GOA is characterised by distal, and proximal to a lesser extent, interphalangeal ( IP ) articulation engagement, Heberden ‘s nodes ( cadaverous expansion of DIP articulation ) , Bouchard ‘s nodes ( cadaverous expansion of PIP articulation ) and familial bunch. It peaks at in-between age and is common in females ( Doherty 1994 ) . Erosive OA: Characterised by engagement of IP articulations of custodies, frequently with aureate redness and erosive alterations, that subsequently take to malformations and anchylosis. A little proportion ( 15 % ) may germinate into seropositive rheumatoid arthritis ( Doherty 1994 ) . Isolated big joint OA: Knee: This is the most common signifier of OA, frequently happening bilaterally. It may affect preponderantly the median femorotibial, sidelong femorotibial or patellofemoral compartment. Hip: Predominantly involves the superior pole or the median compartment. Spinal column: Apophyseal joint engagement is the lone true signifier of OA that can affect the spinal column and is typically manifested my hurting on extention on the spinal column. Intervertebral phonograph record ( IVD ) devolution with osteophyte formation is considered an built-in portion of OA, and normally affects the lumbar and cervical parts. Diffuse intraosseeous skeletal hyperostosis ( DISH ) and ossification of posterior longitudinal ligaments ( OPLL ) are considered to be discrepancies of spondylosis, and comprise fluxing calcification of the disc border and anterior and posterior longitudinal ligament, severally ( mention ) .Clinical FeaturesSigns and symptoms of OA may take many old ages after the oncoming of the disease to go clinically apparent. This is due the fact that the patterned advance of the disease is extremely variable & A ; there tends to be hapless correlativity to radiographic and microscopic patterned advance. Another possible ground that there may be a hold in the visual aspect of symptoms after devolution has taken topographic point is because due to a deficiency of excitation within the gristle ( Lane 1993 ) . Joints normally involved in OA are the articulatio genus, fingers, and spinal apophyseal articulations. Less normally are the hips, acromioclavicular and sternoclavicular articulations, while carpal, cubitus, mortise joint and glenohumeral articulations are seldom involved in isolation.Signs and SymptomsSymptoms if OA often have an insidious oncoming and an asymmetrical distribution, subsequently going symmetric as the disease progresses. Factors that may foretell the presence of diagnostic OA and rate of patterned advance include advanced age, fleshiness and multiple affected articulations. The central marks of OA include bony puffiness, synovial gush, crepitus, restricted scope of gesture, joint malformation and, musculus failing and wasting. Symptoms associated with OA include hurting, joint stiffness and functional damage, although all need n't be present at the same clip & A ; badness: Pain: Pain normally begins as an intermittent localised deep aching in and around the affected articulation, frequently exacerbated by motion. As the disease progresss, hurting may go more relentless, going nowadays at dark and during remainder. In KOA, hurting is normally localised to the front tooth and median facets of the articulatio genus and upper thigh, normally occurs with step usage, mounting in and out of vehicles, and making day-to-day activities such as bathing, standing from a seated place and utilizing a lavatory. These jobs may be amplified in the presence of attendant hip pathologies, where normal walking pace is likely to be altered as a consequence of the inguen and leg hurting. Stiffness: Stiffness in the involved articulations is typically present and worst first thing in the forenoon ( forenoon stiffness ) and lasts between five and 30 proceedingss. Stiffness may besides be present subsequently in the twenty-four hours after periods of remainder or inaction ( gelling ) , but is brief and relieved by soft motion ( Doherty 1994 ) . This stiffness is frequently associated with impaired motion within the joint and my consequence from a figure of causes ; joint adhesion, capsular tightening and thickener, inflexibleness of the overlying soft tissue and/or altered joint construction ( eg. as a consequence of osteophyte formation ) . Functional Damage: The badness of functional damage is mostly dependent on the grade of devolution, type of joint involved every bit good as the specific location of the devolution within the joint. For illustration, if there is pronounced devolution with osteophyte formation on next jointing surfaces, which make contact during motion, one would anticipate to happen that scope of gesture is impaired. Similarly, loose organic structures may ensue in reduced scope of gesture every bit good as possible lockup or buckling, particularly if located within the articulatio genus articulation. Crepitus develops as a consequence of gristle loss articulation and abnormalities on jointing surfaces such that they longer skid swimmingly over one another. This creates a stuttered-type gesture, which can be palpated on scrutiny of scope of gesture. In terrible instances this crepitus may even make hearable â€Å" dads † . Crepitus is present in over 90 % of patients with KOA ( mention ) . In terrible instances, joint subluxation may happen when there is uneven wear of the joint surfaces. Over an drawn-out period of clip this will ensue in asymmetrical joint infinite narrowing and finally prostration. When this occurs in the articulatio genus, the median tibiofemoral articulation to typically more affected than the sidelong and in over 50 % of patients will do the development of a knee varus ( â€Å" bow leg malformation † ) . Functional damage may besides ensue non merely from structural alterations to the joint surfaces, but besides from other alterations associated with OA, such as arthrogenic musculus suppression. In this instance, the patient may see failing due to wasting of the surrounding musculuss, every bit good as stiffness or reduced scope of gesture due to inflexibleness ( Hurley 1998 ) .Table 2.2.2 Outline of Typical Symptoms of OsteoarthritisSymptomsPatient over age of 45 Insidious onset over months or old ages Variable or intermittent hurting over clip Chiefly related to motion and weight-bearing, relieved by remainder Merely brief forenoon ( & lt ; 15 proceedingss ) stiffness and â€Å" gelling † ( & lt ; 1 minute ) after remainder Normally merely one or two articulations painful ( non multiple regional hurting ) ( Adapted from Davidson ‘s )Table 2.2.3 Outline of Clinical Signs Characteristic of OsteoarthritisSignsRestricted motion ( capsular thickener, barricading by osteophytes ) Palpable, sometimes hearable, class crepitus ( unsmooth articular surfaces ) Bony swelling ( osteophytes ) around articulation borders Deformity, normally without instability Joint-line or periarticular tenderness Muscle failing, blowing No, or merely mild, synovitis ( gush, increased heat ) ( Adapted from Davidson ‘s )2.3.3.2 Arthrogenic Muscle Inhibition ( AMI )AMI is defined as the failure of a functional musculus group to enroll all motor units during maximum voluntary contraction ( Suter et al, 2000 ) . When joint receptors are subjected to distention, compaction, ligamentous stretch, gush and hurting, this protective mechanism is activated, doing automatic suppression of the environing muscularure to forestall farther hurt to the joint ( Crossman and Neary, 1995 ) . The hurting, joint annoyance and musculus cramps frequently associated with KOA, taking to biomechanical alterations and redness, consequences in an suppression of the joint motorneuron pool and inability to enroll all the musculus fibers within the musculus groups that cross the affected articulation. The net consequence is: lessening musculus strength ( existent and/or evident failing ) , doing holds in the rehabilitation advancement ( Hopkins and Ingersoll, 2000 ) Altered motion forms due to a alteration in motor control and joint proprioception, increasing the hazard of hurting, re-injury and accelerated devolution because of the deformed articulation forces ( Lee, 4004 )Diagnostic StandardsPrior to the development of clinical standards for diagnosing of OA in 1981? , the diagnosing of OA was frequently based on radiographic visual aspect and standards proposed by Kellgren and Lawrence in 1957, which is accepted by the World Health Organisation. The diagnosing of OA is mostly clinico-radiographic, that is both clinical and radiographic characteristics are taken into consideration to find the presence and badness of the disease. It is widely acknowledged that radiographic alterations may non be present in the early phases of devolution, while merely 40-50 % of patients with radiographic grounds of OA are clinically symptomless ( Roberts 1996 ) . For this ground the American Rheumatism Association devised diagnostic standards for OA in assorted articulations.Table 2.2.4 Clinico-radiographic Classification Criteria for Osteoarthritis of the KneeTraditional formatClassification tree formatKnee hurting OsteophytesPlusOne of three: Age & gt ; 50 old ages Stiffness & lt ; 30 proceedingss Crepitus Knee hurting and OsteophytesOrKnee hurting and age a†°? 40 old ages and forenoon stiffness a†°Ã‚ ¤ 30 proceedingss in continuance and crepitus on gesture( Altman 1986 )Table 2.2.5 Clinico-radiographic Classification Criteria for Osteoarthritis of the HipHip hurting At least two of the followers: ESR Westergreen & lt ; 20mm/hr Radiographic femoral or cotyloid osteophytes Radiographic joint infinite narrowing ( superior, axial and/or medial )( Altman 1991 )Table 2.2.6 Clinico-radiographic Classification Criteria for Osteoarthritis of the HandssHand hurting, hurting, or stiffness Three or four of the followers: Hard tissue expansion of 2 or more of 10 selected joints* Hard tissue expansion of 2 or more DIP articulations Less than 3 conceited MCP articulations Deformity of at least one of 10 selected joints* * 10 selected articulations are 2nd and 3rd DIP articulation, 2nd and 3rd PIP articulation, and 1st carpometacarpal joint( Altman 1990 )Radiographic DiagnosisThere are eight central marks of DJD: asymmetric distribution, non-uniform loss of joint infinite, osteophytes, subchondral induration, subchondral cysts, intra-articular loose organic structures, intra-articular malformation, and joint subluxation. The radiographic presentation of OA varies depending on the joint involved, the anatomic relationships, and the emphasis to which the articulation is subjected. Therefore all eight marks need non be present in order to set up a diagnosing of OA ; nevertheless they may be utile in in finding the grade of underlying diseased sequences affecting the joint compartments. The tabular array below is the scaling system used to set up radiographic badness of OA ( mention – Y & A ; R? ) .Table 2.2.7 Kellgren-Lawrence Classification of OsteoarthritisDescriptionNormal No alteration Class I Improbable narrowing of the joint infinite, possibleA osteophytes Grade II SmallA osteophytes, possible narrowing of the joint Grade III Multiple, reasonably sizedA osteophytes, definite joint infinite narrowing, some sclerosed countries, possible distortion of bone terminals Grade IV Multiple largeA osteophytes, terrible joint infinite narrowing, marked induration and definite cadaverous terminal malformation. mention Asymmetrical Distribution: There is often a seeable disparity when comparing the extent of joint engagement with the unaffected ( or lesser affected ) articulation on the contralateral side. The asymmetrical distribution of OA helps to separate it from inflammatory arthropathies, such as RA, when have a characteristically symmetrical engagement ( mention – Y & A ; R? ) . Non-Uniform Loss of Joint Space: Decrease in joint infinite is most likely to happen at the parts of greatest intra-articular emphasis, which is particularly apparent in weight-bearing articulations such as the spinal column, hip, and articulatio genus ( mention – Y & A ; R? ) . Osteophytes: Radiographically, these are seen as cadaverous branchs widening from the part of capsular interpolation into the joint infinite. In really terrible instances the osteophyte may wholly bridge the joint infinite, doing anyklosis of the joint ( cite – Y & A ; R? ) . Subchondral Sclerosis ( Eburnation ) : This is normally apparent in countries where there is the greatest loss in gristle tallness. It occurs as a consequence of increased mechanical forces being transmitted to the joint surfaces that lack the daze absorbing consequence of normal gristle thickness. In order to antagonize these increased forces, the bing trabeculate bone thickens and new bone is formed. This is seen on radiogram as increased countries of radio-opacity in the subchondral bone underlying parts of reduced joint infinite ( mention – Y & A ; R? ) . Subchondral Cysts ( Goedes ) : These are focal parts of loss in bone denseness, of variable size, which appear as rounded countries of radiolucency and frequently have a sclerosed border. They are located in countries of old subchiondral induration, and occur either as a consequence of synovial fluid invasion through the open articular home base or secondary to trabeculate break and subsequent mortification ( mention – Y & A ; R? ) . Intra-Articular Loose Bodies ( Joint Mice ) : As joint devolution advancements, flaking and atomization may ensue in intra-articular accretion of free drifting organic structures, comprised mostly of gristle and on occasion subchondral bone ( mention – Y & A ; R? ) . Articular Deformity: Progressive distortion of the articular surfaces may happen following insistent emphasis, doing big subchondral cysts, trabeculate remodelling, break and prostration, which may be exacerbated my mortification due to secondary vascular perturbations ( mention – Y & A ; R? ) . Joint Subluxation: The joint finally becomes unstable and prone to displacement due to joint surface distortion, loss of joint infinite, and laxness within the construction of the ligaments and sinews. This alters in the burden distribution, farther increasing the unbalances emphasiss of the joint, speed uping the degenerative procedure ( mention – Y & A ; R? ) .Clinical DiagnosisAltman et Al. ( 1986 ) developed sets of standards for the categorization of idiopathic OA of the articulatio genus.Table 2.2.8 Classification Criteria for Diagnosis of Idiopathic Osteoarthritis ( OA ) of the Knee *Clinical and research labClinical and radiolograohicClinical **Knee Pain + at least 5 of 9: Age & gt ; 50 old ages Stiffness & lt ; 30 proceedingss Crepitus Bony tenderness Bony Enlargement No tangible heat ESR & lt ; 40 mm/hr RF & lt ; 1:40 SF OA Knee Pain + at least 1 of 3: Age & gt ; 50 old ages Stiffness & lt ; 30 proceedingss Crepitus + Osteophytes Knee Pain + at least 3 of 6: Age & gt ; 50 old ages Stiffness & lt ; 30 proceedingss Crepitus Bony tenderness Bony Enlargement No tangible heat 92 % Sensitivity 75 % Specific 91 % Sensitivity 86 % Specific 95 % Sensitivity 69 % Specific * ESR = erythrocyte sedementation rate ( Westergreen ) ; RF = arthritic factor ; SF OA = synovial fluid marks of OA ( clear, syrupy, or white blood cell count & lt ; 2000/mm3 ) . ** Alternative would be 4 of 6, which is 84 % sensitive and 89 % particular. ( mention )Differentiation from other Arthritic DiseasesArthritic arthritis: associated with more marks of redness affecting the MCP, carpus, wrist bones and other peripheral articulations, every bit good as the cervical spinal column. Generalised OA involves the DIP, PIP and first CMC articulations in the manus and, cervical and lumbar spinal column parts. RA distinguished from erosive OA through positive research lab trial, such as arthritic factor, ESR, and synovial fluid analysis ( Boon et al, ) . Joints actively involved in arthritic arthritis seldom show osteophytes, therefore their presence is a utile index of OA if the patient presents with a assorted clinical image. If osteophytes precede arthritic engagement, it indicated that rheumatoid arthritis has evolved from an erosive OA. Conversely, they will merely develop in secondary devolution following RA burn out ( Yochum & A ; Rowe, ) . Pseudogout: differentiated from OA by presence of CPPD crystals in synovial fluid, every bit good the in engagement of articulations that are non typically associated with primary OA, such as the cubitus and shoulder ( McCarthy 1998 ) .Table 2.2.9 Categorization for Subsets of Idiopathic OsteoarthritisLocalised:Handss: Heberden ‘s and Bouchard ‘s nodes ( nodal ) Erosive interphalangeal arthritis ( non-nodal ) Scaphometacarpal Scophotrapezal Foot: Halux valgus Hallux rigidus Contracted toes ( hammer/cock-up toes ) Talonavicular Knee: Medial compartment Lateral compartment Patellofemoral compartment Hip: Eccentric ( superior ) Concentric ( axial, median ) Diffuse ( coxae senilis ) Spine ( peculiarly cervical and lumbar ) : Apophyseal Intervertebral ( phonograph record ) Spondylosis ( osteophytes ) Ligamentous hyperostosis [ DISH* or Forestier ‘s disease ] ) Other individual sites: Shoulder Temporomandibular Sacroiliac Ankle Wrist AcromioclavicularGeneralised ( includes 3 or more sites listed above ) :Small ( peripheral ) and spinal column Large ( cardinal ) and spinal column Mixed ( peripheral and cardinal ) and spinal column * DISH = Diffuse Idiopathic Skeletal Hyperostosis

Tuesday, July 30, 2019

Thomas Jefferson’s Vision of a Free Holding Yeoman Society

Thomas Jefferson is considered as one of the most influential personalities in the history of the US. Jefferson who was the third President of the United States is regarded as one of the most prominent figures in the US, is characteristically known for his ideological promotions of republicanism in his stint as the president. Some of the famous events that are associated with his presidency include the 1803 Louisiana Purchase and the Lewis and Clark Expedition during the period between 1804 and 1806. Thomas Jefferson is also accredited for authoring the Declaration of Independence and since he was a philosophical thinker and politician, he idealized the concept of a free holding yeoman society which was a series of complex ideologies which emphasized various virtues. It was during the 18th century that a number of influential â€Å"poets, politicians and economists created in America a complex of ideas which has been called the Jeffersonian myth† (Hess, 1992). This concept generally emphasized various virtues with simplicity and purity leading and the principal dictated a variety of social choices. The Yeoman term generally refers to farmers who usually cultivate their own land. The yeoman thus can be considered as a small farmer who holds a piece of land. Since Jefferson hailed from this type of yeoman society, he had first class experience of the issues and challenges they faced and therefore in his presidency he decided to make amends so as to ensure that this class in the society was prosperous. This philosophy was coined in a time that could be considered appropriate for a country that was settled by â€Å"land hungry men† (Hess, 1992). Most English men were used to a social system in which the ownership of land was a symbol of a man’s stand in the society and the political power that he yielded. Thomas Jefferson and J. Hector St. John de Crevecoeur came up with a philosophy that dictated the natural rights of any man to own land and that the ownership of land by any man obviously gives him a social status and dignity. The philosophy goes further to describe how mans interaction with nature â€Å"makes him virtuous and happy†. This philosophical thinking as Jefferson and his colleague tend to challenge the government is that it â€Å"should be dedicated to the interests of the freehold farmer† (Hess, 1992). This policies and principles held a lot of significance for Jefferson who is considered as the brains behind the western land policy. In Jefferson’s own words he described the small and self sufficient as â€Å"the chosen people of God† and thus asserted their importance if the new republic would have any chance to survive. Jefferson described the â€Å"virtuous yeoman† as the moral backbone that would lead the nation to greater heights and thus prosperity would be easily achievable (Hess, 1992). The issue of land was embedded deep in Jefferson’s heart and he believed that it was the core of an envisioned republic. Thomas Jefferson had a landscape vision that mainly depended on the unlimited expansion of most of the wilderness in the country and thus make it the peoples will to settle and subdue it for settlement and cultivation purposes. This vision was just a vision and its applicability mainly depended on the prudence of the government of that period in applying the â€Å"public land policies fairly and justly†. Jefferson held the belief in his heart that â€Å"land was the clay from which a free society would be molded and preserved† (Hess, 1992). However, one of the issues that he had to deal with was those of religion. Although religion was a predominant force during his government, it had failed to provide what Jefferson’s landscape vision promised to produce. Land in this era was considered to offer the much needed cohesion and was therefore viewed as an â€Å"icon of secular religion† (Hess, 1992). The success of Jefferson‘s policies and philosophical thinking are still evident today and the western range is the product of his landscape vision. The landscape vision which was envisioned in the â€Å"Jeffersonian agrarianism† was built on a firm foundation (Hess, 1992). This had the obvious effects of spilling its advantages in the years that were to follow and most of its effects are still visible today. The western range which was a harsh testament of nature in the state of a wilderness became a land that would become exceedingly abundant. However, the alteration of nature and its overuse can be considered as one of the negative aspects of his landscape vision. Various factors one of them being drought led to the overstocking of the ranges in a way that nature was almost strained beyond its holding capacity and thus became unforgiving with adverse effects. Collisions among farmers with diverse wants is also a major shortcomings but the experience that was gained from the harsh reactions of nature served to teach the inhabitants valuable lessons and thus take some measures into considerations during when setting future plans.

Monday, July 29, 2019

You can write one that fits Essay Example | Topics and Well Written Essays - 1000 words

You can write one that fits - Essay Example Their works of arts are influenced directly by nature. For instance, Themistokles on his view of Laerdalsoren predominantly employs the use of organic shapes. The southern landscape has some elements of irregularity or rounded forms as directly viewed in the vegetation, rocks, ocean clouds and the sky. The mountain ridges are seen in the background bear curving terrains. The following are the examples of the pieces of art from the two artists. On the other hand, Roberts in his art also considered organic shapes as clearly seen in his work. The terrain around the temple bear smooth curving. The few palm trees seen near the temple have long curving branches. Consequently, the numerously green cover vegetation beneath the tall palms is well represented in the artwork. The irregular bayonet shaped leaves of the palms frond flutter in the sea breeze. In both artworks, above the tidal waves of the sea is the blue sky where the clouds are ambiguous and in a constant morphing into new shapes. The two art pieces can be good examples where the atmospheric perspective technique has been incorporated since the two artists subtlety alters colors, value and details so as to provide a real sense of being in the sunshine state of a tropical climate. In his working, Roberts uses tones of pale yellow color to unite the sandy beach and the sky evoking a humid and hazy atmosphere Egypt is well known for that. The figure of the composition it the smooth curving rocky terrain in the left of the Themistokles’ View of Laerdalsoren extending all the way to the background and surrounding the sea. In the center, lie the ocean, a boat, and some people riding horses at the beach. There is also a white road leading to another bay in the other side of the ocean. The road and the other structures at the other side are diminishing in sizes giving an impression of the increased distance between them and the viewer. These far away structures are seen beyond an increased

Sunday, July 28, 2019

Litirature review Essay Example | Topics and Well Written Essays - 1250 words

Litirature review - Essay Example Strong leadership is a very important ingredient in the success of an organization. A change in the leadership of an organization might result in changes in the organization structure, strategies, policies and the way the organization does it business. Moreover, with the movement of a leader from the organization, the close subordinates also move with the outgoing leader which might result in substantial change in the management of an organization. At the same time, it is important that the employees of the organization must relate to the new leadership. It is important that whenever there is a need to change the leadership of organization, suitable candidates are identified as soon as possible. For this, it is important to identify and nurture young talent in the organization. The transition to a new leader shall be smooth so that the employees do not feel uncomfortable under the changed leadership. Any organization will, for surely have change in its leadership and because of the s ignificant changes undergoing during this period, it is important that the transition is managed in the best possible way. Hence it is important that the area of leadership transition and succession planning is carefully reviewed. This paper will analyze the already existing literature in the area of succession planning, its important and identify the best ways to manage leadership transition. ... Often the area of succession planning is concerned with the succession of leaders. Types of succession planning The process of succession planning needs a thorough understanding of the strategy of the organization. There have been various models of performing succession planning such as ‘relay succession’, ‘horse- race successions’ and ad-hoc succession. While in relay succession, the leaving person identifies an individual, and then grooms the person, horse-race successions are more competitive in nature and the Board decides the successor amongst many candidates. An ad-hoc succession involves selecting the best possible candidate who is present at that particular point of time. In case, firms are not able to identify a potential successor, boards often appoint an interim leader who occupies that position until a permanent person is hired for the position. Of all the ways, relay succession is the most common type of succession planning undertaken by compani es (Brickley et al., 1997). Relation between firm performance and succession planning Previous research has suggested that the performance of an organization is significantly impacted by the succession process adopted. More disruptive succession processes impact the performance of the firms negatively (Zhang and Rajagopalan, 2004). At the same time, the performance after a change in leadership is also impacted by actions of the successor and the internal and external situation of the change (Rowe et al., 2005). The success of a succession planning exercise depends on various factors such as involvement of the outgoing leader, sincerity of the performance review of all the candidates, accurate prediction of the talent need that might arise, and the consistency of

Saturday, July 27, 2019

Recitatif Essay Example | Topics and Well Written Essays - 750 words

Recitatif - Essay Example hildhood relationship, it is the difference in their race which ultimately comes between them and leads to the conflict in their dwindling relationship. The inactive character of Maggie, the mute lady who worked at the orphanage where the two first met, serves as a very active symbol through which the development of Twlya and Roberta’s racial separation can be traced (Androne 134). As children, the pair formed a strong friendship based on a shared background. During this time, race did not play a very central role beyond the difference in their physical appearance. In future recollections, neither can agree on the actual race of Maggie, which highlights the fact that racial identity was not an important factor during their time at the orphanage. Whereas Roberta asserts that Maggie was black, Twyla admits â€Å"I actually couldn’t be certain. She wasn’t pitch-black, I knew, or I would have remembered that. What I remember was the kiddie hat, and the semicircle legs,† (Morrison 2697). Instead, the vulnerability of Maggie’s character is what stands out to them as the hierarchal structure of the orphan age and fighting for their place in this, was their shared preoccupation during this time. Instead of the actual experience of the incident with Maggie in the orchard, it is in memories and shared recollections that the two consistently disagree on. As the two meet again, their racial separation slowly becomes a growing issue. They both live in different parts of a racially-segregated society and they each come to represent different economic classes, as each marry men of varying wealth and professional status. The significance of race manifests when the town becomes engaged in bussing activities and each takes an opposing position. Here, the two must embody their own racial identity which inevitably leads to a direct confrontation about their racial differences. These differences are deepened even further by their diverse socio-economic statuses. The ensuing

Friday, July 26, 2019

Project Design Constraints Research Paper Example | Topics and Well Written Essays - 500 words

Project Design Constraints - Research Paper Example Given the design requirements of flow chambers of the heart, the material chosen for the design of the heart flow chambers has to meet a load of requirements. For instance, alumina as a biomaterial, has to sustain high fluid resistance. Additionally, it has to be economical, and avoid stiffening. The material also has to have good thermal conductivity. The fact that the human body happens to be one of the greatest corrosive surroundings for foreign materials means that the material used to make the flow chambers have to be able to sustain the corrosion from the active enzymes, at the human body temperature. Additionally, caution has to be reserved to guarantee that the material used is not poisonous to the human body. A composite design is proposed; in which the porous synthetic grafts are improved in terms of biocompatibility. Polyester textile can be coated using cross-linked protein. Studies of different kinds of proteins such as collagen, gelatin, elastin, and albumin have been c onducted. There is no ideal material yet, to use in making of prosthetic heart valves. This is because the different available materials like titanium, or stainless steel, polyester, alumina, or pyrolitic carbon have faults in one way or another. When each one of them is used by itself, the patient has to go through long anticoagulant therapy. An example of a design that can be used is the asymmetric design of the natural human heart coined by Gianni Pedrizetti and Vukicevic of Trieste University.

Irish revolution Essay Example | Topics and Well Written Essays - 1000 words

Irish revolution - Essay Example Among other revolutionaries, this essay bases its discussion on the Irish Revolutionary, looking at its outcomes, the great revolutions of the French and Dutch and on the other extreme side of the failed revolutions of the Dutch patriot crisis and the Irish rebellion. Eventually, this varied revolutionary gives a clear difference (Fitzpatrick 38). The French and the Dutch revolution took five main phases and each phase brought with it changes. The French revolution, known as the great revolutionary, because of its success, started in 1789 and ended in 1815. The French revolution brought about changes such as the creation of a new political order. The French government abolished any special power and treatment offered to the nobles and the clergy, feudal dues, game laws, jurisdiction of the noblemen, and the privileges given to the provinces and towns. Therefore, this new political order led to equal powers among all citizens. This first French revolution brought about a new positive change, which resulted in the replacement of the rebellion leaders with the leaders who accepted the new revolution and change. The French revolution caused several impacts on the western countries. ... The men acquired more property despite their social rank and political rank (Fitzpatrick 110). The revolution left a major legacy in the political field. Citizens had the authority to participate highly in the political affairs since they became the highest source of political authority in the state. In addition, the revolution brought created an expansion of the government powers, which was able to cater for the everyday life activities for each citizen. Finally, the revolution also contributed to the giving rise of the two opposing powers of the government, which included the liberal government and the nationalist government. Therefore, the French and the Dutch revolution have influenced the governments and the societies of Europe. Many changes have followed this revolution. Such changes include, change in boundaries, change of the traditional rule. Constitutional reforms also took place and new laws created (Fitzpatrick 371). The French revolution has continued to have force even in the new 19th century. On the other hand, the Irish rebellion and the Dutch patriots set up a revolution, which failed. The Irish uprising broke out in 1798 and it resulted from the resentment from the oppression of the catholic leaders from Irish by the government of the British. The catholic dominated population of Ireland became subject to the ant-catholic laws, rule of the British government and it led to the division of the Irish into several groups, and thus Ireland became divided by the England rule. The emergence of the French revolution had caused unity among the Irish people. After the declaration of war between the British and France, the Irish and the British governments decided to do away with the organization because they became afraid of

Thursday, July 25, 2019

Adam Smith Inquiry on the Wealth of Nations Essay

Adam Smith Inquiry on the Wealth of Nations - Essay Example As the discussion highlights subject to his arguments, Adam smith is onto something. First, by saying that specialization and division of labor is the key to prosperity, he was indeed very right because the two attributes leads to perfection and high productivity. At the same time, specialization allows for the maximization of technical skills and relevant innovations. This amounts to effective and quality labor that guarantees better performance in all fields. However, to achieve the skills for specialization and division of labor, adequate knowledge is required. This is only transmitted in a structured education system that starts at childhood and hence the need for widespread education for children. Though this trend was not famous at the time, it would be highly effective upon implementation. Indeed, in the absence of specialization and division of labor, innovations, perfection, high quality labor, and improved performance can never surface. Lack of specialization leads to gener alization and lack of specific goals that is detrimental to the economy of any nation. The poor on the other hand develop general skills that are very efficient in their livelihood but have no chances of advancement since there are no innovations. Hence, Adam advocates for widespread education that will improve the skills of the citizens and enhance specialization and division of

Wednesday, July 24, 2019

Why is the employment relations system in the USA characterised by low Essay

Why is the employment relations system in the USA characterised by low levels of collective bargaining - Essay Example Every country have specific norms and labour policies based on which the framework of the employee relation system is designed. In USA there are three basic laws with regard to the employee relationship. They are: a) National Labour Relation Act, which is also known as the Wagner Act, b) Labour Management Relation Act, also called the Taft-Hartley Act, and c) Disclosure Act, which is called the Landrum Griffin Act. The Federal authorities throughout USA make sure that these three laws are implemented in organizations. The agency responsible for its enforcement is the National Labour Relation Board (NLRB). It is into labour management and relation assessment. The Department of Labour (DOL) is responsible for the enforcement of the other important aspects in labour relationship management laws. The major requirement for doing such activity is to ensure the democracy of the internal union and the financial accountability. Both of these regulatory bodies are responsible for ascertaining that the laws are strictly followed and organizations are working under the assistance of these stated frameworks. The private sector workforce or employees have laws set for them under the federal labour laws of the two regulatory bodies such as DOL and NLRB. It has been stated in the Commerce Clause that these regulatory bodies even have regulatory authority to control the labour or employee relations in the privately owned companies (Cahuc and Zylberberg, 2004, pp. 371–373). Traditionally, the unions were formed by skilled craftsmen to safeguard their interest in the organization. With the advent of scientific management in the organizations and industries, the rationale for collectively acting to bargain for the disbursement and working conditions among the workers increased. However, the capitalists in those times were extremely powerful and they opposed the union movement. The anti-union employment laws were even floated by them so as to dishevel the union movement of t he craftsmen. However, during the Great Depression of 1930s, the factory workers united and started forming unions. It was during this time when these unions were successful in performing many activities such as the Wagner Act of 1935, which gave the employees or workers the right to plan and organize strikes. In 1940–1950, the unions began to grow though the federal legislation controlled and monitored them from time to time. In 1960 and 1970, the unionization in the public sector increased considerably (Harcourt and Wood, 2006, pp. 141–145). The regulatory bodies in US affect the industrial and employee relation system in many ways such as: They provide the terms and conditions of the employment in details and directly. They regulate the way in which the organized labour or employees and the management are related to one another. The regulatory bodies had ascertained the minimum wage rate and the maximum working hours for the workers. The overtime rates were also asc ertained by the federal and state bodies. The concept of â€Å"employment at will† operates in US. This means that the employer would have to show no specific reason for dismissing any employee. In this scenario, the National Labour Relation Act was introduced, which provided a specific structure of policies for employee rights in relation to the collective actions. A few of the regulations also required union certification through secret ballot (OECD, 1997, pp. 86–87). In 2007, the union density in US was about 36 percent. Among this about 7.5 percent was in the private sector and the rest in the public sector. It is said that the US unions have a unique approach because they provide benefits mainly to the existing

Tuesday, July 23, 2019

A streetcar name desire and death of a salesman Essay

A streetcar name desire and death of a salesman - Essay Example In the real sense Willy was a failure as a father as well as a salesman (Miller 62). In his funereal, his wife wondered aloud on the whereabouts of his friends as he seemed to a famous person. His past reshaped his present to be a famous person and an achiever, as these are the things that he hoped for the future. His past was a mere channel of protecting his failures that are vivid in his future life. As seen in the work of Miller, William has been described as a romantic person in an unromantic world, as Christopher Bigsby describes him (33). This relates to the fact that his lifestyle does not represent the real lifestyle he hoped to achieve. Willy’s life is indeed tragic in his own aspect, but one could actually define his life as a tragedy. His life can be compared to that of an ugly an unromantic person. Willy’s uncertainties actually affect his lifestyle. He represents some forms of uncertainty that led to his misery in the time of his death. Blanche is an ingenious re-creator of the self who was bewildered with the destructive ability of Stanley who did not need to strain much to conceal the aspects that shaped his past life. The force symbolized by Stanley is one that Blanche explains to be a destructive one (Miller 80-164). It is evident that the fantasy world that shapes an individual’s past indeed protects the reality of life as seen in Blanche

Monday, July 22, 2019

The seven Gorge site has been designated a world heritage site Essay Example for Free

The seven Gorge site has been designated a world heritage site Essay The seven George site has been designated a world heritage site. Use the sources, and your own knowledge, to explain why this site is Considered to be so important The seven George has been designated a world heritage site for the simple reason that it Is seen to be such an important site. It is where the iron revolution began. In this piece of coursework I am going to study all of the sources and my own knowledge to explain why the seven George is seen to be so important. Source A shows the importance of the seven George site because it shows that Darby moved to the Coalbrookdale area and took out a lease on works which were made up of an old blast furnace and some forges. From what started as a small sustainable business he then built up a large profitable one. He cast iron goods in sand out of the blast furnace, which was fuelled by using wood charcoal. Later on he went onto using pit coal to power the furnace this was a technological advance to the iron industry. Source B shows the importance of the seven George site because it states that the woods provided abundant fuel for the furnaces. As trade grew in Coalbrookdale the supply of wood decreased so it became very expensive and scarce. Business must have been successful because they had used a large amount of wood for fuel. The Coalbrookdale foundry produced between 5 and 10 tons of iron in a week (they must have been successful to produce such large amounts of iron). Business must have been successful because they produced a range of items e.g. smoothing irons, doorframes, weights etc. Source C shows the importance of the seven George site because it shows the transportation links and what methods of transport which were available e.g. wagons, barge these were all good means of transport. Transport was needed to transport iron items. Turnpike trusts were used as better and smoother transportation links. Source C shows us a number of blast furnaces that leads us to think that there was a lot of iron produced at the site. Lots of wood have been cut-down this could be because the wood was needed in the early days of the iron industry. Source D shows the importance of the seven George site because it shows a number of furnaces in use, also shows that a lot of woods have been cut down. Source E shows the importance of the seven George site because its a map showing a number of ironworks, raw materials, transportation it gives us a full under standing about how things were run. It shows the raw materials were made into the finished goods in the area. It shows good transportation links (turnpike trusts) roads rivers etc. so they could move their products from one place to another more easily. Source F shows the importance of the seven George site because the first ever iron bridge was built there. It had one big arch and was made from cast iron (nothing had ever been made before). It shows the skill of the people who built the bridge. They had built something no one had ever built before. The source shows that the family was thinking about efficiency (wagon ways made of iron rather than wood). All materials were found on or near by. (this made it an excellent site to produce iron) everything from digging up the raw materials to the finished product was all done in Coalbrookdale. Source G shows importance of the seven George site because it shows Darby had thought of many improvements. He had lots innovations that made his business stand out from the others. Darby had roads laid (turnpike trusts) and had them also laid with sleepers and rails. It shows the importance of transportation to the business to move raw materials. Discovered coke for smelting iron from its ore, efficient and profitable method. Source H shows the importance of the seven George site because it shows there were blast furnaces at Coalbrookdale and states the size and different types. Source I shows the importance of the seven George site because its a modern diagram showing how the old furnace worked. The technology that was being used at the time. Source K shows the importance of the seven George site because it states that Coalbrookdale was one mile long and states that the site was quite large. The source tells us about the Iron Bridge being constructed, it says what a huge job it was to build. The bridge was a great advertisement for the company and made the company very famous. It shows another use of iron. Source L shows the importance of the seven George site because its a reconstruction of a toll house, it shows good transport (roads) these roads are known as turnpike roads. Maybe they used roads to transport iron goods. Source M shows the importance of the seven George site because its a reconstruction of a candle makers workshop. It shows a growing business in the Coalbrookdale area (people used candles for lighting their homes) shown a growing population around Coalbrookdale. the site was important because of other industries as well as iron. There are lots of reasons for why the seven George site is seen to be so important. The site is seen to be very important. The site is seen to be where the industrial revolution began. (Very important). The site is not just important in Britain! but also throughout the entire world! The industrial revolution began in Britain and other countries followed. The site is very important because it is one of only a few world heritage sites. The site has been preserved as much as possible and there are a number of museum sites so that the importance of the site and so it can be remembered. Thousands visit the site each year.

Sunday, July 21, 2019

Effectiveness of Treatment of Postnatal Depression

Effectiveness of Treatment of Postnatal Depression TREATMENT But there have been a recent number of studies that looked at the effectiveness of treatment of postnatal depression. From one of the most recent publications (Dennis, 2005) provides a meta-analysis of the factors which influence the outcome in the condition. The author concluded that the only strategy that was shown to have â€Å"a clear preventative effect† was intensive post-partum support from the healthcare professionals who are involved in the care of the mother. Surprisingly, this was found to be more effective than all the similar regimes which included an ante-natal component as well. A stable family life, a person experiences in the first years of life have profound effects on his or her mental health. On the other hand, talking about postnatal depression also have to concerns about the lives of the babies involved. A child from a stable home, looked after by affectionate, caring parents (or other adults), is likely to be mentally stable and able to resist everyday stresses than a child from a home where there is emotional strife, constant bickering or violence this child is more at risk of developing a personality disorder in later life. Although one in four of the population in the UK will suffer from a mental health problem at some point in their lives regardless of age, race, gender or social background. Anxiety and depression for an example in post-natal women is fairly common (Fowles, 1996). Postpartum depression is considered as a factor which can affect the development of a child in the early period of his or her life and partly determines the childs future. The morbidity associated with postnatal depression has a number of potential consequences not only for the mother, but also the child and the rest of the family as well (Oakley et al, 1996). Several recent studies have shown that healthcare professionals often fail to spot the signs of postnatal depression. Making the diagnosis is obviously the prerequisite of establishing a treatment regime so it is clearly vital for all healthcare professionals to be on their guard for warning signs – sleep disturbance, irritability, mood swings and irrationality (Ramsay et al, 1995). The importance of spoting the signs of postnatal depression is stressed in the National Institute of Clinical Excellence clinical management and service guidance on antenatal and postnatal mental health, which was released lately that it is applicable to healthcare professionals who care for women who are designing a pregnancy, are with child or throughout the postnatal period (the first year after giving birth) (NICE, 2007). According to NICE, it is approximated that as numerous as one in seven women experience a mental health disorder in the antenatal or postnatal period (Hagen et al, 2007). The guidance is the first of its kind to make exact recommendations on identification, treatment and management of all mental health disorders, encompassing disquiet, depression, consuming disorders, bipolar disorder, schizophrenia and obsessive-compulsive disorder. It should be read in conjunction with living NICE guidance on mental disorders. The guidance states that service users with a mental health disorder should be granted heritage perceptive data at each stage of evaluation, diagnosis, course and treatment about the influence of the disorder. This data should cover the appropriate use and probable side-effects of treatment (Harris,1994). This recommendation concerns to women with a living mental health disorder who are with a child or planning for a pregnancy, and those who evolve a mental health disorder throughout pregnancy or the postnatal period. Healthcare professionals should work to evolve a believing connection with the woman, and her partner(if they have one), imidiate family members and carers where appropriate and agreeable to the woman. In specific, they should be perceptive to the matters of stigma and disgrace in relative to mental illness (Harris, 1994). Stigma as defined by Abrams et al, (2005) is â€Å"a mark or sign of disgrace or discredit†. Stigma causes people to feel uncomfortable around an issue, or can also cause people to mock the issue in order to make it less threatening to them. Most people who feel uncomfortable is often refused to talk about mental illness therefore causing a silence around the subject. People usually tend to attach stigma to others that are different from them. Often, due to mistaken beliefs, the mentally ill are thought to be dangerous. The stigma attached to mental illness is the main obstacle to better mental health care and better quality of life for people who have the illness, for their families, for their communities and for health service staff that deal with psychiatric disorders (Abrams et al, 2005). Routine communication with doctors and healthcare professionals throughout pregnancy and the postnatal period presents an opening to recognise women who have, or are at risk of evolving, a mental health disorder. At a womans first communication with professionals in both antenatal and postnatal periods, doctors and healthcare professionals should enquire about: (Hagen et al, 2007). Past Previous treatment and medication by a psychiatrist or expert mental health group, encompassing inpatient care; A family history of perinatal mental illness. However, the guidance stresses that other exact predictors, for example poor connections with her colleague, should not be utilised for the usual proposition of the development of a mental health disorder (Gotlib et al, 1991). The following questions must be asked when a pregnant woman attend to a health care professional; During the past month, have you often been bothered by feeling down, depressed or hopeless? During the past month, have you often been bothered by having little concern or delight in managing things? If the woman responses yes to both of these questions, a third enquiry should then be considered: Is this certain thing you seem you require or desire assistant with? The use of self-report assesses for example the Edinburgh Postnatal Depression Scale (EPDS), Hospital Anxiety and Depression Scale (HADS) or Patient Health Questionnaire-9 (PHQ-9) may be advised as part of a later evaluation or for the usual supervising of outcomes (Harris, 1994). If a likely mental health disorder is recognised throughout pregnancy or the postnatal period, a further assessment will be needed: If the woman has or is supposed of having a critical mental sickness (for demonstration bipolar disorder or schizophrenia), she should be mentioned to a mental health care service, encompassing, if appropriate, an expert perinatal mental health service professional (Hagen et al, 2007). The womans GP should be acquainted in all situations even if no further evaluation or referral is made (Hoffman and Drotar, 1991). And in writing care plan covering the pregnancy, consignment and the postnatal period should be evolved for with child women with a present or past history of critical mental sickness, generally in the first trimester. This should be evolved in collaboration with the woman and her colleague, family and carers, and encompass expanded communication with mental health service professional (Fowles, 1996). The guidance suggests there should be apparently particular care pathways so that all applicable prime and lesser healthcare professionals understand how to get access to evaluation and treatment (Hoffman, 1991). NICE states that there is clues to support the use of aimed at psychosocial interventions for women who have symptoms of depression and/or disquiet that manage not rendezvous the threshold for a prescribed diagnosis. The guidance interprets that certain treatment or support for a postnatal woman should be advised when symptoms manage not rendezvous diagnostic criteria but significantly hinder with personal and communal functioning (Hagen et al, 2007). For this assembly of women the following should be considered: Offering one-to-one, short psychological treatment (four to six sessions), for example interpersonal psychotherapy or cognitive behavioural treatment for mental health service users who have had a preceding episode of depression or anxiety; Offering communal support throughout pregnancy and the postnatal period (such as normal casual one-to-one or group-based support) for women who have not had a preceding episode of depression or anxiety (Fowles, 1996). However, it adds that psychosocial interventions conceived expressly to decrease the prospect of evolving a mental health disorder should not be part of usual antenatal and But it adds that treatment conclusions are perplexing by the occurrence of the evolving foetus, breastfeeding and the timescales enforced by pregnancy and birth (Hagen et al, 2007). As an outcome, it contends that the thresholds for non-drug treatments, especially psychological treatments, are probable to be smaller than those set in NICE clinical guidelines. It emphasises that women who require psychological treatments should be glimpsed for treatment commonly within one month of primary evaluation and no longer than three months afterwards (Goodman, 2004). The NICE guidance summaries the function doctors can play in noticing, stopping and nurturing for women with a mental health disorder when planning for a pregnancy, throughout pregnancy and the postnatal period. Mental health promotion becomes very important for the people who are plannning to have a child or those who are already pregnant or newly born mother. It should be mentioned that postnatal depression is possible to occour but they should be aware that it is treatable (Harris, 1994). When in a clinical setting dealing with a patient with a mental illness, it is good practice to communicate effectively and adjust the skills accordingly to the patient. For example speak clearly, slowly and ask open-ended questions. Observing any change in mood and behaviour at all times for safety reasons. REFERENCE Cox, J., Holden, J., Sagovsky, R. (1987) Detection of postnatal depression: Development of the 10 item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry, 150, 782-786.

Market With Respect To Customers And Segmentation Marketing Essay

Market With Respect To Customers And Segmentation Marketing Essay Analysis of market with respect to customers and segmentation is a fundamental process for any market offering. Several researches has been conducting on analyzing the factors on which the homogenous markets are segmented into several groups and are made heterogeneous with respect to some attributes possessed by the customers. Market segmentation is a challenge by marketers to identify group of customers with similar attributes and then target the product according to their different needs. These segments which are made as a result of market segmentation process, are then refined and one or several segments are selected to target a particular product or market offering. The process of selecting appropriate group of customers for a particular market offering is a part of planning before the product is initially launched in the market. The overall marketing efforts are the post consequences of this process or in other way these market efforts are based on attributes possessed by the customer. Each set of customers is targeted according to their attributes. Therefore it is of crucial importance for marketers to identify these attributes of customers that can be satisfied by the product offered in the market. However, after all these planning and marketing segmentation it is a common issue for marketers to indentify the actual target market for their market offering. Sometimes it is also observed that a product targeted to a particular segment is also being used by other customers that falls apart from that targeted segment. Segments are made on several characteristics like age, gender, geographic location, personality type, income group etc. It is the decision of the marketers to segment the market according to a particular or several characteristics. The ultimate goal of this process is to match the attributes of market offering to customer needs. The processes of marketing effort followed by segmentation analysis and selection are given a direction to target that particular segment and highlight the product attributes with respect to customer needs. In our research we make an attempt to study the effect of linking a market offering to a specific segment on its acceptance by another segment. During this research we have identified several products that are linked to a particular customer segment based on different characteristics. Mainly we have divided these market offerings into three sections that are: market offerings linked to a particular gender, market offerings linked to a particular age group, market offerings linked to a particular geographic location. We included these products in our survey to identify customers acceptance of a product that is linked to a particular segment by another segment that is not targeted by that product. Problem statement To study the effects of linking market offerings to specific customer segments on its acceptance by other customer segments. In this problem statement well study the effect of linking market offerings to specific customer segments as an independent variable. We will be including market offerings that are linked to a particular market segment and will study its effect by identifying the acceptance of these products by other segments. Therefore, the acceptance of market offerings that are linked to a particular segment by another segment will be dependent variable. Hypotheses For conducting this research we have created the following hypotheses: H1: Linking a market offering to a particular customer segment based on age does not have any effect on its acceptance by another segment based on age. H2: Linking a market offering to a particular customer segment based on gender does not have any effect on its acceptance by another segment based on gender. H3: Linking a market offering to a particular customer segment based on geographic location does not have any effect on its acceptance by another segment based on geographic location. Outline of the study Initially this study included the introduction to our research. In first chapter we tried to elaborate on our research topic. We discussed the issues that lead us towards our research problem. Furthermore we motioned our research problem statement along with the variables well study from our research problem. To test the variables we have formulated our hypotheses that well check in our result section. The second chapter brings about focus of research studies obtained from various research papers available. We did in depth study of around fifteen research papers related to our study and provided a brief discussion about their views regarding their respective field of study. This will provide a theoretical base for our study. The third chapter describes our research methods in detail. It will cover methods of our data collection. The sampling technique we used to collect our data from respondents, along with the sample size. Instrument of data collection that we have used and the validity and reliability of data collected from that instrument. The research model is represented in diagram and statistical technique that we have used is also discussed. The fourth section includes results of our study. This will be supported by statistical outputs of our data analysis and its interpretation to elaborate our results in theoretical terms. In the end of this section well provide hypotheses assessment summary. The fifth chapter will provide the conclusion on basis our results and discussions about it. The implications of our study on practical grounds. It will further indicate the areas of research that we can vision for further research. Definitions Market offering: any product tangible or intangible that is offered in market or customers. Market segmentation: Process of segmenting market into similar segments. Chapter 2: LITERATURE REVIEW Johnson (1971) found that market segmentation studies can produce result which indicates desired marketing action. Techniques which are presentably available can (1) construct a product space (2) discover the shape of distribution of consumers idea point throughout such a space, and (3) identify likely opportunity for new and modified produce. Wendell R. Smith (1956) found in his studies that market segmentation is done by viewing different preference of different groups. Consumers with similar requirements and preferences are considered as a segment. Segmentation in this way in done in order to satisfy consumer wants. Through market segmentation marketers can identify the required marketing action. These technique help to indentify new offering that could be designed. Different offerings could be designed according to the customer requirements. These groups with different requirements are then divided into segments in order to bring in new products in the market (Johnson, 1971). Market segmentation consists of viewing a heterogeneous market (one characterized by divergent demand) as a number of smaller homogeneous markets in response to differing product preferences among important market segments. It is attributable to the desires of consumers or users for more precise satisfaction of their varying wants. As market segmentation simultaneously addresses the roles of both marketers and customers, the segmentation concept has captured the attention of many scholars and practitioners alike in the field. Accordingly, within the last few years, a number of new developments have emerged in market segmentation. Segmentation is based upon development on the demand side of market and represents a rational and more precise adjustment of product marketing effort to consumer or user requirements.(Smith 1956). Segmentation helps companies to achieve competitive advantage., as different segments leads to different outcomes. Segmentation helps marketers identify the role of consumer preferences. This segmentation is based on the demand by different consumer groups. Marketers design market offerings by evaluating difference preference of different segments so that it could satisfy their needs. Age based segmentation is done by dividing people into similar age groups. The first age group that was born 1946 and 1964 are known as baby boomers I . They are more prone to make saving and questioning authority, so marketers have to design the product that has more cost to benefit ratio plus they have to provide more information about the offering. The second age based segment is baby boomer II 1964 and 1973 these are more towards spending then savings. N-Gens and Generation X segment are the once that are born between 1977 and 1987 and age from 1984 to 1994 respectively. They are more prone to spending money then saving. They prefer using internet as mean to socialize with people they know, so marketers need to produce product that close to technology. (Bidwell) The brand extension decision is strategically critical to an organization. Though an extension is a way to exploit perhaps the most important asset owned by a business, it also risks decreasing the value of that asset. The wrong extension could create damaging associations that may be expensive, or even impossible, to change. Ries and Trout (1981). For most brand extensions, a motivating rationale is that the original brand has associations that will be helpful to the extension. The impact of a brand association, however, can be harmful to the extension. For example, the Betty Crocker attribute association might be viewed as negative if the name were used on fashion product designed to appeal to young women. Zeithaml (1988) Brand extension is of the most dangerous decision that a company make. The motivation behind brand extension is that the existing parent brand helps the new brand to acquire its place in the market. But as it get positive effects from parent brand it could also put a negative effect on the parent brand. As in case of failure or success of brand extension it some how reflects the reliability and success of an existing parent brand. Unrelated extensions are some times might be disastrous for the company. Gender identity, sometimes referred to as an individuals psychological sex, has been defined as the fundamental, existential sense of ones maleness or femaleness. (Spence, 1984) A number of researchers have attempted to relate purchases of product types or specific brands to personality traits of the purchasers. These researchers advanced the basic hypothesis that individuals who consume in a certain manner will also manifest certain common personality characteristics, leading to prediction of consumer behavior. (Grubb Grathwohl, 1967) When attempting to measure whether segmentation has succeeded or failed. It is important to clarify the notion of success. Little research has dealt directly with the question of success and failure in segmentation research. (Dibb, 1998) With many questions regarding the relationship between marketing strategy and measurable business outcomes, proved the link with particular strategic decisions. It is difficult to achieve. (Dibb, 1998) The classic illustration of bad understanding of segmentation principles comes from the following quotation from a MD which emerges from a study examining the competitiveness of British industries. The study recommended that British businesses were reasonably weak in the application of a segmentation approach: I dont know if we segment the markets, or who we really place ourselves against the opposition. I expect our advertising agency knows. I think we are almost certainly up-market, because we advertise in some very posh magazines (Doyle et al., 1986) Some business view segmentation other as a tactical trick than as a staid strategic marketing tool. In some respect it has become industrys buzz expression. The cure for anything and everything. The attraction to view segmentation as an additional of marketings goodies in a kind of bitter shop mentality may be just too huge. Advertising executives sometimes criticize that product and brand managers view endorsement as a tactical answer to short-term declines in sales. When the months figures are reduced, advertising personnel complain that the managers visit the promotions bitter shop, with a steady stream of requirements for quick-hit campaign. Segmentation is sometimes view in the same manner, used tactically to deliver short-term payback, ignoring the need for a longer-term viewpoint. For customers the outcome can be a confusing mix of conflicting marketing programmers. (Dibb, 1998) Managers responsibility segmentation analysis for the first time often state surprise at the lack of sensible guidance and step-by step approach to help. This conversation begins by reviewing the kinds of question which practitioners ask when moving out segmentation study, then examines the degree to which available guidance matches up to these supplies. The following questions, which are characteristic of those asked by practitioners responsibility segmentation for the first time, are drawn from deliberations with managers at several divisions of an industrial chemical trade. (Dibb, 1998) The repayment of following a plan for the entirety of the segmentation project is apparent. Planning encourages the location of clear objectives, so that marketers found from the start exactly what they desire to achieve from the keep fit. This also increases the chance that measures will be designed to confirm that objectives have been achieved. (Doyle et al., 1986) Like the target of any market segment, racial targeting is done by brand manager to maximize sales and income. The basic rationale after this strategy is that a variety of promotion programs (unique combination of products, publicity, pack-ages, pricing, sharing, etc.), each intended to better match the psychology and happiness of a separable section, will eventually produce more sales and income than would a single undifferentiated mar-kiting agenda, so called mass promotion.( Polly, Lee and -Whitney, 1965) Marketing segmentation is ordinary among large consumer merchandise firms and has incurred criticism only when the product itself is challenging. The central concern, therefore, is not classically with the use of event or sex as a basis for marketplace analysis and idea. Selective targeting can be benign or even helpful, but only if the product is. When the mar-kiting process is deferential and appropriately customized it may be more applicable, efficient and may provide better service and settlement to targeted segments. But if the product is unpleasant, even ad-dative and deadly, segmentations competence delivers more death and illness, not more payback, and pro-vides damage, not a service. (Polly, Lee and -Whitney, 1965) Segmentation in commerce markets should reflect the association needs of the party involved and should not be based solely on the customary consumer market loom, which is primarily the collapse method. Through use of both the collapse and the build-up approach, a more correct, in-depth, and potentially more gainful view of industrial market can be achieve (Crittenden, Crittenden, and Musky, 2002). However, evils remain concerning the practical Application and completion of B2B segmentation. Managers account that the analysis process are reasonably clear, but it is not clear how they be supposed to choose and evaluate flanked by the market segments which have been resolute. (Nude and Cheng, 2003). Much segmentation theory has been developed during the period when transactional marketing was the principal approach to marketing, rather than the more relational approaches adopted in todays service-dominated environment. Under these circumstances, the allocation of resources to achieve the designated marketing mix goals was of key importance. (Naudà © and Cheng, 2003). Evils with the segmentation literature debate with a range of market practitioners from industry as varied as industrial substance and car mechanism to distillers and nibble foods are quick to condemn the convenience and ease of use of the so-called academic writing. The use of technical and turgid speech is a particularly common disparagement, though not unique to the segmentation literature. While it is beyond the scope of this piece to conduct a complete examination of general question about the style and arrangement of academic literature, it is important to discover issues which are specific to the segmentation text. One of the most fundamental concerns is that the writing reflects a inlet between educational and practitioner needs and that academics have a research agenda which sets different kinds of priorities to those of practitioners. A second area of worry is that the literature fails to believe some of the sensible constraints faced by marketers seeking to implement segme ntation advance. (Dibb, 1998) Chapter 3: RESEARCH METHODS 3.1 Method of Data Collection The method of data collection for this research will be Personal Surveying Technique which is highly effective for this research study. As far as the procedure is concerned for the collection of data. Firstly we will visit respondents according to the proposed sample size and ask them to solve the questionnaire for the research study. If respondents have the time they can fill the questionnaire at the moment in any other case they can fill at later time or date and the researcher can gather the questionnaire upon the set time from the respondent. 3.2 Sampling Technique Researcher proposes to use Non probability based sampling, where the researcher selects the sample based on convenience sampling, data will be mostly based on questionnaire since the researchers dont have that much time and is short of resources. 3.3 Sample size   Number of respondents for this study is 250 users for around 14 different brands which are gender, age or geography based linked. 3.4 Instrument for Data Collection   Self administered questionnaire will be used to collect data from the correspondents, which will have ample number of questions to address all the variables of the study. Various options would also be assigned to each question to measure the variables. 3.4.1 Validity and Reliability Test The validity and reliability of our data that we gathered in our study is given by the following cron-batch alpha statistical test. TABLE 3.4.1 Reliability and Validity Test Case Processing Summary N % Cases Valid 246 98.4 Excludeda 4 1.6 Total 250 100.0 a. Listwise deletion based on all variables in the procedure. Reliability Statistics Cronbachs Alpha N of Items .769 60 Here the value of Cronbachs Alpha is 0.769 that is about 77%. This confirms that our data is 77% valid and can be consider as reliable data for this study. 3.5 Research Model Developed Figure 3.5 This model refers to our variables and the effect that we have studies in our research. 3.6 Statistical Technique We have used custom table percentage method in which we have developed combine effect of customers perception about the product designed for and who will use the product in percentage terms. CHAPTER4: RESULTS 4.1 Findings and Interpretations of the Results Table 4.1.1 Zong Lahore Unlimited Custom Tables Who else can use People of Karachi People of Lahore People of Pakistan Any other Table N % Table N % Table N % Table N % Designed for Karachi 3.6% 1.2% 1.6% .0% Lahore 5.2% 55.6% 18.8% .0% All pakistan .8% 4.0% 8.4% .4% Any other .0% .0% .4% .0% Table 4.1.2 Ufone-Prepaid Karachi Offer Custom Tables Who else can use People of Karachi People of Lahore People of Pakistan Any other Table N % Table N % Table N % Table N % Designed for Karachi 58.0% 6.4% 18.8% .4% Lahore 2.8% .0% 1.6% .0% All pakistan 4.0% .4% 6.8% .0% Any other .0% .4% .4% .0% Table 4.1.3 Jazz- Karachi Bachat Offer Custom Tables Who else can use People of Karachi People of Lahore People of Pakistan Any other Table N % Table N % Table N % Table N % Designed for Karachi 57.6% 4.8% 20.8% 1.2% Lahore 1.2% 1.2% .4% .0% All pakistan 4.0% .8% 6.8% .4% Any other .0% .4% .0% .0% 14.00 .4% .0% .0% .0% Table 4.1.4 Zong- Karachi Unlimited Custom Tables Who else can use People of Karachi People of Lahore People of Pakistan Any other Table N % Table N % Table N % Table N % Designed for Karachi 62.0% 3.6% 17.2% .0% Lahore 1.2% .4% 1.6% .0% All pakistan 3.6% .4% 9.6% .4% Any other .0% .0% .0% .0% Table 4.1.5 Omore Karachi ka dil khusheyon se fill Custom Tables Who else can use People of Karachi People of Lahore People of Pakistan Any other Table N % Table N % Table N % Table N % Designed for Karachi 42.0% 2.8% 22.0% .8% Lahore .4% 2.4% .8% .0% All pakistan 2.8% 2.4% 22.0% .4% Any other .8% .0% .4% .0% The above mentioned tables are related to geographic location linked to a particular segment. As a common result we can justify that even there is a lot of variation in customers perception and acceptance but if we concentrate on where majority lies we can conclude that a product that is linked to a particular geographic location is used by the customers belonging to that location. Hence the other geographic segment does not accept the marketing offer linked to another geographic segment. Table 4.1.6 Jang- Bachon ka jang Custom Tables Who else can use 10 yrs or below 11-18 yrs 19-26 yrs above 26 All ages Table N % Table N % Table N % Table N % Table N % Designed for 10 yrs or below 18.5% 18.1% 2.8% .4% 3.2% 11-18 yrs 12.0% 19.7% 7.6% .4% 7.2% 19-26 yrs 1.6% .4% 2.8% .8% 2.4% above 26 .4% .4% .8% .4% .0% Table 4.1.7 Jang- Bachon ka jang Custom Tables Who else can use 10 yrs or below 11-18 yrs 19-26 yrs above 26 All ages Table N % Table N % Table N % Table N % Table N % Designed for 10 yrs or below 18.5% 18.1% 2.8% .4% 3.2% 11-18 yrs 12.0% 19.7% 7.6% .4% 7.2% 19-26 yrs 1.6% .4% 2.8% .8% 2.4% above 26 .4% .4% .8% .4% .0% Table 4.1.8 Djuice- its fun to be young Custom Tables Who else can use 10 yrs or below 11-18 yrs 19-26 yrs above 26 All ages Table N % Table N % Table N % Table N % Table N % Designed for 10 yrs or below 1.6% .4% .4% .0% .0% 11-18 yrs 2.8% 11.2% 14.8% .4% 5.6% 19-26 yrs .8% 22.8% 19.6% 6.0% 11.6% above 26 .0% .4% .8% .4% .4% Table 4.1.9 HBL- Young Savers Account (upto 18 years) Custom Tables Who else can use 10 yrs or below 11-18 yrs 19-26 yrs above 26 All ages 14.00 Table N % Table N % Table N % Table N % Table N % Table N % Designed for 10 yrs or below 2.4% 4.4% 1.6% .0% .0% .0% 11-18 yrs 16.0% 35.2% 11.2% .8% 4.0% .4% 19-26 yrs .4% 4.0% 11.2% 2.8% 2.0% .0% above 26 .0% .4% 1.2% 1.2% .8% .0% Table 4.1.10 Dawn- Young World Custom Tables Who else can use 10 yrs or below 11-18 yrs 19-26 yrs above 26 All ages 41.00 Table N % Table N % Table N % Table N % Table N % Table N % Designed for 10 yrs or below 7.6% 10.0% .4% .0% 1.6% .0% 11-18 yrs 14.0% 20.0% 13.2% 2.0% 9.6% .4% 19-26 yrs 1.2% 4.0% 6.0% 2.4% 2.4% .0% above 26 .8% .8% 1.2% .8% 1.6% .0% In this section of our instrument we presented the market offering linked to a particular customer segment based on age group. The general result of all 4 market offerings is showing that there is a significant variation in usage of product designed for a particular age by other age groups. Hence we can conclude that a market offering linked to a particular age group is accepted by other age groups. Table 4.1.11 Garnier Men Custom Tables Who else can use Male only female only both genders Table N % Table N % Table N % Designed for Male only 66.8% 4.0% 14.2% female only 3.2% 2.0% 2.4% both genders 1.2% .4% 5.7% Table 4.1.12 Jazz-Ladies Package Custom Tables Who else can use Male only female only both genders Table N % Table N % Table N % Designed for Male only 6.4% 2.8% 1.2% female only 2.8% 31.2% 29.6% both genders 3.2% 4.0% 18.8% Table 4.1.13 Gillette- The best a Man can get Custom Tables Who else can use Male only female only both genders Table N % Table N % Table N % Designed for Male only 68.1% 4.0% 10.5% female only 4.0% 2.8% 2.0% both genders 2.8% .4% 5.2% Table 4.1.13 Head and Shoulder- for Men Custom Tables Who else can use Male only female only both genders Table N % Table N % Table N % Designed for Male only 41.5% 5.6% 25.4% female only 4.8% .4% 1.2% both genders 2.8% 2.0% 16.1% Table 4.1.14 Ufone- Ladies Package Custom Tables Who else can use Male only female only both genders Table N % Table N % Table N % Designed for Male only 4.4% 3.2% 2.0% female only 3.2% 33.1% 26.2% both genders 3.6% 3.6% 20.6% In this last section we presented market offerings that are linked to a particular gender. In this it is not justifiable to give a general consensus for all the 5 products we presented. There is a different pattern of behavior that is identifies and it is with respect to the nature of the product. Hence we can conclude that for cosmetic or body care products the market offering linked to a particular gender is not used by other gender and hence not accepted. However in case of telecommunication packages, a market offering linked to a particular gender is accepted by other gender and they can use it. 4.2 Hypotheses Assessment Summary Table 4.2 Hypotheses Assessment HYPOTHESES SUMMARY ASSESMENT H1:- Market offering linked to a particular customer segment based on age does not have any effect on another customer segment based on age. With respect to age we have seen there is a lot of variation in usage of product by other age groups. H1 accepted H2:- Market offering linked to a particular customer segment based on geographic location does not have any effect on another customer segment based on geographic location. With respect to geographic location prominent behavior is that a market offering is used by same geographic location its linked to rather than other geographic locations. H2 rejected H3:- Market offering linked to a particular customer segment based on gender does not have any effect on another customer segment based on gender. In this the usage of a product by other gender is according to the nature of product however the prominent behavior suggest that the product linked to a particular gender is not used by opposite gender H3 accepted CHAPTER 5: CONLUSION, DISCUSSION, IMPLICATION AND FU