Thursday, May 21, 2020
Executive summary The marketing plan has close ties with the overall financial and business plan. This plan contents a strategy for success, and breaks it down into coherent, actionable components that will aid The Sub Shop to implement marketing activities to provide a firm return on investment. The following areas will help explain how the company plans to differentiate the business and product offering from the competition, and define the strategy that will drive its business forward. The aim of the marketing plan is to evaluate Subway marketing strategies and the link with its objectives. Firstly, the marketing audit will be assessed using SWOT Analysis, P.E.S.T. analysis and five sources analysis to discuss operating performance andÃ¢â¬ ¦show more contentÃ¢â¬ ¦SubwayÃ¢â¬â¢s menu contains made-to-order customisable subs available in various sizes. The company also sells drinks, salads and wraps, snacks such as toasties and nachos, lunch platters for business meetings, mini-sized meals for kids and treats such as cookies, doughnuts and crisps. A limited number of UK stores serve halal meat. The company offers promotional deals on its food, to promote its value-for-money offering, which comprises of a Ã £2 breakfast deal and a Ã £3 lunch deal. A number of SubwayÃ¢â¬â¢s London outlets offer a click-and-collect service possible to order online or via mobile. This function is incorporated via smartphone app also as well as enabling customers to collect points via the SubCard rewards programme. The Subway UK app is named SubCard and consents customers to scan their iPhone at the till to earn points towards a free sandwich. Recent developments Ã¢â¬â menu In autumn 2013 Subway launched the Steak Jalapeno Melt and Chicken Jalapeno Melt (available as a sub or flatbread) which was marketed in conjunction with the latest cinema release Hunger Games: Catching Fire which was advertised on drinks packaging. The brand has also been attempting to cultivate an image as a healthy eating provider; Subway joined the governmentÃ¢â¬â¢s Responsibility Deal in 2013, pledging to reduce the amount of saturated fat in its KidsÃ¢â¬â¢ Pak by more than 70%, replacing cookies and crisps with healthier options that include one of a childÃ¢â¬â¢s recommended
Wednesday, May 6, 2020
With access to prescription drugs, people are able to treat a multitude of diseases and illnesses. These drugs help deal with pain, inability to sleep, depression, and much more. Every day we are increasingly living in a world where there is better living through chemicals. However, what most do not seem to see is the rising tide of pain, illness, and ultimately death being caused by the pills people take every day. Most keep drugs in a special place in their minds, where they see them as harmless. Sadly, this is not the case, and in some cases our prescription drugs can be just as harmful as illegal drugs (King 68). In addition, these drugs are just as addicting as some of the drugs that most hold to be off-limits, and need to beÃ¢â¬ ¦show more contentÃ¢â¬ ¦Opioid drugs are some of the most widespread pain medications that we have in this country; indeed, the fact is that opioid analgesic prescriptions have increased by over 300% from 1999 to 2010 (Mitch 989). Consequently, the number of deaths from overdose increased from 4000 to 16,600 a year in the same time frame (Mitch 989). This fact becomes even more frightening when you think about today; the annual number of fatal drug overdoses in the Unites States now surpasses that of motor vehicle deaths (Alexander 1865). Even worse, overdose deaths caused by opioids specifically exceed those attributed to both cocaine and heroin combined (Alexander 1865). While our major access to these drugs is doctors, we cannot simply lay blame on them, as there is not enough knowledge about these treatments to correctly appropriate drugs, and therefore extra is given (Hemphill 373). Alexander of the Department of Epidemiology of the Journal of the American Medical Association, states that Ã¢â¬Å"There are serious gaps in the knowledge base regarding opioid use for other chronic nonmalignant painÃ¢â¬ (Alexander 1865-1866), which leads to the unfortunately large number of leftover drugs. In fact, the main place that people get their drugs are from leftover prescriptions (Hemphill 373). This leads to a bigger problem for our youth, where 81% of OTC drug abusers also end up using marijuana and hallucinogens (King 68). Over a million arrests are made every year forShow MoreRelatedPrescription Drug Abuse And The United States With Students2605 Words Ã |Ã 11 Pages Running Head: Prescription Drug Abuse Prescription Drug Abuse in the United States with students Vikash Patel Wayne State University Prescription drug abuse among college students have increased over the past few years and is now a national problem. College students are abusing stimulant prescription pills just to stay awake to study and they will abuse the prescription pills just to stay awake to socialize with friends. According to the journal of Human Behavior in the Social EnvironmentRead MorePrescription Drug Abuse And Prescription Drugs1487 Words Ã |Ã 6 PagesPrescription Drug Abuse Prescription Drug Abuse has increased in an alarming rate over recent years! Prescription drug related deaths now outnumber those from heroin and cocaine combined. The abuse in prescription drugs in America goes back more than a hundred years ago. Prescription drug abuse is the use of a medication without a prescription, in a way other than prescribed, or for the experience or feelings elicited. Although prescription medications are intended to help individuals, they canRead MorePrescription Drug Abuse And Prescription Drugs Essay1413 Words Ã |Ã 6 PagesMost people are familiar with prescription medications; almost everyone has taken them at one point or another during their lifetime. Not all prescription drugs are addicting, but a large number of them are. Prescription drug abuse is a disease that has become a major problem in the United States, which affects over six-million Americans. Prescription drug abuse not only affects the individual, but can additionally have far-rea ching consequences that affect family, personal health, employmentRead MorePrescription Drug Abuse : Drug And Free World1508 Words Ã |Ã 7 Pagesin the United States, 2,500 youth aged 12 to 17 abuse a prescription pain reliever for the first time (Ã¢â¬Å"Prescription Drug Abuse Statistics Ã¢â¬â Overdoes Deaths Ã¢â¬â Drug-Free World,Ã¢â¬ n.d.) A 2007 survey in the United States found that 3.3% of 12 to 17 years olds and 6% of 17 to 25 year olds had abused prescription drugs in the past month (Ã¢â¬Å"Prescription Drug Abuse Statistics Ã¢â¬â Overdoes Deaths Ã¢â¬â Drug-Free World,Ã¢â¬ n.d.) Prescription drug abuse causes the largest percentage of deaths from drug overdosesRead MorePrescription Medications And Illicit Drugs Essay1706 Words Ã |Ã 7 PagesDrugs in the United States are a complex issue that ranges from legal, over-the-counter and prescription medications to illicit substances that are highly addictive. While many people have a legitimate need for me dication to function on a daily basis, there are also many incidences where these potentially helpful drugs are abused. When legal medications are abused, they cause the same personal, social and economic problems as illicit substances. This paper will look at the use of both prescriptionRead MoreThe Problem Of Prescription Drug Abuse1461 Words Ã |Ã 6 Pages(Quotes about Drug Abuse). This quote by Wayne Gerald Trotman describes how heartbreaking it is to contemplate on exactly how many peopleÃ¢â¬â¢s lives have been adversely impacted as a result of abuse. Child abuse, animal abuse, and sexual abuse are all major types of abuse; however, prescription drug abuse is a problem that is drastically skyrocketing in todayÃ¢â¬â¢s society. While other addictions and abuses are equally significant, it is imperative that people put a stop to prescription drug abuse using twoRead MorePrescription Drugs Are Not A Problem961 Words Ã |Ã 4 Pagesthere has been a growing concern for illeg al drugs, alcohol, tobacco products, over-the-counter drugs, and prescription drugs. All of these legal and illegal drugs have caused issues throughout North Carolina as well as the country, but one of the growing concerns is prescription drug abuse. One of the counties in North Carolina that has been affected the most by this epidemic is Robeson County. According to National Institute on Drug Abuse, Ã¢â¬Å"prescription medications, such as those used to treat painRead MorePrescription Drug Abuse. Did You Know That Prescription1173 Words Ã |Ã 5 PagesPrescription Drug Abuse Did you know that prescription drug abuse is one of the leading causes of death in the United States? Ã¢â¬Å"According to the Journal of the American Medical Association, two-hundred and ninety people in the United States are killed by prescription drugs every day. (White)Ã¢â¬ That number is growing every year due to the lack of knowledge of prescription drugs and the potential harm they can cause. Many people are under the misconception that prescription drugs are safe becauseRead MorePrescription Drug Abuse1298 Words Ã |Ã 5 Pagessick. Prescription drugs are being taken for reasons other than the ones they are being prescribed for, fueling an addiction that impacts as many as 48 million Americans (Prescription Drug Abuse WebMD). According to MedLinePlus, an estimated 20 percent of people in the United States have used prescription drugs for nonmedical reasons. This is prescription drug abuse. While a considerable amount of time, resources, and attention are focused on the problems associated with illicit drugs, prescriptionRead MorePrescription Pain Medications Are Supposed To Improve The1225 Words Ã |Ã 5 PagesPrescription pain medications are supposed to improve the health and well-being of an individual. Oxycontin, an opioid drug, is meant to help people manage their pain symptoms; however, many people are unaware that there is a danger of abuse of receiving drugs prescribed by their physicians. The essays Ã¢â¬Å"How to Create an AddictionÃ¢â¬ and Ã¢â¬Å"Erin Daly: OxyWatchdogÃ¢â¬ by Cynthia Andrzejczyk explore the problem of prescription drugs in the United States. Since 1999, prescription drug epidemic in the United
Pediatric ague otitismedia ( AOM ) is a prevailing medical status that affects many persons. This status is treated by prescription antibiotics, which have contributedto the addition in antibiotic immune bacterium. There has been some grounds to demo that antibiotic intervention is non ever necessary for the declaration of symptoms and the remedy of the status. We will write a custom essay sample on Pediatric Acute Otitismedia Aom Health And Social Care Essay or any similar topic only for you Order Now We propose to find the effectivity of 10-day Amoxil versus placebo in intervention of AOM. The survey design will be a randomised, dual blind, placebo controlled clinical test at paediatric and otolaryngology patterns in the Greater Philadelphia country. A sum of 400 Children between the ages of 6 months and 7 old ages will be recruited for this test. 200 participants will have antibiotic intervention, the other 200 will have placebo. The test will besides specifically evaluate intervention result in vulnerable populations, in this instance, kids less than 2 old ages of age. Specific Aims Acute otitis media is one of the most frequent unwellnesss of early babyhood and childhood, therefore one of the most common grounds for kids to see a doctor. ( Sarrell, et al.2003 ) . A In the United States, 93 % of all kids have had at least one episode of AOM by age seven. ( Sarrell, et al.2003 ) . Antibiotics are presently the intervention of pick for AOM in about all states. A In malice of this standard intervention, grounds of their effectivity remains limited in footings of clinical betterment ( Damoiseaux, et Al. 2000 ) . In fact, several surveies have demonstrated that AOM in kids can be managed without antibiotics ( Siegel, et Al. 2003 ) . Furthermore, in past research, there have been disagreements among decisions about the effectivity of intervention with antibiotics for different age groups. A One survey stated that there was no difference between interventions in kids under the age of two compared to kids under the age of six ( LeSaux, et Al. 2005 ) . A Another survey s howed age was an of import determiner of antibiotic effectivity ( Cohen et al. , 1998 ) . These tests have found a 10-day class of Amoxil was more effectual in the intervention of kids less than two old ages of age compared to kids two old ages and older ( Cohen, et Al. 1998 ) . A Aside from incompatibilities sing optimum age for intervention, the literature is missing in surveies comparing antibiotic interventions with placebo for AOM ( McCormick, et Al. 2010 ) . The end of this survey is to turn to the deficiency of grounds sing the efficaciousness of antibiotics for intervention of AOM and the incompatibilities in literature environing the issue of optimum age for intervention. A We propose to carry on a randomized controlled test comparing the effectivity of Amoxil usage for 10 yearss compared to placebo for intervention of AOM in kids between the ages of six months and six old ages. A The undermentioned research inquiries will be addressed: 1 ) What are the differences in intervention results of aten twenty-four hours class of Amoxil compared to placebo in kids with AOM between six months and six old ages of age? A To turn to this, the PCP will prove kids at twenty-four hours two, five, and 10 of the antibiotic or placebo intervention class utilizing the standardised diagnosing tools oftympanometry and otoscopic observationA Hypothesis 1: Both the Amoxil arm and the placebo arm will bring forth the same consequences at the completion of the 10 twenty-four hours intervention period. The differences between results will be undistinguished. 2 ) What are the differences in attach toing symptoms ( febrility and hurting ) in kids utilizing antibiotics versus those utilizing placebo intervention? A This will be addressed by giving the parents journals in which they must enter the kid Ã¢â¬Ës temperature ( A.M. and P.M. measurings ) and the disposal of anodynes throughout the twenty-four hours. A The journal will besides incorporate the FLACC hurting graduated table which is to be used before the kid goes to bed. 3 ) Do younger kids respond otherwise to antibiotics intervention than older kids? To turn to this inquiry we will statistically prove for an age class ( six months-two old ages vs. two-six old ages ) by intervention group interaction consequence. It is our long-run end to get a criterion of diagnosing for AOM research. intervention, and outcomes that will let for farther, more specific surveies in the attention for AOM. Background AccuteOtitis Media ( AOM ) , otherwise known as the common otalgia, is a cardinal subscriber to pediatric health care loads and the most common ground for kids to see a doctor. The standard intervention of attention is a class of antibiotics, therefore doing AOM a outstanding subscriber to antibiotic immune bacteriums ( OÃ¢â¬â¢Neil ) . The in-between ear is connected to the nasopharynx by the Eustachian tubing. One of the maps of the Eustachian tubing is to run out the secernments of the interior ear into the nasopharynx ( Maxson,1996 ) . When the Eustachian tubing becomes compromised, accretion of in-between ear fluid creates an ideal environment for bacteriums growing ( Maxon, 1996 ) . As a consequence, kids suffer through the colonisation and reproduction of bacteriums, doing much hurting and annoyance. The most outstanding causative bacteriums lending to AOM are: Streptococcus pneumoniae, Haemopheliusinfluenzae, and Moraxellacatarrhalis ( Gould A ; Marx, 2010 ) . Therefore, the current criterion of intervention for AOM is through antibiotic therapy ( Cohen ) . In the United States entirely, 93 % of all kids see a instance of AOM by age 3 ( Sarrel et al. , 2003 ) . This per centum does non account for reoccurring instances. The complete use of antibiotics in intervention of AOM has greatly contributed to the addition in the sum of anti-biotic immune bacteriums ( Grevers,2010 ) . The addition in antibiotic opposition has put kids at intensified hazards because there is a possibility that farther intervention with antibiotics will non bring forth a healed result ( Grevers,2010 ) . A A A A A A Otitis media is one of the most frequent diseases of early babyhood and childhood and one of the most common grounds for kids to see a doctor. A AOM is the most normally treated bacterial infection in kids ( Siegel et al.,2010 ) A Siegel references that several probes show that there is small benefit to utilizing antibiotics in most kids with AOM. A Despite ample research ( eg.McCormick et al.,2005 ; Damoieseaux et al 2000 ; Le Saux et al. , 2005 ) attending on the intervention effectivity and results of antibiotics is missing standardisation. A Though there are many research articles on the topic of Pediatric AOM, the literature fails in its consistence. A In being is an array of clinical tests that investigate different fluctuations of antibiotic use ( eg. Leach et al.,2008 ; Sarrell et al. , 2003 ; Roark A ; Berman, 1997 ) but deficiency of survey reproduction has failed to verify the information gathered in the surveies. A Regardless, intervention of this infection a ccounts for gt ; 50 % of paediatric antibiotic prescriptions and every bit much as $ 5 billion yearly in costs ( Siegel et al.,2003 ) . A Pediatric AOM affects such a legion population, that it is merely good to society of farther look into the effectivity of antibiotic usage in AOM. A A A A A A A Confounding information in the presented literature of Pediatric AOM has made it hard to sum up research in the most good and effectual intervention. A bulk of the literature compares antibiotic use to either a placebo or alternate therapy.A A part of this literature considers immediate antibiotic use versus placebo ( a representation of Ã¢â¬Å" alert waiting Ã¢â¬ ) ( eg.A Damoiseaux et Al. 2000 ; Siegel et Al, .2003 ; McCormick et al. , 2005 ; LeSaux et al.,2005 ) . A Other tests are presented with the focal point of high dosage antibiotic usage versus low dose antibiotic usage ( eg.Roark A ; Berman, 1997 ) and alternate intervention use ( such as naturopathic intervention of AOM with Naturopathic Herbal Extract Ear Drops ) ( Sarrell et al.,2003 ) .A A Our literature hunt besides presented tests that investigated the differences in intervention result between different ages ( eg.Cohen et al.,1998 ; Leach et al.,2008 ) A A A A A A A A A A A Even with an array of published literature on paediatric AOM, there is a deficiency of standardisation in antibiotic dose for this medical problem.A A A Through our literature hunt, we have found that different surveies use different doses as the Ã¢â¬Å" current criterion of attention Ã¢â¬ .A In a aggregation of surveies, the criterion of intervention was given at assortment of doses which included: 40mg/kg/day, 50mg/kg/day, 60 mg/kg/day, 80 mg/kg/day, 90mg/kg/day ( Damoiseaux et al.,2000 ; Cohen et al.,1998 ; LeSaux et al.,2005 ; Leach et al.,2008, McCormick et al.,2005 ) .A A This makes it highly hard to compare the effectivity of intervention result between multiple surveies. A A A A A Our proposed research aims to look into and specify the difference in intervention result between antibiotic usage and no intervention in paediatric AOM. A Recently, there has been turning concern over prescription antibiotics and opposition of common bacteriums to antibiotics ( Siegal et al. , 2003 ) . A Block et al. , demonstrated that the pnuemococcal isolates from in-between ear fluids were 16 % comparatively immune and 15 % extremely immune to penicillin in kids who antecedently had AOM ( 1995 ) . A The literature is missing in research that investigates the long-run effects of early paediatric antibiotic usage. A It would be good to the paediatric population to restrict the sum of antibiotics administered in order to forestall the addition in the figure of antibiotic immune bacteriums. A A Literature Specific to Antibiotic Use There is more than one current theory for the intervention of AOM.A The first theory provinces that there is a difference between the doses of Amoxil prescribed to kids with AOM.A The high versus low dose intervention suggests that low dose intervention is merely every bit effectual as high dosage intervention ( Roark et al. , 1997 ) .A A The following theory for the best intervention of AOM is antibiotic intervention versus no intervention or placebo.A The research shows that there is more than one scheme in the attack to this theory.A The SNAP ( Safety Net Antibiotic Prescription ) attack is based on a compulsory 2 twenty-four hours waiting period before intervention ( either antibiotics or placebo ) ( Siegal et al. , 2003 ) .A The other attack is a standard antibiotic intervention versus placebo ( Le Saux et al. , 2005 ; McCormick et al. , 2005 ) .A Most research indicates that there is no difference between placebo and antibiotics ( Le Saux et al. , 2005 ; McCormick et al. , 2005 ; Siegal et al. , 2003 ) .A The concluding theory is based on the bad population, which is correlated to age.A There is a consensus that antibiotic intervention is more effectual in bad populations, largely patients under the age of two old ages old ( Cohen et al. , 1998 ; Leach et al. , 2008 ) . A Our hypothesis will try to clear up the disagreements between the current theories in order to develop a standard intervention for AOM.A The survey will include variables that deal with age, antibiotics, and placebo in order to happen a standard treatment.A Theoretical Model Most medical intervention for paediatric AOM is given as antibiotics. LeSaux Ã¢â¬Ës survey further explains how antibiotic therapy is debated by comparing it to watchful waiting and detecting the declaration of AOM symptoms.Watchful waiting may set kids with AOM at addition hazard for major complications, particularly for kids under 2 old ages of age ( Damoiseaux et al, 2000 ) . However, LeSaux and Damoiseaux agree that abuse or overexploitation of antibiotics may take to antibiotic immune bacteriums. On the other manus, their research surveies raise inquiries because of their little sample size usage to understand how Amoxil and placebo affect kids with AOM. The usage of antibiotics besides involves an fiscal position therefore, in our survey we hope to happen a standard intervention of attention in our survey. LeSaux and Damoiseaux besides discuss how their research can assist extinguish prejudices by including elaborate descriptions of their topics, applied individual clinical d efinition and minimized different result of the survey ( 2005,2000 ) . A A Antibiotic therapy is widely used by doctors across the universe to handle AOM, but research lacks to efficaciously mensurate reoccurrence AOM. Therefore, this federal grant will assist distinguish the antibiotic therapy attack by discoursing their disadvantages and extinguishing prejudice from old research. Alternatively of concentrating on narrow age scope and individual dose of Amoxil, we will concentrate on the differences of intervention result between kids above and under the age of 2 old ages. Finally, the primary informations gathered through the grant will lend to the standardisation of intervention for attention of AOM for different age groups. It is possible for future research to develop alternate hypothesis based on the consequences that are to be found through this clinical test. Future research will be able to spread out the theory of Ã¢â¬Å" alert waiting Ã¢â¬ in many age groups and prove the Ã¢â¬Å" standard intervention of attention Ã¢â¬ from this survey. It is our hope from the information obtained from this survey to better the intervention procedure for AOM by placing the most efficient intervention sing factors that include short-run and long-run effects, antibiotic opposition and socio-economic well being. Methods Subject Selection A ; Diagnostic Procedure Childs who are diagnosed with AOM in between the ages of 6 months to 7 old ages will be eligible to take part in this randomised test. The kids were determined to hold AOM by 2 processs: 1 ) tympanometry 2 ) otoscopicexamination. The undermentioned exclusion standards will be applied: Child could hold undergone antibiotic intervention during the old four hebdomads, allergic reaction to amoxicillin, compromised unsusceptibility, craniofacial defects, the tympanic membrane is non integral, and another instance of AOM within the old three months. Study Procedure If the kid met the inclusion standards, the PCP will exhaustively depict the survey process to the patient Ã¢â¬Ës parent or defender. A At that clip the PCP will besides obtain written informed consent from the parent. A A After informed consent is assented by the parent, they will have a package with a questionnaire sing general patient information ( see appendix a ) . A The package will besides include a digital thermometer ( Lumiscope 2210-214 Quick-Read Digital Thermometer ) for which the parent must mensurate the patient Ã¢â¬Ës organic structure temperature twice daily, one reading in the forenoon and one at dark. The temperature values will be recorded in the journal that is included in the package. A The diary entries ( see appendix B ) will incorporate a subdivision to enter organic structure temperature values, a subdivision to enter analgetic disposal, a subdivision to enter hurting degrees in the eventide, and a subdivision to notice in an open-ended mode on any import ant symptoms associated with AOM. A A TheA 10-dayA trialA ofA amoxicillinA orA placebo will be administered and started on twenty-four hours of diagnosing. A The parents are expected to maintain an adequate and up to day of the month journal of the kid Ã¢â¬Ës intervention class. A Follow up visits will be required on yearss two, five, and 10 of the test with the kid Ã¢â¬Ës well-thought-of PCP. A A The PCP will measure the same measurings taken at the baseline visit ( tympanometry and otoscopic observation ) . A The household will be rewarded $ 20, $ 30, and $ 50 for each follow up visit, severally. A On the 10th twenty-four hours of the test at the follow up visit, the journal will be collected and the parents will be asked to make full out a intervention class contemplation ( appendix degree Celsius ) . A Parents or guardiansA can reach the survey central office or their referred PCP office anytime with inquiries sing the survey or to describe any terrible inauspicious event ( s ) , such as concern, febrility, sickn ess, hurting, or any other types of status. A On twenty-four hours 10, they will turn in the package including the parent journal to the PCP. Data Collection Instruments In the diagnostic and follow up stage of this test, tympanometry and otoscopic rating will be used to corroborate the presence of AOM and to follow its patterned advance through out the intervention class. Otoscopic rating will attach to tympanometry in the diagnostic processeand follow up steps. Otoscopic scrutiny will be the first measure in the diagnosing procedure. The scrutiny allows the PCP to visually corroborate the presence of AOM. The PCP will be looking for purulent in-between ear gush. In order to corroborate AOM quanitavelytympanogram steps will be used. Tympanometry is the noninvasive procedure of mensurating the comparative air force per unit area of the in-between ear. It is able to mensurate the squeezability of the air in the in-between ear ( Johansen ) . If the squeezability is minimum, it is assumed that the in-between ear pit is filled with fluid. Babies and little kids can present as a challenge when seeking to accurtely name due to rapid motions and shouting. D espite this, Palmu identifies the cogency of utilizing the tympanometry trial through his survey that showed that tympanometric measuring was successful in 94 % of babies that were tested ( 1999 ) . The parent journals will incorporate the FLACC ( Face, Legs, Activity, Cry, Consulibility ) ( Appendix C ) pain scale to be filled out day-to-day before anodynes are administered. FLACC is an experimental tool to quantify hurting. Each of the 5 symptoms is graded on a graduated table of 0-2, with a entire possible mark runing from 0-10. Manworren Ã¢â¬Ës survey confirmed that the FLACC hurting graduated table is appropriate for mensurating preverbal kids in hurting from diseases ( 2003 ) . Voepel Ã¢â¬Ës survey confirmed the cogency of the FLACC hurting graduated table by demoing distinguishable differences mark differences in pre/post analgetic disposal. The survey besides showed first-class dependability through exact understanding and kappa statistics ( 2010 ) . Data Management At the initial visit and all following visits to the physician Ã¢â¬Ës office, an employee will come in the patient information into the on-line database. The information from the parent journals will all be transferred into the on-line database after entry at the terminal of the test. All informations entered into the on-line database will merely be accessible to those who have a user login and watchword to the plan. All informations that is handled by the PCP or our research squad will be kept confidential. It is to the parent Ã¢â¬Ës arrested development to find how confidential they will maintain the journals during the intervention class. Statistical Analysis In order to analyse our information we will utilize the PSAW statistical plan, version 18.A This is the most up to day of the month version of the former SPSS program.A This plan includes the statistical trials that are relevant to our analysis. A A To measure the information we will utilize a qi square trial with a logistic regression.A The qi square trial is an appropriate trial because the information that will be used is at the nominal degree, which is nonparametric.A Besides, our informations is reciprocally sole, in that each patient will be assigned to merely one group. We will measure with a 2Ãâ"2 eventuality tabular array, comparing treated and non treated to antibiotic intervention and placebo with a 95 % assurance interval.A The logistic arrested development will be used to find if the age of the patient will impact the result of the treatment.A It will demo the most likely anticipation of a group.A This will unclutter up any disagreement if placebo or antibiotics are th e best intervention option between patients less 30 months of age and 30-72 months.A A Research Timeline This survey does non hold a definite length due to our end to widen the survey until 400 survey participants are involved in the test. We will end the test at 5 old ages irrespective of the achieved participant survey population. In order to maintain standardisation amongst take parting PCP Ã¢â¬Ës, we will keep quarterly visits to verify that the PCPs are following protocol. Once an person is enrolled in this survey ; it will necessitate 10 yearss of engagement. The participant will get down the intervention on twenty-four hours of registration and diagnosing. On the 2nd, 5th, and 10th twenty-four hours of the test, the participants must describe for a cheque in. If the participant suffers from any inauspicious events after the completion of the test, we encourage the parent to describe them. Decision After the completion of the research survey we will anticipate to happen no important difference between antibiotic and placebo intervention of AOM.A These findings will lend to regenerating intervention criterions for the AOM. By extinguishing the demand of antibiotics in certain populations, it will assist to diminish the turning figure of antibiotic resistantbacteria. These findings will besides extinguish some health care costs by eliminating the demand to buy antibiotics.A These findings will assist specify a criterion of pattern for doctors and other attention suppliers which will lend to the well-being of society. How to cite Pediatric Acute Otitismedia Aom Health And Social Care Essay, Essay examples
Friday, April 24, 2020
Jose Luna Mrs. Peterson English 12, P. 2 1/21/12 Patriotism Many people think patriotism means supporting your government during times of war. I donÃ¢â¬â¢t believe that for many reasons. I think you can have patriotism and not support your country. I donÃ¢â¬â¢t think patriotism means supporting your government in times of war. A reason I am against this belief is because it is not always the same thing to be a good man and be a good citizen or patriot What if the government is doing something bad like telling us who to hate or you would be one of them. Would you hate them and be a good American or would you be human and ask why? This has happened before in the USA and is known as McCarthyism. I f you spoke out against the government you would be branded a communist. Eventually more and more people came to their senses and began to rebel against the government. We will write a custom essay sample on My Views on Patriotism or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Another Reason I donÃ¢â¬â¢t agree with this Idea is because what if our country was invading another for the wrong reason and killing thousands of innocent lives. I think a life is worth more than some resources. Would you stand be your government knowing its killing innocent people for a profit? A country that has done this is the USA, it has invaded many countries for it resources. My final reason is you donÃ¢â¬â¢t have to support your government to have patriotism. Patriotism is the love for your country. The government and the country are two very different things. The government is the way a place is governed. I believe we should always be loyal to our country and loyal to the government only when it deserves it. An example happened a long time ago in the time of the Aztecs and the Spanish Conquistadors. Montezuma (Aztec king)Ã wasÃ stoned to deathÃ by hisÃ own people because he represented the he Represented the Agenda of White Spaniards Once He Was Captured. If Montezuma had not listened to the Spaniards then they would have supported him. In conclusion, patriotism does not mean supporting your government during times of war. To be a patriot all you have to do is love your country and be willing to sacrifice to protect it. We donÃ¢â¬â¢t have to support the government but we do have to defend it from threats including from an oppressive government.
Tuesday, March 17, 2020
The decision of the Jackson administration to remove the Cherokee Indians to lands west of the Mississippi River in the 1830Ã¢â¬â¢s was more a reformulation of the national policy that had been in effect since the 1790Ã¢â¬â¢s than a change in that policy. It was more of a reformulation because Jackson acquired more Cherokee lands, he gave them an ultimatum, and he tried to persuade the Indians to move. After 1825 the federal government attempted to remove all eastern Indians to the Great Plains area of the Far West. The Cherokee Indians of northwestern Georgia, to protect themselves from removal, made up a constitution which said that the Cherokee Indians were sovereign and not subject to the laws of Georgia. When the Cherokee sought help from the Congress they only urged them to move. However, the Supreme Court in Worcester vs. Georgia ruled that they constituted a Ã¢â¬Å" domestic dependent nationÃ¢â¬ not subject to the laws of Georgia. Andrew JacksonÃ¢â¬â¢s decision to remove the Cherokee Indians to lands west of the Mississippi River was a reformulation because it continued WashingtonÃ¢â¬â¢s, MonroeÃ¢â¬â¢s, and JeffersonÃ¢â¬â¢s administration to acquire Indian land. The administrations during the 1790Ã¢â¬â¢s to the 1830Ã¢â¬â¢s had gradually acquired more and more land from the Cherokee Indians. According to Document A, the map shows the relationship between time and policies that effected the Indians. From the Colonial and Confederations treaties, a significant amount of land had been acquired from the Cherokee Indians. On December 8, 1829 Jackson gives a speech and the objective seemed to be to convert the Cherokee Indians from hunters into cultivators but the underlying reason for the movement is for gold which was found in Georgia. (Doc.O) In 1906 Jackson gave the Cherokee Indians an ultimatum, which stated the Cherokee Indians move west of the Mississippi or they will have to abide by the laws of Georgia and the United States. The Cherokee Ind... Free Essays on Indian Removal Free Essays on Indian Removal The decision of the Jackson administration to remove the Cherokee Indians to lands west of the Mississippi River in the 1830Ã¢â¬â¢s was more a reformulation of the national policy that had been in effect since the 1790Ã¢â¬â¢s than a change in that policy. It was more of a reformulation because Jackson acquired more Cherokee lands, he gave them an ultimatum, and he tried to persuade the Indians to move. After 1825 the federal government attempted to remove all eastern Indians to the Great Plains area of the Far West. The Cherokee Indians of northwestern Georgia, to protect themselves from removal, made up a constitution which said that the Cherokee Indians were sovereign and not subject to the laws of Georgia. When the Cherokee sought help from the Congress they only urged them to move. However, the Supreme Court in Worcester vs. Georgia ruled that they constituted a Ã¢â¬Å" domestic dependent nationÃ¢â¬ not subject to the laws of Georgia. Andrew JacksonÃ¢â¬â¢s decision to remove the Cherokee Indians to lands west of the Mississippi River was a reformulation because it continued WashingtonÃ¢â¬â¢s, MonroeÃ¢â¬â¢s, and JeffersonÃ¢â¬â¢s administration to acquire Indian land. The administrations during the 1790Ã¢â¬â¢s to the 1830Ã¢â¬â¢s had gradually acquired more and more land from the Cherokee Indians. According to Document A, the map shows the relationship between time and policies that effected the Indians. From the Colonial and Confederations treaties, a significant amount of land had been acquired from the Cherokee Indians. On December 8, 1829 Jackson gives a speech and the objective seemed to be to convert the Cherokee Indians from hunters into cultivators but the underlying reason for the movement is for gold which was found in Georgia. (Doc.O) In 1906 Jackson gave the Cherokee Indians an ultimatum, which stated the Cherokee Indians move west of the Mississippi or they will have to abide by the laws of Georgia and the United States. The Cherokee Ind...
Sunday, March 1, 2020
Ancient Spartan Public Education T. Rutherford Harley (The Public School of Sparta, Greece Rome, Vol. 3, No. 9 (May 1934) pp. 129-139.) uses Xenophons Polity of Lacedaemon, the Hellenica, and Plutarchs Lycurgus for evidence of the Spartan education system. The following is a summary of the relevant sections of his article with a few more recent references. Upbringing of Children to Age 7 A child deemed worth raising is given to its mother to be cared for until the age of 7, although during the day, it accompanies its father to the syssitia (dining clubs) where it sits on the floor picking up Spartan customs by osmosis. Lycurgus instituted the practice of appointing a state officer, the paidonomos, who puts children in school, supervises and punishes. Children are barefoot to encourage them to move swiftly, and they are encouraged to learn to withstand the elements by having only one outfit. Children are never satiated with food or fed fancy dishes. Schooling of 7-Year-Old Boys At the age of 7, the paidonomos organized the boys into divisions of about 60 each called ilae. These were groups of peers of the same age. Most of their time was spent in this company, according to Figueira. The ilae were under the supervision of an eiren (iren) aged about 20, at whose house the ilae ate. If the boys wanted more food, they went on hunts or raids. So seriously did the Lacedaemonian children go about their stealing, that a youth, having stolen a young fox and hid it under his coat, suffered it to tear out his very bowels with its teeth and claws, and died upon the place, rather than let it be seen.From Plutarchs Life of Lycurgus After dinner, the boys sing songs of war, history, and morality or the eiren quizzes them, training their memory, logic, and ability to speak laconically. The Iren, or under-master, used to stay a little with them after supper, and one of them he bade to sing a song, to another he put a question which required an advised and deliberate answer; for example, Who was the best man in the city? What he thought of such an action of such a man? They used them thus early to pass a right judgment upon persons and things, and to inform themselves of the abilities or defects of their countrymen. If they had not an answer ready to the question Who was a good or who an ill-reputed citizen, they were looked upon as of a dull and careless disposition, and to have little or no sense of virtue and honor; besides this, they were to give a good reason for what they said, and in as few words and as comprehensive as might be; he that failed of this, or answered not to the purpose, had his thumb bit by his master. Sometimes the Iren did this in the presence of the old men and magistrates, that they might see whether he punished them justly and in due measu re or not; and when he did amiss, they would not reprove him before the boys, but, when they were gone, he was called to an account and underwent correction, if he had run far into either of the extremes of indulgence or severity.From Plutarchs Life of Lycurgus Spartan Literacy It is not clear whether they learn to read. [For more on the issue of literacy in Sparta, see Whitley and Cartledge.] Physical Training The boys play ball games, ride, and swim. They sleep on reeds and suffer floggings silently, or they suffer again. Spartans study dance as a kind of gymnastic training for war dances as for wrestling. This was so central that Sparta was known as a dancing place from Homeric times. [For more on the importance of dancing in Sparta, see Dionysiac Elements in Spartan Cult Dances, by Soteroula Constantinidou. Phoenix, Vol. 52, No. 1/2. (Spring - Summer, 1998), pp. 15-30. ] Foster Sons Allowed in Spartan Schools Not only were the schools for the sons of the Spartiate, but also for foster sons. Xenophon, for instance, sent his two sons to Sparta for their education. Such students were called trophimoi. Even the sons of helots and perioikoi could be admitted, as syntrophoi or mothakes, but only if a Spartiate adopted them and paid their dues. If these did exceptionally well, they might later be enfranchised as Spartiates. Harley speculates that guilt may be a factor here because the helots and perioikoi often took in the children that the Spartiates had rejected at birth as unworthy of rearing. From Agoge to Syssitia and Krypteia At 16 the young men leave the agoge and join the syssitia, although they continue training so they can join the youth who become members of the Krypteia (Cryptia). Krypteia The passage from Plutarchs Life of Lycurgus: Hitherto I, for my part, see no sign of injustice or want of equity in the laws of Lycurgus, though some who admit them to be well contrived to make good soldiers, pronounce them defective in point of justice. The Cryptia, perhaps (if it were one of Lycurguss ordinances, as Aristotle says it was), Gave both him and Plato, too, this opinion alike of the lawgiver and his government. By this ordinance, the magistrates dispatched privately some of the ablest of the young men into the country, from time to time, armed only with their daggers, and taking a little necessary provision with them; in the daytime, they hid themselves in out-of-the-way places, and there lay close, but, in the night, issued out into the highways, and killed all the Helots they could light upon; sometimes they set upon them by day, as they were at work in the fields, and murdered them. As, also, Thucydides, in his history of the Peloponnesian war, tells us, that a good number of them, after being singled out for their bravery by the Spartans, garlanded, as enfranchised persons, and led about to all the temples in token of honors, shortly after disappeared all of a sudden, being about the number of two thousand; and no man either then or since could give an account how they came by their deaths. And Aristotle, in particular, adds, that the ephori, so soon as they were entered into their office, used to declare war against them, that they might be massacred without a breach of religion. Sources: The Public School of SpartaT. Rutherford HarleyGreece RomeVol. 3, No. 9 (May 1934) pp. 129-139.Cretan Laws and Cretan LiteracyJames WhitleyAmerican Journal of ArchaeologyVol. 101, No. 4. (Oct. 1997), pp. 635-661Literacy in the Spartan OligarchyPaul CartledgeJournal of Hellenic StudiesVol. 98, 1978 (1978), pp. 25-37.Mess Contributions and Subsistence at SpartaThomas J. FigueiraTransactions of the American Philological Association (1974-) Vol. 114, (1984), pp. 87-109
Friday, February 14, 2020
Shell and tube heat exchanger design - Coursework Example The wall has to be conducive to allow heat exchange and still be sufficiently strong to withstand fluid/gas pressures. In shell and tube heat exchangers, two closed process streams move across the unit; one move inside the tube and the other moves on the shell side. Convection and conduction allows heat to pass from hot stream to cold stream from the side of the tube side or from shell side. As temperature variation between the process streams rise, heat exchange rate for every surface area unit also rises. Conversely, heat exchangers per surface are unit drops non-linearly as temperature difference between the two process streams drops. Increasing the effective surface area of the entire system helps in maintenance of the total transfer of heat between two streams although eventually the system reaches a point where extra surface area has no effect on extra heat transfer. The other variable which affects heat exchange in shell and tube exchanger is each process streamÃ¢â¬â¢s velocity. This velocity directly contributes to a rise in convection cold process and hot process streams. Raising the velocity also raises heat exchange, more especially, in countercurrent design. Finally, velocity increments are limited by maximum permitted for a specific metallurgy constituting shell or tube. For carbon steel, for instance, velocity cannot exceed 6 ft. /sec. whilst for the case of stainless and high-alloy steel; rate is 12 ft. /sec. for liquids. The three conventional types of shell and tube heat exchangers are parallel, cross flow and countercurrent flow types. The names are derived from the process stream directions in relation to each other. In countercurrent heat exchanger type, average temperature variation between the process streams is optimized over the exchangerÃ¢â¬â¢s length, showing the highest heat transfer rate efficiency over a surface area un it. With respect to existing temperature variations observed during operation, parallel heat exchangers exhibit the lowest heat transfer rates, and then cross flow heat exchangers, and finally, countercurrent heat exchangers. Counterflow and parallel heat exchangers are illustrated below, Figure 1: Counterflow and parallel heat exchangers The design of shell and tube heat exchanger depends on flow pattern through the respective heat exchanger. It is however the most widely used heat exchanger in industries and can adopt counter-flow, parallel flow or cross-flow pattern. However, heat transfer area is a major factor in design calculation. Theoretically though, shell and tube heat exchanger flow patter is conventionally not specifically counter-flow, or parallel. Rather, it incorporates a mixture of counter-flow, parallel flow and cross-flow. Log mean temperature variation, used for design of shell and tube heat exchanger, works best for varied flow patterns occurring in this kind of heat exchanger. Shell and tube heat exchangers Shell and tube heat exchangers in their various construction modifications are probably the most widespread and commonly used basic heat exchanger configuration in the process industries. The reasons for this general acceptance are several. The shell and tube heat exchanger provides a comparatively large ratio of heat transfer area to volume and weight. It provides this surface in a form which is relatively easy to construction in a wide range of sizes and which is mechanically rugged enough to withstand normal shop fabrication stresses, shipping and field erection stresses, and normal operating conditions. There are many modifications of the basic configuration, which can be used to solve special problems. The shell and tube exchanger can be reasonably easily cleaned, and those components most subject to failure -