Monday, November 4, 2013

Essay on Pricing

Pricing is indeed a very important tool with which an organization can market its products and increase the profit margins. Indeed, I was in a good position to appreciate this fact after I interviewed a few people during the Triathlon MLB even. During the event, I observed that many of the stands that were at the venue were offering some products that had different price tags. 

During the interviews, I found out that price is usually determined based on a number of factor. The first factor is the time within which the product has stayed in the market. In this respect, products that have been on the market for more than two years have always attracted lower prices than those that have been developed and brought into the market in less than two years. 

Pricing of the product is also determined by the nature of clients the vendors deal with. In this respect, price differentiation becomes a very important tool of marketing. For consumers that are in the suburbs, prices of the periods sole would be relatively higher than those that are sold in the low-end user regions. In this respect, business persons do give great consideration to the ability of the consumer to spend on a product. 

The backdrop of this consideration of that the consumer’s price of persons living in the suburbs would be relatively higher than those that love in the low economic regions. 

Thursday, August 22, 2013

Essay on Inferno

The author of the comedy, Dante was reported to have been born in Florence in 1265. The author’s family was not poor and as such he had a good basic education, and even managed  to further his studies exploring Latin, poetry, art, philosophy, history and biblical studies (Lawall & Maynard 1). It is reported that he was studious and private by nature and is unlikely to have produced the comedy had he not started serving the public in various councils and capacities. Politics in Florence was a dangerous game, and during one of his many trips away, his detractors hatched a plot that saw him decide to stay away from the city and live in Northern Italy. It was while here that he began writing his great work that is the subject of this report (Lawall & Maynard 1).

The author in creating the comedy diverged considerably from many norms followed by poets of this era. For example, it’s the first major literature of its time to use Italian vernacular instead of the Florentine dialect. It is reported that due to such divergence Italian vernacular and not Florentine dialect is today the national language (Lawall & Maynard 3).

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Selecting Circles Of Dante's Version Of Hell And Explain How The Punishment Fits The Sin
In addition to variation in language the author also used a considerably different style presentation a sis seen in the three line stanzas and changes in canticles. The author calls the comedy a work of morality and the goal of the poem is to call people to follow the good life as a way to happiness.

In Dante’s poetic depiction of hell, it is divided into nine major circles. Of the nine circles, eight correspond to levels of sin. The first circle is an exception, where the worthy unbaptised, people from before Christianity are punished for the fault of not being baptized (Lawall & Maynard 8). As one goes deeper into hell, the circles get progressively worse both in terms of sin and punishment. The purpose of this report is to provide a brief glimpse of the punishments for different sins. To accomplish this, three sins will be selected and their corresponding punishments. It should be noted that these sins involve breaking God’s eternal law and for which repentance has not been obtained. These sins can be classified as the ‘seven deadly sins’ or cardinal sins. Their punishment is harsh due to their cardinality, as all other sins stems from these roots (Lawall & Maynard 8).

The nature of punishment for the sins is based on Aristotelian philosophy of reciprocity, ‘an eye for an eye’ . For this reason many sins have a significant resemblance to the act itself, for instance the lustful are constantly blown about by winds just as they allowed their passions drive them to distraction. In a similar fashion diviners have their heads turned back, just as they often made claims of possessing an ability to look forward into the future. The wrathful are made constant subjects of each other’s anger and the people who shed blood are immersed in boiling blood and attacked by ferocious beasts each time they surface for air . Though the comedy appears to concur with classical Christian concepts, the main difference in the comedy lies in Dante’s classification of sins. For example as opposed to using the seven cardinal sins, the author comes up with additional classifications. The author includes sins of ‘incontinence’, ‘mad brutishness’ or ‘malice ’ .

Though the sins remain the same, this classification introduces new concepts such as appetite and uses this to create a list of simple and complex sins of the appetite . The use of vulgar language by the author is aimed at making the reading appealing to all, and its wide acceptance is proof of the literary genius behind this work.
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Tuesday, May 14, 2013

Santiago Calatrava Essay

1. Describe the work. In your own words, tell what you see.
    The Santiago Calatrava train station represents a stunning, low-lying bird architectural tunnel; lit in golden yellow colors and white light. The structure represents order and tranquility expected to add value to the rail station scenery. 

A. What is the primary subject matter?
    The rail station subject matter is incorporating a sculpture structure into a functional structure based on a motion by a bird on flight. The primary subject matter of the design enhances the architectural design to function as a railway station.

B. Are the images real or imagined?
    The images are real, the environment is represented, the parking lot is real and functioning and the tunnel railway itself is facilitated as a real image by the presence of the aforementioned features. Use of natural light and shadows creates a sense of reality. Movements of lines create motion and depth that add value to the image realness.

C. What is the form (how is the work put together, what is the medium?)
    Santiago Calatrava used glass and steel frames as medium of expressing his artistic and architectural genius. The work is put together using concrete pillars that support the steel arching structure that make out a bird’s wings that assemble into a beak at the extreme western side.

D. What style is it?
    The style is a naturalistic style, in which steel framework act like a bone structure joined support the glass which fills that space. The naturalistic style is predominant since the roof looks like sky and the walls take a white color.

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2. Analyze the formal aspects of the work.
    From the western side a bird in flight is pronounced creating an illusion of a structure on motion. At first stance, the two sitting steel arches create a striking illusion of reality that tower up high for about 40 meters. Use of line is very particular in strengthening the structure, diagonal lines arching inward into the structure from the roof stand strong pillars that hold up the roof.

 A. Does the work seem unified or chaotic?
    The shape of the structure unifies the work, which is like a human eye from the front and a bird on flight from east and west direction.

B. Does the work feel balanced?
    The work is balanced through use of line and shape. Lines converge at the western end of the structure and the wings rise at both sides leaving a ridge in between to separate the winged outer convex structure. The ridge balances the work; the wings balance each other by the lift acquired on both sides, which represent a fraction that is a quarter to the length of the structure.

C. What is the general mood of the work (pleasant, disturbing, exciting...?)
    The structure creates a general pleasant mood brought about by presence of blue colors at the ridge and arch and a white color at the sides and walls of the hemispherical train station.

3. Interpret the work.
 A. What is the artist saying about his/her subject?
    The artist infused flight into the structure to represent the busy travelers expected to use the Port authority Trans Hudson train station to either catch a train or take a flight.

 B. Is the work pleasant or uncomfortable to look at?
    The work is inspiring to look at and adds value to the topography of the train station as an architectural masterpiece that infuses art, creativity and engineering.

C. Consider the colors used. How do they affect you?
    The artist used blue colors on the ridges’ roof glass to represent the sky. The diagonal glass fillers are transparent to allow direct flow of natural light. The concrete pillars and steel support structures are displayed in excellent white color that creates peace and tranquility.  The steel pillars are painted white to blend with the sky and clouds.

D. Consider any symbols used. Do any images seem “out of place”?
    The most striking symbol is a bird on flight, which correlated with the function of the station’s airport and train facilities. The second symbol is the human eye, through the eye of the station, people travel afar.

E.   Is the work influenced by a particular time, place, or belief?
    The work is highly influenced by the naturalistic belief that architectural structures ought o add value to the environment by either blending in or by standing out as a center of aesthetic value. The Port authority trans Hudson train station stands out as an aesthetic structure of the 21st century away from the old blocks of structures. Use of steel and glass to facilitate use of natural light is a new notion towards curbing global warming by utilizing renewable energy like natural light.  
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Wednesday, March 20, 2013

Susan Glaspell "Trifles" essay

This play is based on a simplistic but deceptive ground as implied by the title. Using a straightforward setting, the author intelligently surfaces two conflicting ideas through the choice of characters. The play is mainly about the “insiders” and “outsiders” as suggested by Holstein. The play presents the audience with two concepts about the scientific methodical investigative approach and the informal disorderly investigative approach. In this case, the investigators were the county Attorney, the sheriff, and a neighbor to this homestead. Mrs. Peters, and Mrs. Hale, who are wives to the Sheriff and neighbor respectively, accompanied them. There is a difference in perception by men and women during the investigations. Women were quiet from the beginning of the investigation because they were not part of the investigation team but had come to collect some household materials for Minnie Wright, who was then behind bars in prison over the alleged murder of her husband, Mr. John Wright. Men are portrayed as “outsiders,” whereas their wives are the “insiders’” in the play. This is based on how they carried on with their investigations and the results (Holstein 45).

Men perceived the setting literally as lone farmhouse that had no evidence of life in it. On the other hand, women perceived the place as a home. The men’s interpretation did not involve any feeling or association to the place, which is why they perceived it from the outside as lonely farmhouse. Mrs. Peters and Mrs. Hale associated with the place as the home where people lived and interacted (Glaspell 8).

The “outsiders” (men) used formal scientific approaches of investigation to gather facts. They were mainly concerned with facts that related to the murder and had no time for other minute details, which they thought was not important at that time. The attorney uses the investigation book to guide in gathering what was required in the case. They are systematic in their investigation procedures as they move from one room to the other conducting their search. At the end of their investigations in the rooms, both the Sheriff and the Attorney are convinced beyond any reasonable doubt that no stone had been left unturned, except for the unnecessary details (Glaspell 12). Interestingly, they discover at the end of the play that they had not gathered any tangible evidence related to the murder and were as naïve as they had been before the investigations. During the investigations, they followed a predetermined procedure and did not associate with Mr. Wright’s situation to dig out some of the details they had overlooked. To them, there was no difference between Mr. Wright and his wife. They are considered as “outsiders” in this play because they separated themselves from the situation and conducted their investigations as third parties. This explains why they gathered information as their approach would allow them. In addition, the source of conflict was internal. It was about the oppression Mrs. Wright had been subjected to by her husband. She killed him to regain her spirit back and be free (Glaspell 22).

On the other hand, women were keen on detail. They conducted their research without a particular but applied one principle that saw them unveiling the critical evidence to the case, something that men had not been able to perceive. They identified with Mrs. Wright’s situation as part of her suffering. They visualized what she had undergone and tried re-enacting her actions. This qualifies them as “insiders” to the conflict. Only the oppressed understands the pain of oppression, not the oppressor. The play was set in a male dominated society where men oppressed and disregarded their wives. Mrs. Hale and Mrs. Peters found it easy to unveil the evidence because they tackled the source of conflict by relating to their own experiences. Perhaps, they were also undergoing the same experience and psychological imprisonment that Mrs. Wright had been undergoing. They understood what had compelled Minnie to kill her husband. Ironically, men could not reach this level of thinking because they had not acknowledged that they were the source of oppression to their wives (Holstein 47).

As described before, this play is set in a male dominated society and women were mistreated by their husbands. This explains why the three men investigating the case looked down upon their wives and thought that nothing good could come out of their investigations. Had they accepted that they were the cause of distress in their wives, they could nave gauged why and how the murder took place (Glaspell 26). Consequently, they would have unveiled the critical evidence. They were not interested in knowing what had compelled Mrs. Wright to kill the husband but only viewed her from the legal perspective, a criminal and murderer. This makes them outsiders to the conflict in the play because of their lack of attention to detail. Mrs. Peters and Mrs. Hale are insiders to the conflict and identify with it through their own life experiences. This is the reason they managed to get to the minute detail and found the evidence men had not been able. Despite their decision to remain silent, they turn out as successful, even though they had been portrayed as inferior. Their decision to keep quiet is justified because Mrs. Wright had done the right thing and as long as men were naïve about it, they would use the same approach to gaining the freedom.

Friday, February 8, 2013

Example of a Research Paper

Free Example of a Research Paper

Major changes to the program in most developed countries for the past eight years have led to significant expert growth programs, particularly those relating to additional education and learning. These were mostly by means of workshops or classes where instructors joined specified schools. They were required to travel, which meant extra time away from universities and expenses such as transport costs. While advantages of in-service exercising are available, some authors are still criticizing it. Different techniques to computer expertise growth that are more affordable with regards to useful sources may better fit the needs of the developed and developing nations.

In this perspective, a research was performed into the effectiveness of school-based computer growth programs.  Below is a very simple edition of the computer database integration levels. The designs' characteristics decide the actual work-flow, which in many circumstances is much more repetitive than this article indicates (Mertler, 2008). Nevertheless, these subsections do provide general information on the database integration strategy that one should use. In broader conditions, one should split the growth procedure into three primary stages: research, development, and distribution. Each of these primary levels should contain several sub-stages, all of which form the complete growth procedure. Each level results to a specific decision or product that is a fundamental element of the overall growth procedure, or both. In most circumstances, the venture designer and customers should communicate during all the three levels.

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Research stage
During the Research Level, one should perform an initial discovery of the customers needs and wants so that a decision can be made on whether or not it is likely that there is a go between the client's needs and wants. If a prospective for such a go prevails and the client is enthusiastic about acquiring the presented solutions, one should settle on the agreement's details. Depending on these discussions, both parties choose on whether or not they want to perform together on the application's growth. The collection of historical data from one’s company or a competitor in the industry would give better results.

Contract developing course
If both associates choose that they do want to perform together on the application's growth, appropriate records are finalized. This phase also represents the client's contract in protecting the necessary costs as described in the finalized agreements. An extensive papers is then put together explaining the program and its performance on growth cost framework and schedule. This procedure is considerably complicated, and usually begins with any heritage programs or currently managed perform procedure analysis. This then continues with an analysis on different kinds of customer’s needs and wants (Hinchey, 2008).

One relatively easy, yet very appropriate way to describe the appropriate procedures from the technological viewpoint is to say that the details that are being gathered from the customers can be separated into topics, features of such topics, and work-flow that explains. Depending on the customer’s needs analysis, topics become platforms and characteristics of these topics become new platforms. Workflow related factors are used for determining what types of customer connections are required. For example, the types of reviews, the components required, and how the types should be linked to each other.

Development stage
The venture associates must do what is required to fulfill the explanations that are published in the Customers Specifications Declaration. The program growth and programming procedure and the examining with the customers procedure that are described below may have to be recurred until all the necessities specified in declaration have been met. Well recorded application requirements help to reduce the number of development and customer testing periods that are required. Project designers should also take notices in planning for the application's next, improved edition (Reilly, 2003).

It should be noted that different customers should test the application. Project designers should make sure that they have the necessary sources available for managing all the reviews. The new application ought to fulfill the customers’ needs successfully. The greatest distinction in this area is the venture producer's ability to carry out performance testing. Based on these findings, the venture designer must recognize the projects and goals that have to be met so that application's utilization issues are exercised.

Project designer should make sure that the customer associate group and the client's control associates stay dedicated to the purposes, its development related organized source needs, and its utilization in the development atmosphere (Mitchell, 2008). Every application development function and performance that is described in customers’ specifications declaration should get enough attention, and in every step of the way, different features should be finished on time.

If required, venture designers should use the additional or back-up sources that were determined during the venture preparation level. Project designers should be careful about assigning some time to other sources for growth of new capabilities, unless the client demands them. If a currently managed step satisfies customers’ specifications statement's information, it is advisable to work with it. People can always think about something better than they have. Therefore, any product can be considered better than it currently is. Reality can never be compared to what individuals’ creativity can create. At a certain point, the additional time put into the additional upgrades simply does not rationalize the outcomes. So, the client should make the advised choices about when the additional costs should be validated. One can always make the next edition of the present program. Below is a representation of a developed program.

Distribution stage
The producer's policy should be to correct the development errors, such as the malfunctions that are found after the realization of the advancement procedure. This should be 100 % free during the specified examining time. In the same way, if one forgets to carry out a task based on the Customers Specifications Declaration, they should happily do so for free as soon as possible. However, there is some period in which the client should analyze the program. After that duration, any perform that needs to be done, such as pining out errors, should be charged independently.

After the program has been applied, the client's associate and the designer analyze it and make sure that all the features listed in Customers Specifications Declaration work as described. Thereafter, client's advisers and the organization's advisers sign on the Customers Specifications Declaration, showing that the stated tasks have been completed. Customer orientation is a very important aspect of the overall database integration procedure. Customers who have not been trained are less effective and less pleased with the program. Very little or no orientation may lead to a change in attitude by the user of the new program. At least some of the individuals operating for the client should become fully familiar with the new program. Preparations should be made so that these individuals can provide solutions to the customers’ questions.

Customer’s declaration
Customer Specifications Declaration identifies that which will be conducted, achievement work deadlines, price framework, and extra terms. Every aspect of customers’ specifications declaration explains the program or the growth procedure from a different position and every aspect of it, such as input/output model, is written information of either certain aspects of the program or the growth procedure. For the best possible results, the venture growth levels and steps can and should be customized using the designs' characteristics (Cohen & Manion, 2004). In the same way, customers’ specifications statement's parts can be customized, so that it uses the designs' characteristics.

This approach improves performance by helping to confirm that all the necessary components have been designed and that all that was designed is in the venture. It also helps to reduce the prospect of uncertainty or arguments between the designer and client about the program after it has been built (Somekh, 2005). After examining and utilizing the program, users may find capabilities that should be included to the program, as well as variations that should be made. Minimal variations can often be managed without price overruns. If the variations are minor and extra value is appropriate, any capabilities and variations can be included to the application's current edition. Otherwise, any of the above can be included to the application's next edition. That is, programs can and often should be, designed in editions so that each one of them is fully useful and develops on the past perform. In such a case, each edition should have its own customer specifications declaration.

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Thursday, January 24, 2013

Free Literature Review Sample

Literature Review: Connective Tissue Repair

The paper proceeds as a literature based review on repair mechanisms in connective tissue. Factors influencing tissue repair mechanisms are estimated. The current paper broadly examines published data on factors that affect aspects of connective tissue repair. The review covers wound healing and tendon healing in particular

The issue connective tissue repair stands nowadays rather acute, as along with development of medicine it becomes vivid, how many issues remain unresolved. Keeping in mind that a human body is a complicated and sophisticated mechanism where nothing remains without due attention, it is necessary to appraise the impact of various factors ranging from local (e.g. wound infection) to behavioral (depression) on the healing process. Literature on the subject is not abundant, however, there is enough publications on virtually any sphere of the issue. The current paper proceeds as a literature based review of publications that deal with connective tissue repair issue. Five publications are appraised in the paper and their analysis is provided.

Surgical physiology of wound healing: a review
An article by Deodhar A.K. and Rana R.E. published in Postgraduate Medicine Journal “Surgical physiology of wound healing: a review” is a general review on the subject. However, it provides a reader with strong understanding of the process of healing and its importance in surgical practice. In brief and to the point the importance of the issue is explained: “any breach in continuity of skin or mucous membrane exposes the deeper tissues to the danger of infections… today wound healing abnormalities are among the greatest causes of disability and deformity”. At first, the article proceeds with a description of the healing stages, which are: vascular and inflammatory response, reepithelization, granulation tissue formation, and matrix and collagen remodeling. This part features brief explanation of the processes, indicating their importance. At the same time, the role of each cell-type and description of possible deviations from the normal process is explicated.

The description of various factors affecting wound healing takes up a considerable part of the article. Authors have classified the factors into two categories: local and systemic factors affecting wound healing. First among local factors is infection. It is the most common cause among local ones for prolonged healing. Clinical infection takes place when a critical amount of pathogenic bacteria is present. Pathogenic organisms prolong healing as they activate alternate pathway and reinforce inflammation, thus prolonging inflammatory phase of the repair process, which in certain cases may last up to one week. Bacteria also produce toxins, which are sometimes damaging to cells. Finally, microorganisms need nutrients and oxygen, thus drawing some of the latter away from body cells. Extraneous bodies also contribute to the possibility of infection. All these effects could be avoided or minimized by using proper surgical techniques.

Among other important local factors affecting wound healing are surgical technique, hematoma formation, foreign body reaction, tissue ischemia, and topical medications and dressings. The use of improper surgical technique, aside from infection risk, may also result in devitalization of tissue if skin edges are crushed.

Among systemic risk factors the authors mention various deficiency states, aging factor, disease states, and influence of medication. Abnormalities in carbohydrate and fat metabolism decelerate wound healing. Deficiency of insulin, which acts as a factor for fibroblast growth, may restrain collagen disposition. Deficiency of protein and/or nitrogen sometimes occurs after major traumas and also negatively affects repair process as it increases inclination towards infection.

There are two vitamins that significantly impact healing process: A, C, and K. Vitamin K deficiency leads to clotting malfunction, which results in hematoma formation and other adverse effects. As ascorbic acid (Vitamin C) is an essential factor for collagen biosynthesis, its deficiency may lead to collagen lysis and it being unstable. Slow down in re-epithelization, malfunction of collagen synthesis and increased danger of infection may be caused by lack of vitamin A. Among minerals and trace elements deficiencies the most dangerous is zinc deficiency as it results in impaired immune responses, malfunction of collagen synthesis etc.

Aging is a very important factor in wound healing. It was observed, that foetal wounds tend to heal faster and without formation of scar tissue. Probably, the fact that collagen is produced in foetal wounds much more rapidly than in adults, could be one of the reasons for high age importance in healing process. However, this statement is controversial and the authors do not take any stance in this issue and just state the facts.

The article lists over 25 diseases that greatly influence healing processes. Among most important are: Ehlers-Danlos syndrome, coagulation disorders, hemophilia, Von Willebrand’s disease, Werner’s syndrome, vascular disorders, atherosclerosis, vasculitis, lymphoedema, chronic renal failure, diabetes, Cushing’s syndrome, immunologic deficiency states, cirrhosis, myelofibrosis and other chronic hematologic disorders associated with thrombocytopenia.

Among medicinal causes that cause impaired wound repair authors mention glucocorticoids, glucocorticoids, anticoagulants, antineoplastic medication, cyclosporin A, and many others. Unfortunately, authors do not discuss the ways medication and disease states influence the healing process and do not provide any supportive evidence while just stating facts. They claim, that only effects of anticoagulants and glucocorticosteroids are sufficiently explored. These drugs decrease inflammation and simultaneously decrease collagen and protein synthesis, interfere with most body defence mechanisms.

The “Surgical physiology of wound healing: a review” article completely justifies its title, as it is a review and does not provide much details on the matter. It is impossible to argue with the authors, as they do not provide any backing to their statements. However, the value of the article should not be underestimated, as it gives a clear understanding of all the basic healing processes and provides a reader with a starting point for further research.

Physiologic, Behavioral Factors Affect Wound Healing
The editorial by John H. Bowker “Physiologic, Behavioral Factors Affect Wound Healing” is significant as it discusses physiological problems along with behavioral component of wound healing processes. Generally, the reason for the author to undertake the research is purely practical. Also, an attempt to evaluate the literature on the matter is undertaken. In the very introduction the author makes a discovery, that literature reports on wound healing methods and systems control or at least consider only one or two influencing factors.

As the article proceeds, the author asks a series of questions, which at the same time serve as subheadings: “Is tissue oxygen perfusion adequate?”, “Is nutritional status normal?”, “Is there evidence of persistent bacterial infection versus mere colonization?”, “Is locomotor function impaired?”, “Have vasoconstrictors been prohibited? Is the patient abstaining from nicotine and caffeine?” etc.

To answer the question of oxygen perfusion in tissues being adequate, which surely affects healing process greatly, Bowker provides rather detailed description of procedures to be carried out in order to answer the question. It is argued, that poor oxygen perfusion in tissues against a background of anemia and diabetic nephropathy may be treatable. The argument is indeed dependable, as it is stated practicing expert. Bowker, along with Deodhar and Rana mention malnutrition as an important factor influencing healing. Bowker emphasizes that in his practice the greatest evidence of malnutrition was deficiency of serum albumin. The problem is rather easily solvable with high-caloric feeding, as the author suggests.

With the passage of time protective sensation may gradually decrease causing serious problems with healing. The decrease is in some cases so gradual, that the patient might be unaware of it, thus, it is suggested to use Semmes-Weinstein for sensation estimation.

Persistent bacterial infection might be caused by cellulites and osteomyelitis. This diseases result in warm wounds producing purulent exudate. This factor definitely slows the healing process down and might be dealt with using antibiotics.

It is often assumed, that behavioral factor is completely in patient’s competence. Yet, Bowker lays responsibility on caregivers too. First, weight-relief devices need to be appropriately chosen and then fitted. This is, indeed, the caregiver’s duty. The problem arises also when examination of the wound was not through enough to ensure that the bone was not penetrated (in this case surgical intervention is strongly recommended).

Another important question the author raises is whether the patient properly uses the plantar weight-relief devices. A study shows, that an opportunity to relief weight results in patients abusing this option. The patient might proceed to undertaking all the usual activities not taking his wound into account. This is a serious problem, as it may lead to additional ulceration and eventually to amputation. The author discusses various means of dealing with this problem including the use of various devices that would limit misuse and proper patient education.

As for the weight-relief shoes, it is emphasized that their use should not exclude following other wound-care procedures on the part of the patient as well as physician.

A more common behavioral issue in wound healing is smoking. Substances like coffee and vasoconstrictors result in the same: constriction of blood vessels with the latter being, probably, less harmful. Uncontrolled habits can greatly influence the process of recovery. Pernicious habits are also very hard to overcome, which may result in considerable problems in the course of treatment. Indeed, taking vasoconstrictors is not a habit, yet this factor could be overlooked in the course of treatment and these drugs not prohibited. It is the responsibility of the physician to control this factor.

It is very important to keep patients informed and educated on importance glucose control programs. The program cannot be comprehensive without patient being well informed.

Among other reasons for inadequate patient’s compliance are depression, denial, etc. the research have shown that noncompliance is related rather to the above mentioned factors than intelligence. Significant results in dealing with the problem can be achieved if proper education is introduced to the patient. However, patients with psychological abnormalities or personality disorders may experience significant problems overcoming denial.

To conclude, the author refers to teamwork as one of the most important factors in wound healing, as well as any other highly complicated activity.

To emphasize on the point stated above, the article is practical and gives valuable information on factors affecting wound healing. It is highly dependable, as the author is a practicing expert and is a well-known specialist in his sphere.

Nutritional factors affecting wound healing
Nutritional factors have already being mentioned in works by Deodhar and Bowker, while Thomas in “Nutritional factors affecting wound healing” addresses the problem directly. The controversy around this subject arises from inability of nutritional improvements to reduce complications or actually improve healing, while the negative effects of malnutrition have already been proved.

The first problem in the scope is diagnosing malnutrition. Patients need not only abundance of nutrients: they need to be appropriately balanced in each specific case. Even if the diet is appropriate it would not necessarily lead to improvements in healing process, as the overall health condition of the patient might be poor.

Treatment needs integrated approach and the role and weight of nutrition in it has not yet been proved. The vast majority of nutrition-related studies are animal-based, which results in deviations of results. Even in clinical settings, various approaches to nutrition such as parenteral nutrient delivery may result in treatment outcome being very hard to estimate. The importance of specific nutrients as vitamins, minerals and trace elements such as zinc, amino acids etc. have been appraised, however, their importance in each individual case varies greatly making it hard to set the individual nutrient supplementation up. However, despite the fact that all the abovementioned issues have not yet being resolved, any patient requires a well-balanced therapeutic diet.

The article proceeds as a discussion of up-to-date knowledge in the sphere of nutrition and sheds light on the scope of problems in the field. The use of examples by the author improves information perception and understanding of the issue.

Factors affecting the strength of flexor tendon repair
The research by Bhatia and others is different from the least of the articles in the current review, as it reports on the research on cadaveric tissue. The objective of the research was to determine the effect of core sutures on flexor tendon repairing. In the course of experiments different types and configurations of core sutures was explored. Some attention was also given to variable thickness of sutures. Various tests including straight and cyclic load were utilized. The researchers used four locked single knots as the most appropriate to their opinion. The publication is characterized by presentation of the research results and absence of broad generalizations. However, the results it yields are deeply practical as they allow for surgeons to choose their technique basing on dependable evidence. The research is important as it sheds light on some aspects of strength of 4/0 suture material.

Is Full Weightbearing Safe Following Achilles Tendon Repair?
The most recent study (2001) in the current review is by Akizyki and others titled “Is full Weightbearing Safe Following Achilles Tendon Repair?” It is believed that immediate weight bearing and neutral plantar flexion following immediately after repair may limit atrophy and stiffness.

However, it may also place some harmful stress on the repair. The study seeks resolves the problem and estimate the strain on the Achilles tendon during weight bearing in different degrees of plantar flexion and with immobilization. In the course of the study, the EMG from plantar flexors of 10 participants without any ankle deviations was recorded. Then, different walking conditions such as immobilized foot walking with neutral or some degree of flexion freedom was applied. It is unnecessary to list all the procedures in the current review. However, it is worth mentioning, that a wide scope of different preconditions was appraised and sophisticated methods of EMG results calculation were used. the result of the study is as follows: “In the immobilized ankle, the addition of a 1" heel lift was sufficient to minimize plantarflexor activity during walking”. The study is significant indeed, as it provides practical guidelines for physicians in applying weight bearing treatment method and proves it to be safe in certain limits. It is valuable that these limits are specifically determined.
The research shows, that there is enough publications and researches behind them on the subject of connective tissue repair and their scope is impressive. a conclusion could be drawn, that this field of study is growing rapidly now, as new technology and advancements in medicine allow for researches to seek new aspects of the issue and ways of dealing with them.

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Thursday, January 10, 2013

Essay on School-based Clinics

This paper will evaluate the advantages and traits of three different school-based clinics information on which was retrieved in the process of a web search. These clinics, based on the information available online have features that can form the basis for a successful school-based medical establishment.
St. Barnabas School-Based Clinic
One example is the St. Barnabas school-based clinic that aims at servicing those teenagers who are underprivileged in access to quality health care due to lack of insurance and under-insurance. This focus on serving less privileged classes seems one of the noble goals for a school-based clinic.
St. Barnabas School-Based Clinic concentrates on preventing risky behaviors that cause drug and alcohol abuse and lead to sexually transmitted diseases and undesired pregnancies. To curb risky behaviors, the clinic presents an «an ideal focal point for integrating comprehensive health education with the provision of basic primary and preventive health and mental health services» (St. Barnabas School-Based Clinic).
The experience of the clinic indicates that its efforts were able to contribute to the improvement in adolescents’ health state in the area.
One of the clinic’s advantages is its concern with offering advanced health care, as the clinic adds new services every year. Now is service range includes «a full range of primary care, dental screening and counseling services» , supplemented with  WIC counselors for pregnant students and a program on education and treatment of Chlamydia.
In 1998 alone, the clinic was able to attract 1,000 new enrollees.
The School-Based Clinic Program: Duke University Medical Center
The School-Based Clinic Program at Duke University Medical Center offers a wide range of services at several schools ranging from elementary to high school level.
The clinic operated by the program boast the determination to serve the needs of every student regardless of the ability to pay. Thus, students are offered assistance in filing insurance claims. In case the student is not covered by insurance, the student is then charged a modest fee based on the ability to pay.
This clinic is able to take conventional school service to a new level as it functions in partnership with Duke University Hospital, Durham Regional Hospital, Durham Public Schools and Center for Child and Family Health. 
Denny Wellness Center
Denny Wellness Center that has been offering health care services in Seattle schools since 1992, operates in five schools of the middle and high school level. The Puget Sound Neighborhood Health Centers (PSNHC) that serves as parent for Denny Wellness Center has been functioning in the Seattle community for over 30 years. Thus, the ability to draw on the well-established culture is one of the distinct benefits of the clinic.
The positive feature of the clinic is the close cooperation between the staff of the clinic and the school nurse, the school guidance counselors and other school staff.
Features of the listed school-based clinics to be incorporated in the creation of a new clinic
In my view, partnership with other healthy care institutions is of great importance for a school-based clinic. At the stage of the clinic formation, it is of special importance to be able to find the establishments that will be able to help the clinic to keep abreast of the latest developments in medical science as it happened at Duke University Health Center.
Besides, the school needs to constantly monitor the effects of the school program so as to be able to measure the effectiveness of the clinic’s efforts directed at the preservation and improvement of the youth’s health. Thus, St. Barnabas School-Based Clinic was able to report positive results in this area.
The school-based clinic has to function in close cooperation with the other school staff, which would enable it to work out effective solutions to improving the youth’s health.

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