Indias Soft Drinks Industry Essay Example for Free

Indias Soft Drinks Industry Essay 1. 1. 1 INDIA’S PHYSICAL RESOURCES India is a country rich of raw materials, resources and land. For this report, we will focus on those physical resources that are essential for the soft drinks industry – water, sugar, aluminium, power sources. With a land space of over 2. 9 million square kilometres (sq km) and a population of 1. 22 billion people, India has only 314,070 sq km of water (CIA World Fact book, 2012). Even though the Indian government has done many things do improved the situation by building water plants and water piping in the urban and rural areas, there are still about 18. 5% of the population (226 million) that lack access to clean, drinkable water (CESS INDIA, 2004) With a sophisticated water purification installed in our soft drinks plantation, A. G. Barr are able to process the unclean water into safe, drinkable water and use it for the basis of the final products. Hence, A. G. Barr will be able to offer an alternative drinking source for the citizens with our soft drinks products. Next, with a total arable territory of about 1. 2 million sq km, agriculture is the biggest industry and plays a major role in the socioeconomic growth of India (Maps of India, 2012). According to Food and Agriculture Organization of the United Nations (FAO) (2012) and the Maps of India (2012), India is the 2nd biggest world producers of sugarcane (sugar) with about 453 sugar mills located all over India. INCLUDEPICTURE http://faostat. fao. org/DesktopModules/Faostat/Images/T20/ChartPic_3nemzw945otecriq01oo. png? 3f2841b2-add0-4841-9dc7-5707a2a011f0 \* MERGEFORMATINET Table 1: Top Production – Sugar cane 2010 Source: FAO Thirdly, for aluminium, India is the fifth biggest producer in the world after Australia, Guinea, Brazil and Jamaica (Maps of India, 2012). Finally, to obtain vast economic growth and a flourishing industrial sector, the Indian government has invested and given top precedence to the power sector of the nation and as of the 21st century, India is able to generate about 90% of its own energy through (Maps of India, 2012): Thermal/Coal Power Hydro Power Renewable Resources Power Nuclear Power With most of the raw materials and resources readily available in India, the price for these materials will be relatively standard and low. Hence, this will lower the cost of production. This is a key factor in venturing into the India market as A. G. Barr require a huge amount of clean water and sugar to produce the soft drink products. 1. 2 THREATS 1. 2. 1 INFRASTRUCTURE The infrastructure in India is one of the most problematic and unreliable in the world. As stated previously, even though India is able to generate 90% of its power, due to the poor financial position of many power supply companies, the power supplies are always inconsistent and frequently being cut-off (India: Risk overview, 2011). Hence, companies, offices and industrial plants need to have their own back-up power facilities to ensure no interruption to the production processes (India: Risk overview, 2011). The road and railway system in India is still undependable and many traffic congestions are resulted due to the inadequacy. Pan (Asiamoney, 2010) notes that while the Indian government are investing US$1 trillion in infrastructure from 2012 to 2017, political bureaucracy and lack of good projects are hindering the developments of infrastructure. At the same time, Roy (Euromoney, 2010) reports that while Mr. Rajiv Lall, chief executive of state-run lender Infrastructure Development Finance Company believes India infrastructure has been slowly improving, the dependable relationship between the public sector and the private sectors in infrastructure will lead to corruption and thus may hinder the progression of big infrastructure projects. Therefore, any company that wish to venture into India soft drinks market will need to spend a sizeable amount on power generator and water purification facilities. This huge expenditure will put a dent on the initial capital investment and A. G. Barr need to take this into account and plan on how much of the expenditure to be transferred over to the final consumers through the products. 1. 2. 2 EDUCATION AND LABOUR According to several organizations; CIA (2012), US Department of State (2011) and WEF (2011), India’s literacy rate is only at 61%. The education level in India is low as many of the population live in poverty or the slump and unable to afford going school. Moreover, the Indian government lacks of provision of education is hindering its people to learn and receive knowledge. This result in a low skilled workforce and the unemployment rate for youth age 15 to 24 in India is high at 10. 5% (CIA World Fact Book, 2012). While a soft drink company with high technology facilities and processes requires employees with minimal skills, it is still essential for these workers have a basic understanding and motor skills to operate the high-tech, expensive machineries. Another end of the spectrum is those highly educated Indians where the information technology (IT) sector is booming. These IT personnel and engineers are viable to our company as they able to manage, supervise and suitable of the higher ranking jobs. Hence, to ensure the workers hired have the essential skills, A. G. Barr will need to frequently conduct training programs, skills development workshops and have simple instructions which are easy to follow. 2. DEMAND CONDITIONS With the relaxation of the Indian government policy on FDIs and foreign companies, the soft drinks industry had change tremendously. As the US and EU markets are highly saturated, companies are looking into the Asian markets to expand and gain more revenues. Apart from China, Japan and South Korea, India is the 4th leading Asian soft drinks market and the market is still growing and has yet to reach its saturation point. In 2010, there is a substantial demand for soft drinks as the market has grown by 10. 4% (Datamonitor, 2011). Datamonitor (2011) even predicts that by 2015, the Indian market will grow to a value of $5. 8 million. Table 2 shows the growth of India soft drink market from 2006 to 2010. Table 2: India soft drinks market volume: million liters, 2006–10(e) Datamonitor (2011) also reports that as of 2010, the soft drinks industry has generated total revenues of $3. 8 billion and with 50% of the total revenues, carbonates sale is the most profitable category. Table 3: India soft drinks market segmentation: % share, by value, 2010(e) It is essential to note that currently there is a growing trend of â€Å"vitamin water† or â€Å"nutrient water† in the world as many people are becoming more health conscious. The Times (London) (2012) reports that even India is not spared from the trend as PepsiCo, together with Tata Global Beverages, intend to market the â€Å"nutrient water† to India’s urban, middle-class consumers where a bottle of such product will cost slightly higher than a standard bottled water. Hence, this could greatly affect the retail sales of carbonates. A. G. Barr has already altered its products to regular variants to low calorie and no added sugar variants in accordance to the gradual shift towards healthly living in the UK (A. G. Barr, 2012). For example, its popular porduct, IRN-BRU now comes in a sugar free variation, the ‘IRN-BRU sugar free’. Thus, the â€Å"nutrient water† market is another sector A. G. Barr could develop into not only in UK but also in India. 3. India has huge supporting industries for the soft drinks market and the availablity of the main components for a soft drinks company in India is high. There are 453 sugar mills in India and the top 6 growing states are located in the Northern, Southern and Western regions of India (Maps of India, 2012). Noteably, the Indian government has been extentsively investing in the agriculture sector to ensure that the process of the sector from raw materials to warehousing and merchandising flow smoothly. And as for the aluminium industry, India has a sizeable number of aluminium plants located mainly in Northern and Southern regions. 3. 2 BARGAINING POWER OF SUPPLIERS As inputs are readily available, suppliers are unable to provide their services or sell their products at a higher price than their competitors as it is of no loss to the soft drinks company since the company is able to get the same or better services and products from other suppliers. A. G. Barr is able to obtain the primary inputs for its products through several sources in the region or state. Thus, the bargaining power of suppliers such as the packaging producers and raw materials and soft drinks ingredients producers are relatively low (Datamonitor, 2011). 3. 3 BARGAINING POWER OF BUYERS The power of the retailers and distributors in this market is weak as most soft drinks manufactures work closely with the local bottling companies to distribute the ready for sale products to buyers within a certain region or sector (Datamonitor, 2011). Datamonitor (2011) also reports that with 46. 3% of the total market volume, the independent retailers such as the small family mart shops are the main distribution channels for soft drinks but this could change with the introduction of super and hypermarkets. Thus, consumers will have a wider range of soft drinks brands to choose from. In order to gain relatively significant market share, A. G. Barr needs to do plenty of advertising and promotion. One of the strategies A. G. Barr could adopt is to set their soft drinks at a lower price than the main competitors, TCCC and PepsiCo in the rural areas while maintaining the same price in the urban areas where most of the middle-income and high-income classes have high consumer purchasing power. 4. FIRM STRATEGY, STRUCTURE AND RIVALRY 4. 1 CULTURAL IMPACT ON FIRM STRATEGY AND STRUCTURE A. G. Barr core strategic focus is based on the following 7 platforms (A. G.Barr, 2012): Core Brands and Markets Portfolio development Route to market Partnerships Efficient Operations People Development Sustainability To ensure these strategies and structure is maintain in other country, A. G. Barr has to train its overseas employees, make them understand and cultivate the A. G. Barr working culture. However, this will be a tough challenge in India due to the poor education and different socio-culture. Thus, A. G. Barr needs to accommodate its Western working culture with India working culture, however without losing its main mission and strategy. To ensure this is excuted properly, A. G. Barr needs to obtain a specialist in the Indian market and culture. 4. 2 RIVALRY AMONG EXISTING COMPETITORS In India, the soft drink market is dominated by three main players The Coca-Cola Company (TCCC), PepsiCo and Parle Bisleri Ltd – securing 74. 1% of the total market volume (Datamonitor, 2011). Table 4: India soft drinks market share: % share, by volume, 2010(e) BBC News (2011) reports that TCCC planned to invest $2 billion in India to boost its market share and expected India to be in its top five markets by 2020. Meanwhile, PepsiCo intend to launch a new product, â€Å"nutrient water† with Tata Water targeting at the young urban consumers to gain more market shares (Pagnamenta, 2012). This shows how competitive the rivalry in the India soft drinks industry where the two major market shares are actively investing and developing new products to gain more shares. 4. 3 THREAT OF NEW ENTRANTS The big players of the India soft drinks industry are actively improving themselves and distinguishing their products through various methods. Furthermore, TCCC and PepsiCo are renowned world soft drinks brands which have been existing in the India market for many years. Though new companies in the industry may have difficulty competing with the existing players, it may accomplish small success by using different production method or focusing on the lesser ventured catergories of the soft drinks markets such as health drinks and energy drinks (Datamonitor, 2011). This could be a major break through for A. G. Barr as its most popular products; the IRN-BRU; is low in sugar and contains additional benefits of an energy drink. In addition, the Rockstar series which are designed to target those who lead active lifestyles may be able to attract the young, urban consumers. With several advertising accolades, A. G. Barr has the knowledge and is able use the power of media to attract potential consumers and gain more market shares. 4. 4 THREAT OF SUBSTITUTES The main substitutes for soft drinks markets are traditonal tea and coffee, homemade juices and fresh water from the water plants or piping system. As A. G. Barr and other leading soft drinks companies have diverse products to cater to the different needs of the consumers – carbonates, bottled water, juices etc – this will narrow down the threat of substitutes. However, the threat is still relatively moderate as retailers and distributors may give more shelf space for traditional tea and coffee products as they may be stored at room temperatures (Datamonitor, 2011). 5. GOVERNMENT BBC News (2011) reports that India is ranked 95th out of 183 nations in the Transparency International Corruption Perceptions (TICP) list. Due to the high corruption scandals among its government officials, low or invisible legislative work, red tape and bureaucracy, India has dropped from 87th in 2010 to 95th (BBC News, 2011). Despite its numerous intervention, corruption in India is an issue which is very difficult to get rid off since most of the political members and officals have their own agendas and are resistant to change (India: Risk overview, 2011). Hence, foreign companies will faced many setbacks when they venture into the India sectors. 6. ROLE OF CHANCE The role of chance plays a small part in factoring the soft drinks industry as most of the technology are at it most advanced state. The only main issue currently is the Iran oil crisis. As India still refuses to cut Iranian oil imports, this may lead to a huge setback if USA decides to attack Iran and ignore India’s relation with Iran (CBS News, 2012, Kennedy, 2012). With a potential strain relationship with USA, this could lead to severe freeze in the trade and foreign direct investments. Furthermore, the other two traid nations, EU and Japan, may follow suit USA’s decision to cut ties with India for refusing to withdraw the purchasing of Iranian oil. CONCLUSION In conclusion, the soft drinks market in India is huge though it is predominately hold by 3 major key players. To venture into this territory, a new company need to set itself apart from the majpr players through unique advertising, differentiated production method and diverse product offerings. New companies may set an initial low price of its products to attract consumers however; this should not be a long term strategy. Companies need to have a huge capital investment to counter the corruption, trade policies and poor infrastructure. Thus, expenditures and initial start-up cost will be high and companies will have to redistribute part of the cost to its final consumers in order to gain profits. PART B: CRITICAL EVALUATION OF PORTERS NATIONAL DIAMOND MODEL Michael E. Porter is a well renowned economic strategist whom has writen 18 books and over125 articles (HBS, 2008). With a core field in competitive strategy, Porter has written and developed a number of strategic frameworks such as the Porter’s National Diamond model and Porter’s 5 Forces analysis. Since the model was based on eight developed countries and two industrialized countries, an analysis on developing, growing countries such as India is flawed. This is because these developing countries are not on the same economic level as the 10 countries. Thus, though the Porter’s National Diamond (PND) model analysis almost every aspect of India’s profile, it still lacks in-depth analysis and companies should not base their analytical evaluation on the PND model alone. As supported by Van Den Bosch, and Van Proojien (1992), both authors believed that PND model provide limited analysis on the control of national culture on the competitive advantage of nations. Similar to the EU countries, India too has a diverse set of culture which plays significant role in the management of the country’s economy, laws, trade policies and governance. There are limited sources on India and the soft drinks market due to the lack of legistative work from the government officals. Furthermore, some of the reports or statistics may not be entirely accurate due to the high corruption level. For example, reports may state that India is able to generate 90% of its power but the power plants are inconsistent and supplies are frequently distrupted. Also, to what extend is the literacy rate of India is correct? The literacy rates may be higher than stated as with 1. 22 billion people, India officials may have a tough job collecting the accurate datas. Moreover, with high poverty and low income, most of Indian citizens have the ‘thrifty mindset’ whereby they prefer things which are basically free even though it maybe harmful such as drinking untreated water. These are the pros of the PND model for India: Analysis different aspect of the country profile Takes into account the role of Government which is the most essential for India These are the cons of the PND model for India: Limited credible sources for analysis Little depth as India is a huge country with various swinging factors. Limited analysis on the cultural effect on a country’s competitive advantage Ways to improve the PND model for India: Supporting the model with other analysis model such as PEST, SWOT, Porter’s 5 Forces and Fons Trompenaars’ Seven Cultural Dimensions. Intentsive research on the market and the growth of the market. REFERENCES A. G. Barr (2012) About Us. Available at: http://www. agbarr. co. uk/agbarr/newsite/ces_general. nsf/wpg/about_us-our_strategy (Accessed: 22 March 2012). BBC News (2011) Coke plans $2bn India investment in bid to boost growth. Available at: http://www. bbc. co. uk/news/business-15731884 (Accessed: 20 February 2012). BBC News (2011) India Transparency International corruption index blow. Available at: http://www. bbc. co. uk/news/world-asia-india-15979646 (Accessed: 01 March 2012). CBS News (2012) U. K. : Attack on Iran has enormous downsides. Available at: http://www. cbsnews. com/8301-202_162-57380838/u.k. -attack-on-iran-has-enormous-downsides/? tag=mncol;lst;1 (Accessed: 20 February 2012). India. CESS (2004) Right to Drinking Water in India. Available at: http://www. cess. ac. in/cesshome/wp%5CWater. pdf (Accessed: 22 March 2012). CIA (2012) South Asia, India. Available at: https://www. cia. gov/library/publications/the-world-factbook/geos/in. html (Accessed: 20 February 2012). FAO (2012) Faostat. Available at: http://faostat. fao. org/site/339/default. aspx (Accessed: 01 March 2012). HBS (2008) Harvard Business School Faculty Research. Available at: http://drfd. hbs. edu/fit/public/facultyInfo. do? facInfo=biofacEmId=mporter (Accessed: 10 April 2012). India: Risk overview’ (2011) Business Asia, 43, 14, pp. 10-11, Business Source Premier, EBSCO [Online]. Available at http://searchebscohost. com (Accessed: 22 March 2012). Kennedy (2012) US Pleas for Asia to Cut Iranian Oil Imports Fall on Deaf Ears, Oilprice. Available at: http://oilprice. com/Latest-Energy-News/World-News/US-Pleas-for-Asia-to-Cut-Iranian-Oil-Imports-Fall-on-Deaf-Ears. html (Accessed: 20 February 2012). Maps of India (2012) India Agriculture.

Employer †Employee Relationship Essay Example for Free

Employer – Employee Relationship Essay Little Lamb Company needs an additional programmer for a special project. The company enters into a contract with Mary to complete this project. Just as the project is nearing completion, initially an independent contractor as she had a high degree of control over how the work is accomplished, and enters into a contract with the company a new need arises for her services. She is asked to continue with the company to complete the new project. While completing the new project, the supervisor begins working more closely with Mary and requires her to use company materials and equipment while adhering to company work schedules. Mary seems to be moving toward an at-will employee position, because she appears to have less control over how the work is accomplished as she will probably have to answer to the supervisor, and using the companies materials and equipment and adhering to the company work schedules. After two years suggests at-will employee because of the length of time being 2 years, economic conditions force the company to make budget cuts. Mary is asked to leave as an employee, as she is obviously no longer working as an independent contractor, when asked to leave the company. Thirty days later, a major contract is acquired by the company, which reinstates the need for Marys services as a programmer. However, the supervisor chooses to hire his equally-qualified cousin and not offer Mary the opportunity to return. The use of word hire implied that Mary had been an employee and not an independent contractor. Is Mary an independent contractor or an employee? Describe the factors that led to your determination. There are several criteria to determine if Mary is a contractor or an employee. For example, one critical aspect to distinguish an independent contractor from an employee is the degree of control over how the work is accomplished. Initially Mary seemed to have more control than she did at the end, so it seems that she moved from being a independent contractor at the beginning to an employee over time. However, there are many factors to consider in making a determination as to whether a worker is an independent contractor or an employee. Some of these criteria include:†¢Whether a distinct occupation or business is  being performed; e.g. programmer, so initially Mary was contracted as an independent contractor for a specific project. †¢The amount of supervision over the means by which the work is performed; e.g. the supervisor begins working more closely with Mary and requires her to use company materials and equipment while adhering to company work schedules implies a move away from independent contractor towards an at will employee. †¢The degree of skill required to perform the work; e.g., programmer equally-qualified cousin†¢Who provides the tools used to perform the work, and, e.g., requires her to use company materials and equipment while adhering to company work schedules and therefore moving towards being an at-will employee†¢The place where the work is done; e.g. Mary is working in the office, the supervisor begins working more closely with Mary and requires her to use company materials and equipment while adhering to company work schedules suggesting an at-will employee position. Has the employer/employee relationship changed over the course of time? If so, how?As mentioned above, it did seem to change over time. It seems that initially, Mary could be considered an independent contractor because Little Lamb Company needs an additional programmer for a special project and Mary entered into a contract with the company. However, Mary was later asked to stay on and began working close to the supervisor, who expected Mary to used the company materials and equipment, to follow the company work schedule, and was terminated at will when economic conditions demanded. Thus, Mary seemed to move from an independent contractor to an at-will employee. 3) Was Marys release legal under the doctrine of employment-at-will? Why or why not?This is murky water and it depends. If Mary had moved into an at will employee, then the doctrine of employment-at-will allows her employee to let her go without reason (however, they initially had a contract, which we look at in the next part of this question below). In the scenario, it says Mary enters into a contract for the first project, however, makes no  mention of a contract when she is asked to stay on (however, sometimes contracts are implied). For example, in most states of the United States all employees are considered at will employees. That means that the employer can terminate or change the employment relationship at will, unless there is a contract with the employer. In general, an employer can fire an at will employee, or change the employees position or compensation with no notice and no reason. Likewise, the employee can terminate his employment at will without notice or reason. However, there are three possible legitimated reasons employee can challenge a wrongful termination:If not, which of the following exceptions to employment-at-will have been violated? Why?a) Breach of public policy (Perhaps) Values, principles and basic rules that the courts and legislatures consider to be in the best interest of individuals and the general public. Employer violations of specific labor and employment laws might be called violations of public policy, instead of or in addition to violations of the specific laws. That is because it is in the best interest of all workers that all employers obey such laws. Public policy may be written or implied, and varies among states and municipalities. Consequently, whether or not an employer has violated public policy is often a matter of interpretation by a court or arbitrator (i.e., hired cousin instead of having Mary return). b) Breach of implied covenant of good faith and fair dealing. Probably not, because it is dealing with contracts and the question is dealing with at-will exceptions. c) Breach of implied contract (this is a possibility). Why? For example, in a contract between the employer and the employee, even in the absence of a formal written employment agreement. For example, language in an employee handbook may promise all layoffs are based on seniority or we give employees at least 2 weeks notice of all layoffs. Therefore, if Mary thins she is wrongfully terminated, as an employee; she can challenge a wrongful termination for these legitimate reasons

Esophagram Barium Swallow Analysis

Esophagram Barium Swallow Analysis Two common radiographic procedures of the upper GI system involving the administration of contrast media are the esophagram, or barium swallow, as it is sometimes referred to, and the upper GI series. Each of these procedures is described in detail, beginning with the esophagram. This examination is used for the patient who have high dysphagia or definite oesophageal symptoms, or have quite often had a normal OGD but are still symptomatic, quite often a motility disorder may be the cause. Esophagram or barium swallow, is the common radiographic procedure or examination of the pharynx and esophagus, utilizing radiopaque contrast medium may be used. The purpose of an esophagram is to study radiographically the form and function of the swallowing aspects of the pharynx and esophagus. No major contraindications exist for esophagrams except possible sensitivity to the contrast media used. the technologist should determine whether the patient has a history of sensitivity to barium sulfate or water soluble contrast media. Known aspiration during ingestion (although this can be overcome by using non-ionic water soluble contrast). The contrast agent for barium swallow is barium sulphate suspension 250% w/v or water soluble contrast medium. Barium sulphate are, high atomic number, not soluble in water, used to coat the lining of organs, supplied in different thicknesses. Used in esophogram, UGI, Small Bowel, Lower GI or BE. History of barium sulphate is starting with, lead substrate-toxic, bismuth subnitrate-toxic, thorium-radioactive, barium sulphte-inert(goes in and comes out the same not absorbed). Barium sulphate mixture are contraindicated if any chance exists that the mixture might escape into the peritoneal cavity. This escape may occur through a perforated viscus or during surgery that follos the radiographic procedure. in either of these two cases, water soluble, iodinated contrast media should be used. Two example of this type gastrografin and Gastroview. Both of these water soluble contrast agent can be easily removed by aspiration before or during surgery. if any of this water-soluble material escape into the peritoneal cavity, the body can readily absorb it. Barium sulfate, on the other hand, is not absorbed. One drawnback to the water soluble materials is their bitter taste. Although these iodinated contrast media sometimes are mixed w ith carbonated soft drinks to mask the taste, they often are used as is or diluted with water. The patient should be forewarned that the taste may be slightly bitter. The technologist should be aware that water soluble contrast agents travel through the GI tract faster than barium sulfate. The shorter transit time of water soluble contrast agents should be kept in mind if delayed images of the stomach of duodenum are ordered. If there is any query that the patient may aspirate, the initial swallow is best carried out using a water-soluble contrast medium, although aspiration of barium has been considered by some to be relatively harmless. Aspiration may not be suspected but unsuspected silent aspiration may be found. The more common pathologic indications for an esophagram procedure suchas, achalasia also term cardiospasm, is a motor disorder of the oesophagus in which peristalsis is reduced along the distal two thirds of the esophagus. Achalasia is evident at the esophagogastric s phincter because of its inability to relax during swallowing. The thoracic esophagus may also lose its normal peristaltic activity become dilated (megaesophagus). Video and rapid digital fluoroscopies are most helpful in diagnosis of achalasia. Anatomic anomalies may be congenital or caused by disease, such as cancer of the esophagus. Patients suffering from a stroke often develop impaired swallowing mechanisms. certain foods and contrast agents are administered during the examination to evaluate swallowing patterns. A speech pathologist may witness the study to better understand the speech swallowing patterns of the patients. Video and digital fluoroscopy are used during these studies. Barretts esophagus, or barrette syndrome, is the replacement of the normal squamos epithelium with columnar-lined epithelium ulcer tissue in the lower oesophagus. This replacement may produce a structure of the distal oesophagus. In advanced cases, the development of a peptic ulcer in the distal esop hagus may occurs. The esophagram may demonstrate subtle tissue change in the esophagus, but nuclear medicine is the modality of choice for this condition. the patient is injected with technetium 99m pertechnetate to demonstrate the shift in tissue types in the esophagus. Carcinoma of the oesophagus includes one of the most common malignancies of the oesophagus, adenocarcinoma. advanced symptoms include dysphagia (difficulty in swallowing) and localized pain during meals and bleeding. Other tumors of the oesophagus include carcinosarcoma, which often produces a large, irregular polyp, and pseudocarcinoma. Dysphagia is difficulty in swallowing. This difficulty may be due to a congenital or acquired condition, a trapped bolus of food, paralysis of the pharyngeal or esophageal muscle, or inflammation. Narrowing or an enlarged, flaccid appearance of the esophagus may be seen during the esophagram, depending on the cause of the dysphagia. Video and digital fluoroscopy are the modalities of choice. Esophagram and endoscopy are performed to detect these tumors. The esophagram may demonstrate atropic changes in the mucosa due to the invasion of the tumor as well as stricture. Because the esophagus is empty most of the time, patients need no preparation for an esophagram only, all clothing and anything metallic between the mouth and the waist should be removed, and the patient should wear a hospital gown. Before the fluoroscopic procedure a pertinent history should be taken and the examination carefully explained to the patient. The first part of an esophagrams involves fluoroscopy with a positive-contrast medium. The examination room should be clean, tidy and appropriately stocked before the patient is escorted to the room. The appropriate amount and type of contrast medium should be ready. esophagrams generally use both thin and thick barium. Additional items useful in the detection of a radiolucent foreign body are cotton balls soaked in thin barium, barium pills or gelatine capsules filled with BaSO4, marshmallows. After swallowing any one of these three substance, the patient is asked to swallow an additional thin barium mixture, because the esophagram begins with the table in the vertical position, the footboard should be in place and tested for security. lead aprons, compression paddle, and lead gloves should be provided for the radiologist, as well as aprons for all other personnel in the room. proper radiation methods must be observed at all times during fluoroscopy. With the room prepared and the patient ready, the patient and radiologist are introduced and the patientis history and the reason for the exam discussed. The fluoroscopic examination usually begins with the general survey of the patients chest, including heart, lungs and diaphragm, and the abdomen. During fluoroscopy, the technologists duties, in general, are to follow the radiologists instructions, assist the patient as needed, and expedite the procedure in any manner possible, because the examination is begun in the upright or erect position, a cup of thin barium is placed in the patients left hand close to the left shoulder. The patient then is instructed to follow the radiologists instructions concerning how much to drink and when. The radiologist observes the flow of barium with the fluoroscope. Swallowing (deglutition) of thin barium is observed with the patient in various positions. Similar positions may be used while the patient swallows thick barium. The used of thick barium allows better visualization of mucosal patterns and lesion within the esophagus. The type of barium mixture to be used, however is determined by the radiologist. After the upright studies, horizontal and trendelenburg positions with thick and thin barium may follow. The pharynx and cervical esophag us are usually studied fluoroscopically with the spot films, whereas the main portion of the esophagus down to the stomach is studied both with fluoroscopy and with post fluoroscopy overhaed radiograph. the diagnosis of possible esophageal reflux or regurgitation or gastric contents may occur during fluoroscopy or an esophagram. One or more of the following procedures may be performed to detect esophageal reflux. First, breathing exercise the various breathing exercises are all designed to increase both the intrathoracic and the intraabdominal pressures. The most common breathing exercise in the valsalva maneuver. The patient is asked to take a deep breath and, while holding the breath in, to bear down as though trying to move the bowels. This maneuver forces air against the closed glottis.  A modified valsalva maneuver is accomplished as the patient pinches off the nose, closes the mouth, and tries to blow the nose. The checks should expand outward as though the patient were blow ing up a balloon. A Mueller manoeuvre can also be performed as the patient exhaled and then tries to inhale against a closed glottis. With both methods, the increase of intraabdominal pressure may produced the reflux of ingested barium that would confirm the presence of esophageal reflux. The radiologist carefully observes the esophagogastric junction during these manoeuvres. Second is water test that done with the patient in the supine position and turned up slightly on the left side. This slightly LPO position fills the fundus with barium. The patients are asked to swallow a mouthful of water through a straw. Under fluoroscopy the radiologists closely observe the esophgogastric junction. A positive water test occurs when significant amounts of barium regurgitate into the esophagus from the stomach. A compression paddle can be placed under the patient in the prone position and inflated as needed to provide pressure to the stomach region. The radiologist can demonstrate the obscure esophagogastric jun ction during this process to detect possible esophageal reflux. The toe-touch manoeuvre is also performed to study possible regurgitation into the esophagus from the stomach. Under fluoroscopy the cardiac orifice is observed as the patient bends over and touches the toes. Esophageal reflux and hiatal hernias are sometimes demonstrated with the toe-touch manoeuvre. If the patient is a female, then a menstrual history must be obtained. Irradiation of an early pregnancy is one of the most hazardous situations in diagnostic radiography. X-ray examinations such as the upper GI series that include the pelvis and uterus in the primary beam and include fluoroscopy should only be done on a pregnant female when absolutely necessary. In general, abdominal radiographs of a known pregnancy should be delayed at least until the third trimester or, if patients condition allows (as determined by the physician), until after the pregnancy. This waiting period is especially important if fluoroscopy, which greatly increase patient exposure is involved. Potential difficulties that may arise out of a Barium Swallow is discomfort of air insufflation. Poor tolerance of swallowed gas mixture can make for poor stomach and oesophageal distension. Where buscopam injection is used to relax bowel for better pictures, patients may experience some blurring of vision.  Tendency  of barium to cause constipation in the days following the procedure. Need for an interpreter in non-English speaking patients. Disadvantages of Barium Swallow Useful for functional assessment allows the assessment of motility, reflux and distension. In comparison to gastroscopy, barium swallow is safer. Available resource. It is difficult to compare costs between barium studies and endoscopy and they may be of comparable costs. However is some centres barium studies are much more accessible to GPs and may be arranged with much less delay for the patient than gastroscopy. Not as comprehensive or accurate method for diagnosis of some conditions in comparison to gastroscopy. Not able to take samples or provide treatment as part of the procedure. Radiation exposure. Dose is 2 3 millisieverts compared with chest film 0.06 millisieverts and background radiation of 2millisieverts per year. Users of ionising radiation are required to inform all women of child bearing age about the risks of radiation in pregnancy. Pregnancy is a relative contraindication to the use of radiation but generally in the context of the barium enema the urgency is such that can delay or choose alternative investigation.

Most Despicable Character in Glengarry Glen Ross, by David Mamet :: Glengarry Glen Ross

The definition of a despicable character is someone who is so worthless or obnoxious as to rouse moral indignation. This definitely fits the description of some of the characters in the play Glengarry Glen Ross, by David Mamet.   Ã‚  Ã‚  Ã‚  Ã‚  Glengarry Glen Ross is a play about real estate salesmen who are basically conmen that always just work toward getting the deal closed, whether or not the customer is happy with the deal. They fit the stereotype of car salesmen, always trying to get the deal closed with the customer walking away feeling that they paid way too much. Dave Moss is one such salesman, except that he is the most despicable among the entire group. In a scene of the play this guy actually has the guts to try to blackmail one of his fellow salesmen; a fellow friend. The conversation starts out as would any among friends, bsing about work or not getting paid enough. Then Dave slowly introduces the topic that their bosses are greedy and selfish, to plant the seed of distrust. They talk about this for a bit but then get around to what â€Å"somebody should do.† Dave says that â€Å"someone† should pay them back, and this leads into robbing the office. He talks about the logistic s of this, that they would get a dollar fifty for each lead and such, but disarms the tense situation, saying that we were just â€Å"talking† about it. But he slowly leads into that he is actually planning on it, and wants Aaronow in on it. He then says that if he does it and Aaronow isn’t in then he would call him as an accomplice, trying to manipulate him into helping; a fellow friend. The best part of this blackmail is that not only is he going to rob his workplace, he’s going to sell out to another team of salesmen.

The Communicable Disease: Pertussis Essay -- Health, Diseases, Whoopin

The Communicable Disease: Pertussis Pertussis is a highly infectious disease. It is also known as whooping cough. For more than a decade, pertussis has become a significant public health problem. CDC reports that since the 1980s, there has been an increase in the number of reported cases of pertussis in the United States (2011a). Worldwide, there are 30-50 million cases of pertussis and about 300,000 deaths per year (CDC, 2011a). Public Health Nurses play an important role in limiting the transmission during outbreaks by educating and ensuring appropriate treatments to the communities. Epidemiologic Triad Model Agent. The main biological pathogen that causes the Pertussis is Bordetella Pertussis. The agent is an aerobic gram-negative bacterium. Bordetella Pertussis attaches to and damages ciliated respiratory epithelium (Guinto-Ocampo, McNeil & Aronoff, 2010). The mechanism prevents cilia from capturing debris and interferes with the respiratory tract from clearing secretions. In addition to the adherence, Bordetella Pertussis releases toxin to stimulate the production of thick mucus which can obstruct the airway. Consequently, the body responds by coughing in order to clear the airway which releases the microorganism into the air. Host. Bordetella Pertussis affects only humans. No animal or insect source or vector is known to exist (CDC, 2011a). The mode of transmission is the respiratory route. The bacteria live in mouth, nose, and throat. An infected person spreads the disease to another person via airborne droplets of respiratory secretions. â€Å"Pertussis is especially contagious during the first week of illness but is easily transmitted during the period starting 7 days following exposure and for up to 3 we... ...evelop the symptoms suggesting the paroxysmal stage, the interventions are antibiotic and supportive treatments. San Diego Health Department can develop a standardized protocol for management of patients exposed to pertussis to all hospital settings (Haiduven, Hench, Simpkins & Stevens, 1998). According to the study, Barriers to Public Health Management, the results showed that there is often miscommunication among healthcare professionals since there was no clear and dependable ways to reach every health care worker (Wheeler, Tran, North, Beavers-May, Schutze & et. al., 2004). San Diego Health Department should send out a team of health department staff to be resources and collaborate with hospital staffs to ensure provision of adequate care. It is important to establish a clear communication between public health teams and local hospitals in the community.

Characterization In A Classic Novel Essay -- essays research papers

Characterization in a Classic Novel   Ã‚  Ã‚  Ã‚  Ã‚  Mary Shelly’s Frankenstein is the story of a scientist, Victor Frankenstein, and his quest to create life from death. Frankenstein’s experiment goes dreadfully wrong and he is forced to flee from the monster he created. Throughout this novel, Frankenstein is characterized by his extreme intelligence, skepticism and withdrawn behavior, and remorse.   Ã‚  Ã‚  Ã‚  Ã‚  In the beginning of this novel, it is clearly stated that Victor has a love for knowledge. â€Å"It was the secrets of heaven and earth that I desired to learn; and whether it was the outward nature and the mysterious soul of man that occupies me, still my inquiries were directed to the metaphysical, or in its highest sense, that physical secrets of the world,† (37). Victor is educated but self-taught in his favorite subjects. He begins reading books dealing only with science and describes himself as, â€Å"always having been imbued with a fervent longing to penetrate the secrets of nature,† (39). When Victor is old enough, he attends college in Ingolstadt. At Ingolstadt, Victor becomes interested in chemistry and the human body. Frankenstein decides to create a human being in hopes that he will be able to restore life to the dead.   Ã‚  Ã‚  Ã‚  Ã‚  It is apparent that Victor dislikes groups of people. During his childhood, he has one friend who remains close to him throughout his life. Instead of talking to his friend or family when...

First meeting Issues

In the first meeting of the Land Committee held on 22nd December, 2004 it was decided to hold public hearings with recognized political parties, civil society organizations and peoples? unions working on land issues of the poor to understand the various issues on land reforms. The Committee held public hearings in Hydrated, Wrangle, Vigilant and Atrophic. The visits to the districts and public meetings were followed by field visits to districts and villages to get a firsthand knowledge of the land issues affecting the poor.In an overwhelming response, political parties and civil society organizations attended all the public hearings and cutting across party lines, have demanded that land issues affecting the poor required immediate attention by the Government. Commissioning of Studies In order to understand the land issues in greater detail and also the relevance and use of the existing Revenue Acts, the committee has commissioned studies on various aspects of land issues by speciali sts and experts.Studies have been conducted on Board Standing Orders and Revenue Acts, Tribal land issues, issues of Tenancy, the phenomenon of absentee landlord's and that of plain paper transactions (Sad bambina transactions), functioning of the legal system and state of the endowment lands (Terms of References of the studies and consultants/consulting organizations conducting the study enclosed).Recommendations immediately operational in nature While commissioning the studies the Land Committee was very clear that recommendations evolving from the studies would not be theoretical in nature and focus shall be on operational issues. The Committee has tried its best to cover the important and pressing land issues. The recommendations of the committee while not exhaustive nevertheless cover substantial ground. Page 3 of 101 Land still the single most emotive issue in rural areas It has been the Committee?s experience that the issue of land continues to be the single most emotive issu e in the rural areas.