Indoor Plumbing and Public Sanitation in Developing Countries Essay Example for Free

Indoor Plumbing and Public Sanitation in Developing Countries Essay The porcelain throne, the pot, the pooper, the potty, the latrine, the toilet. That is something we don’t give much thought to, unless something is wrong with it. What about the shower or the sink? How often to do you go to your sink to get a glass of water and wonder â€Å"Am I drinking someone’s poo? Will it be clean today or will I get sick? † I know for myself, I rarely give this any thought at all and I can honestly say that I have never worried that my drinking water would be contaminated by feces. However, for many around the world, this is a constant concern. Many today either don’t have access to clean water or don’t have access to very much water at all. They openly defecate, as well as drink, cook, and bathe in contaminated water. This causes several life threatening diseases and illnesses. I will discuss the water and sanitation issues in under developed countries, as well as what is being done to improve these situations. Early one December morning in Boise Idaho, I woke up to an especially cold day. I tiredly scuffled myself to my bathroom, went pee and when I went to flush my toilet, nothing happened. Still slightly asleep and confused, I tried a couple more times to get it to flush. Still nothing happened. Frustrated, I opened my tank and found that there was no water in it at all. I thought that that was strange, so I checked my faucet. I turned the handle and no water came out, I quickly checked my shower and kitchen sink next. I had no water at all. Realizing that I had to work in a few hours and I had no way to shower, brush my teeth or clean up in any way, I became quite irate. I called my management company and apparently pipes had frozen in most of their properties. After this experience I started thinking about my reaction and how there are countries that don’t have access to clean water ever. Though I think that the reaction that I had would have been the same for any person living in the U. S. , I don’t know if it was as big of a deal as it felt like in the moment. I didn’t die from not having water for one day, I wasn’t forced to defecate in my front lawn or drink from a sewer. I didn’t get sick and I didn’t even have to go the entire day without a shower. In fact, I didn’t have to go even a couple of hours without access to water. We, in America, are so used to having constant access to clean water and indoor plumbing that if we have to go an hour without it, it’s as though our entire world is crashing down. We rarely give thought to those in underdeveloped countries that lack access to clean water at all. There are approximately 7 billion people living on earth today. There are about 2. 6 billion people today that don’t have a toilet or access to one (Yamaguchi). That is about 40% of the world’s population! That is a huge number of people without toilets. Here in America, there is not a single home that does not have a toilet. Even the homeless have constant access to restroom facilities and clean water. I had a conversation with a friend of mine that works with the homeless on a daily basis to see what the situation was like for the homeless in America in regards to restroom access and sanitation. I asked him if any of the homeless people that he worked with were ever forced to openly defecate or go without a shower. He informed that the only ones that did that were never forced to, but they did it by choice. He also told me that many that are homeless are on Medicaid, so if they get sick they can just go to the doctor. This is quite different from developing countries, where people die all the time from not being able to afford medical care. Developing countries not only lack affordable medical care but they have very limited ability to prevent the spread of illness, such as those caused by exposure to fecal matter (Yamaguchi). However, in America we have sewage systems and plants that filter and treat our sewer water. In Los Angeles there is the Hyperion sewage plant that processes enough fecal matter to fill three Rose Bowl Stadiums every day (Yamaguchi). That is just in Los Angeles, what about the rest of the U.  S.? It is mind boggling to think about how much is processed. Now let’s look at India, a country that has significantly grown economically, however is still severely lacking proper sanitation systems. According to UNICEF, about 600 million people in India are without access to a toilet (â€Å"World Toilet Day 2012†). That is more than half the population of India. Instead of using a toilet, they openly defecate wherever they can. Many use the Yamuna River (Yamaguchi), the largest river in the Ganges of Northern India. The result has been a severely contaminated water source. The river has literally turned black and bubbles from the methane gases. The shores are not only polluted with fecal matter but trash as well and yet still the people are using the water from the river (Yamaguchi). I think many American’s reaction to this would be â€Å"Gross† or we might generalize and think that Indians are just unsanitary people. Is that really the case, though? The people living in underdeveloped countries are rarely living in unsanitary conditions by choice. Many are ignorant to proper sanitation practices and/or are living in conditions where they have no access to clean water. In the urban slums of New Delhi, people are defecating anywhere they can; in the middle of the streets, next to rail road tracks, or just feet from where they eat, drink and sleep. The water they are using to cook, drink, and bathe with is water from a sewer (Yamaguchi). About 1000 children die every day from diarrhea (Bajait, Thawani). This lack of proper sanitation systems is exposing these children and adults to fecal matter on a daily basis, which is causing diseases like Typhoid, Cholera and other severe illnesses linked with diarrhea. Is this the fault of the individual or the fault of their governments? In my opinion, both are at fault. Though developing countries have very little access to informational services, I do believe that it falls in the hands of the individual to get informed and I believe that it is the responsibility of the government to provide the services required to inform its people on proper sanitation, as well as provide a clean environment to live in via sanitation systems. This lack of toilets, which results in a lack of clean water, is obviously a very big problem. So what is being done about it? In 2001 Jack Sim founded the World Toilet Organization. This organization is dedicated to improving the world’s toilet and sanitation situation. They make toilets that are affordable for those living in impoverished conditions. Jack Sim also works with governments of developing countries and small organizations to help provide toilets to those in need. One of those small organizations is run by Bapak Sumadi in Indonesia. Sumadi is a major leader in Indonesia in providing the public with toilets and teaching the importance of public sanitation. Together their goal is to end open defecation (Yamaguchi). Though the changes and effects are small, they are not insignificant. The conditions that these people are forced to live in, is truly a crisis. Thousands die every day from not having proper sanitation systems. The invention of the toilet and sewage systems has not only given us a way to get rid of our feces, but it has provided us with sanitary conditions which keeps our water clean and reduces the chances of contracting diseases. No matter who you are or where you live, everyone deserves to have access to a toilet and clean water. The question now is; what more can be done? Should the government help provide better access to toilets and sanitation systems? What about other countries? Do we hold any responsibility in helping these developing countries? In my opinion, yes we do. One scholarly journal, in reference to David Hemson, stated â€Å"†¦ regular water supply to the rural poor is both a constitutional requirement and a social necessity†¦Ã¢â‚¬  (Phaswana-Mafuya 298). I think it is imperative that we learn to help one another, so that we can grow together rather than grow apart. I know the next time that I use the restroom, take a bath, or even just get a glass of water; I will be grateful for all that I have and that I don’t have to worry about what I am drinking or bathing in. What about you?

Malaysia Airlines System Berhad Mas Commerce Essay

Malaysia Airlines System Berhad Mas Commerce Essay Malaysia Airlines System Berhad is founded as Malayan Airways that the government-owner flag carrier of Malaysia. MAS operate flights in Southeast Asia, East Asia, South Asia, Middle East and in the Kangaroo Route between Australia and Europe. Others operation that MAS provide to their customer is MASkargo, MASCharter, and MASswing. Apart from the MAS airline the group also includes aircraft maintenance, repair and overhaul (MRO) and aircraft handling. MAS have two airlines subsidiaries is Firefly, MASKargo and MASwings. The management that make many change in their structure organization to improve the productivity on employees performance and customer satisfaction. Starting in 1997 MAS get unprofitability and the top management and government should take action to solve this problem. And, MAS make a decision to make managing change to increase the profitability and can increase productivity. Most CEOs or managers in the organization consider to be make managing change to their management to improve the performance and productivity either to employees or organizations. Change perspectives describe the fundamentally different event sequences of change involvement, or what can be thought of as motors of change. Managing change is the systematic approach to dealing with the change from perspective of organization or individual. The goal of managing change is to make improvement in the performance of an organization as fast as possible and increased organization effectiveness. Moreover, when make a managing change has a purpose to achieve the goals. The purpose of change is to make organization more productive by finding ways of supporting or developing its competitive advantages. Before make managing change in MAS, the management should have a purpose for the management and employees can achieve what they want to be success. The purpose of MAS is to make airline market has become more competitive with the rapid increase of the low cost carrier (LCC) segment, continued growth of the Middle Eastern full service carriers and revival in the fortunes of Asia full service carriers. The objectives, MAS plan to move they to profitability by 2013, as well as a set of game changers to sustain our performance and create a platform for continued growth for MASs in future. FACTORS FOR CHANGE AND CONTINUITY IN MALAYSIA AIRLINES Starting from 1997, Malaysia Airlines (MAS) sustain financial problem because of unprofitability on the services and at the same time financial government have a big crisis is recession unemployment. The problem that MAS faced lasts until 2011 and the management and government find many ways to changing the management structure to improve profitability. The factors managing change that MAS contribute is:- 1. Corporate Culture On 1 December 2005, MAS a new CEO appointed Idris Jalal, to manage the management, the change that be contributed is to execute changes in operations and corporate culture. Corporate culture is the culture of each organization is unique, shaped by the values and beliefs of those who work there. As it evolves and takes shape, culture works to coordinate and control behavior, action and decision making within organizations. CEO Idris Jalal, launched its Business Turnaround Plan to improve poor yield management and an inefficient route network. With a new plan has implemented to the organization, it will then lead to a change in culture, beliefs or norms. Coincidentally, it will drive to an innovation in the operational structure to meet parallel with the organizational goals. Otherwise, the new CEO was involve setting up of several new business units, and the re-naming of existing functions as well the introduction of new leaders to pursue other career opportunities. With re-naming or re-branding again the product and services in MAS its can get a new image and the impact of the changing is to give a positive affect toward the management and operational structure. Among business plan that be changing in MAS:- a. Network, alliance, strategic planning is the implementation a new division will support the effective of groups network to meet the lively needs and to influence a strategic alliances and partnerships with other airlines. b. Programme Management Office is the organization was driven implementation, alignment and tracking of a key initiatives and activities to be supported the changing business plan and try to maximize the values of organization. The management office plan also can be improved the productivity of employees and increased the organization performance based on the strategy structure that be produce. c. Communication will be renamed strategic planning. The new organization structure proceeds with the departure of several leaders of the MAS team, the good leader is know how to communication with the employees. The effectives communication in organization will be make employees easy to make a changing in organization. 2. Collaboration with AirAsia. Malaysia Airlines (MAS) collaboration with AirAsia on 2011 to solve the problem that they faced and increase the profitability, productivity and performances. The meaning of term collaboration is working together to achieve a goal and objectives. The process where two or more organization work together to realize shared goals to reach an identical objectives. MAS and AirAsia, they will sharing knowledge, learning can be social within organization. CEO AirAsia says the collaboration between this two company airlines is to improve the productivity and performance of two company airlines and the main factors is to help MAS get profitability in business plan. Collaboration part of managing changing for the organization liked MAS that have a problem in the management structure get solve the problem in other ways under a new leader or CEO. CEO AirAsia says, MAS will need to more focus on rebranding exercise as on way for the national turnaround. In term rebranding products and services there are huge opportunities for MAS to invest in brands, especially to getting people to know more about the airlines. This collaboration also can help organization strategic structure with MAS management can implemented the AirAsia strategic structure into the organization. But, when to implement a new strategic structure into MAS, employees should absorb a new culture and values. The organization change in MAS will used a new vision, mission, and objectives to increase the productivity based on achievement they make it. Working together will benefits all of employees, improves individual cost structures and could lead to greater efficiencies. 3. Continuous Operational Improvement Continuous operational improvement is the process which changing to be continuity to make sure the organization can achieve the goals and objectives. The preferred premium carrier in the region should be lined with the organization vision, it will be making substantial changes to MAS operations to excel on three key dimensions, there are, commercial effectiveness, flight operations and cost management. MAS goals is to achieve the highest customer satisfaction while improving their revenues and operating as efficiently as possible. The improvement that MAS make is flight operations, where they are getting brand new aircraft and ground equipment that will provide a strong in this area. CONCLUSION AND RECOMMENDATION As conclusion, to sustain the improvement changing that be done in MAS, it must have a good strategic structure. Corporate culture is most important in doing changing in organization, because it can include how people in a company are likely to act in given situations both inside or outside the organization. The corporate culture has been implement in MAS is re-naming or re-branding the image of MAS; networkings, alliance, strategic planning; programme management office and communication will be renamed strategic planning. It is influence service quality and the way in which people are treated, whether customers or clients. In make the changes, MAS collaboration with AirAsia for strengthen the position in airlines areas. The collaboration with AirAsia, to expose MAS try moved forward to changing they position and the AirAsia try to help them to make changing in terms of sharing knowledge, learning a new structure, rebranding, absorb new structure and values. MAS try to continuous ope rational improvement and to do extremely well on three key dimensions, there are commercial effectiveness, flight operations and cost management. Managing change in MAS to help them to increase the productivity and performance for can achieve goals of organization. RECOMMENDATION Managing organizational change will be more successful if the organizations apply the continuous improvement. Many factor continuity and change the organization can apply in MAS. Apart from the factor can be recommended to Malaysia Airlines for continuous they can use an analytical framework. The purpose is to provide a base for conceptualized the relationships between the numerous constituents of change management. In an analytical framework, MAS will make much change in the organization, so they should maintaining change that they make it. Maintaining change is the last step in an analytical framework; MAS consider the necessary and sufficient requirements for ongoing change, exploring the process of measuring and evaluating change and examining issues of sustaining change.

Techniques for Donor Nephrectomy Analysis

Techniques for Donor Nephrectomy Analysis Laparoscopic donor nephrectomy versus robotic assisted laparoscopic donor nephrectomy: A prospective randomised comparative study Introduction: Donor nephrectomy is unique surgery which is done on person who is not a patient and come forward for purely altruistic reasons. So the margin of error in donor nephrectomy is nil and hence the stress in donor surgeon is quite high. At the same time all attempts should be done to minimize the donor morbidity to minimum. With the same intension in 1995, Ratner reported first laparoscopic living donor nephrectomy (LDN) (1) and later gradually the laparoscopic approach has become almost the standard of care for living donor nephrectomy. Randomised controlled trials (RCT) comparing the laparoscopic vs. open donor nephrectomy suggested that laparoscopic approach was associated lesser postoperative analgesic requirement and lesser hospital stay and faster returned to work compared to open approach without affecting immediate graft outcome although there was significantly increased warm ischemia time and total operative time with LDN group (2,3). So LDN was associated with dec rease in the disincentives associated with voluntary donor nephrectomy. Further course of time saw further refinement in the techniques of LDN and towards further reducing the morbidity associated with donor nephrectomy. These modifications were introduction of laparo- endoscopic single site surgery(LESS) (4), retroperitoneoscopic donor nephrectomy, robotic assisted laparoscopic donor nephrectomy (RDN) (5) and transvaginal laparoscopic donor nephrectomy (6). In 2002 Horgan first reported the RDN. The goal of this study was to compare the outcomes of LDN and RDN. Materials and methods: The study was started after approval from institutional review board. Study enrollment time was from March 2014 to February 2015.Primary end point was the postoperative visual analogue pain scores of the donors. Secondary end points were donor’s postoperative analgesic requirement, haemoglobin drop, hospital stay ,lost arterial and venous length, total operative time(TOT) , retrieval time (RT) , warm ischemia time ( WIT),. Recipient related secondary end points were graft function at serial follow up. Surgeon difficulty scores for different steps of surgery were also analyzed. Total of 45 donors were to be enrolled into the study with enrollment ratio of 1:2 for Robotic: Laparoscopy arm for establishing mean pain score difference of 1 with standard deviation of 1 to reject the null hypothesis that the robotic and laparoscopic pain score means are equal with probability (Power) of 0.871 and the type 1 error ( ÃŽ ±) of 0.05.The sample size was calculated w ith power and sample size program version 3.0.7. After written informed valid consent for inclusion in study, 45 live related voluntary kidney donor who were completely evaluated and planned for right (N=27) or left donor nephrectomy (N=18) were randomised into robotic (Da Vinci Si TM-Intuitive surgical ® ) or laparoscopic approach for donor nephrectomy with chit method.(Figure 1). Exclusion criteria were patient unwilling for inclusion in study, preemptive transplantation, body mass index (BMI)> 35kg/ square meter, multiple renal artery or veins on donor side or epsilateral adrenal adenoma. Parameters noted in all donors preoperatively were, age, gender, comorbidities, previous surgeries GFR (Cockroft-Gault), serum creatinine BMI, length of renal artery and vein ( up to level of bifurcation) on CT angiogram. RDN was done by two surgeons with expertise in robotic surgery.LDN was done by multiple surgeons (including both the surgeons performing RDN) with expertise in LDN. Bed side surgeons in RDN were the same surgeons who were performing LDN. The operative room team in both the group was same. In Right LDN, access was achieved from three 12 mm ports for camera and working and two 5 mm ports for lifting ureterogonadal packet and liver retraction. In 9 cases additional 12 mm port was placed from Pfanensteil retrieval wound for insertion of vascular stapler. In Left LDN, two 12 mm ports for camera and working and two 5 mm ports for working and lifting ureterogonadal packet were used. Three left LDN could be managed without port for lifting of ureterogonadal packet. In Left RDN, three 8mm robotic working ports and two 12mm ports ,one for robotic camera and another was for bed side surgeon working port were used. In Right RDN in addition to above ports one more 12 mm port in Pfanensteil retrieval wound for stapler insertion was used in 7 cases and one 5 mm port for liver retraction was used in all cases. The steps for the surgery were similar in LDN as well as RDN. The difficulty scores (visual analogue score 0-10; 0 being easiest and 10 being most difficult ) of donor surgeon were noted on for bowel reflection, lifting up the ureterogonadal packet, hilar dissection, upper pole dissection, clipping the ureterogonadal packet, clipping renal artery and vein, cutting renal artery and vein and retrieval of graft in laparoscopy group. The console surgeon difficulty scores were noted for bowel reflection, lifting up the ureterogonadal packet, hilar dissection, and upper pole dissection, cutting renal artery and vein in robotic cases. Bed side surgeon difficulty scores were noted for tasks done by him like clipping ureterogonadal packet, clipping of renal artery and vein and retrieval in robotic cases. A 5-7cm Pfanensteil incision is placed and deepened to the level of parital peritoneum for graft retrieval. In 2 right RDN kidney was flipped for getting longer renal artery stump. Mannitol was given intravenous before cutting ureterogonadal packets. After cutting the ureter brisk urine output was observed from cut ureter before clipping of hilar vessles. After cutting renal vein, graft was freed of lateral attachments and kept free in peritoneal cavity. After incising this parital peritoneum in Pfanensteil incision, graft is retrieved in longitudinal axis by hand introduced into peritoneum by donor surgeon in LDN and patient side surgeon in RDN. During retrieval undocking of fourth arm of robot was necessary in most of the cases with RDN. Intraoperatively noted parameters in robotic as well as laparoscopic cases were number of ports, retrieval time, warm ischemia time total operative time, length of artery and vein (Up to level of bifurcation) on bench, intraoperative complications. Retrieval time was considered from clipping of artery up to the retrieval from donor. Warm ischemia time was considered from clipping of artery up to reperfusion of kidney with perfusion fluid till the time when efflux from renal vein is clear. Docking time was noted in robotic cases. Post operative visual analogue pain scores (VAS) were noted in donor at 6 hours, 24 hours and 48 hours. Donors were discharged when they were allowed full oral diet, passed motions, ambulant and comfortable. Other donor parameters noted postoperatively were analgesic requirement in milligrams of tramadol, complication grades by Clavien –Dindo complication scale, hospital stay, haemoglobin drop, and serum creatinine at 1 month follow up. Recipient parameters noted were e GFR (Cockcroft-Gault) at 7 days, 1month, 3 month, 6 months and 9 months, graft complications, graft loss. Statistical analysis was done with Statistical package for social sciences (SPSS) version 15.0. Analysis was done for comparing RDN vs. LDN. Subgroup analysis was done to compare Right RDN vs. Right LDN and Left RDN vs. Left LDN. The Chi-square test and Student’s t-test was used for categorical and continuous variables respectively. Results: The demographic parameters in donors are as shown in table 1.Demographic parameters in right and left subgroup are shown in table 2 and 3 respectively. Both the RDN and LDN groups as well as right and left donor subgroups were similar in age, gender, BMI, preoperative renal function, previous surgeries and comorbidities and preoperative artery and vein lengths. All 15 RDN were completed without conversion to LDN or open donor nephrectomy. All 30 LDN were completed without conversion to open donor nephrectomy. There were no intraoperative complications in any of RDN or LDN. In all the RND and LDN the ureter was cut at pelvic brim level. All the recipients (N=45) in both the groups had good urine output on table after vascular anastomosis. 2 surgeons (one on console and one on patient side) were necessary in RDN compared to single donor surgeon in LDN. The difficulty score on VAS scale 0-10 for donor surgeon in LDN and console surgeon and patient side surgeon in RND is shown in table 4 for right side and table 5 for left side. The VAS score of patient side surgeon in RDN was higher in graft retrieval compared to donor surgeon in LDN in both right and left subgroup. In right subgroup, the VAS scores of RDN surgeons were less than LDN surgeon except in step of upper pole dissection and adrenal sparing which have comparable VAS scores. In left subgroup, the VAS scores of RDN surgeon and LDN surgeon are similar other than step of renal artery and vein cutting which was easier in RDN group. The analysis of intraoperative and postoperative parameters as well as recipient and graft outcomes is shown in table 6.The subgroup analysis in right and left group is shown in table 7 and 8 respectively. Donor VAS pain score at 6 hours, 24 hours and 48 hours, analgesic requirement, hospital stay was less in RDN group compared to LDN group. There was no significant difference in donor haemoglobin drop, donor complications, donor serum creatinine at 1 month, recipient eGFR at 7 days, 1month, 3 months, 6 months and 9 months or graft complications between RDN and LDN group. More ports were necessary in RDN in either of the subgroups. The total operative time was not significantly different in RDN and LDN group as well as in right and left subgroup. However the retrieval time was higher in RDN group overall as well as in both right and left subgroup. The warm ischemia time is higher in RDN group overall as well as in left subgroup. However it is not significantly different in right subgroup. There was no difference in lost length of vein during clipping in RND or LDN in both subgroups. However in right RDN longer artery length could be preserved compared to right LDN. This was not found in left subgroup. Discussion: More important than introduction of any new technology is safety associated with the technique. This is more so in transplant as there are outcomes in two persons are at stake. As found in our study the RDN is safe technique. It is associated with similar immediate and early postoperative outcomes in donors as well as corresponding recipient’s graft function. Previous literature also suggest that RDN is safe(5,8,9). Study comparing robotic versus laparoscopy suggest that robotic approach is associated with less pain than laparoscopic approach (10). The possible reason for less pain in robotic surgery is robotic arms which are pivoted around port site are moved at fixed remote centre. So there is less leverage around the port site and lesser pressure at port sites which leads to lesser trauma to abdominal wall tissues around the port. Our study suggested that RDN is associated with lesser pain score and lesser analgesic requirement compared to LDN. This also transforms into earlier recovery and discharge from the hospital. Although the voluntary kidney donors donate with altruistic approach, any donor will prefer approach which further reduces the morbidity associated with donor surgery. It is for this reason that live donor nephrectomy rates increase after advent of LDN compared to open donor nephrectomy (11, 12).RDN may further reduce morbidity associated with donor nephrectomy. Most of the transplant centres prefer left sided graft kidney over right in view of small right vein length and need for retrocaval dissection or flipping of kidney on right side to achieve good graft artery length (13, 14) which may be technically more challenging.Studies also propose that the robotic approach with its 3 Dimentional vision,7 degrees of freedom,higher magnification and enhanced dexterity compared to standard laparoscopic approach facilitate the renal hilar dissection(15). In our study we found that the VAS of donor surgeon for right hilar dissection was lesser in RDN than LDN. Right kidney was flipped in two RDN. The preserved renal artery length was more in right RDN than right LDN. The technical ease was felt in right RDN compared to right LDN in all steps other than upper pole dissection and retrieval. However it is worth noting that this technical ease did not reach level of significance in any steps of left RDN vs. LDN except cutting of renal artery and vein. Th e lost artery or vein length was not different in left RDN and LDN. This suggest that robotic approach may provide some technical advantage compared to laparoscopic on right side but not so significantly on left side.At the time of writing this manuscript and during the conduct of this study instruments like robotic vascular stapler are not available. Availability of such instruments will further reduce the role of patient side surgeon and may influence the technical ease of this surgery. It may also reduce the steep learning curve associated with LDN(9). The total operative time was not different in RDN vs. LDN. However the warm ischemia time was significantly more in Left RDN group than LDN (p=0.01, power of test for this parameter=87.8%) which is definitely a matter of concern. The retrieval time was more in RDN in both subgroups. The difference in WIT did not reach level of significance on right side.Possible cause for this increased WIT and RT is need to undock the fourth arm during retrieval. This is also a cause for increased patient side surgeon VAS during retrieval in RDN. The increase in WIT does not correlate with recipient graft function in limited range of time (16,17).In our study as well the recipient graft related complications or e GFR was not different between RDN and LDN group at 7 days,1 month ,3 month,6 month,9 month follow up . We acknowledge the limitation of our study that although it is well powered for its primary end point of post operative visual analogue pain scores of donor, it is less powered for few of the secondary end points. The longest recipient graft follow up is 1 year in our study and we don’t have any longer follow up. Last but not least ,our study does not focus on the economic aspects of comparison between RDN and LDN.The RDN increased the cost of surgery for donor nephrectomy(18).It remains to be determined if the benefits of RDN in reducing donor morbidity and technical ease associated with it out weight the cost implications associated with it. Conclusion: RDN is safe procedure and is associated with better postoperative pain scores, analgesic requirement as well as lesser hospital stay compared to LDN. Robotic approach in right donor nephrectomy is associated with more technical ease to console surgeon compared to laparoscopic donor surgeon in most of the steps of surgery and facilitates preservation of longer length of right renal artery. However there is no significant technical ease associated with left RDN compared to left LDN. Left RDN is associated with longer WIT than LDN however this does not reflect adversely into early graft function from 7 days up to 9 months.

interview :: essays research papers

The family member that was interviewed was Erin. The relationship between the interviewer and the interviewee is third cousins through marriage. The interview took place in Erin’s apartment living room. Since she is an RA she lives in one of the apartments of Sara Tracy Dorm. When the interviewer walked into the room he could tell that she was very clean and rather sophisticated, just by the way her room was set up. The interviewee was sitting on her futon and was very alert. There were pink and yellow carnations on the table, which I found out that they are not real. Erin 20 years old and has an ethnic origin of Irish. Erin is a Caucasian and when asked what religion she was, Erin responded proudly â€Å"Catholic†. The next question to be asked was â€Å"what are you wearing?† and me not paying attention to the question read it allowed, when I could have just observed her to answer the question. But, she caught my slip up and she responded â€Å"nothing† and laughed sarcastically. In reality, she had on a older and faded WJU swimming t-shirt on with a pair of worn out jeans. She seamed happy and content, but when I asked â€Å"what is your mood today?† she said, â€Å"Alright, calm I guess†¦not too happy and not too sad.† Then I asked her about her attitude and she responded with â€Å"happy to be interviewed†.   Ã‚  Ã‚  Ã‚  Ã‚  Erin’s mom’s family is from New York, and her dad’s family is from West Virginia. She was born in San Diego, California, on August 10, 1984. Her family then moved to Connecticut when Erin was â€Å"just a wee lad† as she put it, so she does not remember a whole lot from that particular time period. Then after living in Connecticut for a couple of years her family moved to West Virginia where they are presently located now.   Ã‚  Ã‚  Ã‚  Ã‚  Erin has many of friends who are outgoing and not afraid to speak their mind. All of them are nice and funny. They know how to make a good time out of the worst days. Erin, however, is pretty much the brain of the operations that they carry out. During the interview Erin was sitting on her futon drinking a cup of coffee acting all sophisticated. She was really relaxed and was not fidgeting like I was, so she did not seem like she was nervous.

Low Self Esteem Essay -- essays research papers

Languages, colors, cultures and also the way one behaves may differ from one nation to another. Yet, each and every one of us living on the surface of this planet have several things in common. One of these similarities is that we all have a way of regarding our own self. It is believed that a large amount of individuals feel very good about themselves. Nevertheless, from time to time even the best of us get a dose of negative emotions. Very heartbreaking stories about self dislike were told by many depressed teenagers and older people. What are the causes of this kind of low self esteem and how can one person get solutions to outcome them? Self Esteem is defined as confidence in your own merit as an individual#. Such concepts as self-esteem and self-image have been regarded by some social psychologists as useful, while others have regarded them as unnecessary. There is a considerable amount of research on such topics but it would be very difficult to find the exact definition because volumes have been written about self esteem. Definitions given in self esteem literature run a yard long. But after cutting through all the scientific words, the question of self-esteem really centers down to something quite simple: How do a person feels about his/herself? If the person feels good about him/herself, they have a high self-esteem. If they feel bad about him/herself, they have a low self esteem. Since low self esteem is a worst problem than the higher one, let’s examine it to find some solution by investigating a number of low self esteem causes and personal cases. Individuals with truly high self esteem feel good about themselves and continue believing in themselves regardless of what others think of them. Some people feel good about themselves only as long as others support them and approve them. The moment another person criticizes them, or withdraws her or his support from them, they not only feel bad about themselves, they may even hate themselves. That would be the first step into low self-esteem. When a person acts like that, li... ...they often approach suicide more determinedly than the young and carry it out with a terrible efficiency. "Not only is suicide significantly more prevalent among older persons, but the suicidal act itself reflects important differences between old and young," notes Dr. Hendin, in his book Suicide in America. "In particular, the ratio of attempted to actual suicides shifts quite markedly among older persons. Among the population as a whole, the ratio of attempted suicides to actual suicides has been estimated to be 10 to 1; among the young (15-24), it has been estimated to be 100 to 1; and among those over 55, it has been estimated to be 1 to 1." Self dislike, depression loneliness and suicide have a very great role in one person’s self esteem. Although the above statistics made it seem to be impossible to overcome these feelings, the research hopefully gave us all the possible ways that we can be victorious and set ourselves free from this psychological slavery.

Peer Reviewed Article Summary

Peer-reviewed Articles Kimberly Winkler Psy/500 October 8, 2012 Bridgette Jenkins Abstract Resilience in any human being is vital but it also is important because it is the human capacity to face, overcome and strengthen by or even transformed by the adversities of life (Grotberg E. , Unknown). Every individual faces some sort of adversities which means that no one is exempt (Grotberg E. Unknown). Children are no exception to adversities so they must form resilience so they can overcome trauma (Grotberg E. , Unknown).Articles that will be discussed will show different mother-child interaction and resilience in children with early developmental risk and also using the resiliency scales for children and adolescents who are in the school settings. An article which discusses the comparison of maternal and paternal influences on young children’s behavior and resilience will also be deliberated upon. Mother-Child Interaction and resilience in children with early developmental risk M other Child interaction and resilience in children with early developmental risk speaks about a study which tests 50 children with early developmental delays.The article focused on the contributions of child characteristics and mother-child interaction to the prediction of formal intellectual disability (ID) among children with identified early developmental delays (Fenning & Baker, 2012). Children become resilient in certain situations and the study that was performed showed that children remain at risk for learning difficulties and teaching them resilience tools will help the children at risk for ID (Fenning & Baker, 2012).This article was extremely informative because it showed that mother-child interaction are very important to a child’s wellbeing and if not appropriately followed through with during preschool period they can be at risk for ID which increases resilience. Mother-child interaction is essential to resilience and this article portrays the importance of this. Fenning, R. M. , & Baker, J. K. (2012). Mother–child interaction and resilience in children with early developmental risk. Journal Of Family Psychology, 26(3), 411-420. doi:10. 1037/a0028287Assessing Personal Resiliency in the context of school settings: using the resiliency scales for children and adolescents Resiliency Scales for Children and Adolescents (RSCA) is a method to measure resiliency in students that is applicable for schools private use to utilize within the classroom environment (Embury, 2011). The RSCA will test students and pay attention to the strengths and limitations in personal resiliency (Embury, 2011). Resiliency interventions are then put into place depending on the results of the RSCA test and can be used in the school setting.School settings are just as significant as a child’s environment at home and when testing the children it will only set a foundation to better a child’s personal resiliency tools. The RSCA is easy to use and has ta ken studies pertaining to resilience and put them into a test form for the benefit of children in the school setting. Prince-Embury, S. (2011). Assessing personal resiliency in the context of school settings: Using the resiliency scales for children and adolescents. Psychology In The Schools, 48(7), 672-685. doi:10. 1002/pits. 20581The Comparison and Interdependence of Maternal and Paternal Influences on Young Children’s Behavior and Resilience We all go through tough times in our life and more people than others suffer with bouts of depressions and that does not exclude mothers and fathers. Systematically it has been understood that a mother-child relationship and a mothers depressed mood will affect children more so that a father-child relationship and a fathers depressed mood (Malmberg & Flouri, 2011). Research was done to decipher how depression affects young children’s behavior and their resilience to situations.I was intrigued to discover that economic deprivatio n and family stress have a negative effect on the mother-child relationship and in turn have a poor child outcome. Also, it was stated that during the research there was little evidence that showed the quality of father-child relationships promote resilience ( Malmberg & Flouri, 2011). As important as parent-child relationships are we can learn from them to promote positive behavior and form a positive resilience which is a natural part of young children.Malmberg, L. , & Flouri, E. (2011). The Comparison and Interdependence of Maternal and Paternal Influences on Young Children's Behavior and Resilience. Journal Of Clinical Child ; Adolescent Psychology, 40(3), 434-444. doi:10. 1080/15374416. 2011. 563469 References Edith H. Grotberg, Ph. D. (Unknown). Early Childhood Development: Practice and Reflections. In Guide to Promoting Resilience in Children: Strengthening the Human Spirit. Retrieved October 8, 2012, from http://resilnet. uiuc. edu/library/grotb95b. html.

Health Care †General Health Care Essay

S.W.O.T. (Strengths, Weaknesses, Opportunities, Threats) . For this assignment, you will apply the S.W.O.T. Situational Planning Strategy introduced in Chapter 5 of your course text, based upon the following: Situation: You are the C.E.O. of Community South Medical Center, a large, urban for-profit healthcare facility. This institution has comprehensive health services including acute care, residential care, independent living, in-home nursing, hospice, neonatal, and pediatric services, advanced cardiac services, a major trauma center, a center of excellence for pulmonary services, and a neurosurgery center. Community South Medical Center has a positive bottom line and is striving to enhance health services for the population it serves. The patient care mix has shifted in the last three years and its reimbursement source is currently: 25% Medicaid (up 20%); 35% Medicare (down 12 %); 25% employer sponsored health insurance (unchanged), 8% managed care (down 20 percent), 4% private pay (unchanged) and 4% no-pay (up 25%). The Medical Center is in an older urban area. Businesses with well paying jobs have gradually been replaced by smaller shops and other small businesses. Overall, the community is trending towards a predominantly elderly population. The Medical Center has an excellent reputation and has been recognized in the past by receiving a Baldrige Center of Excellence evaluation and a The Joint Commission (T.J.C.) approval for their quality of services; however, recent self-inspections indicated a slight decline in compliance with T.J.C. standards. Patient satisfaction survey results have an overall mean of 95 percent. The medical staff strongly supports new program development and there is an abundant su†¦ For downloading more course tutorials visit – https://bitly.com/12Cfjo7 Always pay off your credit card every single month so you don’t carry a balance. If you carry a balance, the interest and late fees add up quickly. If paying off your balance is too difficult, keep a credit card to use in emergencies only. Don’t use it to go to the movies, bar or a restaurant. Financial worries can undermine your studies. Health Care – General Health Care S.W.O.T. (Strengths, Weaknesses, Opportunities, Threats) . For this assignment, you will apply the S.W.O.T. Situational Planning Strategy introduced in Chapter 5 of your course text, based upon the following: Situation: You are the C.E.O. of Community South Medical Center, a large, urban for-profit healthcare facility. This institution has comprehensive health services including acute care, residential care, independent living, in-home nursing, hospice, neonatal, and pediatric services, advanced cardiac services, a major trauma center, a center of excellence for pulmonary services, and a neurosurgery center. Community South Medical Center has a positive bottom line and is striving to enhance health services for the population it serves. The patient care mix has shifted in the last three years and its reimbursement source is currently: 25% Medicaid (up 20%); 35% Medicare (down 12 %); 25% employer sponsored health insurance (unchanged), 8% managed care (down 20 percent), 4% private pay (unchanged) and 4% no-pay (up 25%). The Medical Center is in an older urban area. Businesses with well paying jobs have gradually been replaced by smaller shops and other small businesses. Overall, the community is trending towards a predominantly elderly population. The Medical Center has an excellent reputation and has been recognized in the past by receiving a Baldrige Center of Excellence evaluation and a The Joint Commission (T.J.C.) approval for their quality of services; however,  recent self-inspections indicated a slight decline in compliance with T.J.C. standards. Patient satisfaction survey results have an overall mean of 95 percent. The medical staff strongly supports new program development and there is an abundant supply of physicians.