Complications of Endoscopic Sinus Surgery

Complications of Endoscopic Sinus Surgery INTRODUCTION: Endoscopic sinus surgery, a widely used method in the treatment of chronic sinus disease can lead to major (0-1,5 %) and minor (1,1-20,8% ) complications. These complications are still important nowadays. Central nervous system (CNS) fistula, hemorrhage, meningitis, orbital injury and even death are major pathologies. These are usually the result of injury of fovea ethmoidalis or orbital structures [1-4]. If the skull base anatomy and its possible variations are well known these risks will be minimized. ‘Fovea ethmoidalis’ which seperates ethmoid cells from anterior cranial fossa forms the roof of ethmoidal labrynth [5, 6]. Fovea ethmoidalis adheres to lateral lamella of cribriform plate which is a medially located very thin bone [7]. Keros [8] classified the depth of olfactory fossa as the height of lateral lamella in 1962. According to his classification if the height of lateral lamella MATERIAL-METHOD Two hundred paranasal sinus computed tomographies performed for various reasons as a total of 400 hemisides of paranasal region were analyzed retrospectively. Patients under 18 years of age, with a history of prior surgery, trauma which led to massive destruction of bones and patients with congenital anomalies were excluded from the study. A hundred of the patients were female (18-77 years old, mean age: 36,91) and 100 male (18-76 years old, mean age:34,25), respectively. MDCT scanner (Siemens Medical Solutions, Enlargen, Germany) with consecutive 1mm thick sections were obtained and coronal multiplanar reconstructions were performed. Bone algorithm was used. In our study , we measured that the depths of olfactory fossa, identifying Keros types, the distances of the ethmoidal roof from hard palate, the distances between upper and lower limits of the orbita bilateraly. The height of ethmoid roof was calculated by measuring the distance between ethmoid roof and the upper limit of orbit a. Measurements in coronal sections were performed at the level of the optic nerve just posterior to the orbital globe. Also the shapes of the bone from the confluence of ethmoidal fovea with lateral lamella are called type 1 if its shape looks like a broken arrow (broken wing) and type 2 if its shape is flat (flattening) and forms of the asymmetry were investigated. Keros typing, ethmoid roof height and asymmetric shape of the fovea were investigated in both sexes whether there is a relationship between them. NCSS statistical analysis (Number Cruncher Statistical System) 2007 Statistical Software (Utah, USA) was performed with the package program. Data were evaluated by descriptive statistical methods (mean, standard deviation), as well as comparisons between groups one-way analysis of variance, in the sub-group comparisons Tukeys multiple comparison test, in the binary comparisons of groups and independent t test, in the qualitative comparisons of data chi-square and weighted kapp a compatibility test was used. Results significances were evaluated at p RESULTS: According to the classification of Keros, 3.75% of the patients Keros type I (n = 15), 59.5% Keros type II (n = 238), 36.75% Keros type III (n = 147). Keros type III is more common in males (n=86, 43%) than females (n=61, 30.5%) (p = 0.017). The shapes of fovea ethmoidalis in 97.25% (n = 389) of the patients were the broken arrows (type 1), while 2.75% (n = 11) of the shapes were flat (type 2) . In 54 cases (13.5%) an olfactory fossa Keros type asymmetry, in 11 cases (2.75%) foveal shape asymmetry was found. In seven patients (3.5%) as well as the foveal shape asymmetry also Keros olfactory fossa type asymmetry was seen . Keros type I patients’ orbital maximal height average were measured 33.07  ± 1.24 mm, Keros type II patients 32.57  ± 1.97 mm, Keros Type III patients 33.31  ± 2.11 mm respectively. In the male patients , the average heights of the orbits of Keros III group were significantly higher than Keros group II (p = 0.034). The olfactory fossa depth was measured at an average 6.45  ± 2.16 mm on the right , 6.39  ± 2.21 mm on the left. The average depth of the olfactory fossa in males (6.7  ± 2.45 mm) was higher than in females (6.13  ± 1.84 mm) (p = 0.01). There was no significant difference between the olfactory fossa depth between type 1 or type 2 foveal shape. Right and left olfactory fossa depth which were used for detection of Keros typing was compared. In 93 patients (46.5%) from the total of 200 patients asymmetry was detected. In 55 patients > 1 mm (27.5%), in 38 patients had > 2 mm (19%) difference was found. Forty-eight of them female and 45 were male. In seven of the same patients showed foveal shape asymmetry also. Average right ethmoid roof height 7.59  ± 2.25 mm ,average left ethmoid roof height was measured 7.75  ± 2.38 mm. In men with type 2 foveal shape the groups average height of the ethmoid roof (9.59  ± 2.77 mm) was higher than the foveal shape of type 1 group (7.66  ± 2.36 mm) (p = 0.042). In women, the average height of the ethmoid roof of type 2 group (8.75  ± 1.76 mm) was higher than type 1 group (7.34  ± 2.11 mm) (p = 0.03). There was no statistically significant difference was observed between the averages of heights of ethmoid roofs in Keros type I, II and III patients. Right and left ethmoid roof heigh ts were compared in total of 200 patients. There was an asymetry between left and right sides in 93 patients (46.5%) . In 55 patients > 1 mm difference (27.5%), in 38 patients had > 2 mm difference (19%) was found. Forty-nine of them were female, 44 of them were male. Five of the same patients showed asymmetry in the shape of the fovea also. In 54 patients (27%), asymmetry was observed in both ethmoid roof height and olfactory fossa depth . Twenty-nine of them were female, twenty-five of them were male. In the same group; the foveal shape in four patients showed asymmetry also. For the Keros type I patients both sides of the olfactory fossa depth asymmetry ratio was found to be more (53,3%) than the other types. For the same measurement, the ratios were found 40,8% and 29,4 % with Keros type II and type III respectively. Kerosian ethmoid roof height of both sides in patients with type I, asymmetry ratio was found to be greater (40.0%). For the same measurement, the results were 33.3% and 29.4% in Keros type III and type II respectively. In the Keros type I patients foveal shape asymmetry was found to be greater (20.0%) than the other types . The foveal shape asymetry for Keros type II was 4.2% and 4.08% for Keros type III respectively. DISCUSSION: The ethmoid sinuses have special importance especially in patients undergoing sinus surgery . Because these sinuses are close to vital organs such as the anterior cranial fossa, dura, orbita, optic nerve and anterior ethmoid artery [12, 13]. During endoscopic sinus surgery, the maximum likelihood of injury of the skull base is in Keros type III cases in which olfactory fossa are deep [9]. In 1962, in Keros’ study with 450 patients, type II patients at a rate of 70.16% (which was the most common type in that study), type III 18.25% and type I 11.59% of the patients [8]. In our study 3.75% of the patients were Keros type I (Figure 1), 59.5% of the patients were Keros type II (Figure 2), 36.75% of the patients were Keros type III (Figure 3) . After the point of the junction of fovea ethmoidalis with cribriform plate as well as the depth; the shape and symmetry of these structures are also important . In our study, in 93 patients (46.5%), olfactory fossa height asymmetry was detected and in another 93 patients (46.5%) foveal shape asymmetry was found. In 54 cases with height asymmetry there was also shape asymmetry (27%). In a study made by Basak et al. [14] in Turkey on 64 children with Keros type I, type II and type III incidences were explained in the following way; 9%, 53% and 38% . Anderhub et al. [15] researched 272 cases of German children for the analysis of cases of ethmoid roof . The results of their study were as follows: 14.2% of the patients Keros type 1, 70.6% of the patients Keros type II, 15.2% of the patients Keros type III . In Jang and his collegues study [16], on 205 adult patients, type II was the most common (69,5%). In Alazzaw and his collegues study [17] on 150 patients with 3 separate ethnic group type I 80%, type II 20% and type III 0% of the patients were detected. In a study made by Elwany and et al. [18] on 300 Egyptian 42,5% of type I, 56,8% type II and 1,4% type III were found respectively. In this study, the type II olfactory fossa was the commonest type in men (66.7%), while the type I fossa was commonest in women (53%). In a study made by Souza et al. [19] on 200 Brazilian with type I 26,3%, type II 73,3% and type III, 0,5% of reported cases. Solares et al. [20] in United States examined 50 cases, 83% of the cases type I, 15% type II and %2 type III respectively. In a study in Turkey Erdem et al. [21] showed 8,1% in 136 patients with type 1, 59,6% type II, 32,3% type III; Sahin et al. [22] in 100 cases detected 10% of the patients type I, 61% type II, 29% type III. Dr. Satish Nair [23], found that 77,2% of type II in the study, 17,2% of type I and 5,6%. of type III 5,6% respectively. As seen in the studies, differences are observed between different countries. In a study by Lebowitz et al. [24] 200 paranasal tomographies were interpreted. In 86 of the cases, olfactory fossa shapes were symmetric and their heights were the same. Ninety-six cases had shape asymmetry, 19 cases had height asymmetry in olfactory fossa, one case had both shape and height asymmetry. In a study made by Dessi et al. [11] on 150 Italian patients, 10% identified asymmetry of the height of the olfactory fossa. In Fan and et al. [25] studies’ on 160 Chinese patients, 15,6% of cases showed olfactory fossa height asymmetry, 38,75% of cases had foveal shape asymmetry. Souza et al. [19] showed ethmoid roof height asymmetry in 12% of the cases, contour asymmetry in 48,5% of the cases. Michael Reiss et al. [26] studied 644 patients, of which 31 % was detected height asymmetry. Kizilkaya et al. [2] reported that in 37,95% patients was detected height asymmetry. Dr. Satish Nair [23] identified height asymmetry in 11,7% of the cases. In the same study, ethmoid roof heigh t and contour asymmetry was found in patients at the highest rate with type I (67,8%); than 32,3% and 40% with type II and type III followed. In a study made by Kaplanoglu et al. [27] on 500 patients ; in 80% of cases was found height asymmetry, the foveal shape asymmetry was detected in 35% of the patients in the same study. Our current study in patients with Keros type I both olfactory fossa depth and height of the ethmoid roof asymmetries had greater percentage. But in our population Keros type I is less seen. However, most of the skull base injuries were seen in Keros type III cases at a prevalance of 36,75% in our study in which olfactory fossa depth and height of the ethmoid roof asymmetry rates were quite high (respectively 40,8%, 33,3%). Preoperative computed tomography must be interpreted in detail. Especially Keros typing must be done and all the variations should be evaluated carefully. CONCLUSION In patients undergoing endoscopic sinus surgery; knowledge of anatomic details and average lengths of skull base and their neighbouring structures and the possible variations of anatomical structures are very important for the prevention of complications that may occur during the operation. Therefore, the preoperative evaluation of paranasal sinus CT by considering the various possibilities is necessary and inevitable. REFERENCES 1. Hemmerdinger SA, Jacobs JB, Lebowitz RA. Accuracy and cost analysis of image-guided sinà ¼s surgery. Otolaryngol Clin North Am. 2005; 38:453–60. 2. E. Kizilkaya, M. Kantarci, C. C. Basekim et al., â€Å"Asymmetry of the height of the ethmoid roof in relationship to handedness,† Laterality, vol. 11, no. 4, pp. 297–303, 2006. 3. May M, Levine HL, Mester SJ, Schaitkin B (1994) Complications of endoscopic sinus surgery: Analysis of 2108 patients incidence and prevention. Laryngoscope 104: 1080-1083. 4. Ulualp SO. Complications of endoscopic sinus surgery: appropriate management of complications. Curr Opin Otolaryngol Head Neck Surg 2008; 16: 252-9. 5. Stammberger HR, Kennedy DW; Anatomic Terminology Group. Paranasal sinuses: anatomic terminology and nomenclature. Ann Otol Rhinol Laryngol Suppl 1995; 167: 7-16. 6. Stammberger H (1993) Endoscopic anatomy of lateral wall and ethmoidal  sinuses. St. Louis Mosby-Year Book 13-42. 7. Terrier F, Weber W, Ruefenacht D, Porcellini B. Anatomy of the ethmoid: CT, endoscopic and macroscopic. AJR Am J Roentgenol 1995; 144: 493-500. 8. Keros P. On the practical value of differences in the level of the lamina cribrosa of the ethmoid. Z Laryngol Rhinol Otol. 1962; 41:809–813. 9. Ohnishi T, Yanagisawa E. Lateral lamella of the cribriform plate – an important high-risk area in endoscopic sinus surgery. Ear Nose Throat J. 1995;74:688–90. 10. Lee JC, Song YJ, Chung YS, Lee BJ, Jang YJ, et al. (2007) Height and shape of the skull base as risk factors for skull base penetration during endoscopic sinus surgery. Ann Otol Rhinol Laryngol 116: 199-205. 11. Dessi P, Moulin G, Triglia JM, et al. Difference in the height of the right and left ethmoidal roofs: a possible risk factor for ethmoidal surgery. Prospective study of 150 CT scans. J Laryngol Otol. 1994;108:261–2. 12. Zacharek MA, Han JK, Allen R, Weissman JL, Hwang PH. (2005)Sagittal and coronal dimensions of the ethmoid roof: a radioanatomic study. Am J Rhinol 19: 348-52. 13. Ohnishi T, Tachibana T, Kaneko Y, Esaki S (1993)High-risk areas in endoscopic sinus surgery and prevention of complications. Laryngoscope 103:1181-1185. 14. Basak S, Akdilli A, Karaman CZ, et al. Assessment of some important anatomical variations and dangerous areas of the paranasal sinuses by computed tomography in children. Int J Pediatr Otorhinolaryngol. 2000;55:81–9. 15. Anderhuber W, Walch C, Fock C. Configuration of ethmoid roof in children 0-14 years of age. Laryngorhinootologie. 2001;80:509–11. 16. Jang YJ, Park HM, Kim HG. The radiographic incidence of bony defects in the lateral lamella of the cribriform plate. Clin Otolaryngol Allied Sci. 1999;24:440–2. 17. Alazzawi S, Omar R, Rahmat K, Alli K. Radiological analysis of the ethmoid roof in the Malaysian population. Auris Nasus Larynx 2012; 39: 393-6. 18. Elwany S, Medanni A, Eid M, Aly A, El-Daly A, Ammar SR. Radiological observations on the olfactory fossa and ethmoid roof. J Laryngol Otol 2010; 124: 1251-6. 19. Souza SA, Souza MMA, Idagawa M, Wolosker AMB, Ajzen SA. Computed tomography assessment of the ethmoid roof: a relevant region at risk in endoscopic sinus surgery. Radiol Bras 2008; 4: 143-7. 20. Solares CA, Lee WT, Batra PS, Citardi MJ. Lateral Lamella of the cribriform plate. Software-enabled computed tomographic analysis and its clinical relevance in skull base surgery. Arch Otolaryngol Head Neck Surg 2008; 134: 285-9. 21. Erdem G, Erdem T, Miman MC, Ozturan O. A radiological anatomic study of the cribriform plate compared with constant structures. Rhinology 2004; 42: 225-9. 22. Ã…Å ¾ahin C, YÄ ±lmaz YF, Titiz A, Ozcan M, Ozlugedik S, Unal A. Analysis of Ethmoid Roof and Cranial Base in Turkish Population. KBB ve BBC Dergisi 2007; 15: 1-6. 23. Nair S (2012) Importance of Ethmoidal Roof in Endoscopic Sinus Surgery. Open Access Scientific Reports; 1: 251. 24. Lebowitz RA, Terk A, Jacobs JB, et al. Asymmetry of the ethmoid roof: analysis using coronal computed tomography. Laryngoscope. 2001;111: 2122–4. 25. Fan J, Wu J, Wang H, Lang J, Lin S. Imaging analysis of the ethmoid roof. Ling Chuang Er Bi Yan Hou Ke Za Zai 2005; 69-71. 26. Reis M, Reis G. Height of Right and Left Ethmoid Roofs: Aspects of Laterality in 644 Patients. Int J Otolaryngol 2011; 508907. 27. Hatice Kaplanoglu, Veysel Kaplanoglu, Alper Dilli, Ugur Toprak, Baki HekimoÄÅ ¸lu. An Analysis of the Anatomic Variations of the Paranasal Sinuses and Ethmoid Roof Using Computed Tomography. Eurasian J Med 2013; 45: 115-25. 1

Caribbean culture Essay

Creolisation is a top element of the Caribbean culture. It is a word derived from the word Creole; it however is not meant to just describe the Creole culture. It is a broad anthropological term used to describe the coming together of different cultural traits especially of the West Indies to form a new trait. This occurs when two or more languages are combined to give one unique language. In essence, Creolisation refers to the blending of diverse cultures to give one unique culture. The adaptability of Creolisation by the Caribbean culture in this age of globalization is a good thing for the Caribbean economy but may be injurious to the culture of the Caribbean peoples. Because the people of the caribbeans will be speaking a common, creolized language it will be relatively easy for the member states of the Caribbean region to communicate with each other. Creolisation of their cultures will enhance further understanding among the creolized states of the Caribbean. ( Ancelet et al, 2001) Nearly all the states of the Caribbean have â€Å"creolized† cultures. From the Jamaicans, the Cajuns, the Bahamas, British Guyana etc. Their various cultures have been creolized. They all speak the language of their colonial masters in the pidgin form and have adopted certain cultures form their colonial masters. Like the drinking of processed liquor, smoking of cigarettes etc. These imperialist cultures have made several African countries’ economies to suffer. Country like Nigeria which used to eat the type of the imperial master’s food, his wine and wear his clothes spent fortunes of its country earnings to fund the importation of these items. This led to a plunge in the fortunes of this country. The Caribbean however are people that are very proud of their heritage. They designed their own music form (e. g. reggae) have their own drinks- which are largely influenced by the culture of their forefathers. Their food has however been creolized as it is influenced by imperialist cultures. Though it is still very much part of their own creation. In creolising, care must be taken not to change an existing culture completely. This fear is as captured by Appiah as thus: â€Å"Nevertheless, contemporary multiculturalists are right in thinking that a decent education will teach children about the various social identities around them. First, because each child has to negotiate the creation of his or her own individual identity, using these collective identities as one (but only one) of the resources; second, so that all can be prepared to deal with one another respectfully in a common civic life. Much of current multicultural education seems to me to have these reasonable aims: let us call this weak version â€Å"liberal multiculturalism† (1997). † From Appiah’s documentation, creolisation has been viewed from these perspectives: a. creolisation as the major social and cultural fact about Caribbean life (what matters will of course be the social process but it may prove illuminating to proceed via linguistics) and b. Arnold’s accounts of i. Western culture as an amalgam of Hellenism and Hebraism, and ii. the English race as an amalgam of Celtic, German and Norman â€Å"bloods†. Considering the errors that are often linked with cultural talk, the creole context, and an Arnoldian perspective on the West or simply on England, both reveal that a culture lives, changes, innovates, is in a process of continuous evolution. Where alternatives are to hand, this often means selection, not simply preserving and reproducing. It is not therefore a complete or necessarily coherent bundle to which we may add Gellner’s point about the multiplicity of nearly all cultures: the official first eleven has a fall-back for other occasions, scriptural Islam versus the dervishes. The Creole context makes it plain that there is nothing genetic in operation. More importantly, that context gives no one reason to think a culture will continue in the same old way. As noted already, we find proper examples in Trinidad or now in St Lucia. Alleyne was sad to see that a form of Twi-Asante is â€Å"dying† (Alleyne, 1988) in Jamaica. There is reason for the Caribbean to regret that they no longer speak like Chaucer, or Arnold. One may regret death, but that does not entail that one would endorse immortality — we must move to a view that puts life and death in their place and accepts both. Or to return to less exalted matters, it may be pleasant to discover†retention† but it is not what makes or breaks a culture. â€Å"Transculturation† (Bolland, 2001) can be endorsed with out it. without it. Economic integration will automatically come in with the achievement of cultural integration. This will provide for a bigger, more cohesive, stronger and unity front for which the Caribbean states can push for economic and political relevance in the world order. It is good to note however that there is a significant level of creoliastion in the Caribbean. They all speak an almost similar language; pidgin English, have similar music etc. however a lot can still be done in the creolisation of the in the Caribbean. Major impediments to a successful creolisation in the Caribbean are the influence of colonialists. Different states of the Caribbean had different colonialists who set then in captivity, freed them and are now coming back in the name of neo-imperialism. The different states of the Caribbean speak the languages of their colonialists-maybe in the pidgin form. A perfect example of creolisation is with the Cajun language, which is a mixture of French and English and also African languages. Language is in general evaluatively neutral. As Macaulay pointed out long ago, there is no intrinsic basis in the language to prefer Latin to Chinook as a component of elite education. If one thinks of culture by reference to conventions like language, there is scarcely any scope for evaluatively ranking exemplars, but if one focuses on the way culture operates as â€Å"an engineering program for producing persons† (Nerlich, 1989) then there is no more reason not to discriminate among them than there is not to distinguish a saint or an ordinary decent person from the likes of Pinochet or Burmese generals. â€Å"Moral† equality among persons is no bar to moral discriminations. Of course creolisation doesn’t provide us with a recipe. There is still much difference of opinion on what has actually happened in the case of prototypical creoles and pidgins. But one lesson I would wish to draw from recent debates is that what is salient for ordinary usage (once upon a time, foreign-born, now whatever it is) or for some theoretical perspective (e. g. , origin in a colonial slave plantation) does not uniquely characterise the outcomes of contact situations. There are a host of types of language contact bringing with them a host of outcomes, perhaps depending on particular social or historical configurations. Mufwene has enunciated his idealised and apparently deterministic version of this idea in relation to creoles, immigrant workers’ varieties, etc. by saying that â€Å"in all these cases of language contact we still deal with the same equation for restructuring; only the value of some variables keep changing† (Mufwene, 1997). Taking this in conjunction with the fact he has particularly stressed, that the categories we rely on have been taken from the contingencies of the social reality, not from theory, we find that what structurally or in some other respect are very similar situations become classified differently. The terminology remains affected by the connotations attached to terms by metropolitan non-specialist users. So, speaking of American or Australian English, Mufwene remarks â€Å"there are other good socio-historical reasons why these varieties have not been called creoles: they developed in settings in which descendants of non-Europeans have been in the minority; and they have not been disowned by Europeans and descendants thereof† (Mufwene, 1997). References 1. Appiah, K. A. (1997). The Multiculturalist Misunderstanding, New York Review of Books, October 9, 2006 2. E. P. Brandon, (2001). Creolisation, syncretism, and multiculturalism

The War Against Topics for Essay Ielts

The War Against Topics for Essay Ielts New Questions About Topics for Essay Ielts IELTS essay writing is a rather difficult exam and requires the utmost training. Take a look at the questions and become acquainted with topics you would get on the true exam. Looking at IELTS essay topics with answers is an excellent method that will help you to get ready for the test. Actually, obtaining an idea about the the latest IELTS Essays has a competitive advantage as it gives someone an idea about the sort of essays he might expect in his exam on the 1 hand, and increase his preparation on the opposite hand. Through carrying adequate research, writers are in a position to generate original and highest excellent essay papers. You might consider obtaining a personal trainer who can inform you where you must work harder and deliver you feedbacks on your writings. When writing essays, a great deal of research is demanded. Although there's a consistent essay formula that will assist you to structure your essay and paragraphs, you will need to be careful of the various kinds of essay questions there are. The cost of an essay rides on the total amount of effort the writer has to exert. There are several essay writing online companies which are readily available. There are two major means by which you can use the most typical IELTS essay topics to your benefit. What About Topics for Essay Ielts? Writing companies should make certain that customers get essay papers which are in compliance with instructions. Healthcare shouldn't be provided for free regardless of someone's income. Compliance with deadlines is vital because students are supplied with time for doing revisions. Other individuals believe it's up to each person to be environmentally responsible. The IELTS essayAKA IELTS Writing Task 2is the most dependable portion of the exam. Questions can vary from topics like the classroom to the curriculum. You're able to take my online IELTS Writing Practice Test anywhere on the planet and find a score, corrections, and feedback in only two days. Learning from perfect case in point is not a poor system for language apprehension. Successful sports professionals can make a whole lot more cash than people in other significant professions. In case you're unsatisfied with the work it is possible to secure the job revised free of charge. Moreover, healthy food is normally inferior to fast food in conditions of taste and prices as an issue of fact. In addition, compared with the wide range and availability of fast food stores and menus, it is seriously limited. Some people believe that strict punishments for driving offences are the trick to reducing traffic accidents. On the other hand, they doubt the effectiveness of education for certain reasons. All people ought to be vegetarian. Explain a few of the methods by which humans are damaging the surroundings. The Fundamentals of Topics for Essay Ielts Revealed By comparison, nowadays, a lot of the men and women think that choosing their own marriage partner is the ideal approach to have a long-lasting relationship. Without love, there's no future for their kids and as a consequence, it results in divorce. From another perspective, a lot of people support that marriage should be dependent upon love. In my opinion, education may be a viable measure with careful consideration of different impediments. For instance, the firm may not be providing great customer service through social networking and thus you could suggest how to improve it. You wouldn't should know any particularly obscure words (although it may help you a little) like the internal components of an engine or the names of archaic kinds of transport. There are different kinds of technology papers. It's possible for you to purchase technology papers which have been custom written by professional writers in the discipline of technology. Topics for Essay Ielts Options Some people believe computer games are bad for kids, while some believe they're useful. Additionally, the memory of test-takers might not be reliable. Well, there's another method out for you. While it might not be feasible to receive familiarised with them all, we can certainly practice with those that are common. As stated above, one of the methods where the examiner judges your vocabulary is the way many topic particular words you use. You should also discover the correct words and sentences. If you're not acquainted with a topic, utilize the internet to discover more. Each topic is broken up into subtopics that you should prepare. The very first step would be to decide on a suitable topic in the event the topic is not yet provided by your instructor. Quite frequently, the very best topic is one which you truly care about, but you also will need to get well prepared to research it.

The Global Economy - 1112 Words

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These contributors are a low demand for oil in many countries, specifically Europe, that is caused by a lack of economic growth, the increase in TheRead MoreQuestions On The Global Economy Essay700 Words   |  3 Pages Running H ead: Exchange Rates - MNCs 1 Excha nge Rate Stability and Multinational Companies Patten University Professor Wade MBA 630 The Global Economy - RJO Unit 6 Essay Assignment Running Head: Exchange Rates - MNCs 2 When we take a neophyte view of m ultinational companies, it is often tainted by media stories of behemoth organizations than plunder the world in search of selfish destructive profit motives that produce investment returns for greedy board members, managers and investors. RarelyRead MoreGlobalization And The Global Economy1720 Words   |  7 PagesFor many of the world’s population, the growing integration of the global economy has provided the opportunity for substantial income growth. This is reflected not only in higher incomes, but also in the improved availability of better quality and increasingly differentiated final products. However, at the same time, globalization has had its dark side. There has been an increasing tendency towards growing equalization within and between countries and a stubborn incidence in the absolute levels ofRead MoreGlobalization : A Global Economy Essay1521 Words   |  7 PagesGlobalization is the process in which we as humanity are coming together to form a global economy around all sorts of different infrastructures. â€Å"The globalization process implies the incorporation of national economies, cultures, political systems and various identities of capitalist system which require the removal of all hurdl es to cross-national interaction and exchange often created earlier by protectionist states† (Aamir, 1). Globalization is the greatest thing to happen to us as humans, we

Critical Thinking Analysis of Penn-Marts Health Care...

A Critical Thinking Analysis of Penn-Mart’s Health Care Strategy Revisions Dennis D. Puskas University of Maryland University College DMBA 610 September 21, 2014 Abstract The following paper will use a set of 10 critical thinking steps recommended by Browne amp; Keeley to objectively analyze the memorandum sent by Salvador Monella who is the Senior Vice President of Human Resources to the Board of Directors at Penn-Mart. Mr. Monella has conducted a review of Penn-Mart’s healthcare strategy involving a number of issues including cost to the company and employee involvement, to name a few. The purpose of the review, findings, discussion and recommendations will all be analyzed using critical thinking skills in an objective manner.†¦show more content†¦Question 2: What are the reasons? Now we want to identify and analyze the reasons that support the conclusion we have identified in the previous section. We want to learn why the Mr. Monella thinks that his conclusion is true, which will be all of the reasons that he mentions which will draw us to the conclusion. The reasons that support the conclusion in Penn-Mart have been extracted f rom internal research that has been conducted under Mr. Monella. The reasons mentioned are listed below: 1) Growth in benefits costs is unacceptable driven by an aging workforce with average tenure. 2) Benefits costs could consume as much as 15 percent of their total profits in 2015. 3) Penn-Mart’s wages and benefits make up about 40 percent of their annual budget. 4) The least productive and least healthy employees are a drag on earnings. Question 3: What words or phrases are ambiguous? Next, we want to identify any phrases or words that are ambiguous including abstract terms or loaded language. Looking at the first reason, the word â€Å"unacceptable† is used to describe the growth in benefits costs. This is clearly ambiguous as we have no idea how the author defines unacceptable. Also, within that same phrase is â€Å"aging workforce†; this is also ambiguous. Aging to someone else could mean in their mid-30s, but to other people it could mean late 50s, thus this is another ambiguity. In reason number 2, 15 percent ofShow MoreRelatedRecommendation For Revision Of Penn Mart s Health Care Strategy2485 Words   |  10 PagesAbstract This paper is an analysis of the critical points of the â€Å"Recommendation for Revision of Penn-Mart’s Health Care Strategy† memo (Penn-Mart Memo) in relation to the points in the report by Roy Eichhorn, Strategic Systems Department, Army Management Staff College, entitled, Developing Thinking Skills: Critical Thinking at the Army Management Staff College. The author of the Penn-Mart memo is Senior VP of Human Resources, Salvador Monella whose indicated purpose is to offer a remedy to the spiralingRead MoreTeaching Notes Robert Grant - Strategy 4th Edition51665 Words   |  207 PagesBroking Strategies: Merrill Lynch, Charles Schwab and E*Trade 83 10 11 12 Emi and the CT Scanner [A] [B] 88 Rivalry in Video Games 98 Birds Eye and the UK Frozen Food Industry 109 1 CONTENTS 13 14 15 16 Euro Disney: From Dream to Nightmare, 1987–94 116 Richard Branson and the Virgin Group of Companies in 2002 125 General Electric: Life After Jack 131 AES Corporation: Rewriting the Rules of Management 139 2 Introduction This new edition of Cases in Contemporary Strategy Analysis

Coca-Cola and Pepsi harm India’s ecology Free Essays

Introduction Coca cola and Pepsi are MNC’s localized in almost every country. Their approach towards making profit is strategically not the same everywhere. India is a developing country, are the rules and regulations strict enough to stop these corporations to exploit the Indian locals. We will write a custom essay sample on Coca-Cola and Pepsi harm India’s ecology or any similar topic only for you Order Now We are focusing on marketing communications strategy followed by these corporations also other unethical activities carried out in India. The purpose of this research is to explain that the rules and regulations of a developing country are not enough to stop the localized MNC’s to continue their unethical activities keeping India as an example. The objective of our research is to analyze weather the actions of these MNC’s are ethical. Coca cola entered India in1956 since they had no foreign exchange act it made huge profits. After the formation of Indian foreign exchange act coca cola left India in the late70’s. Coca cola made its reentry in the 1990’s when the environment was liberalized and deregulated. Pepsi entered in 1986 as a joint venture with two local ventures in India. Both companies soon discovered competing in India requires special knowledge skills and local expertise†¦Ã¢â‚¬ what works here not always work there† (Cateora Graham, 2008, p. 604). Literature review Our research is based on different issues regarding environment and consumer rights violation. Previously Dr S.K. Chokroborty in 1997 wrote an article on the journal of business ethics about business ethics in developing countries. Harvard law review wrote on international environmental law Also Dr Panchali das researched on deception on advertising ethics. Chicago journal on Nationalism and Ideology in an Anticonsumption Movement. The global strategies of coke and pepsi are explained in economic and political weekly 1999 by Arijit biswas and Anandya sen Proposed study Our research study seeks to analyze three controversial issues related to operations of coca cola and Pepsi in India Advertisement in rocks of India Use of ground water in India and dumping of chemical wastes Pesticides in products of India The research seeks to study the background and the regulatory framework within which it functions. Issue 1: Advertisement in the rocks of India â€Å"Advertising is a non-moral force, like electricity, which not only illuminates but electrocutes. Its worth to civilization depends upon how it is used.† – J. Walter Thompson International soft-drink rivals Pepsi and Coke spend millions of rupees on a marketing war in the mammoth Indian market. They have marketed many super stars of Bollywood, who are admired in whole South Asia. The most prominent cricketers have also been roped in. As brand ambassadors their well-known faces are seen on billboards, newspaper pages and television. The Coke-Pepsi rivalry is so vigorous that nearly every shop, bus-stop stall and roadside restaurant has been created into the one or the other’s empire. In September 2002 both companies were blamed for winding mountain road from manali to the 4000 metre-high Rohtang pass in himachal Pradesh, Northern India. There were averages of 4 to 5 ads per kilometer either painted on to rock faces or nailed on to trees on the mountainsides, the billboards for almost 56-km stretch. The forest conservation act 1980 of India makes it clear that no individual must use forest as a source of making personal gain. It was a clear violation of the act. The first to react was Indian express with an article â€Å"rape of the rock†. The Supreme Court had put a stop to the advertisement campaign. . The intervention brought to the notice of the Supreme Court the painting of huge Pepsi and Coke logos on rocks that has destroyed geological evidence dating back to 45 million years. Geologists understand the geology of the area by studying and observing rocky outcrops. If the area has been painted over they cannot do research. The newspaper quoted a profes sor in the Geology Department of Punjab University saying â€Å"these mountain facades have a huge eco-system. There is moss that grows on these rocks, and then there are innumerable species of microorganisms. All is completely destroyed when the rock surface is painted.† After the case was solved both the companies had to pay 10 million for compensating the damage done to the ecology. The Supreme Court also asked the forest department to look around for such activities prevailing in some other states. Issue 2: Use of ground water in India The village of Mehdiganj is located approximately 20 kilometers from the holy Indian city of Varanasi. In Mehdiganj, a resistance was started in 2002 by farmers under the banner of Gaon Bachao Sunghursh Samiti to protest the pollution and water shortage attributed to Coca-Cola. Farmers in Mehdiganj and surrounding villages are agitating against the Coca-Cola bottling plant located in Mehdiganj. The anti-Coke activists further claim that the Coca-Cola plant is destroying the region by consuming 2.5 million liters of water every day and is contributing to a serious water crisis. In highlighting the problem of water, activists claim that Coca-Cola uses its financial muscle to buy government favor and influence its functioning as a regulatory authority. They say The company dumped sludge in the fields around. People started to develop sores on their feet after they walked through the water discharged was the flooding of their fields. Mosquitoes were a serious threat, and malaria cases have increased. Many have said that some hand pumps in the area have been issued for errors, unsafe drinking water. Still both cola rivals are carrying out operations in India putting their future at risk. Issue 3: Pesticides in products of India In 2003, the Centre for Science and Environment (CSE), a non-governmental organization in New Delhi, said aerated waters produced by soft drinks manufacturers in India, including multinational giants PepsiCo and Coca-Cola Company, contained toxins including lindane,DDT,malathion and chlorpyrifos–pesticides, that can contribute to cancer, a breakdown of the immune system and cause birth defects. Tested products included Coke, Pepsi, 7 Up,Mirinda,Fanta,Thums Up,Limca and Sprite. Today’s youth icons from the cricket world like Sachin Tendulkar, Virender Sehwag and Dhoni freely endorse Pepsi coke. The sponsorship of a sport like cricket in particular may cultivate positive attitudes by associating the product with characteristics which young people admire. In the wake of the recent controversies shrouding Coke and Pepsi, regarding allegations of containing pesticides, these stars not only endorsed these soft drinks but also went so far as to claim that they were safe. This was advertising going too far Aerated soft drinks, apart from promoting the wrong kind of images, have long been suspected of leading to lower calcium levels and higher phosphate levels in the blood. When phosphate levels are high and calcium levels are low, calcium is pulled out of the bones. The phosphate content of soft drinks like Coca -Cola and Pepsi is very high, and they contain virtually no calcium. In the Indian state of Kerala, sale and production of Pepsi-Cola, along with other soft drinks, has been banned. Five other Indian states have announced partial bans on the drinks in schools, colleges and hospitals East India Company that came into the country for trade robbed India of its wealth for 200 years and soon invaded us. Today in place of East India Company, 14,000 multinational firms are robbing India. Leading this pack are Pepsi and Coca Cola. These firms sell several varieties of cold drinks and are taking away 5000 million rupees. References Nationalism and Ideology in an Anticonsumption Movement Author(s): Rohit Varman and Russell W. Belk Source: Journal of Consumer Research, Vol. 36, No. 4 (December 2009), pp. 686-700 Published by: The University of Chicago Press 1997 A Conceptual Review Of Advertising Regulation And Standards: Case Studies In The Indian Scenario -panchali Das* Ivan L. Preston (1987). A Review of the Literature on Advertising Regulation, 1983-87. Current Issues and Research in Advertising, 10 (2): 123-152. Michael A. Kamins and Lawrence J. Marks (1987). Advertising Puffery: The Impact of Using Two-Sided Claims on Product Attitude and Purchase Intention. Journal of Advertising 1997 A Conceptual Review Of Advertising Regulation And Standards: Case Studies In The Indian Scenario -panchali Das* Agrawal, Anil, and Sunita Narain 1991 GlobalWarming in an UnequalWorld:ACase of Environmentalism. Delhi: Centerfor Science and Enviroment. How to cite Coca-Cola and Pepsi harm India’s ecology, Essay examples

Windows Networking Design Implementation †Myassignmenthelp.Com

Question: Discuss About The Windows Networking Design Implementation? Answer: Introduction The present IT infrastructure of B2B Company will be investigated. The exisiting threats of the present network will be studied. The secured network design with necessary IP addressing , hard ware and software requirements will be studied. The network devices that are needed to implement the secured network design will be explained briefly. Network diagrams and IP addressing designs will be made. Network Design Project Scope The network planning[1] by keeping security as one of the important parameters.B2B company has six departments and the requirement is a router across each department and hence the network is designed with 6 routers and these six router share 500 workstations. Finance department has 100 workstations. Transport office has 50 workstations. Research office has 25 workstations. Sales office has 25 workstations. Information technology has 250 workstations. The head office has 50 workstations. Security devices are provided in layers to implement the safe handling of the network. As a network security architect, the criteria to be implemented are taken into consideration. The network is designed in such a manner that it has proper flow of information [2]. To implement the confidentiality, the network is protected or crypted with passwords. Web based filtering is also implemented by using proper certified website through a web filter and also by blocking the insecure sites. Role based access control is also implemented in the network. RBAC is used to aid the users perform specific tasks according to the departments. The network also has IPS, firewall and webservers[3]. Security Threats A security threat[5] is nothing but a risk that can create harm or damage the network's working environment. The threat mostly comes in the form of a software threat. There are many threats that can affect the network. Some of the security threats are Ransom ware Software vulnerabilities Hacktivism Online hacking Cloud attacks The threats may also come in the form of virus, Trojans. DoS attack is nothing but the denial of service attack that is used to create data traffic artificially and can make a server drown very easily. The threats can also be categorized into physical and non-physical threats. The physical threats are nothing but the threats that cause damage to the devices. The types of physical threats are internal, external and humans. Nonphysical threat is the one that creates loss of data or information. The nonphysical threats are also called the logical threats. The logical threats are more dangerous. Secure Network Design Security is considered as a major factor in designing the network. More layers of security are provided. The first layer of security is provided by the VPN[7][8]. The second layer of security is provided by the firewall. The third layer of security is provided by IPS. VPN diagram is shown below. Since different sites are used the end users may need to send the data through WAN. VPN will give lot of security features in this type of IT network infrastructure. Detailed diagram of the LAN network is shown. The IP addressing scan be as per the requirement. Finance Office got 100 workstations. In DHCP server this can be Scope_Finance and the allowed IP ranges can be 192.168.1.1-192.168.1.120 Transport Office got 50 workstations. In DHCP server this can be Scope_Transport and the allowed IP ranges can be 168.1.121-192.168.1.180 Research Office got 25 workstations. In DHCP server this can be Scope_Research and the allowed IP ranges can be 168.1.181-192.168.1.210 Sales Office got 25 workstations. In DHCP server this can be Scope_Sales and the allowed IP ranges can be 168.2.1 - 192.168.2.40 Information technology got 250 workstations. In DHCP server this can be Scope_IT and the allowed IP ranges can be 168.3.1-192.168.1.254 Head Office got 50 workstations. In DHCP server this can be Scope_Headoffice and the allowed IP ranges can be 168.4.1-192.168.4.60 The security blocks used in the network include Firewall Antivirus server IPS system Three layers of security are implemented in the network diagram. First layer of security is implemented by the firewall. Second layer of security is implemented by the anti-virus servers. The third level of security is implemented by the IPS system. Firewall is installed between the router and the server. In order to provide the security to the servers, antivirus server is also implemented. PS is the abbreviation of Intrusion Prevention System. It protects against the threats by examining the network traffic. Hardware requirements and devices Required hardware [6] to implement the secured network is explained below. A router is a one that establishes connection between two or more wired or wireless devices that frames a structured network. Router has memory and operates like a embedded device. Router is also responsible for handling incoming and outgoing packets. Packets are basic unit of the network. There are many types of router like Brouter, Core router, Edge router, Virtual router, Wireless router. Manufacturers Name-- Cisco Series Series-- Integrated Services Routers Model-- 4000 Switches are used to connect devices. Router also serves the same functionality but the difference is that routers are used to connect the network and the witches are used to create the network. There are two main types of switches. They are manageable switches and non-manageable switches. Switches are considered as valuable assets for a network. Switch have many ports. According to the port, the switch can be 2 port switch, 4 port switch or the multiple port switch. Switch allows the flow of the network in a structured manner. Manufacturers Name Cisco Series Catalyst Switch Model 6880-X Network cables are used to connect one device to the other device physically.There are many types of cables used in network.They are Twisted pair Fiber optic Coaxial Patch Power lines Twisted pair cable is one which has pairs of wires in twisted form.Fibre optic cable is one which has glass core in the center that is surrounded by many protective materials.The protective layer is nothing but the layer of insulating jacket. Patch cable is one which is mostly used for connecting electrical devices Manufacturers Name Hitech Products Private Limited (falcon Cables) Series Networking cable Model CAT-5 Like a wall which gives security to the buildings, firewall also refers to the system which provides security to the networks. Firewall blocks the authorized access. Firewall can be a software application or a hard ware device. Web Server A webserver is one that aids one to browse or handle webpages. The webserver works with the help of HHTP.HTTP is a type of protocol. They share the viewing and editing control of webpages upon request Software Requirements Windows servers need Windows 2012 R2 Operating system[10]. Web server can be implemented in Apache/IIS. Routers and switche3s will be having inbuilt OS. CIAA CIAA stands for confidentiality, integrity, availability and authentication[8]. In the present network VPN is configured. So the data confidentiality is ensured. Integrity can be checked by using many techniques like parities. Availability can be implements for keeping the data in multiple palces. Authentication can be achieved by using active directory in this design Conclusion The security implementation to the various blocks used in the network diagram is clearly explained. The misconfiguration of webserver by an attacker is prevented by using the antivirus server. The antivirus server protects the application server from vulnerable software. Suppose a malicious document gets opened by an employee, it can be considered as a threat. The threat can be avoided by taking care of the network traffic using the IPS system. DNS server is also kept away from the cache poisoning using the IPS system. References [1]"Network design checklist: How to design a LAN",SearchITChannel, 2017. [Online]. Available: https://searchitchannel.techtarget.com/feature/Network-design-checklist-Six-factors-to-consider-when-designing-LANs. [Accessed: 29- Sep- 2017]. [2]I. Cisco Systems, "Introduction to Cisco Network Design Designing Campus Networks",Ciscopress.com, 2017. [Online]. Available: https://www.ciscopress.com/articles/article.asp?p=25259. [Accessed: 29- Sep- 2017]. [3]"Campus Network Design Models",Network Computing, 2017. [Online]. Available: https://www.networkcomputing.com/data-centers/campus-network-design-models/1685370612. [Accessed: 29- Sep- 2017]. [4]P. Oppenheimer,Top-down network design. Indianapolis, Ind.: Cisco Press, 2011. [5]"Security Threats",Msdn.microsoft.com, 2017. [Online]. Available: https://msdn.microsoft.com/en-us/library/cc723507.aspx. [Accessed: 29- Sep- 2017]. [6]"Network Devices", 2017. [Online]. Available: https://www.certiology.com/computing/computer-networking/network-devices.html. [Accessed: 29- Sep- 2017]. [7]"How VPN Works: Virtual Private Network (VPN)",Technet.microsoft.com, 2017. [Online]. Available: https://technet.microsoft.com/en-us/library/cc779919(v=ws.10).aspx. [Accessed: 29- Sep- 2017]. [8]"Information Security Concepts +1: Confidentiality, Integrity, Availablity, and Authenticity",Bright Hub, 2017. [Online]. Available: https://www.brighthub.com/computing/smb-security/articles/29153.aspx. [Accessed: 29- Sep- 2017]. [9]V. Ltd., "Network solutions, network monitoring, network filrewall systems, network security - VirtueWorld - Website Design and Development",Virtueworld.com, 2017. [Online]. Available: https://www.virtueworld.com/network_solutions/designing_and_implementation_of_vpn_networks.html. [Accessed: 29- Sep- 2017]. [10]"Windows Networking Design Implementation Guide",Cisco, 2017. [Online]. Available: https://www.cisco.com/c/en/us/support/docs/additional-legacy-protocols/ms-windows-networking/10624-winnt-dg.html. [Accessed: 29- Sep- 2017].