Symbiosis Mini Essay free essay sample

Parasitism is a relationship, usually between two organisms in which one organism benefits greatly (the parasite) and the other is negatively affected (the host). Commensalism: A relationship existing between two organisms which results in one organism benefitting while the other is unaffected. Mutualism General Example: The Hermit Crab and Sea Anemone. Hermit Crabs have been shown to remove sea anemones and attach them to their shells. Both organisms benefit because the crabs drop food particles in the water when feeding, these food particles are then eaten by the anemones. The crab benefits because if any predator tries to attack, not only can it retract into its shell but the anemone can sting the predator which usually scares it away. Caribbean Example: Ants and Aphids. Aphids when feeding on plants secrete a sweet substance called honeydew, this honeydew is loved by ants and as a result they consume it. In exchange for the honeydew, the ants provide protection for the aphids from predators such as Ladybugs. We will write a custom essay sample on Symbiosis Mini Essay or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Both organisms benefit equally from this relationship (2). Parasitism General Example: Tapeworm and Humans. Tapeworms are parasitic worms from the Class Platyhelminthes. This organism reaches maturity in the gut in which the tapeworm feeds on nutrient rich food which the human has eaten. Mature proglottids of the tapeworm separate from the adult and are expelled in the feces. These feces may be eaten by herbivorous animals such as sheep or cattle which then become infected and pass the tapeworms along if their meat is improperly prepared. Tapeworms can also pass on a variety of illnesses e. . blindness, pain and inflammation. Caribbean example: Parasitic Dodder Vines and Golden apple tree: Dodder vines can attach themselves to a wide variety of plants and use its parasitic connections called haustoria to gain access to the plants vascular system. This essentially robs the host plant of food it has produced and in many cases can lead to the death of the host. Commensalism General Example: Shark and Remora. Remoras are small fish which can att ach themselves to a shark’s skin via a disc on its head. When the shark hunts the remora would detach itself and eat scraps which float by, by this method the remora benefits because it is allowed to feed but the shark is unaffected by the remora’s attachment. Caribbean Example: Human beings and Egrets: Usually before planting a crop the field must be ploughed and this is done in more recent times using heavy machinery, namely a tractor. As a result of the soil being turned over many insects and worms can be exposed and the Egret takes advantage of this. Usually wherever there is soil being ploughed many egrets can be found feeding, sometimes even an entire flock of them.

The Lost Chinatown

The Lost Chinatown Free Online Research Papers â€Å"Welcome! Please come in!† piped the recorded voice as we went in a store. Those were the first few words I heard when I went to Chinatown, (Manila) a few days ago with my friends. As we strolled along the streets of the bustling little Chinese town, I was filled with mixed emotions. On one hand, I was feeling a bit nostalgic. The sight of the old buildings and restaurants, the distinct smell of incense and Chinese medicine, the old and revered Binondo church, the noisy street vendors and the colorful calesas, brought back memories of my first home. On the other hand, I was feeling uneasy seeing all the changes that had taken place in the past ten years. I felt that the addition of foreign shops, construction of new and modern buildings, the commercialization of restaurants and stores have changed more than just the appearance of Chinatown. Something was missing in today’s Chinatown. In the past, Chinatown was the core of the Chinese business enterprises. It used to be a landmark, the main source of China’s best goods. Anyone strolling around the streets of Chinatown would undoubtedly have a genuine Chinese experience. Everything was practically Chinese- the people, the food, the traditions, the architecture, the music, and the festivities. The Chinese have long strove to keep the richness of their culture intact. Since then, Chinatown has constantly changed. Through the years, it has continually kept pace with the waves of technology. In fact, the Chinatown I lived in was already a far cry from what it used to be. Yet, visiting my hometown ten years later, well- indeed a lot has changed. Perhaps if you would compare a sketch of Chinatown ten years ago and one of today, you would notice that the main difference would be the addition of electronic stores, beauty shops, spas, foreign restaurants and cafes. In fact, my friends and I agreed to meet in Starbucks for this trip! I tell you, years before; there was little chance of finding a restaurant serving a different cuisine other than Chinese in Chinatown, much less a foreign cafà ©! The additions of the foreign stores are not the only things that have changed the solely Chinese territory at Chinatown, but also several structural and technological improvements. A day’s activities in Chinatown ten years ago would be characterized by a ride in a calesa, a trip to the wet Aranque Market, a visit to the Chinese medicine stores and a taste of their exotic medicines, lunch in a quaint Chinese restaurant with the owner’s family themselves serving you, a stroll along the bridges across the dirty Pasig River, a stop to buy fruits from the street vendors, a sip of the yummy sugarcane juice, a friendly chat with familiar faces you would meet along the road, and perhaps for a young lass like me, a day full of games that would include the jump rope and the jackstones with my neighbors in the wide hallways of our buildings. A day in today’s Chinatown could start with coffee at Starbucks, a stroll along the newly renovated Plaza San Lorenzo Ruiz, a stop at the Eng Bee Tin store which sells the uniquely flavored hopias in nice, printed packages for pasalubong (gifts) for your workmates, perhaps lunch with your friends at a well-known, commercialized restaurant with Filipino waitresses dressed with traditional Chinese outfits serving you, a sip of one of those modern Chinese energy drinks, a ride in your BMW to the nearby supermarket to buy fruits and food for your family who live in a fancy new condominium with narrow hallways and unknown neighbors, a stop in the Globe Business Center, and perhaps, for the youth of today, a day full of computer games in the internet stations scattered throughout Chinatown. I have also noticed that because of modernization movement, some things are becoming obsolete- or should I say, â€Å"antique†. Such as, the calesa. I vividly remember my childhood years when my only means of transportation to school was the calesa: thewooden, colorful and sometimes rickety, carriage-pulled-by-the-horse. My yaya (Nanny)would bargain with the kutsero (driver)for the fare to be lowered. She would shout, â€Å"Bente nalang po (Could we pay twenty pesos instead?)† Some kutseros would stubbornly refuse the twenty peso fare. My yaya would persist. He would refuse. My yaya would persist. He would refuse. And the cycle would go on and on, every day of my school life. And I just smiled when I saw my friend Sheena persisting for a ride in a calesa. Today, only the wowed tourists ride them. With fares set at a very high price, and designated roads where the calesas cannot pass, people have opted to use cars and other â€Å"practical† means of transportation . Even so, calesas have contributed to the unique identity of Chinatown and therefore should not be simply put aside. Globalization has also brought a revolution in this part of the Manila. I remember years ago people from all over Metro Manila and perhaps other parts of the country would go and visit Chinatown to buy Chinese goods. Chinatown used to be the best source for Chinese goods - the best hopia, the best dimsum, the best congee- you name it, they have it, and they have the best in town. Also, Chinatown was the only source for authentic Chinese paraphernalia: costumes, luck charms, medicine, etc. But today, due to the increase in demand for Chinese goods, shops had to open branches in different parts of the city and the country. In short, there was. But, as a result of this expansion, Chinese shops are no longer unique to Chinatown. Those delectable goods can be bought anywhere now, and sometimes, even at a cheaper price. I recall the â€Å"dragonfruit expedition† that my friends and I had in our visit to Chinatown. It was the first time for some of my friends to see that fruit, and everybody wanted to taste something â€Å"unique† to Chinatown. But after bargaining with several fruit vendors, we still found it expensive, and concluded that it can be bought nowadays in supermarkets, so why bother? My friend Sheena asked me a while later, â€Å"So what else is here? What’s the specialty of Chinatown? Something that’s really different that we could experience?† I found that question difficult to answer. Practically nothing is completely unique to Chinatown anymore, including food. Chinese restaurants are scattered all around the city and I cannot deny that I have appreciated a lot of them. Authentic Chinese furniture, clothes and other imported products can be found everywhere. I could point out some distinct characteristics that Chinatown possess, but I cannot really name a unique quality anymore. I cannot deny that the commercialization, modernization and globalization of Chinatown have brought good. The improvements have been and are serving their purposes. In fact, the enhancements in this town have increased its charm to lure more tourists, and perhaps, have made the lives of the people living there easier. Chinese goods are now easily accessed by people living outside Chinatown. However, I sincerely regret that, for the sake of keeping up with the times, the changes have led to the dilution of the authenticity and the uniqueness of Chinatown. The essence of Chinatown, that special C-factor which keeps Chinatown authentic and unique, is now lost. What has kept the Chinatown authentic and unique throughout the years is its constant and strict following of its traditions. In today’s Chinatown, a great deal of these traditions have either been disregarded or compromised to give way to modern technology. It has long been the practice of the Chinese to keep themselves exclusively Chinese. With the influx of foreign restaurants and cafà ©s, the essence of keeping Chinatown solely Chinese as its name suggests, is slowly diminished. The commercialization of buildings and other structures in Chinatown has changed the atmosphere in the relationships of the people living there. The narrow hallways and stiff, condo-type designs give an air of professionalism and discourage familiarity among neighbors. Thus the Chinese ideology of close ties has been disregarded. Chinese businessmen nowadays have adopted Western ways of doing business; thus, losing the traditional, personal way of the Chinese. It has long been a tradition among th e Chinese that the whole family would contribute in the family business. In a restaurant, the father cooks, the mother serves the customers, the children wash the dishes, etc. Nowadays, children are exposed to several Western ideas and do not see the significance of this anymore. And, in the age of expansion and commercialization, hired help replace the family in service. â€Å"Thank you! Please come again!† piped the electronic recorded voice as we left Eng Bee Tin store, after buying some pasalubongs (gifts)for our families. Again, these technological improvements are not wrong. They serve their purpose and make people’s lives easier. But, let us not disregard the values of the past generations because they are essential in keeping the identity of Chinatown unique from any other place in the country. Instead, let us use technology to our advantage. That way, we could have both, technology and the preservation of the culture. Let’s keep that special C-Factor, so Chinatown would stay authentic and unique, the way it was before, the way it was known to be. So that anyone in the future, strolling along the streets of the little Chinese town, would have the benefit of a true Chinese experience. Research Papers on The Lost ChinatownWhere Wild and West MeetTwilight of the UAWThe Spring and Autumn19 Century Society: A Deeply Divided EraThe Effects of Illegal ImmigrationDefinition of Export QuotasMarketing of Lifeboy Soap A Unilever ProductPersonal Experience with Teen PregnancyBringing Democracy to AfricaHip-Hop is Art

Interview with an immigrant 4 pages single spaced Essay

Interview with an immigrant 4 pages single spaced - Essay Example Nabeeb: Learning English was really hard, especially considering that I had spoken a different language for 20 years. In Tanzania, I was accustomed to speaking the national language which is Kiswahili, in addition to my local Chagga dialect. It is very rare to find people speaking in English in Tanzania, and in fact, most people perceive English as a foreign language. Considering that I spoke very little English by the time I came to the United States, the language barrier was so much of an issue that most of the time, I did not make sense in my broken English, and people would laugh at me. Interviewer: It must have been really hard to get laughed at. How did you handle it? Nabeeb: At first, it was so humiliating. Imagine having kids as young as 6 years old laughing at you because they speak better English than you. It became so bad that I opted not to talk to people and this made me very lonely and homesick. Interviewer: So how did you overcome the language barrier issue and speakin g of home sickness, how bad was it? Nabeeb: After secluding myself for around two months, I realized that life would not get any easier if I did not take up the responsibility of fighting of the language barrier problem. I, therefore, enrolled at a local grammar school where I took up English lessons, started interacting with people and actually urged them to correct me whenever I spoke bad English. But I must say that for an immigrant, having to distinguish between formal English and American slang is an uphill task. The homesickness? No words can fully describe what it feels like to be in an alien land, away from friends and family, and forced to adapt to new life. I would get so home sick that I would spend my free time trying to find other Tanzanians who help me manage the homesickness. Communicating with my family back in Tanzania via telephone also helped ease the homesickness. However, the international calls were very expensive at the time for a student, meaning that communi cation was very rare. Interviewer: Apart from the language barrier and homesickness, what other challenges have you faced as an immigrant in the United States? Nabeeb: Once I set foot in the United States, everything was totally different. It is like waking up to a new world; the weather, the food, the modes of dressing, the accents, and more so the system of education, all gave me a culture shock. In class especially, I found the teaching methods so strange that I used to be the quietest student in class. I could not dare ask questions or even answer them. It really took me time to get adjusted to the American classroom. In addition, there are too many laws controlling the lives of immigrants that one almost feels suffocated. Obtaining a driving license, getting a work permit, travelling out of the country, getting social security, among many other regulations almost make one feel like a suspect. I must also add that it took me quite a while to get used to eating burgers and pizzas . I used to crave for Tanzanian food so much that I would try the recipes only to end up disappointed because the ingredients I found here are not the same as those used in Tanzania. Anyway, after months of complaining, I finally adjusted and I got used to the food here. Interviewer: But the experiences could not have been all bad. Is there anything positive about being an immigrant in the United States? Nabeeb: Everyone wants to live the American dream. That is what I came chasing for and that is the best decision I ever

Why we should have a Black President Essay Example | Topics and Well Written Essays - 1250 words

Why we should have a Black President - Essay Example The United States should have an African, or Black President, because it's the only way to demonstrate principles of equal human rights in actual fact. All the history of the United States has never been anything but a chain of white male presidents. Oddly, little has been said about this embarrassing subject. Of course, America probably has to break a few more social barriers before a black president could be elected. To be frank, a lot of people are not ready to have a black man or woman as President. On the other hand, there are a lot of progressive people, black and white, concerned that democratic principles should be implemented in the real life indeed.Electing of African President in 2008 will help to attract an attention of publicity to the problems of black community, such as educational, health, social, political and other issues. According to the recent Gallup Survey on "Black-White Relations" cited in Cronc, seven out of ten whites believe that blacks are treated equally in their communities: an optimism with which only 40 percent of blacks agree. Eight in ten whites say blacks receive equal educational opportunities, and 83 percent say blacks receive equal housing opportunities in their communities. Only a third of whites believe blacks face racial bias from police in their areas. If a Black President is elected in the United States in 2008, these problems will more likely to be solved. (1999)I think that the main benefit of Black President is providing the United States with the real equality in all areas of life. Also it will show to every black person that there is nothing impossible for him or her in self-development. Self-confidence of colored people will serve as a powerful tool for further development of democracy in the United States. Also, Black President will stimulate black people to get involved in the political process. If we have a black woman as a President, feminist's movement will also become more politically active and more significant. The idea of America having its first Black president has resonated with many African-Americans over the years, especially with the emergence of Illinois Senator Barack Obama. Obama is the third African American since the Reconstruction Era to serve in the United States Senate. He is also the only African American currently serving in the Senate. Obama showed he had national appeal last year, when he delivered the keynote address at the Democratic National Convention. Though he was not even elected into office yet, dreams of a black President popped into the heads of many African Americans who watched as Obama electrified an audience of all races. Obama is not the first African American to show national appeal as a potential presidential candidate. The Rev. Jesse Jackson ran twice in the 1980s, and though he did not win the White House Jackson showed that he had enormous appeal outside of the African-American community. Jackson managed to attract 6.9 million votes from Urban Blacks, Hispanics, poor rural whites, farmers, factory workers, feminists, homosexuals and white progressives. One more step to an African President is Bill Clinton, who often is referred to as the "black president" because he was so receptive to the needs of African Americans and because he worked to include them in the political process more than any other president. Reasons cited here for Clinton's popularity among blacks include his poor Southern upbringing and underdog status, the fact that he appointed more blacks to his cabinet and other federal posts than any other president, and good timing (he came into office after three consecutive Republican administrations). But perhaps the biggest factor discussed is the genuine ease with which Clinton relates to black Americans. Blacks trust him to consider their perspective and do not view him as just another white politician who appears only during election years. This is not to say that Clinton always did their bidding; he often disappointed them. But they also shared common enemies and a common outlook that brought

Workplace related issues Research Paper Example | Topics and Well Written Essays - 2250 words

Workplace related issues - Research Paper Example Many factors affect workers at the work place. With the growing business world, more opportunities are presented for employees to venture into; hence, the management is left with no choice but to find means of making sure that the employees are satisfied with the working conditions. These issues at a glance appear minor, but in the actual projection, they determine a great deal the motivation and efficiency of the worker (Hancock & Szalma, 2008). These issues range from the office design, office layout, the furniture in the office and the lighting systems. The services provided to the employees, such as refreshments, recreation facilities, health care plans and the rules and regulations as well as the policies of the organization (Hancock & Szalma, 2008). The level of interaction with the management and the influence of technology on the employees are also major issues. The employers are thus in the run to provide quality environment and services to the employees in order to be able to keep them for tomorrow. The ego of the employees determines a lot their motivation, and since the worker spends most of his or her lifetime at work, it is true that the quality of the place of work will affect the employee’s ego. A well-designed office, well built, partitioned and painted is a key motivator to a person’s attitude towards the work (Hancock & Szalma, 2008). For instance, if the work designated requires privacy for the employee, and the office does not provide such, the worker may feel an easy while executing their duty hence underperforming. A good design of building attracts and motivates the employee to stay around and provides essential factor for enhancing the creativity and innovative skills of an employee. The human mind is such that it makes preferences over color, and this generally affects the attitude of an individual towards a place. If the office is painted in such colors that the worker does not like, this will cause them to be de-motivat ed to stay in the office. Thus, it is important for the office to be painted in standard colors. The lighting system also matters a lot. A dimly lit room will cause low mood and negative attitude to the worker, toward the work. A moderately brightly lit office provides a serene working atmosphere hence motivating the employee to work. The arrangement of the office equipment and furniture is another key determinant factor to the attitude of the employee towards the office (Burke & Witt, 2002). A shabbily organized office will represent a job that is not taken seriously. The workers will tend to dislike the office hence this will affect his or her concentration in work, resulting to poor results. The furnishing of the office also affects the attitude of the worker towards their job. An office with old and shaggy looking office furniture will discourage the worker. For instance if the furniture is old and rugged, the employee who is expected to sit on them for most of the hours of his day will definitely not look forward to a new day at work. They as a result will just come to work for the pay but not to give quality work as is expected of them (Hancock & Szalma, 2008). The worker will do a job that is as good as the environment allows him or her to do. However, if the furniture is of quality, every worker will enjoy being at their workstation. In addition, they will be motivated to put in their best efforts and skills to work, since the setting is comfortable. A healthy health is essential for an individual to deliver quality service in all areas of life. An ailing person is not in a good state of mind

Physiotherapy Management of Lower Limb Tendonopathies

Physiotherapy Management of Lower Limb Tendonopathies A Systematic Review of the physiotherapy management of lower limb tendonopathies Tendonitis is a condition which is comparatively commonly seen in various clinics. The largest cohort of patients tend to have developed their condition as a result of various sports-related activities but it is acknowledged that there is a substantial cohort of RSI sufferers and occupation-related forms of tendonitis. (Kader et al 2002) In this piece we aim to review the various treatment modalities and to concentrate primarily on the eccentric muscle strengthening modalities of treatment, the rationale behind them and any evidence that they actually work. Before we can consider the direct question of eccentric loading as treatment for tendonopathies we must examine the rationale for its uses well as the basic science and theory behind the actual practice. We will do this largely by the mechanism of a literature review. Methodology In this review we shall be examining the literature for not only the methods that are currently employed in treating the various lower limb tendonopathies but also for justification for these methods and the quality of the science behind them. We shall therefore critically review the literature available and present it in a rational form. In addition to this we intend to present an overview of various factors in a wider picture that are relevant to our considerations. We shall consider the current views on the pathophysiology of tendonitis and the experimental evidence on the response of the tendon to exercise in general terms. Although it is accepted that the majority of patients currently seen in clinical practice with various forms of lower limb tendonitis are suffering from a sports related injury, we shall also look at the effects of ageing on tendon physiology as it is acknowledged that the elderly are another highly represented group with tendonitis. We conclude the preamble with a number of clinical considerations, most prominently the difficulties posed by the differences in nomenclature and terminology which renders both assessments and comparisons between clinical trials difficult. We conclude the dissertation with a review of various currently employed treatment modalities and the rationale behind them. We focus specifically on the use and place of eccentric muscle strengthening exercises in the spectrum of rational treatments.. Pathophysiology of tendonitis At the macro-anatomical level, the tendon is usually easily defined as a semi-rigid white or grey structure, generally found in close proximity to synovial joints. One of its prime functions is to transmit forces generated by muscles to the skeletal system, often inducing movement. (Huxley HE 1979). At the micro-anatomical level, it’s structure is very much more complex and requires a detailed examination before we can realistically and meaningfully consider the issues relating to the therapy of tendonitis. Tendons form part of the anatomical structures that are functionally grouped together as the extracellular matrix (ECM). The rate of turnover – both synthesis and degradation – is influenced by a number of different factors including metabolic and disease related factors, but the strongest influence on the turnover rate is mechanical stress, usually as a result of various degrees of physical activity. (Agar Pet al 2000) Tendon (and intramuscular) collagen, turns over at a rate which is about half as fast as myofibrillar protein turnover. The main physiological stimulus to turnover appears to be the multiple stimuli arising from mechanical or contractile activity.(Cuthbertson D et al2005) At the cellular level, degradation of collagen is mediated largely byte metalloprotease group of enzymes and synthesis is most strongly influenced by a number of different trophic factors which are released at the cellular level. (Algren MS. 1999) These growth factors are mainly responsible for both the transcriptional changes as well as the post-translational modifications that take place as a result of either physiological changes or disease processes. (Sand Meier et al 1997) Until comparatively recently, tendon tissue was thought to be fairly inert. Recent research work has given good supportive evidence that the internal metabolic processes, the internal vascular responses (Alstom et al 1994) and the actual catabolic turnover of the collagen protein in response to physical activity, is considerably greater than originally thought. The converse is also true, as inactivity appears to have the same inhibitory effect on tendon tissue as the better known effect of wasting in muscle tissue. (Abrahamson SO et al 1996). This effect is of particular importance in our considerations (later) when we consider that some authorities suggest that outright rest is inappropriate initial treatment for tendonitis. Collagen is a large polymer-type protein made up of many repeating subunits, (triple helices of polypeptides with a high proportion of proline and hydroxyproline). It is made by fibroblasts. In the muscle, it forms a basket-like network around the muscle fibres but then forms progressively more coherent and solid structure as it forms discrete tendon. In this way it allows the efficient transmission of forces generated by the myofibrils to the tendon – and hence to the bone. (Kjaer M 2004). Training, in the form of physical work, exercise or repetitive movements, will have a trophic effect on the tendon as a whole. Collagen turnover can be increased and there can be an overall increase in the amount of collagen protein in the tendon. (Herzog W et al 2002) Collagen, in the form in which it is found in a tendon, has enormous on-elastic tensile strength and a modest degree of ability to bend under lateral stress. As the amount of collagen in a tendon increases, the tendon’s mechanical (or more accurately, viscoelastic,) properties change. It decreases it’s stress levels for a given load, and thereby renders it more load resistant.(Fowls JL et al. 2000). Again this facts of great relevance to our clinical considerations later in this piece. The stiffness, or resistance to lateral stress, is a function of the cross-linking of sulphur bonds across the parallel bands of protein. In general terms, the more cross-links, the stiffer the tendon. The degree of cross-linking is a result of a complex interaction between a number of enzyme systems in the matrix of the tendon. (Hamill OP et al.2001) Polyglycans are an important feature of this enzyme cascade and become an increasingly important functional component as age increases. Older or ageing collagen will tend to exhibit glycolated cross links in addition to the sulphur links of youth. This is part of the reason why older tendons are less flexible (and possibly more prone to injury). (Inglemark BE 1948). The functional significance of these links is that they render the tendon even stiffer and less able to bend.(Davidson PF 1989).Understanding these processes is fundamental to the prescribing of a rational treatment regime for tendon injuries and other pathologies. It is also important to have a complete understanding of both the vascular and neurologically mediated adaptation processes that are present in the my-tendon complex. These work on a far more rapid and immediate time frame than the processes that we have just described, and are primarily responses to rapid changes in the mechanical loading stresses. As muscle tissue develops physiologically, there is a symbiotic relationship between the muscle and the extracellular matrix. The various physiological mechanisms that stimulate muscle growth and hypertrophy appear to have a similar effect on the extracellular matrix. (MacLean et al 1991) But in the latter case, they are less well understood. We know that that significant and repeated mechanical loading will trigger off, or initiate a process, which starts with the activation of trophic gene in a cellular nucleus, (Banes AJ et al.1999), it progresses through the complex processes of protein synthesis and functionally ends with the deposition of collagen in the tendon tissue.(Yasuda et al 2000) Responses of the tendon to exercise There would appear to be some form of integration between the muscular and the extracellular matrix signalling pathways, which optimises the co-ordinated activity of the trophic processes in response to the stimuli (which can be both loading and tensile in nature), which produce the response in the first place. (Viidik A.1993). This co-ordination mechanism must exist, as it is a well-recognised phenomenon that a tendon hypertrophies to accommodate the increased mechanical stress that its associated hypertrophied muscle produces. (Derwin et al 1999) Considerable research effort has been expended in trying to delineate the mechanism, but to date, the results have not increased our understanding of the situation significantly. (Vierck J et al 2000) Specific studies in this area have been able to show a clear correlation between collagen response and an increase in physical training. (Langberg et al 2001). The response was detectable after a 4week training programme and was maximal at 11 weeks. When we consider the pathophysiology of RSI (repetitive strain injury) or even chronic overload syndrome, the stimuli that can produce muscle hypertrophy or increase muscle fibrosis can also produce fundamental changes in the tendon structure. (Birk DE et al 1990) These changes can include changes in both the chemistry and the functionality of cross bonding of the collagen fibres, (Barnard K et al1987), changes in the size of the collagen fibrils, areas of locally increased blood flow (known as hyper vascularisation zones), and an increase in the catabolic processes which can result in either (or both) collagen being synthesised and laid down, or increase in fibroblastic activity which increases the fibrous component of the tendon. (Greenfield EM et al 1999) It is a fundamental recognition of the fact that these processes require â€Å"adjusted loading† rather than an enforced absence of loading(immobilisation) to reverse the physiological processes, that underpins most of the thrust of this review.( Howell JN et al 1993), (Jà ¤rvinenTAH et al 2002) The experimental evidence to support this view comes from the classic set of investigations by Gibson (et al 1987) who compared the rate of collagen synthesis and turnover in an immobilising long-cast leg with the rate of turnover in the unaffected leg. The rate of collagen synthesis dropped by half over a seven week period in the immobilised leg. The investigators also found an adaptive (and compensatory)reduction in the rate of collagen degradation which had the overall effect of reducing the protein loss in the tendons. In the overall context of our investigation it is also important to note that the authors also found that minimal electrical stimulation of the muscle (5% of maximum voluntary contraction for 1 hr. per day),increased protein synthesis to such an extent that there was no net protein loss over the same seven week period of the trial. (Gibson etal 1989) In a study that was remarkable for its invasiveness (the authors took repeated biopsies of human patella tendon after periods of exercise), Miller (et al 2004) demonstrated that tendon collagen synthesis showed a 30% rise within 6hrs of exercise and up to a 50%rise within a 24 hr. period. This was found to exactly follow the pattern of protein synthesis in skeletal muscle. This finding is strongly supportive of the assertions made earlier in this essay, that there would appear to be a mechanical or humeral mechanism that links the trophic effects that are apparent in both tendon and skeletal muscle. Various authors have postulated different mechanisms (it has to be said with scant evidence), including integrin’s, (Levenhagen et al2002), growth factors including transforming growth factor beta (TGFB) (Moore et al.2005), or mechano growth factor (MGF) (Rennie et al 2004),which they suggest may be responsible for the co-ordination of the trophic effects of perimysium collagen, tendon collagen and the myofibrils. More concrete evidence exists (and is arguably of greater relevance to our investigation here), for the fact that dietary protein alone can produce a trophic stimulus for tendon collagen. (Jefferson Kimball 2001). It is postulated that there is some form of amino acid sensor that is responsive to the availability of amino acids. This haste effect of changing the availability of various protein kinases in the extracellular matrix generally and a subsequent enzymatic cascade which results in an increase in various anabolic signalling molecules which are, in turn, responsible for the activation of mRNA. This is then responsible for the increased synthesis of collagen (and other related proteins), in tendon and other extracellular matrix tissues. This series of very elegant experiments was done in carefully controlled conditions which removed the possibility of other anabolic factors being relevant as the only variable was the availability of amino acids. (Cuthbertson et al 2005) There is further evidence of the effect of exercise on tendon structure in the form of the set of experiments by Rennie and disco-workers. Looking specifically at the metabolism of collagen Rennie found that after strenuous exercise, the rate of incorporation of a marker into tendon collagen followed a specific pattern (Rennie Tipton 2000). There was a latent period of about 90 mines after exercise where there was no change in metabolic rate. It was then noticed that there was a dramatic increase to about 5 times normal rates of synthesis, which peaked at about 12 hrs., was maintained for about 12hrs, and then declined over the next 48 hrs. In line with the findings of Cuthbertson (above) the investigators noted that the rise in levels of synthesis is greatest if associated with an amino acid load just pre- or post-exercise, and this effect can be further enhanced by the administration of insulin secretagogues(such as glucose). There is therefore little doubt that feeding helps the post exercise response. (Atherton P et al 2005) The effects of ageing on tendon pathophysiology We have already commented, in passing, on the physiological effects of ageing in relation to the polyglycan cross bonding in tendons. There are a number of other changes which will naturally occur in relation to advancing years, which are of direct relevance to our considerations here. It is clearly a matter of observation that muscles, bones and tendons deteriorate as age increases. This deterioration leads to physical symptoms such as loss of strength, mobility and suppleness together with an increase in fatigability and a general reduction in proprioception. This condition is sometimes called â€Å"sarcopenia†.(Forbes 1987) Epidemiological studies (Dorrens et al 2003), provide good evidence to support the popularly held view that an active lifestyle into old age is more likely to support a higher level of bone density, muscle bulk and tendon flexibility, than a sedentary one. One can postulate that the trophic mechanisms referred to above, stay active for longer when constantly stimulated by mechanical activity. One effect of ageing that has been experimentally demonstrated, is that the trophic effects of available amino acids in the bloodstream are not as great in the elderly as in the young. The elderly appear to have an ability to develop resistance to the trophic effects of amino acids, which was not present when they were younger. (Cuthbertson et al 2005) Another physiological change that can be demonstrated in the elderly, is a reduced RNA : DNA ratio in tendon tissue, which is a marker of a reduced ability to manufacture protein. This, together with reduction in the amount of detectable anabolic signalling proteins, seems to be central in the failure of the muscle and tendon synthesising mechanisms. (Smack et al.2001). If we add these findings to other work of Smack (et al 2001) and Leverhagen (et al 2002) which shows that the elderly can show responsiveness in terms of trophic changes in the collagen content of tendons by manipulation of the diet. Both studies showed that maximising the protein : energy ratio of ingested food is a reasonable strategy. It should also be noted that they also demonstrated that one has to be careful to keep the energy content of the food low in order to minimise unwanted weight gain. The elderly could reasonably be assisted to maximise the benefit they get from training (resistance training in these particular studies), by integrating it with feeding concentrated in the immediate pre- or post-exercise period. This appears to have the effect of increasing the positive synergistic relationship between exercise and amino acid delivery.( Williams et al. 2002) Clinical considerations Differential diagnosis The first and possibly most fundamental issue that we have to consider when looking at the issues of the treatment of tendonitis, is the issue of correct diagnosis. This, sadly, is compounded by the fact that there appear to be several different terminology vocabularies in common clinical use. It therefore can be difficult to directly compare treatment studies of â€Å"tendonitis â€Å" unless one has direct and clear diagnostic criteria. (Saxena 1995) Tendonitis may be taken in some medical circles to include all those conditions which come under the broad heading of â€Å"painful overuse tendon conditions† (Khan et al 1999). This is generally accepted by the uncritical, as meaning that this equates with a painful inflammatory reaction in the tendon tissue. Histological investigation of the typical chronically painful tendon, generally shows an absence of the polymorphonuclear and other associated inflammatory cells. In some literature we can see the emergence and replacement of the term tendonitis with tendinitis. This latter term tends to be defined as pertaining to areas of collagen degeneration, increased ground substance and neo-vascularisation. (Purdue et al 1996) To both illustrate and clarify the point, let us consider thevarious clinical entities that may either present like, or may be diagnosed as, â€Å"tendonitis†. For ease of classification and clarity, in this section we shall consider the term â€Å"tendonitis† in specific relation to the Achilles tendon. Williams (1986) produced the (arguably) most commonly currently accepted definitions of Achilles tendon pathologies. He classified them into:- Rupture, Focal degeneration, Tendinitis, Per tendonitis (peritendonosis), Mixed lesions, Origin/insertion lesions, Other cases such as metabolic/rheumatic causes. In common clinical parlance, any of them can be referred to, with reasonable accuracy, as â€Å"tendonitis†. (Galloway et al 1999) The aetiologies can vary (and this may well have a bearing on treatment), from trauma, reduced flexibility, abnormal or changed biomechanical considerations (such as excessive pronation, supination or limb length inequalities) to name but a few. (Saxena, A 1998) It should be noted that the anatomy of the Achilles tendon is unusual and certainly different from any other in the lower limb. It does not have a true synovial sheath but a petition which extends from its origin in the muscle to its insertion in the calcaneus. Peritendonosisis therefore a commonly misdiagnosed as Achilles tendonitis. It is also clinically significant that there is a region of decreased vascularity in the tendon, which is typically about 6 comes above its insertion (Hume 1994). The clinical difference between these two conditions is that true Achilles tendonitis may, if chronic, be characterised by fucoid, or fatty focal degenerative, changes in the tendon itself, where asperitendonitis will not involve the Achilles tendon at all. (Kvist1994). These degenerative changes may be extremely resistant to non-surgical forms of treatment. In practice, the two conditions may well be presenting the same individual. (Killer et al 1998) The differentiating signs are, however, fairly easy to detect and the two conditions can be separately distinguished in most cases. Per tendonitis is the inflammation of the petition and can usually be clinically distinguished by the presence of clinical crepitus as the Achilles tendon tries to glide back and forth along the inflamed petition. This sign together with pain, generally tends to increase with activity and the tenderness is normally felt along the whole length of the tendon. Achilles tendonitis on the other hand classically gets better with movement and is at its worst after a period of rest. The discomfort tends to be more localised into discrete areas and is more commonly found in cases where there has been either a partial or even a complete rupture in the past. (Clement et al 1994) Other pathologies can arise associated with the Achilles tendon, and for the sake of completeness we should briefly consider them as they could be potentially confounding factors in any trial which aims to consider tendonitis. Tendocalcinosis is an inflammatory process which involves the Achilles tendon but only at the point of insertion to the calcaneal bone. It typically will result in calcification and therefore should be considered a different entity to Achilles tendonitis as such. It is characterised by localised pain, and prominence of the calcaneal insertion of the tendon which may well be associated with a retro-tendon bursitis. (Williams 1986) If we apply the same rationale to the patella tendon, we are again faced with a bewildering array of terminology and conditions which tend to get lumped together as â€Å"tendonitis† and may also therefore be confounding factors in any study. We shall therefore spend a few paragraphs delineating them. Some authors point to the fact that conditions that had been previously referred to as tendonitis, when examined at a histological level, are found to be the result of collagen breakdown rather than inflammation (Khan et al 1996), and therefore suggest the title oftendinosis is more appropriate. (Cook et al 2000) (I) The whole issue of the role of the inflammatory process in the tendonopathies appears to be far from clear. An examination of the literature can point to work (such as that by Khan – above), who demonstrated that the prime histological changes were non-inflammatory and were more typical of fucoid, hyaline or fibrous degeneration with occasional calcific processes being identified. Other investigators however, point to the clinical picture which commonly includes the classic inflammatory triad of dolour, rub our and tumour (pain, redness and swelling)(Almekinders et al 1998). This, associated with the evidence of the relieving effect of NSAIA’s or corticosteroids(Friedberg 1997) leads to an ambiguous picture. The pathophysiology of this condition is most commonly thought tube related to jumping and landing activity which is the mechanism which appears to cause the rupture of the collagen filaments and hence the histological appearances. The characteristics of this type of condition are that it tends to be focal, and often in the region of the lower pole of the patella. Initially it tends to be self healing but as the chronicity increases, the pain levels can increase to the point where pain is experienced even at rest (Cook et al 2000) (II) This type of condition must clearly be differentiated from there-patella bursitis (Housemaid’s knee) which is often mistakenly diagnosed as a patella tendonitis. (Halaby et al 1999) Factors which appear to predispose to tendonopathy Many authors identify chronic overuse as being one of the major factors in tendonopathy generally. (Kist 1994) (King et al 2000). This applies equally to the occupational tendonopathy as much as the sports-related conditions. (Jon stone 2000) (Kraushaar et al 1999). We should acknowledge that the term overuse can refer equally to overuse in terms of repetitive action just as much as it can refer to overloading. The two factors being independent (but often related). Some of the current literature points to the fact that there can be differentiation in the spectrum of overuse injuries between those conditions that arise from some form of biochemical change in the structure of the tendon itself (Joss et al 1997), those that are associated with biomechanical changes (such as change in function or previous injury) (Alstom 1998) and those that arise as a result of ageing or other degenerative changes (Alstom et al 1995). These factors can arise as a result of, or independently from, other factors such as the fact that the anatomical path of a tendon can take it over (or in close proximity to) friction-inducing structures such as a bony prominence – as in the case of the tibias posterior tendon, (Benjamin et al 1998) or factors relating to the site of insertion of the tendon into the bone – as in the case of theAchilles-calcaneum interface.(Benjamin et al 1995) We can point to evidence that extraneous factors can also predispose to tendonopathy. There are genetic factors (Singer et al 1986), and a relationship to blood type (Joss et al 1989). The presence of certain concomitant chronic or debilitating illnesses can certainly be associated with tendonopathies (Kannur et al 1991) as can the chronic use of certain medications – most notably the fluoroquinolone group.(Huston 1994)(Ribard et al 1992). The mechanism in the latter case appears to be associated with an increase in the amount of MMP and its associated activity which seems to be associated with an increase in the rate of degradation of protein (especially collagen) in certain tissues. (Williams et al 2000). Other authors have identified biomechanical factors as being significant (rather than necessarily causal), in the development oftendonopathies, but we shall discuss this in specific relation to treatment, and so will not discuss it further here The spectrum of currently available treatment Before beginning any rational consideration of the various forms of treatment available, one must appreciate a common truth in medicine, and that is that different treatments and different patients will respond differently to a specific treatment modality, and one of the factors that will influence this phenomenon is the skill and experience of the practitioner concerned. For example, a surgeon may well find that he gets good results from tenotomise but poor results from eccentric exercises and therefore will recommend surgery. Physiotherapist may find the converse. It is therefore important to be critical of such factors in any appreciation and appraisal of different techniques for the treatment of the lower-limb tendonopathies. In this section we shall examine the available literature to try to obtain an overview of the various treatment modalities that are currently being prescribed and examine the rationale behind their use and efficacy Most authors seem to agree that, before considering the specific conditions, a general approach of conservative measures (such as load reduction, strengthening exercises, and massage) should be tried before other modalities such as medication and physical interventions(ultrasound etc.), and that surgery should only realistically be considered as a last resort. The only obvious exception to that approach would be when complete (or sometimes perhaps partial ) rupture of the tendon has occurred, and then surgery may well be considered the prime intervention. (Cook et al 2000) (I) Let us consider the various options in turn. In this section we will begin (again, for the sake of clarity), by specifically considering the options available for patella tendonitis. We accept that there will, of course, be overlap between the treatments for the various tendonopathies, but it makes for a rational approach to consider each in turn. The first comment that we must make is that, after examination of the literature it is noticeable that there are only a comparatively few well constructed, placebo controlled randomised trials in this area.(Almekinders et al 1998). Those that we can examine appear to suggest that the traditional treatments aimed at minimising the inflammatory processes in the condition are largely ineffective. The authors (Cooked al 2000) (II) suggest that this may well be because of the findings we have quoted earlier (Khan et al 1996) that histologically, the prime pathology is not inflammatory. Relative Rest Cook (et al 2000) (I) points to the fact that many strategies can rationally involve load reduction and the (now outmoded) instruction to â€Å"Stop everything and rest† is positively contraindicated. The rationale for this relates to the mechanisms that we have examined earlier in this piece. Immobilisation of a tendon is actually harmful as we can point to evidence (above) that shows that tensile stress and mechanical action not only stimulates collagen production, it also is vital in tendon to ensure it’s optimal fibre alignment. Rational treatment suggests that a programme of â€Å"Relative rest† may be beneficial. By that, the authors (Cook et al 2000)(I) suggest that activity should continue as long as the prime traumas of jumping, landing or sprinting can be avoided and reintroduced in a carefully graded fashion. Biomechanical Correction Because patella tendonitis is primarily related to jumping and sprinting sports ( in numbers that present clinically), we will consider treatment in relation to them. The forces that are generated in the patella tendon on landing after a jump are considerably greater than those that produced the jump in the first place. (Richards et al1996). It logically follows that if biomechanical methods can be employed to more efficiently minimise the forces, they would be best employed on landing strategies than jumping ones. One should appreciate that the energy-absorbing capacity of the limbs dependant, not only on the patella tendon, but factors at the hip and ankle as well. Studies show that the ankle and calf are the prime sites of absorbing the initial landing load (Richards et al 1996) and, if these structures are not biomechanically sound, then this will increase the forces transmitted to the knee. Prilutskii and his co-workers (et al 1993) completed a series of studies which showed that up to 40% of the energy absorbed on landing is transmitted proximally from the ankle/calf mechanism. It follows that it must be biomechanically sound if it is to absorb the 60% bulk of the load which otherwise would be transmitted upwards to the knee mechanism. Another set of studies (Prapavessis et al 1999) concluded that when flat-foot and fore-foot landings were compared, the latter generated less forces throughout the lower limb and that the forces could be reduced further (up to another 25%) by increasing the range of both hip and knee flexion on landing. There are a number of other potential biomechanical deficiencies that can be amenable to correction and should therefore be sought outspans planes may be an obvious anatomical problem detectable at an initial examination (Kaufman et al 1999), but there are other types of functional abnormality (such as excessively rapid pronation on landing) (McCrery et al 1999), that may require far more sophisticated evaluation. Outhouses inside shoes may go a long way to help these problems Some authors, (McCrery et al 1999), regard a reduced range of movement in the sub-taller joints as an aggravating factor which places and undue stress on the Achilles tendon and that manual mobilisation of the joint is indicated in these cases. Cry therapy In the light of the histological findings mentioned earlier,cryotherapy has a rational place in treatment. It is thought th Physiotherapy Management of Lower Limb Tendonopathies Physiotherapy Management of Lower Limb Tendonopathies A Systematic Review of the physiotherapy management of lower limb tendonopathies Tendonitis is a condition which is comparatively commonly seen in various clinics. The largest cohort of patients tend to have developed their condition as a result of various sports-related activities but it is acknowledged that there is a substantial cohort of RSI sufferers and occupation-related forms of tendonitis. (Kader et al 2002) In this piece we aim to review the various treatment modalities and to concentrate primarily on the eccentric muscle strengthening modalities of treatment, the rationale behind them and any evidence that they actually work. Before we can consider the direct question of eccentric loading as treatment for tendonopathies we must examine the rationale for its uses well as the basic science and theory behind the actual practice. We will do this largely by the mechanism of a literature review. Methodology In this review we shall be examining the literature for not only the methods that are currently employed in treating the various lower limb tendonopathies but also for justification for these methods and the quality of the science behind them. We shall therefore critically review the literature available and present it in a rational form. In addition to this we intend to present an overview of various factors in a wider picture that are relevant to our considerations. We shall consider the current views on the pathophysiology of tendonitis and the experimental evidence on the response of the tendon to exercise in general terms. Although it is accepted that the majority of patients currently seen in clinical practice with various forms of lower limb tendonitis are suffering from a sports related injury, we shall also look at the effects of ageing on tendon physiology as it is acknowledged that the elderly are another highly represented group with tendonitis. We conclude the preamble with a number of clinical considerations, most prominently the difficulties posed by the differences in nomenclature and terminology which renders both assessments and comparisons between clinical trials difficult. We conclude the dissertation with a review of various currently employed treatment modalities and the rationale behind them. We focus specifically on the use and place of eccentric muscle strengthening exercises in the spectrum of rational treatments.. Pathophysiology of tendonitis At the macro-anatomical level, the tendon is usually easily defined as a semi-rigid white or grey structure, generally found in close proximity to synovial joints. One of its prime functions is to transmit forces generated by muscles to the skeletal system, often inducing movement. (Huxley HE 1979). At the micro-anatomical level, it’s structure is very much more complex and requires a detailed examination before we can realistically and meaningfully consider the issues relating to the therapy of tendonitis. Tendons form part of the anatomical structures that are functionally grouped together as the extracellular matrix (ECM). The rate of turnover – both synthesis and degradation – is influenced by a number of different factors including metabolic and disease related factors, but the strongest influence on the turnover rate is mechanical stress, usually as a result of various degrees of physical activity. (Agar Pet al 2000) Tendon (and intramuscular) collagen, turns over at a rate which is about half as fast as myofibrillar protein turnover. The main physiological stimulus to turnover appears to be the multiple stimuli arising from mechanical or contractile activity.(Cuthbertson D et al2005) At the cellular level, degradation of collagen is mediated largely byte metalloprotease group of enzymes and synthesis is most strongly influenced by a number of different trophic factors which are released at the cellular level. (Algren MS. 1999) These growth factors are mainly responsible for both the transcriptional changes as well as the post-translational modifications that take place as a result of either physiological changes or disease processes. (Sand Meier et al 1997) Until comparatively recently, tendon tissue was thought to be fairly inert. Recent research work has given good supportive evidence that the internal metabolic processes, the internal vascular responses (Alstom et al 1994) and the actual catabolic turnover of the collagen protein in response to physical activity, is considerably greater than originally thought. The converse is also true, as inactivity appears to have the same inhibitory effect on tendon tissue as the better known effect of wasting in muscle tissue. (Abrahamson SO et al 1996). This effect is of particular importance in our considerations (later) when we consider that some authorities suggest that outright rest is inappropriate initial treatment for tendonitis. Collagen is a large polymer-type protein made up of many repeating subunits, (triple helices of polypeptides with a high proportion of proline and hydroxyproline). It is made by fibroblasts. In the muscle, it forms a basket-like network around the muscle fibres but then forms progressively more coherent and solid structure as it forms discrete tendon. In this way it allows the efficient transmission of forces generated by the myofibrils to the tendon – and hence to the bone. (Kjaer M 2004). Training, in the form of physical work, exercise or repetitive movements, will have a trophic effect on the tendon as a whole. Collagen turnover can be increased and there can be an overall increase in the amount of collagen protein in the tendon. (Herzog W et al 2002) Collagen, in the form in which it is found in a tendon, has enormous on-elastic tensile strength and a modest degree of ability to bend under lateral stress. As the amount of collagen in a tendon increases, the tendon’s mechanical (or more accurately, viscoelastic,) properties change. It decreases it’s stress levels for a given load, and thereby renders it more load resistant.(Fowls JL et al. 2000). Again this facts of great relevance to our clinical considerations later in this piece. The stiffness, or resistance to lateral stress, is a function of the cross-linking of sulphur bonds across the parallel bands of protein. In general terms, the more cross-links, the stiffer the tendon. The degree of cross-linking is a result of a complex interaction between a number of enzyme systems in the matrix of the tendon. (Hamill OP et al.2001) Polyglycans are an important feature of this enzyme cascade and become an increasingly important functional component as age increases. Older or ageing collagen will tend to exhibit glycolated cross links in addition to the sulphur links of youth. This is part of the reason why older tendons are less flexible (and possibly more prone to injury). (Inglemark BE 1948). The functional significance of these links is that they render the tendon even stiffer and less able to bend.(Davidson PF 1989).Understanding these processes is fundamental to the prescribing of a rational treatment regime for tendon injuries and other pathologies. It is also important to have a complete understanding of both the vascular and neurologically mediated adaptation processes that are present in the my-tendon complex. These work on a far more rapid and immediate time frame than the processes that we have just described, and are primarily responses to rapid changes in the mechanical loading stresses. As muscle tissue develops physiologically, there is a symbiotic relationship between the muscle and the extracellular matrix. The various physiological mechanisms that stimulate muscle growth and hypertrophy appear to have a similar effect on the extracellular matrix. (MacLean et al 1991) But in the latter case, they are less well understood. We know that that significant and repeated mechanical loading will trigger off, or initiate a process, which starts with the activation of trophic gene in a cellular nucleus, (Banes AJ et al.1999), it progresses through the complex processes of protein synthesis and functionally ends with the deposition of collagen in the tendon tissue.(Yasuda et al 2000) Responses of the tendon to exercise There would appear to be some form of integration between the muscular and the extracellular matrix signalling pathways, which optimises the co-ordinated activity of the trophic processes in response to the stimuli (which can be both loading and tensile in nature), which produce the response in the first place. (Viidik A.1993). This co-ordination mechanism must exist, as it is a well-recognised phenomenon that a tendon hypertrophies to accommodate the increased mechanical stress that its associated hypertrophied muscle produces. (Derwin et al 1999) Considerable research effort has been expended in trying to delineate the mechanism, but to date, the results have not increased our understanding of the situation significantly. (Vierck J et al 2000) Specific studies in this area have been able to show a clear correlation between collagen response and an increase in physical training. (Langberg et al 2001). The response was detectable after a 4week training programme and was maximal at 11 weeks. When we consider the pathophysiology of RSI (repetitive strain injury) or even chronic overload syndrome, the stimuli that can produce muscle hypertrophy or increase muscle fibrosis can also produce fundamental changes in the tendon structure. (Birk DE et al 1990) These changes can include changes in both the chemistry and the functionality of cross bonding of the collagen fibres, (Barnard K et al1987), changes in the size of the collagen fibrils, areas of locally increased blood flow (known as hyper vascularisation zones), and an increase in the catabolic processes which can result in either (or both) collagen being synthesised and laid down, or increase in fibroblastic activity which increases the fibrous component of the tendon. (Greenfield EM et al 1999) It is a fundamental recognition of the fact that these processes require â€Å"adjusted loading† rather than an enforced absence of loading(immobilisation) to reverse the physiological processes, that underpins most of the thrust of this review.( Howell JN et al 1993), (Jà ¤rvinenTAH et al 2002) The experimental evidence to support this view comes from the classic set of investigations by Gibson (et al 1987) who compared the rate of collagen synthesis and turnover in an immobilising long-cast leg with the rate of turnover in the unaffected leg. The rate of collagen synthesis dropped by half over a seven week period in the immobilised leg. The investigators also found an adaptive (and compensatory)reduction in the rate of collagen degradation which had the overall effect of reducing the protein loss in the tendons. In the overall context of our investigation it is also important to note that the authors also found that minimal electrical stimulation of the muscle (5% of maximum voluntary contraction for 1 hr. per day),increased protein synthesis to such an extent that there was no net protein loss over the same seven week period of the trial. (Gibson etal 1989) In a study that was remarkable for its invasiveness (the authors took repeated biopsies of human patella tendon after periods of exercise), Miller (et al 2004) demonstrated that tendon collagen synthesis showed a 30% rise within 6hrs of exercise and up to a 50%rise within a 24 hr. period. This was found to exactly follow the pattern of protein synthesis in skeletal muscle. This finding is strongly supportive of the assertions made earlier in this essay, that there would appear to be a mechanical or humeral mechanism that links the trophic effects that are apparent in both tendon and skeletal muscle. Various authors have postulated different mechanisms (it has to be said with scant evidence), including integrin’s, (Levenhagen et al2002), growth factors including transforming growth factor beta (TGFB) (Moore et al.2005), or mechano growth factor (MGF) (Rennie et al 2004),which they suggest may be responsible for the co-ordination of the trophic effects of perimysium collagen, tendon collagen and the myofibrils. More concrete evidence exists (and is arguably of greater relevance to our investigation here), for the fact that dietary protein alone can produce a trophic stimulus for tendon collagen. (Jefferson Kimball 2001). It is postulated that there is some form of amino acid sensor that is responsive to the availability of amino acids. This haste effect of changing the availability of various protein kinases in the extracellular matrix generally and a subsequent enzymatic cascade which results in an increase in various anabolic signalling molecules which are, in turn, responsible for the activation of mRNA. This is then responsible for the increased synthesis of collagen (and other related proteins), in tendon and other extracellular matrix tissues. This series of very elegant experiments was done in carefully controlled conditions which removed the possibility of other anabolic factors being relevant as the only variable was the availability of amino acids. (Cuthbertson et al 2005) There is further evidence of the effect of exercise on tendon structure in the form of the set of experiments by Rennie and disco-workers. Looking specifically at the metabolism of collagen Rennie found that after strenuous exercise, the rate of incorporation of a marker into tendon collagen followed a specific pattern (Rennie Tipton 2000). There was a latent period of about 90 mines after exercise where there was no change in metabolic rate. It was then noticed that there was a dramatic increase to about 5 times normal rates of synthesis, which peaked at about 12 hrs., was maintained for about 12hrs, and then declined over the next 48 hrs. In line with the findings of Cuthbertson (above) the investigators noted that the rise in levels of synthesis is greatest if associated with an amino acid load just pre- or post-exercise, and this effect can be further enhanced by the administration of insulin secretagogues(such as glucose). There is therefore little doubt that feeding helps the post exercise response. (Atherton P et al 2005) The effects of ageing on tendon pathophysiology We have already commented, in passing, on the physiological effects of ageing in relation to the polyglycan cross bonding in tendons. There are a number of other changes which will naturally occur in relation to advancing years, which are of direct relevance to our considerations here. It is clearly a matter of observation that muscles, bones and tendons deteriorate as age increases. This deterioration leads to physical symptoms such as loss of strength, mobility and suppleness together with an increase in fatigability and a general reduction in proprioception. This condition is sometimes called â€Å"sarcopenia†.(Forbes 1987) Epidemiological studies (Dorrens et al 2003), provide good evidence to support the popularly held view that an active lifestyle into old age is more likely to support a higher level of bone density, muscle bulk and tendon flexibility, than a sedentary one. One can postulate that the trophic mechanisms referred to above, stay active for longer when constantly stimulated by mechanical activity. One effect of ageing that has been experimentally demonstrated, is that the trophic effects of available amino acids in the bloodstream are not as great in the elderly as in the young. The elderly appear to have an ability to develop resistance to the trophic effects of amino acids, which was not present when they were younger. (Cuthbertson et al 2005) Another physiological change that can be demonstrated in the elderly, is a reduced RNA : DNA ratio in tendon tissue, which is a marker of a reduced ability to manufacture protein. This, together with reduction in the amount of detectable anabolic signalling proteins, seems to be central in the failure of the muscle and tendon synthesising mechanisms. (Smack et al.2001). If we add these findings to other work of Smack (et al 2001) and Leverhagen (et al 2002) which shows that the elderly can show responsiveness in terms of trophic changes in the collagen content of tendons by manipulation of the diet. Both studies showed that maximising the protein : energy ratio of ingested food is a reasonable strategy. It should also be noted that they also demonstrated that one has to be careful to keep the energy content of the food low in order to minimise unwanted weight gain. The elderly could reasonably be assisted to maximise the benefit they get from training (resistance training in these particular studies), by integrating it with feeding concentrated in the immediate pre- or post-exercise period. This appears to have the effect of increasing the positive synergistic relationship between exercise and amino acid delivery.( Williams et al. 2002) Clinical considerations Differential diagnosis The first and possibly most fundamental issue that we have to consider when looking at the issues of the treatment of tendonitis, is the issue of correct diagnosis. This, sadly, is compounded by the fact that there appear to be several different terminology vocabularies in common clinical use. It therefore can be difficult to directly compare treatment studies of â€Å"tendonitis â€Å" unless one has direct and clear diagnostic criteria. (Saxena 1995) Tendonitis may be taken in some medical circles to include all those conditions which come under the broad heading of â€Å"painful overuse tendon conditions† (Khan et al 1999). This is generally accepted by the uncritical, as meaning that this equates with a painful inflammatory reaction in the tendon tissue. Histological investigation of the typical chronically painful tendon, generally shows an absence of the polymorphonuclear and other associated inflammatory cells. In some literature we can see the emergence and replacement of the term tendonitis with tendinitis. This latter term tends to be defined as pertaining to areas of collagen degeneration, increased ground substance and neo-vascularisation. (Purdue et al 1996) To both illustrate and clarify the point, let us consider thevarious clinical entities that may either present like, or may be diagnosed as, â€Å"tendonitis†. For ease of classification and clarity, in this section we shall consider the term â€Å"tendonitis† in specific relation to the Achilles tendon. Williams (1986) produced the (arguably) most commonly currently accepted definitions of Achilles tendon pathologies. He classified them into:- Rupture, Focal degeneration, Tendinitis, Per tendonitis (peritendonosis), Mixed lesions, Origin/insertion lesions, Other cases such as metabolic/rheumatic causes. In common clinical parlance, any of them can be referred to, with reasonable accuracy, as â€Å"tendonitis†. (Galloway et al 1999) The aetiologies can vary (and this may well have a bearing on treatment), from trauma, reduced flexibility, abnormal or changed biomechanical considerations (such as excessive pronation, supination or limb length inequalities) to name but a few. (Saxena, A 1998) It should be noted that the anatomy of the Achilles tendon is unusual and certainly different from any other in the lower limb. It does not have a true synovial sheath but a petition which extends from its origin in the muscle to its insertion in the calcaneus. Peritendonosisis therefore a commonly misdiagnosed as Achilles tendonitis. It is also clinically significant that there is a region of decreased vascularity in the tendon, which is typically about 6 comes above its insertion (Hume 1994). The clinical difference between these two conditions is that true Achilles tendonitis may, if chronic, be characterised by fucoid, or fatty focal degenerative, changes in the tendon itself, where asperitendonitis will not involve the Achilles tendon at all. (Kvist1994). These degenerative changes may be extremely resistant to non-surgical forms of treatment. In practice, the two conditions may well be presenting the same individual. (Killer et al 1998) The differentiating signs are, however, fairly easy to detect and the two conditions can be separately distinguished in most cases. Per tendonitis is the inflammation of the petition and can usually be clinically distinguished by the presence of clinical crepitus as the Achilles tendon tries to glide back and forth along the inflamed petition. This sign together with pain, generally tends to increase with activity and the tenderness is normally felt along the whole length of the tendon. Achilles tendonitis on the other hand classically gets better with movement and is at its worst after a period of rest. The discomfort tends to be more localised into discrete areas and is more commonly found in cases where there has been either a partial or even a complete rupture in the past. (Clement et al 1994) Other pathologies can arise associated with the Achilles tendon, and for the sake of completeness we should briefly consider them as they could be potentially confounding factors in any trial which aims to consider tendonitis. Tendocalcinosis is an inflammatory process which involves the Achilles tendon but only at the point of insertion to the calcaneal bone. It typically will result in calcification and therefore should be considered a different entity to Achilles tendonitis as such. It is characterised by localised pain, and prominence of the calcaneal insertion of the tendon which may well be associated with a retro-tendon bursitis. (Williams 1986) If we apply the same rationale to the patella tendon, we are again faced with a bewildering array of terminology and conditions which tend to get lumped together as â€Å"tendonitis† and may also therefore be confounding factors in any study. We shall therefore spend a few paragraphs delineating them. Some authors point to the fact that conditions that had been previously referred to as tendonitis, when examined at a histological level, are found to be the result of collagen breakdown rather than inflammation (Khan et al 1996), and therefore suggest the title oftendinosis is more appropriate. (Cook et al 2000) (I) The whole issue of the role of the inflammatory process in the tendonopathies appears to be far from clear. An examination of the literature can point to work (such as that by Khan – above), who demonstrated that the prime histological changes were non-inflammatory and were more typical of fucoid, hyaline or fibrous degeneration with occasional calcific processes being identified. Other investigators however, point to the clinical picture which commonly includes the classic inflammatory triad of dolour, rub our and tumour (pain, redness and swelling)(Almekinders et al 1998). This, associated with the evidence of the relieving effect of NSAIA’s or corticosteroids(Friedberg 1997) leads to an ambiguous picture. The pathophysiology of this condition is most commonly thought tube related to jumping and landing activity which is the mechanism which appears to cause the rupture of the collagen filaments and hence the histological appearances. The characteristics of this type of condition are that it tends to be focal, and often in the region of the lower pole of the patella. Initially it tends to be self healing but as the chronicity increases, the pain levels can increase to the point where pain is experienced even at rest (Cook et al 2000) (II) This type of condition must clearly be differentiated from there-patella bursitis (Housemaid’s knee) which is often mistakenly diagnosed as a patella tendonitis. (Halaby et al 1999) Factors which appear to predispose to tendonopathy Many authors identify chronic overuse as being one of the major factors in tendonopathy generally. (Kist 1994) (King et al 2000). This applies equally to the occupational tendonopathy as much as the sports-related conditions. (Jon stone 2000) (Kraushaar et al 1999). We should acknowledge that the term overuse can refer equally to overuse in terms of repetitive action just as much as it can refer to overloading. The two factors being independent (but often related). Some of the current literature points to the fact that there can be differentiation in the spectrum of overuse injuries between those conditions that arise from some form of biochemical change in the structure of the tendon itself (Joss et al 1997), those that are associated with biomechanical changes (such as change in function or previous injury) (Alstom 1998) and those that arise as a result of ageing or other degenerative changes (Alstom et al 1995). These factors can arise as a result of, or independently from, other factors such as the fact that the anatomical path of a tendon can take it over (or in close proximity to) friction-inducing structures such as a bony prominence – as in the case of the tibias posterior tendon, (Benjamin et al 1998) or factors relating to the site of insertion of the tendon into the bone – as in the case of theAchilles-calcaneum interface.(Benjamin et al 1995) We can point to evidence that extraneous factors can also predispose to tendonopathy. There are genetic factors (Singer et al 1986), and a relationship to blood type (Joss et al 1989). The presence of certain concomitant chronic or debilitating illnesses can certainly be associated with tendonopathies (Kannur et al 1991) as can the chronic use of certain medications – most notably the fluoroquinolone group.(Huston 1994)(Ribard et al 1992). The mechanism in the latter case appears to be associated with an increase in the amount of MMP and its associated activity which seems to be associated with an increase in the rate of degradation of protein (especially collagen) in certain tissues. (Williams et al 2000). Other authors have identified biomechanical factors as being significant (rather than necessarily causal), in the development oftendonopathies, but we shall discuss this in specific relation to treatment, and so will not discuss it further here The spectrum of currently available treatment Before beginning any rational consideration of the various forms of treatment available, one must appreciate a common truth in medicine, and that is that different treatments and different patients will respond differently to a specific treatment modality, and one of the factors that will influence this phenomenon is the skill and experience of the practitioner concerned. For example, a surgeon may well find that he gets good results from tenotomise but poor results from eccentric exercises and therefore will recommend surgery. Physiotherapist may find the converse. It is therefore important to be critical of such factors in any appreciation and appraisal of different techniques for the treatment of the lower-limb tendonopathies. In this section we shall examine the available literature to try to obtain an overview of the various treatment modalities that are currently being prescribed and examine the rationale behind their use and efficacy Most authors seem to agree that, before considering the specific conditions, a general approach of conservative measures (such as load reduction, strengthening exercises, and massage) should be tried before other modalities such as medication and physical interventions(ultrasound etc.), and that surgery should only realistically be considered as a last resort. The only obvious exception to that approach would be when complete (or sometimes perhaps partial ) rupture of the tendon has occurred, and then surgery may well be considered the prime intervention. (Cook et al 2000) (I) Let us consider the various options in turn. In this section we will begin (again, for the sake of clarity), by specifically considering the options available for patella tendonitis. We accept that there will, of course, be overlap between the treatments for the various tendonopathies, but it makes for a rational approach to consider each in turn. The first comment that we must make is that, after examination of the literature it is noticeable that there are only a comparatively few well constructed, placebo controlled randomised trials in this area.(Almekinders et al 1998). Those that we can examine appear to suggest that the traditional treatments aimed at minimising the inflammatory processes in the condition are largely ineffective. The authors (Cooked al 2000) (II) suggest that this may well be because of the findings we have quoted earlier (Khan et al 1996) that histologically, the prime pathology is not inflammatory. Relative Rest Cook (et al 2000) (I) points to the fact that many strategies can rationally involve load reduction and the (now outmoded) instruction to â€Å"Stop everything and rest† is positively contraindicated. The rationale for this relates to the mechanisms that we have examined earlier in this piece. Immobilisation of a tendon is actually harmful as we can point to evidence (above) that shows that tensile stress and mechanical action not only stimulates collagen production, it also is vital in tendon to ensure it’s optimal fibre alignment. Rational treatment suggests that a programme of â€Å"Relative rest† may be beneficial. By that, the authors (Cook et al 2000)(I) suggest that activity should continue as long as the prime traumas of jumping, landing or sprinting can be avoided and reintroduced in a carefully graded fashion. Biomechanical Correction Because patella tendonitis is primarily related to jumping and sprinting sports ( in numbers that present clinically), we will consider treatment in relation to them. The forces that are generated in the patella tendon on landing after a jump are considerably greater than those that produced the jump in the first place. (Richards et al1996). It logically follows that if biomechanical methods can be employed to more efficiently minimise the forces, they would be best employed on landing strategies than jumping ones. One should appreciate that the energy-absorbing capacity of the limbs dependant, not only on the patella tendon, but factors at the hip and ankle as well. Studies show that the ankle and calf are the prime sites of absorbing the initial landing load (Richards et al 1996) and, if these structures are not biomechanically sound, then this will increase the forces transmitted to the knee. Prilutskii and his co-workers (et al 1993) completed a series of studies which showed that up to 40% of the energy absorbed on landing is transmitted proximally from the ankle/calf mechanism. It follows that it must be biomechanically sound if it is to absorb the 60% bulk of the load which otherwise would be transmitted upwards to the knee mechanism. Another set of studies (Prapavessis et al 1999) concluded that when flat-foot and fore-foot landings were compared, the latter generated less forces throughout the lower limb and that the forces could be reduced further (up to another 25%) by increasing the range of both hip and knee flexion on landing. There are a number of other potential biomechanical deficiencies that can be amenable to correction and should therefore be sought outspans planes may be an obvious anatomical problem detectable at an initial examination (Kaufman et al 1999), but there are other types of functional abnormality (such as excessively rapid pronation on landing) (McCrery et al 1999), that may require far more sophisticated evaluation. Outhouses inside shoes may go a long way to help these problems Some authors, (McCrery et al 1999), regard a reduced range of movement in the sub-taller joints as an aggravating factor which places and undue stress on the Achilles tendon and that manual mobilisation of the joint is indicated in these cases. Cry therapy In the light of the histological findings mentioned earlier,cryotherapy has a rational place in treatment. It is thought th

Salmonella †description, pathogenesis, symptoms Essay -- Medicine Foo

Salmonella – description, pathogenesis, symptoms Salmonella is a gram-negative bacillus that causes inflammation of the GI tract and in some cases, if the immune response is not sufficiently powerful and treatment is not administered, can become systemic and cause even more serious conditions throughout the body. After ingestion, these bacteria cause infection by invading the epithelial cells of the small intestine and macrophages. Though there are more than two thousand different subspecies of Salmonella, few of them are able to cause serious conditions in humans—for most, the disease resolves itself in a matter of days. Those who are most affected by Salmonella infection are infants, the elderly, and people with compromised immune systems. Some of the main conditions caused by Salmonella are gastroenteritis, enteric fever, and bacteremia, while the general symptoms of salmonella include vomiting, nausea, diarrhea, and abdominal pain. While there are typically few to no long-term effects as a result of a Salmonella infectio n, more serious complications may arise. The mention of the latest salmonella outbreak is often enough to make anyone’s stomach turn—people in the US and other countries have long maintained a strong aversion to, and even anxiety towards, the very idea of salmonella entering the food supply. It is this fear that drives the government and the agricultural industry, which are also prey to the overwhelming dread of the salmonella contamination, to take extreme measures to prevent the slightest risk of salmonella contamination and that continually puts the public on edge—but despite this widespread apprehension, much of the public remains ignorant of what salmonella really is. For many, it is but an ominous nam... ...=0>. Lunsford, Andrea A. â€Å"MLA Format for In-text Citations.† The St. Martin’s Handbook. Fifth Edition. Bedford/St. Martin’s. 20 July 2008. . MayoClinic. â€Å"Salmonella infection.† Infectious Disease. 12 Apr. 2007. Mayo Foundation for Medical Education and Research. 19 July 2008. . MedicineNet. â€Å"Salmonella.† Diseases and Conditions. MedicineNet, Inc. 19 July 2008. . Slack, John M. and I. S. Snyder. Bacteria and Human Disease. Chicago: Year Book Medical Publishers, Inc., 1978. World Health Organization (WHO). â€Å"Drug-resistant salmonella.† Media Centre. April 2005. World Health Organization. 19 July 2008. .

International Buisness

(a) What was the critical catalyst that led Kodak to start taking the Japanese market seriously?until early 1980s when Fuji launched an aggressive export drive, attacking Kodak in the north American and European markets. ====================(b) From the evidence given in the case do you think Kodak’s charges of unfair trading practices against Fuji are valid? Support your answer.The charges were very valid.the Japanese government helped to create a ‘ profile sanctuary’ for Fuji in Japan by systematically denying Kodak access to Japanese distribution channels for consumer film and paper. Kodak claims Fuji has effectively shut Kodak products out of four distributors that have a 70% share of the photo distribution market. Fuji has an equity position in two of the distributors, gives large year –end relates and cash payments to all four distributors as a reward for their loyalty to Fuji, and owns stakes in the banks that finance them. Kodak also claims that Fuj i uses similar tactics to control 430 wholesale photo furnishing labs in Japan to which it is the exclusive supplier. Moreover Kodak’s petition claims that the Japanese government has actively encourages these practicesWhich company is truly Multinational ? Why?COMPANY A IS Geocentrism ORIENTATION [GLOBAL MULTI ORIENTED]Integrated global outlook More powerful total company throughout Better quality of products and services Worldwide utilization of best reaources Improved local country management Greater commitment to global objectives Higher global profitsCOMPANY B– IS ETHOCENTRIC Ethnocentric Orientation †¢ domestic market extension concept: †¢ Domestic strategies, techniques, and personnel are perceived as superior †¢ International customers, considered secondary †¢ International markets regarded as o outlets for surplus domestic production †¢ International marketing plans o developed in-house by international division 2 List three differences between Company , Multi National company and Trans Multi National Company ? Content of the Four Basic Multinational Strategies a) Explain why MNCs have located R & D centres in developing countries?SOME OF THE DEVELOPING COUNTRIES OFFER(a) access to highly qualified scientists as shortages of research personnel emerge in certain fields in industrialised countries, (b) Cost differentials in research salaries between developing and industrialised countries, and (c) rationalisation of operations, assigning particular affiliates the responsibility for developing, manufacturing, and marketing particular products worldwide.(b) Mention the areas where R & D activities can easily be decentralised.1.INTEGRATED CHIPS/OPTICAL DATA DEVICESFor instance, Sony Corporation of Japan has around nine R & D units in Asian developing countries. It has three units in Singapore conducting R & D on core components such as optical data shortage devices, integrated chip design for aud io products and CD-ROM drives, and multimedia and microchip software.2. VIDEO/ DESIGN/DERIVATIVE MODELS It has three units in Malaysia working on video design, derivative models and circuit blocks for new TV chases, radio cassettes, discman and hi-fi receiver designs.3.DESIGN UNIT FOR COMPACT DISCS/RADIO CASSETTES ETC It has one unit in Republic of Korea focusing on the design of compact discs, radio cassettes, tape recorders, and car stereos.4.DESIGNING/DEVELOPING RECORDERSIt has one in Taiwan designing and developing video tape-recorders, minidisk players, video CDs, and duplicator. Finally, it has one unit in Indonesia focusing on the design of audio products.Such units often work in collaboration with science and technology institutes in the host country. For instance, Daimler Benz has established such a unit in Bangalore, India, in collaboration with the Indian Institute of Science to work on projects related to its vehicles and avionics business. Current work includes interfac e design of avionics landing systems and smart GPS sensors for use by the group’s business worldwide.VARIABEL COST 27000 30000 57000FIXED COST 13000 13000 2600040000 43000 830001. The Profit Volume ratio [pvr] pvr=contribution/ sales =sales-variable cost / sales = 95000-57000/95000= 0.40 ====================== 2. Fixed Expenses=======26000 ======================= 3. Break-Even Sales Sales- variable = contribution margin Break even sales= total annual fixed cost ___________________ Contribution margin/total sales =26000/ 0.40 =65000.4. Percentage of margin of safety †¢ Subtract from the projected sales the amount of sales you need to break even. For example, if you anticipate sales of $95,000, but only need $65,000 to break even, subtract $65,000 from $95,000 to get a safety margin of $30,000. †¢ 2Divide the safety margin by the projected sales to find the margin of safety ratio. In this example, divide $30,000 by $95,000 to get 0.315. †¢ †¢ 3 Multiply the margin of safety ratio by 100 to find the margin of safety percentage. In this example, multiply 0.315 by 100 to get an 3.15 percent margin of safety.

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buy custom Decision Support Systems Network Flow Models essay Decision support system enables modeling of data and influencing decision making basing the reason on the data. In many successful businesses, decisions are made after analyzing data in order to suggest strategies and solutions. This is important in that it becomes easy to predict the future performance of the business. Decision support systems (DSS) are computer applications with human as a major component. The systems can analyze large loads of data effectively and guide the human component in making choices. When DSS was introduced in businesses, many thought that the systems belong to certain areas in business. However, nowadays, many businesses have actually incorporated the systems in all aspects of their operations; for instance, the systems have been applied in the budget sheets, data concerning sales, and in forecasts such as in projects. Network flow models are an example of a DSS; the ability to predict the success or failure of programs by using the arcs and the nodes is an interesting aspect of the network model. For instance, in case of project management, some of the key procedures include evaluation of the program and review of techniques used. The use of network model enables determination of success of the project. To determine this, the project is represented as a network flow models and by using node interdependency, it becomes easy to predict the performance of the project. The network model provides a clear picture of a system; this enhances understanding through visual representation. The network has nodes and branches, the nodes represent locations while the branches represent a flow by joining the nodes. When a program or a project is represented inform of a network flow, it is efficient to identify an existing problem and identify ways to deal with the problem. Buy custom Decision Support Systems Network Flow Models essay

Business Intelligence Plan Essays

Business Intelligence Plan Essays Business Intelligence Plan Essay Business Intelligence Plan Essay Business Intelligence Plan Executive Summary The purpose of this report is to explain the importance of Business Intelligence and all of its components for implementation into the business structure. During the recent years obtaining useful information in real time has become something that is extremely important, if not even a critical, factor of success for companies. The time managers have available for use in making business decisions has been reduced dramatically. Competitive pressures are now requiring that businesses make intelligent decisions based on their incoming business data, and these decisions ust be made immediately (Business Intelligence and Data Warehousing, 2005, p. 5; Hocevar Jaklic, 2010, p. 91). Businesses are looking at tools that will enable them to keep up with technology and its swift movement throughout the business environment. The tool that will enable those managers to do this is called business intelligence. Due to the swift pace of todays business environment, these systems of business intelligence have become an almost indispensable part of the success of many organizations. With the aid of business intelligence, managers are able to fficiently and effectively detect important trends, analyze the behavior of customers and facilitate expedient decision-making (Hocevar Jaklic, 2010, p. 91). Business Intelligence is defined as a broad concept which includes the appropriate orientation of the entire organization. It deals with the acquisition, management and analysis of large amounts of data about business partners, products, services, customers and suppliers, activities and transactions between them (Lu Zhou, 2000, p. 3; Hocevar Jaklic, 2010, p. 92). The implementation plan provided will allow the stakeholders to nalyze the many different ways in which business intelligence will help the company grow. In this implementation there are several different structures that will assist the company with business intelligence. Areas covered will include a comprehensive review ot Business Intelligence, data sources and characteristics in the organization, data governance and quality overview, the selection of a data mining vendor, business analytics summary along with the selected vendor, Bl service provider value and provider selection, and lastly a business dashboard with the vendor comparison. Introduction to Business Intelligence According to Skriletz (2002) reviewing the principles behind Bl best practices and technology innovations reveals some interesting points about managing Bl strategically. The principles are to: Create stability in the basic structures of data fundamental for providing Bl and running the business. Ensure that each data element stands on its own as a fact or attribute. Keep an enterprise-wide focus, not a departmental, regional or other category focus. Make Bl not simply the analytical report, but the information a manager or executive needs in order to make an informed decision. Use several different Bl technologies that play well together. The organizational roles that will benefit from business intelligence (81) would be marketing managers, medical professionals, Logistic managers, campaign managers, HR managers, and also office managers. When effectively integrated into processes, Bl can help an organization meet mission-critical goals such as improving sales results, growing customer satisfaction, workflow processes, advancing corporate goals including sustainability management, cultivating return on investment, and saving lives (Felix, 2009). A component of Bl would be Data. This component is considered to be one of the key components of business intelligence. When implementing business strategies an important component most times is the data. Data is always created in order to derive at business decisions that are being made. The source of the data will also be extremely important and will aid in understanding trends and issues that exists for the business. Another component is the data quality. This is an essential component of Bl for arriving at valid business decisions. Similar data can be stored in multiple repositories within a single business; one example would be he inventory of items for sale. When considering data sources, it is important to understand if there is a recognized authoritative source for a specific type of data. In many enterprises, the data required for making business decisions is created by wide ranging applications, perhaps from separate lines of business (Theme 1). Bl systems today have the capacity to work with numerous types of data such as numerical or non-numerical data. The quality ot this data is as important as any other data. The difference in the level of data quality is one of the many factors that ay explain why some organizations are successful with their Bl initiative while some are not so successful (Isik, 0. , Jones, M. C. , Sidoroya, A. 2011). Component three is Data Analytics. This component is used for the analysis of data. Data analytics refers to the business intelligence technologies that are grounded for the most part in data mining and statistical analysis. Due to the success that has been achieved overall by the data mining and statistical analysis community, data analytics continues to be an active area of research (Hsinchun, Chiang, Storey, 2012). Data analytics are tructured in statistical theories and models, multivariate statistical analysis. It also covers other analytical techniques such as regression, factor analysis, clustering, and discriminant analysis that have been used and have been successful in innumerable business applications (Hsinchun, Chiang, Storey, 2012). Also, in order to create a Business Intelligence environment you would need to build an analytical data warehouse for managers. In many institutions, the most important decision metrics are calculated based on information obtained from numerous systems (Mircea Andreescu, 2009). An industry that could and probably does benefit from the application of business intelligence would be Industrial-organizational (1/0) Psychology. Psychological research is riddled with data that is essential to the outcome of the research being done. Data analytics and data quality is essential to research. In doing research there is much value that can be derived from the use of business intelligence. Because one of the components is data analytics this adds direct value to the research. Research is a compilation of data that is used for validating theories. Industrial-organizational psychologists help companies bring bout compliance and raise employees productivity in the workplace. They will also focus on the operation and design of organizations (Feldman, 2013). The scientific method in psychology require that the approach used by psychologists to systematically acquire knowledge and understanding about behavior and other phenomena of interest is done in a way that can be explained, seen, and proven with more accuracy (Feldman, 2013). The potential value that could be derived from its use is that you can achieve valid data, as well as being able to use the statistical data that s derived using methods such as factor analysis, clustering, and regression in a way that aids in achieving reliable data. For instance, if they are doing research on emotional intelligence because of using data quality and data analytics researchers may be able to find out how to have increased efficiency in communication that will lead to the resulting ability to establish mutually beneficial working relationships (Bennett, 2009). Business Intelligence adds value to the data that is being gathered by providing the 1/0 psychologists with a tool for providing the companies that they re working for researched data and valuable information that can aid in the enhancement of employee/employer relationships. It can also lead to improved decision making for the companies also. In the next section of this paper we will be discussing the data sources and also characteristics in the organization. This section will give some clarity on data and how it is used in Business Intelligence. Data Sources and Characteristics in the Organization The Term big data has emerged to describe the growth ot data along with systems and technology required to leverage it. As with many new technologies, the term has yet to be universally defined, but generally speaking, big data represents data sets such as structured and unstructured data that can no longer be easily managed or analyzed with traditional or common data management tools, methods and infrastructures (Rogers, 2011). Even today, the scope of big data is growing so rapidly. It is growing beyond niche sources to include sensor and machine data, transactional data, metadata, social network data and consumer authored information (Rogers, 2011). There is a lot of room for research opportunities that xists for Business Intelligence. It can be used for managing semi-structured information (Negash, 2004). Data Sources Structured data is going to be produced by a generally large amount of information that includes a vast amount of raw data. Structured data is anything that has an enforced composition to the atomic data types. Structured data is going to be managed by technology and it allows for querying and reporting against predetermined data types and understood relationships (Weglarz, 2004). Structured data typically resides in databases. Such data is organized into tables with columns nd rows of defined data types; relationships between various data fields and tables are clearly defined. Some of the most common are relational database management systems (RDBMS) that are capable of handling large volumes of data such as Oracle, IBM DB2, MS SQL Server, Sybase, and Teradata (Brannon, 2010). Unstructured data is going to consists of any data that is stored in an unstructured format at an atomic level. That is, in the unstructured content, there is a no conceptual definition and no data type definition in textual documents, a word is simply a word (Weglarz, 2004). Unstructured data is going to reside outside of structured databases. This data includes electronic documents, PowerPoint presentations, spreadsheets, email, images, schedules, IM logs, and Multimedia files, etc. This data will also usually reside on individual computers or on file servers (Brannon, 2010). HR Data Sources Human Resource (HR) collects and utilizes data as a direct result of their daily activities. They utilize unstructured data at a high volume and also have a high volume of structured data that they have to handle. They are collecting data on prospective employees, current employees, and even former employees. Information such as payroll, hours worked, vacation time, sick time, days absent, performance evaluations, pay grade, raises, age, date of birth, start date, end date, Job title, etc. need to be input and stored into a myriad of spreadsheets that exists within a database that is designated for that specific information. This activity of collecting information and inputting information leads to high volumes of workflows and massive amounts of related data (PemmaraJu, 2007). As HR is called on as a partner in corporate decision making, it must first began by taking inventory of what is being easured and how. HR first needs to make sure the right applications and technologies are in place. Even though human resource information systems are increasingly implemented, if the proper tools are not available to access the data in a meaningful way, the data collected is of little use. An abundance of data should never be confused with implementing true workforce analytics (PemmaraJu, 2007). Importance of Data Characteristics Business intelligence can attord an organization wit n the means to an end. There is so much data that needs to be taken into account when conducting business that it is rucial that a business has a way in which to maintain all information needed. When using Bl data characteristics will aid in the success of Bl. When making decisions in regards to business matters data characteristics will weigh heavily on the outcome of the decision. Having sound and effective data is going to be imperative. According to Sauter (2011, p. 3) good decision making means we are informed and have relevant and appropriate information on which to base our choices among alternatives. Data Characteristics Relevance One characteristic is the relevance of the data. Relevance of the data can be defined s a function of the choices and alternatives available to the decision makers (Sauter, 2011, p. 78). Relevance is going to be of value to the HR department because of the amount of information that they will have stored on each employee. Maintaining only needed information according to relevance is going to be essential to quality, timeliness, and storage space. Reliability Many will assume that the data is correct if they are included in the database; designers therefore need to ensure that they are accurate. They should always verify the input of the data and the integrity of the database (Sauter, 2011, p. 0). The value of data reliability is that there is time saved on time being spent with the periodical reports (report collecting, diverse consolidations and adjustments, reducing the amount of time spent on repetitive activities, reducing the part played by the IT department in generating reports in favor of the end-user and , the most important thing, reducing the time for decision making (Luminita Magdalena, 2009). Understandability According to Sauter (2011, p. 76) if decision makers cannot understand what is in the database and if the database lends itself to perceptual errors then the decision akers cannot use it effectively. The key is going to be simplifying the representation in the database without losing the meaning of the data. The value that this will add to HR is that it will save time when they are attempting to make decisions when hiring, firing and going over information that is being used for assessments and benefits. Summary These data sources and characteristics can provide the HR industry with tools that will assist them in effectively using Business Intelligence. Because there are many different sources and characteristics it is essential that businesses know the value of having this information. There is so much information out there and so much information and data that we have to rely on. The importance of data and its structure should always be utilized with reverence to the business. Protection from too much information and providing access to useful data without overwhelming or misleading is going to be a valuable asset to any business (Sauter, 2011, p. 85). Having useful information is key to helping the decision makers make sound decisions for the business. This next section will discuss data governance and quality overview. The importance of both will be seen in this section providing the rganization with valuable information in regards to this area of Business Intelligence. Data Governance and Quality ta governance will assist the company in ascertaining power over now intormation is handled. This will give assurance to those within the organization that the company is being managed in the proper manner when it comes to processing and handling information. When data governance is incorporated into the business process the company can better monitor issues. Data governance is also about teamwork and helping those within the company to work together in a more consistent and orderly method. According to Sarsfield, (2009, p. 153) the choice about data governance is one about hearing the voices of your people within the organization. The sound of bad harmonization and discord can be heard loudly in companies that dont listen to it. Its only when you harmonize the voices of technologists, executives and business teams that it allows you to product a beautiful song; one that can bring your company teamwork, strategic direction and profit. Data governance is going to be important to the existence of the company. It is going to help the company more effectively manage our data and treat it like the valuable nterprise asset it is. In all actuality effective data governance isnt going to be Just about data at all. Its also about changing how the company views its data (Griffin, 2011, p. 11-12). Data governance will assist with the guarantee that our data can be trusted and that people can be made accountable for any adverse event that happens because of poor data quality. It is about the company putting people in charge of fixing and preventing issues with data, so that the enterprise can become more efficient (Sarsfield, 2009, p. 38). Having said that governance of company stakeholders will be essential to the company and its goals. In order to effectively implement governance there needs to be a governance team in place. One critical step in establishing a data governance program is identifying the owner of each type of data. Once you can link data quality to the processes and people that generate the data, you can get accountability for on-going maintenance (Badrakhan, 2010, p. 36). Organizational Roles The organization roles will include a cross-functional team along with the Board of Directors, CEO/President, COO, VP Finance and Operations, and a chief data office (CDO). Board of Directors The role of the board should be set down in the organization by-laws. So too must the policies and procedures be established and documented. These will differ between organizations, but it is important that all board members be informed of their expected roles and responsibilities at the beginning of their term. CEO/President The CEOs main duty is setting strategy and vision. The CEO ultimately sets the direction of the organization. The CEO decides, sets budgets, forms partnerships, and hires a team to steer the company accordingly. COO Through a respectful, constructive and energetic style, guided by the objectives of company, the COO provides the leadership, management and vision ecessary to ensure that the company has the proper operational controls, administrative and reporting procedures, and people systems in place to effectively grow the organization and to ensure financial strength and operating efficiency (www. shrm. org). VP Finance and Operations In this role the VP Finance and Operations will advise the president and other key members of senior management on financial planning, budgeting, cash flow, investment priorities, and policy matters. They will also serve as the management liaison to the board and audit committee, while continuing to ettectively communicate and present critical financial matters at elect board of directors and committee meetings (www. bridgespan. org). The CDO or equivalent position should have real accountability and may exist at either or both of the group and the divisional levels depending on the culture and strength of the bonds between the business units. There will also be principles set forth and they will become the key performance indicators (KPIs). The role and the budgets should include an element expressed in terms of the selected information currencies. Apart from the authority that the role needs to carry though a senior executive reporting ine, the office of the CDO should have direct accountability to the board and specifically the audit subcommittee or its equivalent (Hillard, 2010, p. 24). Data governance for the stakeholders can lead to effective compliance with government regulation, improved customer satisfaction, improved market position, cost reduction, improved business intelligence reporting, and the ability to respond faster to business change (Waddington, 2010, p. 5). Data quality is going to be an essential aspect of data governance; therefore the company is going to need to place a great amount of emphasis on measuring data quality. Success in a Business Intelligence environment will require that people in the organization and the team trust the results they receive. This can only be accomplished if the data meets quality expectations set forth by the data governance team and it is clearly understood by the business and its community (Geiger, 2010, p. 37). A detriment of poor data quality might be when information is put into the computer by someone for the purpose of obtaining a number that provides them with how much to charge someone for something like insurance. If the age is incorrect then that could cause the rates to be ither higher or lower because age is an important part of the quoting process. So for instance if someone was to put 21 instead of 41 in the system for the persons age that could cause their rates to go up because of the level of experience that is sometimes equated to the age. Not knowing that there is an error in the data could cause the company to lose business because the person feels that the quote is too high. Data governance will provide standards that will be set forth in regards to the data quality. There are going to be three key elements that exist for data quality measurements. They should be applied to the data residing in the database. They are completeness, compliance, and accuracy. The completeness measure provides a count of how many records in a data set are missing one or more details. The compliance counts the records that fail to meet business rules on each record. The accuracy measure estimates using statistical and other techniques whether there are likely to be errors in the data set (Hilliard, 2010, p. 160). These elements will aid in assisting the team with data governance. The goal of data governance is not Just to clarify who owns data but also to optimize its value. The data itself is merely the means to the desired end of improved business performance. Accordingly, the responsibility for data governance efforts should fall at least as much on the business as it does on IT?and preferably more (wmw. nformatica. com). Data governance will provide the business with proper guidelines in order to effectually operate. Data governance is also key to providing sufficient data quality. The implementation of data governance through business intelligence will ultimately provide the company with a tool to monitor and sustain efficient data quality. The next section will iscuss data mining and also obtain a choice tor a vendor that will provide the organization with what it needs in order to effectively launch a successful Bl implementation. Data Mining Data Mining is considered to be a deeper search in the source data. It is also known as knowledge discovery in large databases. It is very a very powerful instrument that can often be used to extract useful information. Many times the knowledge can be considered to be previously unknown valid and the same time operational. The extracted knowledge has to be translated and applied in reality. Data Mining is going o be different from some of the other data processing for data analysis, such as data query, reports, OLAP etc. Information obtained through Data Mining techniques can be predictive or descriptive. Predictive information is used to describe an event, such as the possibility of fraud (Emil Claudia, 2010, p. 806). Given a data set, the data mining process is going to start off with elementary data analysis. It will allow the analyst to understand the characteristic of the attributes of the data set (dependency, ranges, max, min, count, average, standard deviation, quartiles, outliers, etc. ). The data set is then going to be divided into a training set and a testing and validation data set (holdout). The training data set is used to build the mining structure and associated mining models. If a model is valid and its accuracy is acceptable, it is then used for prediction Oafar, 2010, p. 17). Data mining is also a valuable tool in decision report and uses algorithms and statistics to analyze large data sets. Data mining is going to connect data to the business practice. It can also be used in business to understand customers. Data mining is going to measure what the business knows and what they should know. Data Mining has proven to be highly effective in addressing business problems. By taking advantage of the information treasures in a data mine companies are able to fit pieces of information together to solve their most challenging business puzzles and those of their clients. If you use data mining to support business planning and decision making you are able to put together the vast amount of data in order to see the big picture (Mehok, 2013, p. 83). The two data mining vendors to choose from are Weka (Pentaho) and RapidMining. Both will offer some great qualities that will only add to the success of the rganization. RapidMining The first vendor is RapidMining. RapidMining is a product of Rapid-I. Rapid-I offers software and services for business analytics. The company was founded in 2006, and is headquartered in Dortmund, Germany. It has been in development since 2001. The company has more than 30 partners on all continents, 3 million production downloads, more than 35,000 production deployments and more than 400 customers in more than 40 countries (rapid-i. om). RapidMining is data mining software that offers a complete package to its users. The software is easy to use and install. Installation usually takes about five minutes. It is considered open source software. It is one of the most comprehensive data mining solutions that offer data integration, transformation, and modeling methods. It is a complete business intelligence solution. RapidMiner is a complete business analytics workbench with strong foc us on data mining, text mining, and predictive analytics. It uses a wide variety of descriptive and predictive techniques to give you the insight to make profitable decisions. There are no software license fees and it offers flexible and affordable support options. Fast development is available even when highly complex data mining processes exist. RapidMiner also offers guaranteed operational reliability. RapidMining offers one tool for all task involved allowing the processes to interact with one another and be transformed for integration with a few clicks ( rapid-i. com). Some of the mining methods offered are stream mining, In-database-mining, and Radoop. For stream mining instead of holding complete data sets in the memory, only parts of the data are taken through an analysis process and the part results aggregated in suitable location later on. Instead of taking the data to the algorithm n-database-mining supports taking the algorithms to the data. Radoop is the worlds first graphical connection of Hadoop for the handling of big data analytics, meaning that even terabytes and petabytes of data can be transformed and analyzed (www. Rapid-l. om) Weka (Pentaho) The second vendor is Weka. Weka was originally created in 1993 at the University of Waikato in New Zealand and was available on sourceforge. net since 2000. The Weka project was established by the University of Waikato as a platform for the research and testing of advanced machine learning techniques. Since that time, Weka has eveloped a large and loyal following in both academic and industry c ircles, and has been downloaded more than 600, 000 times (www. pentaho. com). Sometime in 2006 Pentaho Corp. , acquired the Weka open source data mining project. Pentaho is considered to be one of the worlds largest open source business intelligence suites out there. Weka is currently widely used as a great tool for data mining. It has what they call an open source code and it can be used for machine learning and it can also be used for mining large datasets. Machine learning algorithms will aid in finding significant consistencies in large data sets. Weka is easy to use and easily accessible. Weka is considered open source software and it is issued under the GNU General Public License. Organizations use Wekas data mining tools to understand relationships between internal factors like price, product placement, or staff skills as well as external factors like economic indicators, competition, and target market demographics; analyze the impact of potential changes to critical business metrics like sales volumes, customer loyalty, and profitability; and perform business-critical calculations such as market-basket analysis, customer segmentation, pricing ptimization and fraud detection (www. pentaho. com). Weka (Waikato Environment for Knowledge Analysis) is an ensemble of data mining algorithms written in Java. These algorithms can either be applied directly to a dataset using the Weka explorer or called from your own modified Java code. It contains tools for data pre-processing, classification, regression, clustering, association rules, and visualization and can be used to develop new machine learning schemes (NA, Weka, 2010). The main point of integration between WEKA and the Pentaho platform is with Pentaho Data Integration PDI), also known as the Kettle proJect4. PDI is a streaming, engine driven ETL tool. Its rich set of extract and transform operations, combined with support for a large variety of databases, are a natural complement to WEKAS data filters. PDI can easily export data sets in WEKAS native ARFF format to be used immediately for model creation (Hall, M. , Frank, E. , Holmes, G. , Pfahringer, B. , Reutemann, P. , Willten, nd). Vendor Choice The suggested data mining vendor choice is Weka (Pentaho). This would be a great vendor to use tor our organization because ot what it otters in i s sottware. It offers an extensive amount of features and we can expect that any data sets used we will receive a thorough and extensive mining process that will assist the business in looking at customer loyalty, items being used by customer, customer concerns, along with monetary values. All features of business intelligence will be supported including web services, workflow integration, security, auditing, scheduling, navigation, portal integration, workbench-based designer and administration tools Oira. pentaho. com). Business Analytics Summary and Vendor Selection Companies are increasingly delivering value through business analytics (BA), which includes the people, processes and technologies that turn data into the insights that drive business decision and actions. Organizations with enterprise BA capabilities establish a sound foundation of high-quality, usable and integrated data. Business users identify insights from the data, make decisions and solve important business problems, thereby triggering actions that generate a wide range of tangible and intangible business value (Wixom, Yen, Relich, 2013, p. 11). Some vendors that utilize business analytics are SAS and Oracle. Both vendors supply a product that provides businesses with valuable tools that will assist them with queries, reporting and advanced analytics software. Business analytics is the most advanced component of business intelligence. Having an analytic capability will enable fact- based decisions using quantitative models. These models will ultimately draw on statistical and quantitative analysis of large data repositories. An analytic capability is especially critical in healthcare because lives are at stake and there is intense pressure to reduce costs and improve efficiency (Ghost Scott, 2011). An analytic apability drives fact-based management decisions and actions with extensive use of data, statistical and quantitative analysis, explanatory and predictive models [Davenport and Harris, 2007]. Success with advanced analytics is highly dependent on the quality and completeness of the data subject to analysis, as well as the sophistication of the algorithms and models on which analyses depend [Adams et al. 2010]. The availability of high quality data and technology needs to be coupled with organizational routines and individual skills for an analytic capability (Shanks et al. , 2010; Ghost Scott, 2011). There are some key components to todays business analytics solutions they are data and text mining, Data visualization, Forecasting, Operations Research and Analysis, Quality improvement, and Statist ical analysis. Data and text mining is one that e