Perishable shipping Research Paper Example | Topics and Well Written Essays - 750 words

Perishable shipping - Research Paper Example A dealer and manufacturer may agree to set a maximum price that will prevent dealers from charging higher prices. Setting floor prices, as well as limiting territories may force dealers to offer services that the producer intends in the event of buying products. However, avoidance of antitrust cases may be paramount through the setting of independent prices. Different swell allowances may affect TEDSBOX policies that would in turn affect packaging and the unsaleable food products. A swell allowance is the uniform rate that is applied to sales. Most business practices advocate for charging same swell allowance among manufacturers. Charging different rates may prove to be ineffective especially to products that have consistent handling policies. The non-pursuance of the adjustable rate policies may discourage benefits associated with swell allowances. Adjustable rate policies aid in offering various reimbursement rates by product category. Highly perishable products require much of these policies. Without the existence of adjustable rate policies, the sales shift of highly perishable goods will be difficult and reimbursements will not take place. In addition, the manufacturers will experience rigidity in adjusting policies with changes occurring in the business environment. This situation creates inefficiency in the agricultural industry as it tends to be the most flexible industry in terms of price adjustments and business policies (Sykes 1995). The cold chain is a process that incorporates the shipping of temperature sensitive commodities along through a supply chain (Ayers and Odegaard 2008). Transportation occurs through refrigerated and updraft packaging methods. Logistical planning is necessitated to ensure security and protection of these shipments. There are several shipping methods; however, FEDEX uses air cargo when transporting sea

Mune Company Essay Example for Free

Mune Company Essay Mune Company recorded journal entries for the declaration of $50,000 of dividends, the $32,000 increase in accounts receivable for services rendered, and the purchase of equipment for $21,000. What net effect do these entries have on equity? Decrease of $18,000. Maso Company recorded journal entries for the issuance of ordinary shares for $40,000, the payment of $13,000 on accounts payable, and the payment of salaries expense of $21,000. What net effect do these entries have on equity? Increase of $19,000. During the first year of Wilkinson Co.s operations, all purchases were recorded as assets. Store supplies in the amount of $19,350 were purchased. Actual year-end store supplies amounted to $6,450. The adjusting entry for store supplies will: increase expenses by $12,900. Panda Corporation paid cash of 18,000 on June 1, 2010 for one year’s rent in advance and recorded the transaction with a debit to Prepaid Rent. The December 31, 2010 adjusting entry is: debit Rent Expense and credit Prepaid Rent, 10,500. Recording the adjusting entry for depreciation has the same effect as recording the adjusting entry for: a prepaid expense. An accrued expense can best be described as an amount: not paid and currently matched with earnings. A document prepared to prove the equality of debits and credits after all adjustments have been prepared is the: Adjusted trial balance. Under International Financial Reporting Standards (IFRS) the book of original entry is also known as the: Journal

Concepts Of Appropriation Under The Theft Act Law Essay

Concepts Of Appropriation Under The Theft Act Law Essay The Theft Act 1968  [1]  was legislated as a result of complicated, confusing and highly technical prior statutes and case law. Antiquated terminology like larceny, embezzlement and false pretences were to be replaced by a simple and short Act that was aiming towards codification of the criminal law. The Criminal Law Revision Committee advised on the recommendation, which as a result fully transpired. The report affirmed larceny, embezzlement and fraudulent conversion should be replaced by a single new offence of theft. The important element of them all is undoubtedly the dishonest appropriation of anotherers property.  [2]  Unfortunately the courts interpretation of the Theft Act has not went as smooth as anticipated; it became highly disputed as the House of Lords reached contrasting outcomes on several cases. Parliament was possibly at fault to some extent due to the Act being formulated very simplistic, the consequence was that judges had to work out exactly what the law was. My purpose will be to chronologically evaluate the crucial case law, academic opinion, as well as objectively conclude from a theoretical and practical perspective. The definition of The Theft Act 1968 is A person is guilty of theft if he dishonestly appropriates property belonging to another with the intention of permanently depriving the other of it; and thief and steal shall be construed accordingly.  [3]  This section is pivotal and fundamental as the whole Act is structured around this definition. Dispute surrounds the element of appropriation. Academics and lawyers have and still are extensively contesting on whether consent should be relevant or irrelevant for an individual to appropriate property. The Criminal Law Revision Committee which prompted the Act stated We hope and believe that the concept of dishonest appropriation will be easily understood even without the aid of further definition.  [4]  This lack of further definition in hindsight, demonstrated poor judgment from the Committee as cases will illustrate that interpretation of appropriation has led to difficulties even in straightforward circumstances. In Lawrence  [5]  an Italian student who was unfamiliar with the currency opened his wallet to a taxi driver to allow him to acquire the fare. The driver took money which was well over the excess of the fare. The driver disputed that his conduct could be appropriation because the student consented. The House of Lords held that it was irrelevant the student consented and dismissed the defendants appeal; the drivers conviction was upheld. This case concluded that appropriation can occur even when the victim has consented in handing over their property. Under the old Larceny Act 1916 a requirement for appropriation was without the consent of the owner  [6]  . Viscount Dilhorne highlighted this contrast in his judgment as he quoted Parliament by the omission of these words has relieved the prosecution of the burdon of establishing that the taking was without the owners consent  [7]  . Furthermore, Lawrenece means that certain crimes of deception may also be identical to crim es of theft, due to consent being irrelevant. Surely Parliaments intentions were not to have it amalgamated with s15 Obtaining Property by Deception. P. R. Glazebrook brought up this illogical consequence as he wrote Should it matter tuppence whether a crook snitched his victims property or tricked him out of it? Parliament thought not.  [8]  I myself find it hard to comprehend that Parliament enacted a meaningless provision but this is a practical and theoretical effect of the courts verdict. Shute and Horder also disagreed with the crimes being amalgamated by writing in a journal The label thief does not carry the same moral import as the label conman;  [9]  they also went on to say The nature of the wrongdoing in theft has a separate moral foundation from that of obtaining by deception. There is no doubt that these crimes are entirely different in reality and should be treated entirely different by the law; the outcome of Lawrenece does seem to question the merit and prac ticality of the Theft Act. The House of Lords in the case of Morris  [10]  casted uncertainty on this proposition as they held that the defendant must have done something objectively criminal for appropriation to occur. The facts involved the defendant exchanging labels on goods in a supermarket in order to pay less for the item; he was seized before paying and charged with theft. His council submitted that he could not have appropriated the item as he had handled the item in the supermarket with implied consent of the owner. Judging on Lawrence the defendant should have been convicted but the court completely opposed. Lord Roskil quoted appropriation in my view involves not an act expressly or impliedly authorised by the owner but an act by way of adverse interference with or unsurpation of those rights.  [11]  So on this judgment, a consensual acquirement of property would not be theft since the element of appropriation is absent. For the next eight years until R v Gomez  [12]  , this case was us ed in preference to Lawrence. The facts of Gomez involved the defendant who was an employee of a store in. He convinced the manager to sell goods to an accomplice and accept payment by cheques. He told the manager that the cheque was as good as cash but was aware that they were stolen. Gomez was convicted of theft at the trial court. The defendant appealed to the Court of Appeal, Lord Lane CJ was very clear on his position and stated anyone who obtains goods in return for a cheque which he knows will be dishonored on presentation, or indeed by way of any other similar pretence, would be guilty of theft  [13]  . He then went on to say that appropriation never occurred as There is no appropriation at the moment when he takes possession of the goods because he was entitled to do so under the terms of the contract of sale.  [14]  Lord Lane expressed that this conduct should not fall within the Theft Act as in practice it expands it enormously. Professor Shute obviously agreed with Lord Lanes reasoning as he w rote To create a new offence of theft to include conduct which ordinary people would find difficult to regard as theft would be a mistake.  [15]  Lord Lane also stressed that by making consent irrelevant created a clear conflict between civil and criminal law. Gomez was appealed to the House of Lords. The house had to clarify if consent was relevant and if appropriation involvedadverse interference with, or usurpation of, some right of the owner  [16]  The lords concluded 3:2 in favor for Lawrence against Morris and decided that consent is irrelevant to appropriation. Lord Keith quoted in the leading judgment Belief or the absence of belief that the owner had such knowledge is relevant to the issue of dishonesty, not to question whether or not there has been an appropriation.  [17]  This decision was of vast importance and had extensive implications to the offence of theft. In practical situations it could determine the point of arrest, for example, an individual can in theory be arrested in a shop for simply touching an item, perhaps just looking at the ingredients, if the law enforcement suspect the individual is planning to steal this item then in theory then they can be arrested. In practice this seems completely absurd; in add ition it means the law authorities have enormous arbitrary powers resulting from this legislation. Although in practice I doubt this example would occur often but arbitrary powers this broad should be taken very seriously as it may contravene human rights, the rule of law and the manifest criminality rule  [18]  that George Fletcher discusses. This rule maintains the notion that a reasonable person should identify the theft that has occurred. To some degree criminal activity like theft should be obvious to the objective observer. Alarmingly, by omitting the consent element for appropriation means that it practically vanishes the necessity to have an actus reus for a conviction. Also, there is no doubt that in certain cases consent will distinguish if the defendants conduct was dishonest or not. By dismissing consent the law is virtually relying on the entire mens rea element. Lord Lowry dissented in Gomez cited a dictionary definition of appropriate, he quoted take possession of, take to oneself, especially without authority.  [19]  He concluded that consent was relevant and there had to be some sort of adverse interference, which I do believe should be an element of appropriation. Later on in the 1990s, appropriation was at the centre of a further legal concern. The question the courts had to address was; could a recipient of a valid gift in civil law have appropriated property and be charged with theft if there was no deception? Again, consent was questioned. There were several cases with similar facts but it was R v Hinks  [20]  which resolved the issue. The defendant befriended a man of limited intelligence and naivety although he was mentally able of understanding the concept of ownership and a gift. The defendant encouraged the man to withdraw sixty thousand pounds and deposit it in her account. The Court of Appeal held that it was irrelevant the gift was valid in civil law and the question was certified to the House of Lords. Hinks defence submitted sound reasoning on why it would be wrong to hold a valid civil gift as appropriated, they referred to numerous examples of when contractual problems under such a expansive definition of appropriation whic h could now become theft. The defence also highlighted that it would create disharmony and a blatant conflict with civil law. Lord Steyn countered this issue as he quoted The tension between the civil law and the criminal law is therefore not in my view a factor which justifies a departure from the law as stated in Lawrence and Gomez.  [21]  In addition, on the matter of consent and authority he said this was immaterial.  [22]  The court appeal was dismissed as the gift was appropriated, only with Lord Hobhouse dissenting. Therefore in practice if there is an acquisition of property through dishonestly then the gift will have been appropriated and stolen. There are several consequences of the final decision in Hinks. First of all it means that there is no longer any distinction between fraud and theft, which does not seem to be logical as they are entirely different crimes. Lord Steyn discarded appropriation as being narrow due the number of unjustified acquittals that may be the consequence. Although this is a convincing justification and I can see the logic due to the defendants unconscionable conduct, but I believe this should not be the criminal law. The contrast with civil law could been evaded by perhaps declaring the gift voidable due to undue influence. The court asserting the legitimacy of the gift as irrelevant was perhaps unconvincing. J.C Smith strongly disapproved as he wroteWho ever heard of ordinary literate people describing the receipt of a gift as an appropriation?  [23]  Numerous academics have agreed with Smith and understandably criticized the courts decision. Clarkson and Keating have described Hinks decision in particular as lamentable  [24]  as the House of Lords do not identify what actually constitutes appropriation. J.C Smith emphasized how expansive appropriation is currently, the commentary stated Millions of employees are appropriating their employers property, millions of customers are appropriating the property of shopkeepers, husbands are appropriating the property of their wifes and vice versa every hour of the day  [25]  , therefore if mens rea is perceptible then these examples can all be theft. Reflecting on the judgments, journals and commentary, I believe adverse interference should be present in the definition of appropriation. Perhaps the negative aspect is there may be an undeserved acquittal but better this than innocent individuals convicted due to the law being so expansive. It is simply more practical and just for adverse interference to be an element in of the Theft Act. Adverse iterference establishes the progress from actual guilty contemplation or consideration to which should be the full mens rea of theft. Individuals with criminal thoughts and ideas should not be liable for theft if the criminal act has not been executed. Unfortunetly due to adverse interference being ommitted from the requirement of the Theft Act, thoughts and ideas can be criminal in the present law which in my opinon is completely unsound and dangerously premature for a justifiable conviction.

Deciphering Low-Carb Diet Jargon :: Nutritio

Deciphering Low-Carb Diet Jargon The medical world is a complicated one with constant changes in what is recommended for good health. Trying to keep up with current information is challenging enough, but deciphering the technical jargon can be the most confusing part. The low-carb diet craze exploded into the media with Atkins, The Zone, and the South Beach Diet. Accompanying these names are words such as glucose and fructose with many people know are different forms of sugar. But what do some of these other common words and phrases mean? What are insulinemia, glycemia, and a glycemic index? They are frequently used, but what do they mean?   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  First of all, the goal of the low carb bars and snacks is to reduce the postprandial (after a meal) insulin levels. Insulin levels are important for health reasons, particularly diabetes. It is well- known that there is increasing concern over the rising obesity and diabetes rates in this country. Glycemia is the presence of glucose in the blood. Hypoglycemia is an abnormal decrease of sugar in the blood. It is important to test people with diabetes regularly for their glycemic status because they have certain glycemic goals of where their blood sugar level needs to be and this can vary from person to person.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  This is where the glycemic index comes into play. The glycemic index is a ratings system for food based on their glycemic response, which is the speed at which a food is able to increase a person’s blood glucose level. White bread is an example of a food with a high glycemic index. Foods with a high glycemic index break down into sugars more quickly than those with a low index. Studies show that foods with a low glycemic index may help to manage diabetes by helping to control glucose levels. With the growing diabetes trend this information could e crucial for maintaining health for those with diabetes.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Insulinemia is the presence of an abnormally high concentration of insulin in the blood. Insulin is important in order to get the sugars out of our blood and into organs or storage.

Obstetric Brachial Plexus Palsy Health And Social Care Essay

The estimated incidence of OBPP in the UK and the Republic of Ireland is 0.42 [ 1 ] , in the US 1.5 [ 23 ] and in other western states 1-3 per 1000 unrecorded births [ 3,5,9,22,24-30 ] . Variations in the estimated incidence may be explained by differences in populations and in the antenatal and intrapartum direction [ 31,32 ] . A population-based survey from western Sweden estimated that between 1999-2001 the incidence of OBPP was 2.9 per 1000 unrecorded births, and of prevailing OBPP was 0.46 per 1000 births ( REF Lagerkvist ) . . In another survey from Sweden Bager [ 13 ] had antecedently found an addition in the incidence of brachial rete paralysis ( BPP ) from 1.3 per 1000 vaginal bringings in 1980 to 2.2 per 1000 vaginal bringings in 1994. Chauhan et Al. [ 3 ] compared two clip periods ( 1980-1991 1991-2002 ) and found that the incidence of OBPP has non changed significantly ( 0.9 per 1000 and 1.0 per 1000 severally ) . Gurewitsch et Al. [ 10 ] estimated an incidence of 5.8 per 1000 between the old ages 1993 and 2004 and noted that this remained changeless during the period of their survey. Many writers have admitted that an addition in the cesarean subdivision rates over the past few decennaries may hold been counteracted by an increased birthweight. Furthermore, despite the debut of systematic preparation in the direction of shoulder dystocia with usage of standard manoeuvres, manikins and simulators no important decrease of the incidence of OBPP has been noted.Hazard FactorsThe hazard factors for OBPP are foetal, maternal, and obstetric, [ 37 ] the most important being foetal macrosomia [ 3,18,20,22,26-28 ] which is a hazard factor for shoulder dystocia [ 27,38-42 ] . Nesbitt et al conducted a big population based survey and reported the undermentioned rates of shoulder dystocia for single-handed births of nondiabetic female parents: 5.2 % for birthweight 4000-4250g, 9.1 % for 4250-4500g, 14.3 % for 4500-4750g, and 21.1 % for 4750-5000g ( Nesbitt et al. 1998 ) . OBPP after rear of barrel bringings can besides happen, normally in low birthweight foetuss [ 43,44 ] . The upper roots are often affected in these instances and the hurts tend to be more terrible [ 45 ] . Diabetess mellitus [ 22 ] , fleshiness [ 46,47 ] or inordinate weight addition [ 47 ] , maternal age ( & gt ; 35years ) [ 48 ] , maternal pelvic anatomy ( platypelloid, level pelvic girdle ) [ 3,22,27,39,40,49 ] and primiparity [ 50 ] are common maternal hazard factors. Diabetess mellitus is a important hazard factor for OBPP, as it frequently causes foetal macrosomia [ 51 ] . Nesbitt et Al found that the hazard of shoulder dystocia for single-handed births to diabetic adult females was 8.4 % , 12.3 % , 19.9 % , and 23.5 % when the birth weight was 4000-4250g, 4250-4500g, 4500-4750g, or & gt ; 4750g, severally. ( Nesbitt et al. 1998 ) . Mild glucose intolerance in adult females without diabetes is besides associated with hazards of OBPP, proposing that there is a continuum of glucose-insulin impact on foetal growing that is correlated to the hazard of OBPP [ 52 ] . Shoulder dystocia is a major hazard factor for OBPP [ 9,22,24,40,54-57 ] . The reported incidence of OBPP in bringings complicated by shoulder dystocia varies widely from 4 % to 40 % [ 14,57,58 ] and the incidence of lasting brachial rete hurt after shoulder dystocia is 1.6 % [ 59 ] . Although foetal macrosomia is the most important hazard factor for shoulder dystocia and is associated with most of the other hazard factors ( maternal diabetes, multiparity, old macrosomic baby, drawn-out gestation, maternal fleshiness or inordinate weight addition ) , about half of the instances of shoulder dystocia occur in babies & lt ; 4000g ( Acker et al. 1985 ) . The hazard of OBPP is increased by labour abnormalcies. OBPP occurs more often in induced labours [ 52 ] . Cephalopelvic or fetopelvic disproportion ( the size or place of the foetal caput or the foetus precludes transition into the maternal pelvic recess ) is a hazard factor for shoulder dystocia and OBPP. A relentless occipito- posterior place [ 65 ] has been associated with an increased incidence of OBPP. Lurie et al [ 60 ] found no difference in rates of distension or continuance of the 2nd phase in instances with shoulder dystocia and concluded that protracted labour was non a hazard factor for it. Gross et al [ 66 ] showed that a drawn-out 2nd phase increased the hazard of OBPP, but concluded that shoulder dystocia can non be predicted from labour abnormalcies. Weizsaecker et al support the association of drawn-out 2nd phase in labour with OBPP independent of macrosomia, diabetes, and other factors [ 52 ] . Several other surveies considered a drawn-out 2nd phase as a hazard fac tor for shoulder dystocia [ 46,62,67-69 ] and for OBPP [ 27,66 ] . In contrast, a high incidence of hasty 2nd phase of labour among babies with OBPP has besides been demonstrated [ 70 ] . However, Poggi et al suggest that although hasty 2nd phase is the most prevailing labour abnormalcy associated with shoulder dystocia, no feature of second-stage of labour predicts lasting brachial rete hurt [ 37 ] . Operative vaginal bringing is another hazard factor for shoulder dystocia and OBPP [ 3,21,22,26,27,68,71,72 ] . In Nesbitt ‘s survey the hazard of shoulder dystocia for operative vaginal bringings to diabetic female parents was 12.2 % for babies 4000-4250g, 16.7 % for those 4250-4500g, 27.3 % for those 4500-4750g, and 34.8 % for those 4750-5000g ( Nesbitt et al. 1998 ) . Cesarean subdivision decreases the hazard, but OBPP may still happen accounting for merely 1-4 % of all instances [ 22 ] [ 73 ] . When looking at combinations of hazard factors including manner of bringing, maternal diabetes and foetal macrosomia [ 22 ] , the incidence of OBPP appears similar in aided vaginal bringings of nondiabetic adult females and self-generated vaginal bringings in diabetic adult females. The combination of maternal diabetes, foetal macrosomia ( & gt ; 4500g ) and assisted vaginal bringing has the highest OBPP rate ( 7.8 % ) . Gilbert et Als have besides shown stronger associations between shoulder dystocia and brachial rete hurt with increasing birth weights. Twenty two per cent of neonates weighing 2.5-3.5kg with OBPP besides had shoulder dystocia, which increases to 74 % in newborns weighing more than 4.5kg. Overall, 53 % of brachial plexus hurt instances were associated with shoulder dystocia. The frequence of diagnosing of other malpresentation was increased ( OR 73.6, 95 % CI 66, 83 ) in this survey. This determination, harmonizing to the writers, suggests that â€Å" brachial rete hurt has other causes in add-on to shoulder dystocia and might ensue from an abnormalcy during the antepartum or intrapartum period † [ 22 ] . A old gestation complicated with OBPP is another hazard factor [ 74 ] . Al-Qattan and al-Kharfy [ 74 ] reported a high return rate in adult females with history of old childbearing with lasting OBPP and advocated elected cesarean bringing in these instances particularly if there is besides foetal macrosomia. However it is non known whether these consequences would use to instances of old impermanent OBPP. Gordon et al [ 6 ] besides found that 14 % of their 59 topics with OBPP were born to female parents who had given birth to babes with OBPP in old gestations.PathogenesisOBPP has been considered as a effect of inordinate grip and sidelong extension exerted on the foetal cervix during bringing, which consequences in stretching, rupturing or avulsing the cervical nervus roots from the spinal cord [ 75 ] . However, OBPP may happen in the absence of any grip or any identifiable hazard factors. During labour, the brachial rete is exposed to two potentially harmful forces: the endogenous ( intrauterine ) forces and exogenic ( grip ) forces applied by the clinician. Mathematical theoretical accounts, manikins and computing machine simulations have been used to quantify the forces applied on the brachial rete and the threshold for doing hurt. Although these surveies attempted to objectively quantify the grade of both endogenous and exogenic forces, their consequences should be interpreted with cautiousness due to their experimental nature. Exogenous ( grip ) forces If the foetal shoulders remain in a relentless anteroposterior place at the pelvic recess, as observed in instances of foetal macrosomia with an increased bisacromial diameter ( e.g. , with maternal diabetes mellitus ) [ 76,77 ] or precipitate 2nd phase of labour [ 54,70 ] the anterior shoulder may go wedged behind the symphysis pubic bone and farther descent of the foetal caput consequences in stretching of the anterior brachial rete. In shoulder dystocia the applied force and the clip to present the foetal shoulders is frequently significantly increased. Forceful downward grip of the caput when the shoulder is impacted under the symphysis pubic bone can potentially ensue in farther impaction and cause overstretching and hurt of the brachial rete. Downward grip of the foetal caput appears strongly associated with OBPP ( OR: 15.2, 95 % C.I. : 8.4-27.7 ) and the hazard is significantly increased with the grip force applied. Rotation of the shoulders into oblique pelvic diameter is bes ides associated with hazard of OBPP ( OR: 5.5, C.I. :1.6-18.9 ) [ 30 ] . Gonik et al [ 88 ] , showed that downward sidelong flexure of the foetal caput was associated with a 30 % addition in brachial rete stretch ( 18.2 % ) compared with axial placement of the caput ( 14 % ) . Furthermore, the foetal caput is in an unnaturally distorted place in relation to the shoulders, as the shoulders remain in the AP diameter at the recess while the caput has rotated in the AP diameter at the mercantile establishment { Sandmire, 2009 # 6162 } . The badness of the hurt may depend on the grade of grip, writhing and extension of the foetal caput { Sandmire, 2008 # 6057 } . The usage of force feeling devices has shown that the applied extremum grip forces are about 47 N for everyday bringings, 69 N for hard bringings, and 100 N for bringings complicated by shoulder dystocia, proposing that, as the badness of dystocia additions, stronger grip is normally observed [ 86 ] . Even in bringings non complicated by shoulder dystocia the forces applied during downward grip can be frequently underestimated as significant forces were found to hold been used in many OBPP instances [ 30 ] . Direct compaction of the symphysis pubic bone against the brachial rete may besides be a conducive factor to injury [ 13 ] . OBPP may happen regardless of the figure and type of manoeuvres used in instances of shoulder dystocia [ 12,14,69 ] , but the trouble to accomplish bringing of the shoulders and the demand for extra manoeuvres is correlated to the hazard of OBPP. Experimental surveies utilizing pelvic and foetal theoretical accounts, tactile feeling baseball mitts and computerised informations acquisition systems have besides shown that as the trouble of the bringing increases with increasing grip forces, there is a concentration of force on the brachial rete from exogenously applied sidelong flexure [ 87 ] . In these experiments it was demonstrated that the wider the foetal shoulder girth, the greater the force demands and the higher the incidence of hurt. In contrast, the McRoberts manoeuvre appeared to cut down the grade of brachial rete stretching. Slightly more than 10 % of the shoulder dystocia instances that resolve with the McRoberts ‘ manoeuvre entirely have brachial plexus hurt [ 78 ] . After an unsuccessful McRoberts ‘ manoeuvre, brachial plexus hurt rates range from 15.7 % if bringing is achieved by the Woods ‘ manoeuvre to 31.8 % if bringing of the posterior arm is undertaken [ 14 ] . Intrauterine causes As several instances of OBPP occur in the absence of grip or any known hazard factors, hurts to the brachial rete may be caused by the normal forces of labour and bringing. In one of the first surveies proposing that OBPPs are non needfully caused by clinician-applied grip, it was estimated that 26 out of the 51 OBPP instances were non associated with a bringing complicated by shoulder dystocia. { Gordon, 1973 # 615 } . Since so, several other surveies have shown that about half of all OBPPs are non associated with shoulder dystocia [ 5,12,13,18,19 ] and many instances have non been preceded by a hard bringing or grip on the anterior shoulder [ 20,79,80 ] . Harmonizing to different series, up to 20 % of lasting OBPPs are non associated with shoulder dystocia { Chauhan, 2005 # 48 } { Sandmire, 2009 # 6162 } . Jennett et al [ 18 ] concluded that brachial plexus hurt might be the consequence of intrauterine maladaptation and should non be needfully considered as leading facie grounds of birth procedure hurt. In the absence of shoulder dystocia, OBPP occurs by a different mechanism [ 81 ] . The bulk of OBPPs in the absence of shoulder dystocia ( 67.7 % ) appear to impact the posterior arm [ 59,84 ] . OBPPs of the posterior arm ( 39 % of all OBPPs { Gherman, 1998 # 114 } ) or after cesarean bringing suggest an intrauterine cause [ 3,4,18,19,27,38,82,83 ] . Brachial plexus stretching may be caused by an wedged posterior shoulder on the sacral headland while the propulsive forces of labour cause farther descent of the foetus { Sandmire, 2002 # 79 } . OBPPs may besides be secondary to compaction of the brachial rete on the sacral headland. Sandmire and DeMott { Sandmire, 2009 # 6162 } back up the impression that after the caput is delivered, the posterior shoulder can non be obstructed as the distance from the headland to the vaginal mercantile establishment ( 12-13 centimeter ) is excessively long to allow obstructor of the posterior shoulder and the foetal cervix can non be stretched that f ar { Sandmire, 2002 # 79 } , It is hence of paramount importance to document the place of the caput and shoulders in a instance of shoulder dystocia, as this type of hurt caused by impaction of the posterior shoulder on the sacral headland is unrelated to any action of the clinician and should non be considered negligent. Mathematical theoretical accounts have been used to gauge the exogenic and endogenous forces on the brachial rete during shoulder dystocia [ 89 ] . The endogenous forces were estimated to be 4 to 9 times higher than the clinician-applied forces ( 91.1 to 202.5 kPa vs 22.9 kPa ) proposing that self-generated endogenous forces may lend well to OBPP. However the writers of this survey acknowledged that their theoretical account did non account for a figure of confusing factors including soft tissue opposition, the dissipation of force throughout the womb or the compound consequence of grip and compaction forces. Further unfavorable judgment on this theoretical account focused on the gross premises made for the impaction site, the parametric quantities specifying the endogenous force distribution and the broad scope of contact force per unit areas between the foetal cervix and the symphysis pubic bone, which includes values that in existent life would transcend the fatal bounds [ 90 ] . Harmonizing to a little series, all of the 6 OBPPs following atraumatic cesarean subdivision had relentless hurt after a twelvemonth [ 85 ] . Brachial rete hurts have occured even when cesarean bringing was performed in early labour [ 82,85 ] . Uterine anomalousnesss, such as a lower uterine section fibroid or an intrauterine septum, may ensue in unnatural intrauterine force per unit areas and hurt to the brachial rete [ 85 ] . OBPP and phrenic nervus paralysis associated with a bicornuate womb have besides been reported [ 80 ] . Allen et Al, utilizing delivering simulators found that greatest stretch occurred in the posterior brachial rete during descent in non-shoulder dystocia bringings, whereas anterior brachial rete stretch, rotary motion, and extension were similar among non-shoulder dystocia, one-sided and bilateral shoulder dystocia bringings. The writers concluded that shoulder dystocia per Se does non present extra hazard of brachial rete stretch over everyday bringings [ 91 ] . However, they admitted that they did non command for loss of musculus tone secondary to hypoxia, the simulations were undertaken merely in occiput anterior place and the continuance of the 2nd phase in their experiment was less than 2 proceedingss. Although these experiments have improved our cognition on the mechanisms of hurt, clinical verification of their consequences is virtually impossible due to the emergent nature of shoulder dystocia and methodological and ethical issues around clinical research on the foetus during labour.Prediction and PreventionOur ability to foretell OBPP is rather limited as the bulk of the affected babies have no identifiable hazard factors [ 67 ] . In a series of 63 OBPPS most of the patients were nondiabetic ( 89 % ) , nonobese ( 76 % ) , had normal labour ( 91 % ) , and did non hold an assisted bringing ( 79 % ) . No hazard factors were identified in about 30 % of OBPP instances in another survey by Peleg et al [ 27 ] . Multiple logistic arrested development analysis utilizing prenatal, intrapartum, and neonatal factors predicted merely 19 % of the brachial rete hurts in the series of Perlow et Al [ 54 ] . Donnelly et Als have besides concluded that OBPP is non predictable by hazard factor hit ing or analysis of the partogram [ 63 ] . Shoulder dystocia, a major hazard factor for OBPP is mostly unpredictable. Statistical theoretical accounts have been developed to gauge this hazard utilizing combinations of birth weight, maternal tallness and weight, gestational age and para [ 92,93 ] . The presence of multiple hazard factors appears to be a forecaster for shoulder dystocia [ 94 ] . Designation of hazard factors and an prenatal direction with tight control of glucose degrees in pregnant adult females with diabetes may cut down the incidence of foetal macrosomia and shoulder dystocia. A program for bringing in high hazard instances should include a multidisciplinary squad attack with a senior accoucheuse or an experient obstetrician available at the 2nd phase. Initiation of labour Initiation of labour has been antecedently recommended in instances of suspected macrosomia, in order to cut down the hazard of shoulder dystocia and birth hurt, nevertheless, a Cochrane reappraisal showed that initiation of labour for nondiabetic adult females with suspected foetal macrosomia does non look to cut down the hazards of maternal or neonatal morbidity [ 95 ] . Cesarean Section The hazard of brachial plexus hurt is lower in cesarean bringings [ 3,96 ] . If identifiable hazard factors are present, an elected cesarean delivery bringing might forestall OBPP. Yeo et al suggested that bringings by elected cesarean subdivision for birthweights in surplus of 4kg would forestall 44 % of shoulder dystocias and halve the perinatal mortality among births with shoulder dystocia with a 2 % subsequent addition of the cesarean subdivision rate [ 97 ] . On the other manus, Gilbert et Al found that 92 % of the high hazard patients ( diabetic adult females delivered by operative vaginal bringing with babies of & gt ; 4.5kg birthweight ) did non hold OBPP and cesarean bringing would hold been unneeded [ 22 ] . Although macrosomia is normally associated with OBPP, Rouse et Al [ 32 ] found no benefit to elected cesarean bringing in adult females with estimated foetal weights of & gt ; 4.5 kilogram, unless they were besides diabetic. These writers estimated that when elected ces arean bringing was performed for estimated foetal weights of a†°?4.5kg, 3695 cesarean delivery bringings would be required for the bar of one permanent OBPP, whereas a policy of elected cesarean delivery bringings for birthweights of a†°?4kg was associated with 2345 several cesarean bringings. For diabetic adult females, more favorable ratios for cesarian bringings were estimated: 443 bringings with the 4.5kg policy, and 489 bringings with the 4kg policy. Ecker et al [ 38 ] besides suggested that at most birth weights, the figure of cesarean bringings necessary to forestall a individual hurt is high. In this survey, it was estimated that in nondiabetic adult females, between 19 and 162 cesarean subdivisions would hold been necessary to forestall a individual brachial rete hurt and among diabetic adult females between 5 and 48 extra cesarean delivery subdivisions would hold been required. The writers could hence non recommend the everyday usage of cesarean bringing in insta nces of macrosomia. The Royal College of Obstetricians and Gynaecologists recommends that elected cesarean subdivision can be considered in diabetic adult females when the estimated foetal weight is & gt ; 4.5kg and in nondiabetic adult females when the estimated foetal weight is & gt ; 5kg [ 98 ] . Nonetheless, some writers advocate a policy of offering elected cesarean bringing to adult females with kids with lasting OBPP [ 22 ] . Maneuvers at bringing For the bar of shoulder dystocia, contraceptive manoeuvres at bringing ( McRobert ‘s manoeuvre and suprapubic force per unit area ) have been evaluated, but there is deficiency of clear grounds to back up their modus operandi usage [ 99 ] . Management of shoulder dystocia The purpose of direction should be bar of foetal asphyxia, while avoiding foetal and maternal hurt. The go toing accoucheuse or obstetrician should be able to acknowledge a shoulder dystocia instantly and continue through a bit-by-bit sequence of manoeuvres to hasten bringing. Knowledge of the constructs that underlie manoeuvres and the practical inside informations of their executing appears much more effectual than cognition of the precise definitions or eponyms of each manoeuvre ( Crofts et al. 2008 ) . First line manoeuvres Mc Roberts manoeuvre involves acute flexure of the hips while the adult female is on supine place. This place straightens the lumbosacral angle, leting descent of the posterior shoulder. The maternal pelvic girdle is perpendicular to the way of the maternal expulsive forces. Gonik et al [ 88 ] , utilizing computing machine silent person theoretical accounts showed that with lithotomy placement, both endogenous and exogenic bringing forces were associated with brachial rete stretching during shoulder dystocia ( the per centum of brachial rete nervus stretch was 15.7 % vs 14.0 % , severally ) . McRoberts positioning resulted in 53 % less brachial rete stretch ( 6.6 % ) . Directed suprapubic force per unit area can be uninterrupted or ‘rocking ‘ force per unit area on the posterior facet of the anterior shoulder which may ease adduction of the shoulders, a decrease of the bisacromial diameter and rotary motion to an oblique place. Second line manoeuvres Delivery of the posterior arm is undertaken by infixing the manus in the vagina posteriorly and using soft force per unit area at the antecubital pit to flex the foetal forearm, which is so grasped and swept across the foetal thorax. If bringing of the posterior arm is achieved, the anterior arm rotates posteriorly or descends behind the symphysis pubic bone as Kung et Al showed that the shoulder dimensions are reduced by 2.5cms with this manoeuvre particularly in larger foetuss ( Kung et al. 2006 ) . Rubin ‘s manoeuvre: rotary motion of the shoulders is attempted by insertiong two fingers in the vagina behind the anterior shoulder. The shoulder is pushed frontward and the bisacromial diameter rotates into an oblique place. If unsuccessful, this can so be combined with the Woods ‘ prison guard manoeuvre. Forests ‘ prison guard: force per unit area is applied with two fingers on the anterior facet of the posterior shoulder and use force per unit area taking to revolve the foetus towards the same way as the Rubin manoeuvre. Reverse Woods ‘ prison guard: with two fingers behind the posterior shoulder rotary motion is attempted in the opposite way to the original Woods ‘ prison guard. All these manoeuvres aim to revolve the shoulders and enable bringing by conveying the anterior shoulder posteriorly. Interpolation of the whole manus in the vagina may enable better push on the shoulder and facilitate rotary motion ( Crofts et al. 2008 ) . All-fours: the adult female is on her custodies and articulatio genuss and soft grip is applied taking to present the buttocks shoulder which may fall due to gravitation and to a possible addition of the anteroposterior diameter of the maternal pelvic girdle. Clavicular break: although the bisacromial diameter is reduced with this manoeuvre, there is an increased hazard of iatrogenic brachial rete hurt, vascular and soft tissue foetal injury. Third line manoeuvres Zavanelli manoeuvre involves flexure of the foetal caput, reversal of damages, rotary motion of the caput back to the occipito-anterior place, and replacing into the womb. Tocolytics and general anesthetic agents are used for uterine relaxation. The foetus is so delivered by cesarean subdivision. Although this manoeuvre has success rates of up to 92 % , it is associated with terrible fetal and maternal morbidity including foetal hurts and deceases, uterine and vaginal rupture. Symphysiotomy requires surgical expertness and is associated with important hazards of lower urinary tract hurt. The patient is on a supine place and the thighs are abducted no more than 45IS from the midplane. A urethral catheter is inserted and the urethra is displaced laterally. Following local infiltration with lignocaine, a perpendicular pang scratch is made on the symphysis with a scalpel. The symphysis is normally partly separated by cutting through the fibers by rotational motion of the blade. This allows the anterior foetal shoulder to be disimpacted. In instances of shoulder dystocia, the hazards of OBPP may be reduced if manoeuvres are conducted suitably and forceful downward grip of the caput is avoided ( figure 1 ) . Gonik et al [ 88 ] , showed that downward sidelong flexure of the foetal caput was associated with a 30 % addition in brachial rete stretch ( 18.2 % ) compared with axial placement of the caput ( 14 % ) . Fundal force per unit area should be avoided as it can decline shoulder dystocia and grip combined with fundal force per unit area can be associated with neurological complications [ 57 ] . Consequences may be better and hazards of OBPP lower if there is no terror, force per unit area on the fundus, sidelong grip or pivoting of the caput at the cervix and when tortuosity or rotational motion of the caput to revolve the shoulders is avoided { Doumouchtsis, 2009 # 6174 } .DecisionOBPP is a potentially annihilating complication of childbearing. Shoulder dystocia is merely one of a battalion of hazard factors for OBPP, most of which may be hard to foretell. Future research should be directed in prospective rating of the mechanisms of hurt, in order to enable accoucheurs, accoucheuses and other wellness attention professionals identify modifiable hazard factors, develop preventative schemes and better perinatal results.

HIV Prevention essays

HIV Prevention essays Some people think that HIV or AIDS is something that other people need to worry about like homosexuals, drug users, and people who sleep around. These ideas are mistaken. All young people need to take the threat of HIV seriously, except for the ones who are abstinent. HIV (scientifically known as Human Immunodeficiency Virus) is the virus that causes AIDS. By killing or damaging cells of the body's immune system, HIV progressively destroys the body's ability to fight infections and certain cancers. People diagnosed with AIDS may get life-threatening diseases called opportunistic infections, which are caused by microbes such as viruses or bacteria that usually do not make healthy people sick. This virus is passed from one person to another through blood-to-blood and sexual contact. In addition, infected pregnant women can pass HIV to their baby during pregnancy or delivery, as well as through breast-feeding. People with HIV have what is called HIV infection. Some people diagnosed with HIV, have a high chance of developing a certain form of cancer. Most of these people will develop AIDS as a result of their HIV infection. During the past decade, more than 400,000 individuals in the United States have been diagnosed with HIV or AIDS. Officials from the United States Centers for Disease Control and Prevention reported that the number of deaths from HIV and AIDS in the U.S. has dropped by a record of 47 percent. Officials attributed the reduction to an extremely effective combination drug treatment that allows people affected with HIV to live longer and healthier lives. Unfortunately, no such decline occurred in the new number of new HIV infections in the United States. The infection rate remains at about 40,000 new cases a year. HIV can be passed on because it would be present in the sexual fluids and blood of infected people. If infected blood or sexual fluid gets into your blood, then you will become ...