Customer Service at Richer Sounds Essay Example for Free

Customer Service at Richer Sounds Essay Richer Sounds believe that the most important measure of the success would be to give all their customers a great service and satisfaction. This is even important than making the profit margins high and gaining a lot of profit this is because Any organisation can increase their profits by increasing prices of goods, buying cheaper and low quality goods, cutting down on employees and many more but doing this Richer Sounds believe that there wont be good customer service due to less employees, customers wont purchase any expensive products which is not of good quality and through this they will keep losing customers The company believes once a customer purchases a product and thinks it was at low price and also sees it is off good quality with an excellent customer service given to him the he/she will always tend to come back to purchase more goods, in-fact the customer may also tell some of its friends and families about the prices that Richer Sounds have and like this the company will benefit in getting new and new customers all the time. How Richer Sounds strive to achieve superb customer service They think the following are important: Management commitment this means every director and every manager states the customer service as most essential in the business. This also means spending money to give excellent services Recruiting and training right people Colleagues are looked at their personalities and attitude while there are been giving an interview. All colleagues that have been given the job have a 3 day induction course which even concentrates in training the new colleagues how to give an excellent customer service Motivated colleagues if all colleagues are treated well and valued they will give good service to customers. For this reason the colleague support function is so critical. Measuring the results The best way to find the right results are to ask customer themselves therefore Richer Sounds does this through it sales questionnaires. Richer Sounds also have a mystery shopper who looks how well the colleagues manage their customers and how greatly they give customer service. The company also has telephone call system, which is been recorded, and through this they check how well store colleagues answer to customer problems. A customer friendly environment this include the ease of walking around the store, the layout of the store and how well are the products displayed and also how well each customer will be able to search for his/her product The company insist their colleagues to wear smart clear clothes with clear name badges and to greet all their customers. Responding to customer needs Training in customer service All new colleagues have to attend the three day induction course before they are allowed to serve customers. While doing this course they are also taught on the aspects of customer service, which includes: How to approach a customer within the stores Richer Sounds has several policies on approaching a customer such as: Not to approach a customer as soon as they have entered the store for any help, Once a customer enters they should greet them by saying hello and most strict rule is to not approach anyone from behind because it may scare them and only approach from the side or from the front The appearance of the colleagues all colleagues working in the sores have to were the Richer Sounds uniform with a name badge on it How to cope on busy days All tills must be used to serve customers and try to serve quite faster. When the queues are very long colleagues should offer customers standing and not standing in the queues a cup of tea or coffee. Usually no customers like to wait in queues especially when the store I very crowded. How to ask questions to customers colleagues should ask questions relating on the type of product they are looking for and not to encourage customers to buy items they dont wont because richer sounds believe this is the worse thing to do. How to handle payments the company uses all types of credit cards or any type of purchase whether the item is 99p or even if the item is i 99. 99. This is because there are times when people wont to pay later for the item they need because you get a time period to pay the amount and there are times when customers may have forgot their money at home but want to purchase the item so they can use the credit card. Due to this reason no one may leave the store without anything just because they forgot their money. How to cope with technical questions Health and safety each colleague should know how to take actions in emergency to do this they may need this training How to deal customers who have disabilities All colleagues should have respect for customers who have disabilities and should help them in all ways for which product they are looking for. All colleagues should be truthful in what they sell and how much they take because if there is a blind person needing a tape player the colleagues shouldnt charge more money to what it should be. How Richer Sounds Identify Customer needs and Expectation There are three main ways how richer sounds identify customer needs and expectation, which are: The till receipt questionnaires these are most important questionnaires because everyone who purchases a product will receive and if they taught they did get treated well at the store then he/she may fill the questionnaires. These questionnaires are also seen everytime the customers will see the receipt and so next time when they may come back to the store to purchase another item then they could also bring the filled questionnaires with them.

Shakespeares baptismal Essay Example for Free

Shakespeares baptismal Essay William Shakespeare was born in April of 1564. There is no specific date of birth because at that time the only date of importance was the date of baptism, though infants often were baptized when they were three days old. Shakespeares baptismal date was April 26, 1564. Shakespeare was born in the village of Stratford-upon-Avon in Warwickshire. At the time of his birth, the village had a population of 1500 people, and only 200 houses. Shakespeares father came from a family of yeomen, and he gained many prestigious positions in the community. Shakespeares mother came from an ancient family of landed gentry. The whole family was Anglican. The familys financial situation was well off. Not much information is known about Shakespeares youth, although undoubtedly he was educated in the local school, where he studied Latin and Greek, among other subjects, during a school day that often lasted from dawn to dusk. Shakespeares first exposure to the theatre probably occurred when he was young. As a child his father probably took him to see plays when travelling troupes of actors came to town, although that was not often. Shakespeare was married to Anne Hathaway in 1582, when he was 18; she was 26, eight years his senior. The exact wedding date is uncertain, but the marriage certificate was issued on November 27, 1582. William and Anne had their first child, Susanna, in May of 1583. This was followed by the birth of twins, Hamnet and Judith, in January of 1585. Most historians believe that Shakespeare was not often around his family in Stratford after that because historical records show him in London during the following years. The first written reference to Shakespeares existence in London occurred in 1592, when Shakespeare was in his late twenties. He seems to have been fairly well established in the theatre by that point, since the reference, written by another playwright, hints of jealousy at Shakespeares success. With his two patrons, the Earls of South Hampton and Pembrooke, Shakespeare rose quickly in the theatre as both an actor and an author. He joined the Lord Chamberlains Men, an acting company which was protected by the Queen, becoming a shareholder and senior member in 1595. Because of his success in London, he was able to purchase New Place, the largest and most elegant house in his home town of Stratford, when he was in his early thirties (1597). In addition to his popularity as both an actor and playwright, Shakespeare became joint owner of the famous Globe theatre when it opened in 1599. His share of the companys management added heavily to his wealth. Shakespeares financial success in the London theatre enabled him to retire and return to his home in Stratford around 1610. He lived there comfortably until his death on April 23, 1616 (it is popularly believed that he died on his birthday). He is buried in Holy Trinity Church in Stratford-upon-Avon. Though Shakespeare is most closely associated with the Elizabethan period, his career can be categorized as both Elizabethan and Jacobean, as several works were completed after James I became king in 1603.

Efficacy Of Dynamic Splinting Health And Social Care Essay

Efficacy Of Dynamic Splinting Health And Social Care Essay The procedure has proven to both reliable and durable. A successful total knee replacement allows patient to resume almost all activities of daily living with minimal difficulty. In most cases patients no longer require external aids or chronic medications. Finally total knee replacement helps patients to maintain their overall self esteem. Total knee replacement is indicated when there is unremitting severe pain in the knee with or without deformity. The pain/ deformity may be due to osteoarthritis, Rheumatoid arthritis and various non specific arthritis. It relieves pain, provides mobility and correct deformity. Total knee replacement is a surgical procedure in which injured or damaged parts of the knee joint are replaced with artificial parts. The procedure is performed by seperating the muscles and ligaments around the knee to expose the knee capsule. The knee capsule is opened, exposed the inside of the joint. The end of the femur and tibial are removed. The artificial parts are cemented into place. The knee will consist of metal shell at the end of the femur, a metal and plastic trough on the tibia and if needed a plastic button in the cap. In a way this could be more appropriately called a Knee resurfacing operation. The common pathology for total knee replacement is knee flexion contracture. DEFINITION: Flexion contracture is defined as the shortening of the connective tissue thereby stiffening the joint. It is due to tightening of the posterior capsule combined with the tightening of biceps femoris and collateral ligaments. Hence rehabilitation program should be undertaken soon after TKA to maintain joint range of motion. In particular this study examined the value of dynamic splinting in increasing range of motion and reducing the flexion contracture. Dynamic splinting utilizes the biomechanical adaptation of keeping the joint at end-range to achieve a physiological change of molecular realignment to elongate the connective tissue. This protocol of low-load, prolonged-duration stretch with dynamic tension continually reduces the contracture. ANATOMY OF KNEE JOINT: The knee joint is the largest and most complex joint in the body. It is synovial modified hinge joint. It is formed by fusion and medial tibio- femoral and patella- femoral joint. ARTICULAR SURFACES: It is comprised the Femoral condyles: distal end of femur Tibial condyles : proximal end of tibia. Patellar facetes : posterior surface of patella. Femoral condyles: The articular surfaces of femur are pulley shaped. The femoral condyles are convex in both planes. They are extended interiorly by the pulley shaped patellar surfaces. The neck of the pulley is represented anteriorly by the central groove on the patellar surface and posteriorly by the intercondylar notch. 111 Tibial condyle: The tibial surfaces are reciprocally curved and comprises two curved and concave parallel gutters which are separated by a blunt eminence running antero- posteriorly eminence lodges the two intercondylar tubercles. Tibio-femoral joints: The tibial condyles correspond to the femoral condyles while the inter condylar tibial tubercles come to within the femoral intercondylar notch, these surfaces constitute functionally the tibio-femoral joint. Femero-patellar joints: The facets of patella correspond to the patellar surface of the femur while the vertical ridge of the patella fits into the central groove of the femur. LIGAMENTS OF KNEE JOINT: Medial collateral ligament: It is flattened band rhomboidal in outine. It is attached above to the medial epicondyle of femur, below to the medial margin and the adjoining medial surface of tibia. Function: restrain valgus rotation Lateral collateral ligament: Function: restrain varus rotation and resist internal rotation kneeanat Anterior cruciate ligament: It is attached below to the anterior part of the intercondylar area of tibia between the anterior ends of lateral and medial semilunar cartilages. Above it is attached to the posterior part of the medial surface of lateral femoral condyle. Function: To resist anterior displacement of the tibia on the femur when the knee is flexed To resist varus or valgus rotation of the tibia, especially in the absence of the collateral ligaments Resists internal rotation of the tibia. Posterior cruciate ligament: It is attached below to the posterior part of intercondylar area of tibia, posterior to the attachment of posterior end of medial semilunar cartilage. Above it is attached to the anterior part of lateral surface of the medial condyle of femur. Function: To allow femoral rollback in flexion Resist posterior translation of the tibia relative to the femur Controls external rotation of the tibia with increasing knee flexion. Retention of the PCL in total knee replacement has been shown biomechanically to provide normal kinematic rollback of the femur on the tibia. This also is important for improving the lever arm of the quadriceps mechanism with flexion of the knee. MUSCLES OF KNEE JOINT: Quadriceps femoris Popliteus Semitendinosus Semimembranous Sartorius Biceps femoris Gastrocnemius Plantaris BURSAE AROUND THE KNEE JOINT: Anteriorly: The suprapatellar bursa The prepatellar bursa Superficial intrapatellar bursa Deep infrapatellar bursa Laterally: A bursa between lateral collateral ligament and biceps tendon A bursa between lateral collateral ligament and popliteus tendon Popliteus bursa lies between the popliteus and lateral condyle of femur. Medially: The tibial inter tendinous bursa( pes anserine bursa) A bursa between medial collateral ligament and semimembranous tendon A bursa between semimembranous tendon and tibia. Posteriorly: A bursa between lateral head of gastrocnemius and capsule. Semimembranous bursa(brodies bursa) NERVE SUPPLY: Femoral nerve Sciatic nerve Obturator nerve BLOOD SUPPLY: The arterial supply to knee joint, is from the branches of Popliteal artery Femoral artery Tibial artery TIBIO-FEMORAL ARTHROKINEMATICS: Viewed in the sagittal plane, the femurs articulating surface is convex while the tibias in concave. We can predict arthrokinematics based on the rules of concavity and convexity: During Knee Extension During Knee Flexion Open Chain Closed Chain Open Chain Closed Chain Tibia Glides Anteriorly On Femur Femur Glides Posteriorly On Tibia Tibia Glides Posteriorly On Femur Femur Glides Anteriorly On Tibia from 20o knee flexion to full extension from full knee extension to 20o flexion Tibia rotates externally Femur rotates internally on stable tibia Tibia rotates internally Femur rotates externally on stable tibia THE SCREW-HOME MECHANISM: Rotation between the tibia and femur occurs automatically between full extension (0o) and 20o of knee flexion. These figures illustrate the top of the right tibial plateau as we look down on it during knee motion. top of tibial plateau top of tibial plateau top of tibial plateau During Knee Extension, the tibia glides anteriorly on the femur. During the last 20 degrees of knee extension, anterior tibial glide persists on the tibias medial condyle because its articular surface is longer in that dimension than the lateral condyles. Prolonged anterior glide on the medial side produces external tibial rotation, the screw-home mechanism. THE SCREW-HOME MECHANISM REVERSES DURING KNEE FLEXION top of tibial plateau top of tibial plateau top of tibial plateau When the knee begins to flex from a position of full extension, posterior tibial glide begins first on the longer medial condyle. Between 0 deg. extension and 20 deg. of flexion, posterior glide on the medial side produces relative tibial internal rotation, a reversal of the screw-home mechanism. TOTAL KNEE REPLACEMENT Total knee replacement is indicated when there is unremitting severe pain in the knee with or without deformity. The pain/ deformity may e due to osteoarthritis, Rheumatoid arthritis and various non specific arthritis. It relieves pain, provides mobility and correct deformity. Total knee replacement is a surgical procedure in which injured or damaged parts of the knee joint are replaced with artificial parts. The procedure is performed by seperating the muscles and ligaments around the knee to expose the knee capsule. The knee capsule is opened, exposed the inside of the joint. The end of the femur and tibial are removed. The artificial parts are cemented into place. The knee will consist of metal shell at the end of the femur, a metal and plastic trough on the tibia and if needed a plastic button in the cap. In a way this could be more appropriately called a Knee resurfacing operation. E:New FolderNAGU PROJECTimAGESTotal-Knee-Replacement.jpg The total knee replacement can be: Unicompartmental arthroplasty: The Articular surface of femur and tibia, either the medial or lateral compartment of the knee are replaced by an implant. Eg: osteoathritis. Bicomprtmental arthroplasty: In bicompartmental arthroplasty, the articular surface of tibia and femur of both medial and lateral compartments of the knee joints are replaced by an implant. The third compartment i.e.., the patellofemoral joint is however left intact. Tricomprtmental arthroplasty: the articular surface of the lower femur, upper tibia and patella are replaced by prosthesis. Most commonly performed arthroplsty. The prosthesis consists of a tibial component, a metal femoral component and a high molecular weight polyethylene button for articular surface of the patella. TKA GOALS Restore mechanical alignment [neutral tibiofemoral alignment = 4 °-6 ° of anatomic valgus], Horizontal joint line, Soft tissue balance (ligament), (Patella tracking (Q-angle) INDICATION Oteoarthritis Rheumatoid arthritis Hemophilic arthritis Traumatic arthritis Sero negative arthrides Crystal deposition disease Pigmented villonoular synovitis Avascular necrosis Bone dysplasias Asymmetric arthrits CONTRA INDICATION Absolute contraindications Recent or curren joint infection Sepsis or systematic infection Neuropathic arthropathy Painful solid knee fusion Relative contraindications Severe osteoporosis Debilated poor health Non functioning extensor mechanism Painless, well functioning arthrodesis Significant peripheral vascular diseases TKA Complications Death: 0.53% Periprosthetic Infection: 0.71% Pulmonary emboli: 0.41% Patella fracture: Component Loosening: Tibial tray wear: Peroneal Nerve Palsy: 0.3% to 2% Periprosthetic Femur Fracture: Periprosthetic Tibial Fracture: Wound Complications / Skin slough: rare Patellar Clunk Syndrome: rare Patellofemoral Instability: 0.5%-29% DVT: Instability: Popliteal artery injury: 0.05% Quadriceps Tendon Rupture: 0.1% Patellar Tendon Rupture: Stiffness: Fat Embolism MCL rupture NEED AND SIGNIFICANCE OF STUDY: Need of the study: To reduce flexion contracture To improve range of motion To improve functional activity Significance of the study: This study is to evaluate the efficacy of dynamic splinting for knee flexion contracture following a total knee arthroplasty. Statement of the problem: To study the efficacy of dynamic splinting for knee flexion contracture following a total knee arthroplasty. Hence the study is entitled as efficacy of dynamic splinting for knee flexion contracture following a total knee arthroplasty. Objectives: To reduce flexion contracture To improve range of motion To analyze the effect of dynamic knee splint Null hypothesis: The null hypothesis can be stated as follows there is no significant difference in knee flexion contracture after the application of dynamic knee splint. Alternate hypothesis: The hypothesis can be stated as follows there is significant difference in knee flexion contracture after the application of dynamic knee splint. 2. REVIEW OF LITERATURE: 1. TOTAL KNEE ARTHROPLASTY: Simon H Palmer, MD, Consultant Surgeon: Sep 21, 2010 Osteoarthritis destruction of the knee is the most common reason for total knee replacement. Jayant joshi, prakash kotwal says that total knee replacement relieves pain, provides mobility corrects deformity. 2. FLEXION CONTRACTURE: J. Ilyas; A.H. Deakin; C. Brege; and F. Picard Flexion contracture is a common deformity encountered in patients requiring total knee arthroplasty (TKA). Department of orthopaedics, golden jubilee national hospital, clydebank, glasgow, g81 4hx, uk. One hundred and four continuous TKA were completed by a single consultant using the OrthoPilot (BBraun, Aesculap) navigation system and Columbus implants. Seventy-four knees had preoperative flexion contracture (including neutral knees) while 30 were in hyperextension. Ouellet D, Moffet H. Arthritis Rheum October 2002 Large movement deficits are present, especially in single-limb support pre-op and 2 months following TKA. Huei-Ming Chai, PHD. November 24, 2008 total knee arthroplasty limits range of motion 3. DYNAMIC SPLINT: Dennis l armstrong, m.d. Buck willis, phd evaluates the efficacy of dynamic knee extension splinting for knee flexion contracture following TKA. Finger  E, Willis  FB Health Physical Education, Recreation, Texas State University, Cases Journal 2008, Physical therapy alone did not fully reduce the contracture and dynamic splinting was then prescribed for daily low-load, prolonged-duration stretch. Finger E, Willis B 29Dec2008: Dynasplint offers extension Systems to aid in rehabilitation and recovery from flexion contracture. Clinical studies have demonstrated greatest average reduction in rehabilitation time and cost with the use of Dynasplint Systems in conjunction with physical therapy. Willis FB Biomechanics.2008 Jan; 15 After surgery, a patient is often left with shortened connective tissue and may have a difficult time walking normally again. Wearing a dynamic knee splint will lengthen and remodel the tissue to restore range of motion. McClure P, Blackburn L, Dusold C Ideally, wearing your Dynasplint for 6-8 continuous hours yields the best results as it allows a safe, long lasting remodeling of the soft tissue. Cliffordr.Wheeless, Iii, Md.December3, 2008. The purpose of this report is to review the use of external fixator for the gradual correction of severe knee flexion contractures that limit patient function. James f. Mooney iii, md, l. Andrew koman Posted: 05/01/2001 Average preoperative flexion contracture was 80.5 °. Each patient achieved full extension. There was one recurrence, despite bracing, which was managed with replacement of the fixator and soft tissue procedures 4. CONVENTIONAL PHYSICAL THERAPY FOR KNEE ARTHRITIS: Jan.K.Richardson, Pt, Phd, Ocs Said that arthritis is a degenerative disease of the cartilage and bones that results in pain and stiffness in affected joint. There is no cure for arthritis, but physical therapy can make living easier and less painful. Brigham And Womens Hospital Department of Rehabilitation Services Physical Therapy .ROM along with proper soft tissue balance is required to ensure proper biomechanics in the knee joint. Aggressive post-operative PT has been shown to be effective in improving patient outcomes and shortening length of stay Balint G And Sz Ebenyl.B Showed that therapeutic exercises decreases pain, increases muscle fatigue and range of motion as well as improve endurance and aerobic capacity. Weight reduction is proven in obese patients with OA of knee. Therapeutic heat and cold, electrotherapy, acupuncture are widely used. Dr. Margriet van baar reported that significant beneficial effects from exercise therapy including improvements in self reported pain, disability, walking ability and overall sense of well being. Dorr LD.   J Arthroplasty June 2002 CPM helps achieve knee range of motion quicker in first post-op weeks but at final follow-ups, no difference in final range of motion Byrne, et al.   Clin Biomech October 2002 Deficits in knee strength balanced by increased hip extensor work; rehab should optimize bilateral hip and knee function after TKA McManus et al 2006, Jorge et al 2006 the higher frequencies (90-130Hz) to stimulate the pain gate mechanisms thereby mask the pain symptoms. Ozcan et al, 2004 Low frequency nerve stimulation is physiologically effective (as with TENS and NMES) and this is the key to IFT intervention. Adedoyin, R. A., et al. (2002).IFT acts primarily on the excitable (nerve) tissues, the strongest effects are likely to be those which are a direct result of such stimulation (i.e. pain relief and muscle stimulation). National Taiwan University Hospital, November 2008 PNF stretching techniques has been used frequently for patients with total knee arthroplasty in clinical practice to increase range of motion effectively and reduced knee pain during exercise. Huei-Ming Chai, PHD November 24, 2008 PNF stretching technique is a therapeutic technique using the PNF concept to the related muslces either to increase neuro-inhibition mechanism for releasing muscle spasm and elongating muscle length, or to increase neuro-excitation mechanism for enhancing muscle strength Harold B. James H. Beaty, MD Range-of-motion exercises, muscle strengthening, gait training, and instruction in performing activities of daily living are important. 5. GONIOMETRIC MEASURENT FOR ROM: Carlos Lavernia, MD, Range of motion assessment through direct observation without a goniometer provides inaccurate findings. Mark D. Rossi, PhD, PT, CSCS The Journal of Arthroplasty Vol. 23 No. 6 Suppl. 1 2008 Measured scores using a goniometer provided an improved degree of accuracy, but results appear to be dependent on the clinician performing the measurement. Richard l. Gajdosik Associate Professor Physical therapists may accept most knee goniometric measurements as clinically valid, and the evidence indicates that most of these measurements are reliable. 6. KNEE SOCIETY SCORE: Gil Scuderi, MD-Chair; Jim Benjamin, MD; Jess Lonner, MD; Bob Bourne, MD and Norm Scott, MD, 2007,The Knee Society rating system (KSS) was first published in CORR in 1989 and has become the standard clinical evaluation system for reporting results for patients undergoing Total Knee Replacement. John N. Insall, MD, Lawrence D. Dorr, Scott, MD Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res. 1989 Nov:The Knee Society has proposed this new rating system to be simple but more exacting and more objective. MD, Richard D. Scott, MD, and W. Norman It is hoped the knee society rating system will become universally accepted and will be adopted by all authors, even if they wish to report results using a customary scoring method as well. 3. MATERIALS AND METHODOLOGY: MATERIALS: Evaluation tool: Goniometry Knee society score Outcome measure: Range of motion Knee score Function score Material used: Dynamic knee splint METHODOLOGY: (A) Study design: 30 subjects with flexion contracture following unilateral TKA assigned in two groups. GROUP A: 15 subjects: Dynamic Splint Along With Conventional Physiotherapy. GROUP B: 15 subjects: Conventional Physiotherapy. (B) Study setting: This study was carried out in the department of physical medicine and rehabilitation, Sri Ramakrishna hospital, Coimbatore. (C) Study duration: This study was carried out for a period of 6 months. (D) Sampling: Random sampling. INCLUSION CRITERIA: Age: 45 to 70 years. Both sex Flexion contracture : 20 12 deg (post operatively) Unilateral TKA Reduced flexibility in AROM of knee extension Pain that is worsened by bending over while legs are straight Impaired gait pattern Ability to understand informed consent and experiment responsibilities EXCLUSION CRITERIA: Fractures Bilateral TKA TKA Knee sepsis Osteomyelitis or any orthopedic infection Extensor mechanism dysfunction Psoriasis Knee joint neuropathy Previous Stroke or Brain Injury STATISTICS TOOL: The data collected was analyzed using independent t-test. The test was carried out between two groups. Independentt test was used to compare the effectiveness of treatment between the groups. t = S = X1 = Difference between pretest and posttest values of Group I X2 = Difference between pretest and posttest values of Group II = Mean difference of Group I = Mean difference of Group II n1 = No. of samples in Group I n2 = No. of samples in Group II S = Combined standard deviation TREATMENT: Dynamic knee Extension splint: The Rebound Effect http://www.dynasplint.com/uploads/user-uploads/rebound2.gif 53% Average Reduction in Time and Cost Associated with ROM Rehabilitation High-force, short-duration stretching favors recoverable, elastic tissue deformation, whereas low-force, long-duration stretching enhances permanent plastic deformation. In the clinical setting, high force application has a greater risk of causing pain and possibly ruptures of tissue. Dynasplint Systems improve range of motion by creating permanent, non-traumatic tissue elongation and remodeling, thus virtually eliminating the range of motion rebound effect often observed in the clinical setting. RangerKnee2 Features Benefits LLPS (Low-Load, Prolonged-Duration Stretch) technology has been proven to successfully treat joint stiffness and limited range of motion. Early application can reduce time and cost associated with range of motion rehabilitation Simple, adjustable and reproducible bilateral tensioning System Available for rent or purchase Biomechanically correct Comfortable to wear Each Dynasplint System is recycled to reduce waste and help the environment A Dynasplint Systems consultant will fit your patients and oversee their treatment to ensure the best possible results Over a quarter of a million patients have been successfully treated with Dynasplint Systems Conveniently labeled and easy to use Patient Wearing Protocol Please review the tension your Dynasplint consultant set for you initially. In the beginning, the splint should be worn for 2-4 hours. Do not increase the tension until you can tolerate overnight wear. Time is the most important factor and your first goal should be 6-8 hours of pain free wear. After achieving this time goal, when you take the splint off if you have less than 1 hour of post-wear stiffness, turn tension up by one on both sides. However if you are unable to wear the splint for a prolonged period of time, decrease the tension by a half to one full turn. During the process of regaining your range of motion, if you have any question or concerns contact your Dynasplint consultant. http://www.wheelessonline.com/images/i1/imk11.jpg CONVENTIONAL TREATMENT: MODALITIES FOR PAIN CONTROL, EDEMA REDUCTION: Moist Heat Functional electrical stimulation Transcutaneous electrical stimulation Ice therapy Interferential therapy Galvanic Stimulation JOINT MOBILIZATION: Flexion restriction Position: patient seated Posterior glide of tibia on femur-grade 3 Oscillation with 30 second hold, Repeated 5 times with patellar mobilization of inferior glides (5 mins) Extension restriction Position: patient prone with patella off of table Anterior glide of tibia on femur- grade 3 oscillation and static hold (10 secs in 3 repetitions) with patellar mobilization superior glides (5 mins) EXERCISE PROGRAM: Closed and open kinetic chain strengthening exercises Proprioceptive/balance exercises targeting the trunk and lower extremity musculature Partial body weighted squats Gait training Range of motion exercises Heel slide (supine sitting) Stretching (prone/supine) to increase knee extension ROM GAIT TRAINING: Forward Walking Sidestepping Backward or Retro-Walking FUNCTIONAL TRAINING: Standing Transfer Activities Lifting Carrying Pushing or Pulling Squatting or Crouching Return-to-Work Tasks ENDURANCE TRAINING: Upper body exercise. Ambulation activities One-leg cycling, using non-operative leg with resistance to motion. BALANCE/PROPRIOCEPTION TRAINING: Tandem Walking Lateral Stepping over/around objects Weight-Shifting Activities Closed Kinetic Chain Activities 5. DATA ANALYSIS AND INTERPRETATION: KNEE EXTENSION ROM: GROUP I Pre test (Two months after TKA) Post test (conventional PT with SPLINT) Difference X1 16 0 16 16 1 15 16 2 14 16 2 14 16 4 12 14 0 14 14 0 14 14 1 13 14 1 13 14 2 12 12 0 12 12 0 12 12 1 11 12 1 11 12 1 11 Mean=12.93 PRE TEST AND POST KNEE EXTENSION ROM: GROUP I KNEE EXTENSION ROM: GROUP II Pre test (Two months after TKA) Post test (conventional PT without splint) Difference X2 18 7 11 18 6 12 18 6 12 18 6 12 18 4 14 16 7 9 16 7 9 16 4 12 16 4 12 16 4 12 14 3 11 14 4 10 14 4 12 14 2 12 14 2 12 Mean=11.46 t=2.82 s.dev=1.42 degrees of freedom = 28 The probability of this result, assuming the null hypothesis, is 0.009 PRE TEST AND POST KNEE EXTENSION ROM: GROUP II KNEE SCORE AND FUNCTION SCORE: S.No. Parameters Groups Mean S.D.Value t Value 1. Knee Scores Group A 18 4.47 3.06 Group B 13 2. Function Score Group A 35.6 4.98 3.01 Group B 30.1 MEAN DIFFERENCE BETWEEN KNEE SCORE AND FUNCTION SCORE DEMOGRAPHIC DATA THE AGE OF THE SAMPLES BETWEEN 45 -70 YEARS IN EACH GROUP Age (years) No. of Samples Total Group A Group B 45-50 4 3 7 50-55 5 4 9 55-60 2 5 7 60-65 2 2 4 65-70 2 1 3 TOTAL NUMBER OF MALES AND FEMALES IN EACH GROUP Sex No. of Samples Total Group A Group B Male 8 10 18 Females 7 5 12 TOTAL NUMBER OF RIGHT AND LEFT SIDE INVOLVEMENT IN EACH GROUP Side of involvement No. of Samples Total Group A Group B Right 11 8 19 Left 4 7 11 5. DISCUSSION Total knee arthroplasty (TKA) is considered the treatment of choice for patients with intractable pain and substantial functional disabilities who have not had acceptable relief and functional improvement after conservative treatment. Knee flexion contracture is a common pathology following TKA affecting up to 61% of these patients. The purpose of the study is to determine the effectiveness of dynamic splinting in treating patients with flexion contracture following Unilateral TKA. Literature review states that there is significant difference between dynamic splinting and conventional physiotherapy management in reducing flexion contracture following Unilateral TKA. A total of thirty patients with unilateral TKA were selected under inclusive criteria and were randomly allocated into an experimental group and control group as Group A and group B respectively. In each group 15 Individuals were allotted In Group A, dynamic splint along with conventional physiotherapy was given and in Group B, Conventional physiot

Capitalism and the Common Man :: Economy Economics Essays

Capitalism and the Common Man There are some arguments, having a faint measure of plausibility, that have served politicians, charlatans and assorted do-gooders for well for over a century in their quest for control. One of those arguments is: capitalism primarily benefits the rich and not the common man. That vision prompts declarations such as: Congressman Richard Gephart's assertion that high income earners are "winners" in "the lottery of life." Then there's, Robert Reich, former Secretary of Labor, who says high income earners the "fortunate fifth." These nonsensical visions lead to calls for those who've been "blessed" to "give back" either voluntarily or coercively through the tax code. While demagogic statements like these have high emotive worth, they reflect resolute, near incurable stupidity about the sources of income. Listening to some of the talk about income differences, one would think that out there somewhere is a pile of money. People who are wealthy just happened to get there first and greedily took an unfair share. Justice requires that they "give back." Or, there's talk about income distribution. The way some people talk, unequal distribution of income means that there is a dealer of dollars who shells out $1,000 to one person, $100,000 to another and a million dollars to yet another. Thus, the reason why some people are wealthy while others are not wealthy is that the dollar dealer is a racist, sexist, a multi-nationalist, or just plain mean. Economic justice requires a re-dealing of the dollars, income redistribution, where the ill-gotten gains of the few are returned to their rightful owners. In a free society, for the most part, people with high incomes have demonstrated extraordinary ability to produce valuable services for, and therefore please their fellow man. Sam Walton, founder of Walmart, Bill Gates, founder of Microsoft, and singer Michael Jackson provided services deemed highly valuable by their fellow men who voluntarily took money out of their pockets to purchase those services. Their high incomes stand as unambiguous proof of that service. Their high incomes also reflect the democracy of the market place. For example, millions upon millions of independent decision makers decided to fork over $200 or $300 for Microsoft founder Bill Gates' "Windows 98" operating system. Those who think Bill Gates is too rich, and want to redistribute his income, are really registering disagreement with the democracy of the market place and want to cancel or offset the market "vote.

Essays --

Why is Ethiopia Always Hungry? In 1974, Louis Leake discovered a 3.2 million year old skeleton he named â€Å"Lucy† in the Afar region of Ethiopia. This evidence indicates human inhabitants have lived in the region for millions of years. In Ethiopia today, the people are chronically hungry. There have been recurrent famines leading to starvation and death of hundreds of thousands of people. The country’s population is outpacing its food production. Did â€Å"Lucy† die from starvation? Why can’t Ethiopia feed its people? Ethiopia is the oldest independent country in Africa with a long and complex history dating back thousands of years. Located in the eastern Horn of Africa, Ethiopia is a landlocked country slightly smaller than twice the size of Texas. In 1994, a federal republic was created consisting of nine ethnically based states and lead by a president elected by the people (â€Å"Central Intelligence Agency†). It has a current population of 93 million people. In 2013, Ethiopia had a population growth rate of 2.9%, ranking it ninth in the world in population growth. This growth rate is projected to continue over the next 40 years (Population Challenges). The country is made up of many ethnic groups with the Oromo (35%) and the Amhara (27%) making up the largest groups. In general, the population is rural and poor. Only 17% of the people live in urban centers. Agriculture is the main driver of the Ethiopian economy. Most of the farming occurs on small farms and consists of subsi stence agriculture. There is very little commercial farming. Agriculture contributes 46% to GNP and employs 85% of the population (â€Å"Ethiopia†). The geography of Ethiopia is a high plateau divided by the Great Rift Valley. There is a central mounta... ...e weather conditions, the problem continues to grow. Solving these problems requires action on all levels--from the international community and the United Nations, by the Ethiopian federal government, and members of the regional and local communities. The course of action for Ethiopia will take both time and financial support. The problem did not develop overnight and it cannot be solved quickly. By working together to provide sustainable solutions, the people of Ethiopia may one day be protected during times of drought by having enough food available to prevent famine and starvation. Hopefully, Ethiopia will be able to implement the reforms and changes needed to someday sustain itself. By providing adequate food for its people, it will eliminate the need for food handouts. Maybe some day soon we will be able to quit asking, â€Å"Why is Ethiopia always hungry?†

Symbolism in Fuentes Aura Essay -- Carlos Fuentes, Aura Essays

On the surface, Fuentes' Aura is a very strange and eerie book. It draws you in and keeps you there, forcing you to read the book to its very end. Just below the surface, a world of symbolism, words and parallels lead to a greater understanding of what is happening throughout this captivating tale. Skimming the surface of the story, an abundance of symbols can be signaled out, but a recurrence of symbols is very important. One of the most prevalent symbols found in this story is the darkness of Senora Consuelo's old colonial mansion. The house is so dark the characters must learn to maneuver by sound and touch. The darkness sets the tone for the whole story. Senora Consuelo's room is not bathed in light but filled with "perpetual shadows". Of course darkness and shadows are a staple of the Gothic, but darkness could also be suggestive of the unknown or not being able to think clearly. Shadows could be interpreted as that which is clouded, hard to grasp, or just beyond clear vision. Did the darkness and shadows contribute to Felipe?s state of mind and make him more susceptible to Senora Consuelo's will? The rooms where the action of a story takes place are also very important. Some the rooms used in the book are bedrooms, the dining room, the parlor, and the enclosed garden patio. The first room we see inside of this old house is the garden patio. This room is interesting because the smell from the patio is always associated with the title character. Felipe looks for her in this garden; he smells the patio plants in her hair. Symbolically, the garden can be associated with the mind, with the unconscious, or it may give you clues to your own inner state. The plants, flowers, and fruit found in the garden may also enhance t... ...book. These symbols and recurrences are not coincidental or superficial, but upon investigation, give deeper insight into how deeply the mindset of our main character was affected. We now know that Felipe had almost no choice and was lulled into this household. Then there is a plausible explanation about the true relationship between Aura and Senora Consuelo. This book turns out to be a very strange life/death cycle that still leaves questions that need to be answered. Work Cited Fuentes, Carlos. Aura. Trans. Lysander Kemp. New York: Farrar, Straus and Giroux, 1981. Fuentes, Carlos. "Worlds Apart." Modernism/Postmodernism. Ed. Peter Brooker. London: Longman, 1992. 244-46. Gillespie, Kathleen " A literary Legend Speaks ? Carlos Fuentes at the Askwith Education Forum" 1 de Diciembre de 2003 http://www.gse.harvard.edu/news/featrures/fuentes12012000.html

Obama VS Chamberlain

When Chamberlain went to Munich on September 29th, 1938, to ask Hitler to discontinue, as he would have said, his plans to take over Poland, Chamberlain had good intention, but bad execution. He claimed that the appeasement was for, â€Å"The peace of our time,† and that his agreement with Hitler, that which Hitler biblically disregarded 7 days later, would allow Europe to continue war-free, sparing It from the trauma and anxiety associated with war. It Is well known that Chamberlain failed utterly to accomplish anything with the appeasement, and war did in fact break out he following year.Recently, President Obama went to Geneva to negotiate peace terms with Iran regarding them physically possessing nuclear weapons, and failed to accomplish anything. In fact, Iran slapped America in the face by completely undermining America's request, and this is the cause for much controversy and ill feelings toward Obama as of late. In comparison to Chamberlain's utter failure at Munich, B eam's inability to impose his country will Is far more severe than what happened in 1938.While It Is rue that both Britain and the US practically surrendered to Germany and Iran, respectively, Nazi Germany was much larger of a world power In its day when compared to modern day Iran. In addition, Brutal was In a weak state economically and militarily, while the united States, although Isn't In tip-top shape economically due to the recent recession, has one of, if not, the largest and most powerful militaries in the entire world. To have to surrender to a country whose inferiority on the world scale of sovereignty is an obvious step in the wrong direction.In defense of Chamberlain, he didn't have the power of hindsight in terms of WI. The same cannot be said for Obama and Iran. Obama had clear historical evidence and resources to show that appeasement, in large part, does not work. Ben Shapiro, who hosts his own radio talk show and is author of a bestseller, said â€Å"The deal with Iran Is Worse than Munich' in part because In 1938 Hitler had not made known his plans to exterminate European Jews, while Iran has explicitly expressed a desire to completely wipe Israel off the map.How, then, could Obama simply request that Iran hand over one of Its most prized possessions, that being nuclear weapons, which are clearly documented as present in the country, when America's greatest ally is at risk and is the direct victim of Iran's plans? This isn't acceptable, and is a clear sign that Obama, who was supposed to be America's FAD, is becoming America's Nixon. Obama VS. Chamberlain By Broadband disregarded 7 days later, would allow Europe to continue war-free, sparing it from the trauma and anxiety associated with war.It is well known that Chamberlain failed impose his country's will is far more severe than what happened in 1938. While it is respectively, Nazi Germany was much larger of a world power in its day when compared to modern day Iran. In addition, Britain wa s in a weak state economically and militarily, while the United States, although isn't in tip-top shape economically deal with Iran is Worse than Munich' in part because in 1938 Hitler had not made that Iran hand over one of its most prized possessions, that being nuclear weapons,