Dhl Logistics Essay Example

Dhl Logistics Essay DHL Logbook in cooperation with Technical University Darmstadt Historical development of logistics The great logistics success story Logistics has been playing a fundamental role in global development for almost 5,000 years now. Since the construction of the pyramids in ancient Egypt, logistics has made remarkable strides. Time and again, brilliant logistics solutions have formed the basis for the transition to a new historical and economic era. Examples of this fundamental progress include the invention of the sea-cargo container and the creation of novel service systems during the 20th century. Both are integral parts of globalization today. Around 2700 B. C. : Material handling technology in pyramid construction. Blocks of stone weighing several tons were transported and assembled at the construction site. To build the Great Pyramid of Giza, which is 146 meters high and weighs 6 million tons, the Egyptians needed sophisticated material transport equipment capable of moving the massive building blocks and putting them into place. Even today, we still cannot fully explain how this level of precision was achieved using the hoisting equipment and means of transport available around 2700 B. C [1]. 1/7 DHL Logbook in cooperation with Technical University Darmstadt Around 300 B. C. : Revolutionary Greek rowing vessels – the new foundation of intercontinental trade. The revolutionary invention of rowing vessels created the basis for rapid travel across the high seas. This invention formed the foundation for the creation of enormous logistics supply systems required by mobile army camps. Using these logistics capacities, Alexander the Great undertook campaigns with his troops, their families and their weapons of war that extended all the way to India [1]. We will write a custom essay sample on Dhl Logistics specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Dhl Logistics specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Dhl Logistics specifically for you FOR ONLY $16.38 $13.9/page Hire Writer Around A. D. 700: Procurement logistics in the construction of the Mezquita Mosque – pillars came to Spain from all parts of the Islamic empire. Construction of the famous Mezquita Mosque in Cordoba, Spain, began in 756 under the Caliph of Cordoba in the Umayyad dynasty. It is considered to be the largest mosque in Europe. Extraordinary procurement logistics was required to transport the pillars of the mosque from all parts of the Islamic empire [1]. 2/7 DHL Logbook in cooperation with Technical University Darmstadt Around 1200: The international network known as the Hanseatic League – cooperation for transport bundling and international sea transport. In 1188, the city of Hamburg, Germany, was founded as a base on the North Sea for the Hanseatic League to make travel on the sea more secure and to represent business interests abroad. Up to 200,000 fur pelts were transported by a single Hanseatic cog ship. Hanseatic trade extended from the Black Sea to Reval. From a modern-day vantage point, the league’s cross-border trade bears strong similarities to the European Union [1]. Around 1500: Progressive postal service in Europe – the first time-definite mail shipping service. Under an agreement with Philipp of Burgundy, Franz von Taxis organized the first postal service with strictly defined transit times. Letters were delivered to places such as Paris, Ghent, Spain and the imperial court of Vienna. In view of the infrastructure of the times and the political fragmentation created by the array of small principalities, the mail reached its destination with very little delay [1]. 3/7 DHL Logbook in cooperation with Technical University Darmstadt Around 1800: Discovery of new road conveyances and the railroad – expansion of logistics tasks through new technologies and means of transport. The practical use of the steam engine, the invention of vehicles, railroads and ships as well as the discovery of crude oil ushered in a new economic era that generated new missions, tools and opportunities for logistics [1]. Around 1940: Military logistics during the world wars – transfer of military logistics concepts to the business world. During World War I, military logistics was the vital link in the network that supplied troops with rations, weapons and equipment. With the onset of World War II, logistics was further refined. As a result, logistics gained an important place in the business world as well. 4/7 DHL Logbook in cooperation with Technical University Darmstadt 1956: Invention of the sea container – structural evolution of world trade and the boom of international flows of goods. The invention of the sea container by the American Malcom P. McLean changed production conditions for nearly all industries around the world and, as a result, altered people’s consumption habits. Even today, the sea container continues to ensure that harbors gain major contracts, new countries and regions experience commercial booms, markets arise and products from all parts of the world can be bought and sold at reasonable prices. In this way, the container has significantly contributed to globalization. Around 1970 – 1980: Kanban and just-in-time – logistics concepts with a special emphasis on procurement. The Kanban and just-in-time (JIT) concepts were developed and introduced at Japan’s Toyota Motor Co. by Taiichi Ohno – with the objective of effectively linking logistics to other operational functions. Special emphasis was placed on procurement. 5/7 DHL Logbook in cooperation with Technical University Darmstadt Around 1990: QR and ECR technologies – logistics concepts with a special emphasis on distribution. The quick response and efficient consumer response (ECR) technologies were developed during the 1990s and applied by many retail and wholesale companies. These technologies had a major impact on logistics. As a result of this technology, distribution centers are tasked with moving goods instead of storing them. This allows companies to accelerate reaction times to market developments and to set up efficient goods-supply systems. Today: Supply chain management – a look at the entire logistics chain from the vendor’s supplier to the end customer. Supply chain management is a term that has grown enormously in use and significance since the late 1980s. Today, supply chain management is viewed as a holistic consideration of key business processes that extend from the vendor’s supplier to the end user. Accordingly, supply chain management is an extremely interactive, complex system requiring simultaneous monitoring of many conflicting objectives. 6/7 DHL Logbook in cooperation with Technical University Darmstadt Today: Advancing globalization – efficient logistics as a competitive edge in the era of globalization. Global competition began to arise and spread in the 1970s and accelerated in the 1990s. Globalization is still moving forward today. Efficient logistics creates a crucial competitive edge for companies that are expanding in global markets. Successful logistics efforts in international supply chains can fuel the development of global markets. From pyramid construction to the supply chain Recommended reading Logistik Stories | Gopfert / Froschmayer 2005 Strategic Logistics Management | Stock / Lambert 2001 References [1] Episoden des Logistik-Managements in Antike und Mittelalter | Dulfer 2005. In: Logistik Stories | Gopfert / Froschmayer (Hrsg. ) Related articles Trends in the economy as drivers of logistics development URL http://www. dhldiscoverlogistics. com/cms/en/course/origin/historical_development. jsp 7/7

Bringing Visibility Into Marketing With Dree Ziegler From Fulton Fish Market

Bringing Visibility Into Marketing With Dree Ziegler From Fulton Fish Market Unexpected projects derail your marketing process or work management. It happens. How do you prepare or respond to such stress? Do you find a way to complete your work and meet deadlines? Marketing teams are always expected to do more with less.   Today’s guest is Dree Ziegler, director of digital marketing at Fulton Fish Market. Every marketer has similar tactics, but they’re all talking to different audiences and pitching different services and products. Dree brings a fresh perspective and describes how she created a process using to stay organized and constantly communicate.   Not a Can of Corn: Fulton Fish Market in New York City follows the same way of doing things since the beginning of time Nothin’ Fishy about Dree’s Marketing Experience: Digital and eCommerce marketing and technology strategy that moved to merchant side of business Remote Headquarters: Dree manages a dispersed team of people in a number of places who are in contact with all the people in the market on a daily basis Challenges: Dree understands importance of visibility across the team, staying organized, and constant communication Gone Fishin’: Fultonfishmarket.com’s goal is to bring that fresh seafood experience to people, wherever they may live It’s not the same: Fresh fish from a grocery store is fish caught months ago, frozen, kept in a warehouse, trucked across country, thawed, and put on display Fulton Fish Market features about 40 vendors that bring fresh fish that’s sent overnight and delivered to your doorstep Fulton Fish Market’s Documenting Strategy for Marketing Plan:   Set high-level goals for team that’s still growing Update Website to improve consumer experience Put baseline digital marketing tools in place to plan daily tasks Draft and create day-to-day marketing plan and content Fish-on-the-Fly Campaigns: Ordering and buying fish that’s only good for so long; purchasing department buys what’s fresh in the market and expected to sell Project Plan: Visual waterfall of tasks and who’s doing what; monitor team’s tasks, pickup slack, work collaboratively, and deliver what’s promised   Fulton Fish Market’s next frontier is doing the things that people should be doing vs. automation and machine learning (ML) tools Marinating on Future of Digital Marketing: No experience needed, continue to learn, differentiate yourself, and stay hungry Links: Fulton Fish Market Fulton Fish Market (for restaurant owners) Fulton Fish Market (for retail consumers) Slack MailChimp Google Data Studio Magento eCommerce Platform Shopify The Marketing Management + Strategy Statistics You Need to Know in 2019 New Marketing Suite If you liked today’s show, please subscribe on iTunes to The Actionable Content Marketing Podcast! The podcast is also available on SoundCloud, Stitcher, and Google Play. Quotes by Dree Ziegler: â€Å"Our goal is to bring that experience to people wherever they may live. We want to deliver that freshly good experience to their doorstep quickly.† â€Å"We’re taking fish that comes into the Fulton Fish Market. You’re getting the freshest possible fish, and it’s delivered to your doorstep within overnight shipping.† â€Å"We’re doing a combination of big initiatives that over arch the year, as well as small daily marketing tidbits that go out on our social media and through our emails.† â€Å"We’ve automated a ton of things which allows us to work ahead and then when people disrupt the flowwere able to be more agile and supportive of what they need.†

About a memorable experience Essay Example | Topics and Well Written Essays - 500 words

About a memorable experience - Essay Example These make me overlook the negative side of life, with all the bad experiences it presents. They always remind me that the bad experiences never last, and it is always a matter of time before I smile again. Among all the good experiences I have had, there is only one, which will remain embedded in my mind forever. This is one bittersweet, but memorable experience that has in many ways, influenced my life, especially the way I perceive the world today and the things therein. It all started as a joke, and little did I know that this could culminate into a life-changing experience. On this warm summer afternoon, I asked my friends for their opinions about what we would do for my birthday, as the normal house parties had become monotonous, and I wanted a different experience. â€Å"How about this time round you be the one giving out gifts? Give gifts to people on your birthday!† one of my friends suggested. â€Å"That sounds great . . . but how?† I wondered. â€Å"The homeless!† another friend quickly suggested. The six of us agreed to make it our project, and we started counting down days. Each person would start keeping stuff, which we would take as our gifts. Each one of us would also save little money to buy food and other stuff. With only one and a half months remaining to my birthday, everyone was committed to playing their role. When it was only two weeks remaining, we identified the homeless people we would visit and set everyt hing in order. Finally, it was the eve of my birthday. I invited my friends to our house so we could set all the stuff in order in preparation for the next day. Both my friends’ parents and my parents were happy with our plan and offered us a little more money and stuff to add up. When morning came, we all were happy and anticipated for the unfolding of events in that day. My mum offered to drive us to the designated place. In an hour’s time, we arrived at our destination. We unpacked our luggage and went ahead to

Methods used to Analyze the Marketability of a Firm Essay

Methods used to Analyze the Marketability of a Firm - Essay Example Interviews, by mail and on-site, were conducted to determine the demographics and characteristics of the typical angler. Discovering the motives of paying anglers proved to be beneficial in the analysis (relationship). This analysis will assess needed requirements and how well they are suited to the company's capabilities. Organizations can use this data to choose ideas and products which match their technical support, leading to competitive advantages. This analysis will also help to determine whether in-house or external technical support is the most feasible. A number of methods can be used when conducting a technical analysis. Checklists, scoring tools, environmental scanning, and decision-making models (as used by the West Virginia Department of Forestry) are some of the most widely used methodologies. A company should not, however, make the technical analysis its main focus. The analysis may show the firm's marketability in a glowing light, but this opinion may not be equally shared by its customers. A case in point is RCA's introduction of their quadraphonic 8-track system in 1970. This product issued booming marketability for RCA; however, predictions for future technology were not illustrated on their then-technical analysis. Collection of market data on products and ideas are essential to determine marketability. ... This product issued booming marketability for RCA; however, predictions for future technology were not illustrated on their then-technical analysis. MARKETING ANALYSIS Collection of market data on products and ideas are essential to determine marketability. If a company isn't competent in marketing skills, it will not succeed. An example is the largely-populated country of China. They can offer numerous opportunities; however, it has been quite challenging for the Chinese to market their products in their own country. Marketing challenges must definitely be addressed. Each concept requires different marketing data and strategies. Very much like the technical analysis, checklists, scoring tools, and environmental scanning are effective tools. A decision-making resource, such as the Analytic Hierarchy Process (AHP) is also beneficial. Always keep in mind that a firm is never marketable without customers who are seeking your products or ideas. It's also crucial to analyze your target customer base and the demand and supply of your products. FINANCIAL ANALYSIS The primary goals of an organization are to produce a profit, increase sales and customers, and to show a return on their investment. To be marketable, a firm should set financial guidelines. To get an accurate financial analysis, much financial data is needed. Budget goals must be set and met. Benchmarks must also be laid down to agree with financial returns put in place. The most widely used financial analysis methodology is the Net Present Value method (NPV). This method associates the monetary benefits and expenditures against the products. The product's NPV is then weighed against the interest rates and the

Impact of Technology on Society Paper Research Example | Topics and Well Written Essays - 2500 words

Impact of Technology on Society - Research Paper Example At the present, the Internet is being used for a large number of reasons. Though, it has brought a large number of benefits and opportunities to this world however, there are also some risks and challenges associated with its usage. In addition, the benefits of the Internet cover up the associated challenges. The basic purpose of this research is to determine the impact of the Internet on society. This paper presents a detailed analysis of effects that have been posed by the Internet on society. This paper discusses advantages and ways people and organizations are currently making the use of the Internet. 2. Introduction Up till now, no other technology has received as quick recognition and acceptance as the Internet has received. Without a doubt, it has changed the entire world and turned this world into a global village where people are from all over the world are connected to each other. At the present, almost everyone uses the internet to carry out specific or ordinary tasks. In fact, the internet has turned out to be a significant part of the majority of people’s lives. ... This paper also discusses some of the negative effects that this technology can have on society. 3. An introduction of Internet The internet mostly acknowledged basically â€Å"the Net,† the Internet is a universal structure of computer networks-a network, in which users at any one computer can receive information from any other computer (as well as they can communicate straightforwardly with users at different computers in different locations). Nowadays, the Internet is a, supportive, public, self-financing facility available to hundreds of millions of users internationally. Actually, the Internet makes use of a part of the whole resources of the presently accessible public telecommunication networks. In principle, what differentiable the Internet its use of a collection of protocols known as TCP/IP (Turban, Leidner, McLean, & Wetherbe, 2005, p. 71). The appearance and growth of the Internet has made business markets more workable and competitive than ever before. With the In ternet, every organization (small, medium, and large) in the world is potentially a local competitor. At the present, all the business marketers understand that the Internet is a precious instrument or technology for extending reach to international markets and dealing customers in a superior way (Summers, Gardiner and Lamb 67). In addition, at the present the ways business organizations and people of a society carry out their tasks and survive in the twenty-first century are measured via the huge web of electronic networks that was referred to normally as the information thruway however at the present is generally acknowledged as the Internet (Turban, Leidner and McLean). The internet can be defined as a huge network of networks that connects the millions of businesses, government

An overview of atrial fibrillation

An overview of atrial fibrillation Section1: Atrial fibrillation (AF) is a condition when the heart does not beat to its normal speeds or rhythm, often it beats faster than it should. This irregularity leads to an increased risk of stroke and death. The pump function of the heart deteriorates as a result of the un-coordination (due to uncoordinated excitation of muscles). The net result of impaired pump action is the upper chambers of the heart contract randomly and at times too quick for the heart to relax before it can contract again effectively. At the junction of the pulmonary veins in the left atrial musculature, abnormal impulses fire which override the heart natural pace maker. There are 3 major classifications for AF: Paroxysmal AF- lasts from 30 seconds to 7days Persistent AF- longer the 7days Permanent AF- AF that fails to terminate using cardioversion, or is terminated but relapses within 24hours. If there are no obvious cause and all investigations are normal, this is known as lone AF. Lone AF tends to occur in Paroxysmal cases. Otherwise the most common causes are ischaemic heart disease hypertension mitral stenosis hyperthyroidism Other causes which arent as common are can be classified into 3 sub catagories; Cardiac: Rheumatic heart disease, Sick sinus syndrome, Pre-excitation syndromes (such as Wolff-Parkinson-White syndrome) and heart failure. Less commonly, congenital heart disease, atrial myxoma , atrial septal defect, pericardial disease, and cardiomyopathy. Non-cardiac: Drugs (e.g. bronchodilators/thyroxine), Electrolyte depletion infection, Pulmonary embolism, Lung cancer Diabetes. Lifestyle: Obesity, high caffeine or alcohol intake1. A fast pulse (often >140bpm) which may or may not be irregular is the most common symptom of AF however it is also accompanied by tiredness, breathlessness, dizziness, angina1, syncope, reduced exercise tolerance, or polyuria2. The decreased efficacy of the pumping of the heart may result in the reduction of blood pressure. AF is diagnosed by the use of an ECG and is characterised by the absence of consistent P waves and presence of fibrillation. The method of management of suffers of AF has two main strategies, either by the control the arrhythmia aspect of the condition or by the tachycardia side of the condition. Rhythm controlling drugs include flecainide (and other similar drugs), beta-blockers (particularly sotalol), and amiodarone. Rate controlling drugs such as beta-blockers bisoprolol atenolol or the calcium channel blockers verapamil ordiltiazem. Thrombolytic and antiplatelet drugs are also used to manage the thromboembolic risk. There are non pharmacological ways to manage AF, the most common being cardioversion. Aspirin inhibits cycloxygenase from producing thromboxane A2 which is responsible for platelet activation and thus aggregation Diltiazem of use in AF for its affects on calcium channels on the heart. The blocking of calcium channels reduces excitability of cardiac muscle and hence decreasing fibrillations it also decreases the force of contraction Atenolol is a beta receptor blocker(a classII), it decreases the effects of the sympathetic drive to the heart, such that the neurotransmitters adrenaline and noradrenaline are competitively blocked. Thus the levels of cAMP decrease. cAMP mediates many events in the heart:decreases stability in resting potentials (phase 4) of nodal tissue(AVN conduction SAN firing). In nodal tissue(myocytes) a decrease in cAMP reduces Ca2+ entry thus action potentials take longer, it also causes repolarisation to longer i.e. increasing the refractory period Amiodarone has all four classes of activity (of Vaughan Williams system MAKE APPENDIX) however its main method of action is its class III mechanism. By the blocking potassium channels the potassium efflux in an action potential is blocked, thus action potentials duration is a prolonged refractory period (causing a region of unidirectional block remain refractory for longer effectively having a bi directional block)3 Verapamil a non selective calcium channel blocker (classIV), by reducing the Ca2+ into the cell through L-type channels in the nodal tissue (SAN AVN) depolarization takes longer as does the refractory period causing slower AVN conduction. Reduces tachycardic impulse from AVN to the ventricles and also AVN re-entrant rhythms. Phase 2 is limited in nodal tissue (myocytes and purkinje fibres) reduces triggered automaticity4. Warfarin inhibits the effective synthesis of biologically active forms of the vitamin K-dependent clotting factors: II, VII, IX and X, as well as some regulatory proteins. Flecainide a class1c sodium channel blocker.There is decreased diastolic excitability and Phase 0 (depolarization) takes longer as does the refractory period together causing slower conductions4. Propafenone is a class1c sodium channel blocker.There is decreased diastolic excitability and Phase 0 (depolarization) takes longer as does the refractory period together causing slower conductions4. Digoxin is a K+/Na+ ATPase inhibitor which leads to an increase in the intracellular concentration of sodium this stimulates of sodium-calcium exchange as a result there is an increase in the intracellular concentration of calcium causing stronger less frequent contractions. Cardioversion may be tried in some people with AF. The heart is given a controlled electric shock to try to restore a normal rhythm1. Catheter ablation is a procedure that very carefully destroysthe diseased area of your heart and interrupts abnormal electrical circuits. It is an option if medication has not been effective or tolerated1. A pacemaker may be fitted alternatively to drug treatment when it is not appropriate of failing1. Section 2: AF is the most common rhytm disorder of the heart with up to 500,000 sufferes in the UK1. In the UK over 46,000new cases of AF are diagnosed each year5. The incidences increase with age, with a higher incidence in men, when data is adjusted for age6. AF is uncommon in the young unless there is an existing heart disorder. At 50-59years of age, the prevalence is around 0.5%. At 80-89years of age, the prevalence is around 9%. Section 3: AF is a significantly increases the chance of stroke and emboli. The decision to use antithrombotic therapy involves a complex balancing of risks, benefits, and costs. The probabilities of stroke, bleeding complications, and death; the associated costs of all treatment options and outcomes; and the quality of life associated with treatment and disability. These have shown that warfarin therapy is generally cost-effective and often cost-saving. However, the economic value of antithrombotic therapy in terms of cost-effectiveness is most strongly influenced by 2 factors: stroke risk and perceived quality of life. The cost-effectiveness models indicate that warfarin can be cost-effective or, indeed, cost-saving for a wide variety of patients with AF, provided that it is prescribed appropriately based upon stroke risks7 In patients at high risk of stroke, anticoagulation is most cost effective, but not for those at low risk of stroke8. Aspirin 75mgx28 Â £1.66, Aspirin 300mgx28 Â £0.55, Warfarin 1mgx28 Â £1.10, Warfarin 3mgx28 Â £1.15, Warfarin 5mgx28 Â £1.21, Atenolol 25mgx28 Â £0.82, Diltiazem MR 60 mgx84 Â £3.52, Diltiazem MR 60 mgx56 (or over 70yrs), verapamil 40mgx80 Â £1.55. Section 4: Symptoms should be monitored; often AF has no symptoms, however you should look for the common presenting symptoms (stated in section 1). Tests: Heart Rate- Should be done when treating with rate lowering drugs Electrocardiography- every 12months blood electrolytes, urea and creatinine- 1-2 weeks after initiation, and 1-2 weeks after reaching the maintenance dose, then every 6 months. For Beta-blockers, digoxin, amiodarone Monitor blood pressure Liver function tests- every 6months for amiodarone Thyroid function test- when using amiodarone eye examinations- annual eye examinations. Plasma levels- for digoxin, shortly after initiation or after a dose increaee. 0.7and 2.0nanograms per millilitre Drugs to reduce the risk of thromboembolism (warfarin, aspirin and clopidogrel) The target INR for oral anti coagulants is 2-3 usually 2.5. Patients should be considered for warfarin use if risk is perceived to be medium or high according to nice (see appendix)9. It is important that INR be measured daily or alternate days at initiation of treatment. Then at longer intervals depending on dose response up to 12 weeks10. Note the importance of increased monitoring as drugs are added to the regimen, pre-adjustment to warfrin are sometimes necessary e.g. decreasing dose by one or two thirds before initiation of amiodarone1. Section 5: Although systematic reviews have shown that aspirin reduces the rate of stroke by 25%8 The Atrial Fibrillation, Aspirin Anticoagulation Study demonstrated a reduction of strokes by 64% per year with warfarin (INR 2.8-4.2), compared with placebo, a 3.5% per year reduction. A non-significant reduction in stroke was seen with aspirin 75mg8. Where warfarin is contraindicated or patient requests not to initiate therapy, it has been found that a combination of antiplatelets (aspirin and clopidogrel) was associated with a significant reduction in major vascular events compared with aspirin alone. The number of people that would need to be treated with aspirin plus clopidogrel for 3.6years to prevent one vascular event was 421. According to a meta-analysis the combination of both aspirin and warfrin yielded no significant reduction in stroke rates and had increased side effects8. No mortality difference was found between rhythm control and rate control. Although for people older than 65years of age or those with coronary artery disease, a significant difference was found in favour of rate control in terms of all-cause mortality. Studies showed significantly higher rates of hospitalisation and adverse events in the rhythm control group and no difference in quality of life between the two groupsa.Incidence of ischaemic stroke, bleeding and systemic embolism was similar in the two groups, but certain malignant dysrhythmias were significantly more likely to occur in the rhythm control groupa. No cognitive decline was seen with the use of rhythm controlling drugs. Quality of life scores were similar in both groups. Therefore it is recommended that rate control, is used as it is less costly11. IA, IC and III drugs are effective in maintaining sinus rhythm but increased adverse effects. Class IA drugs may increase mortality. Calcium antagonists versus digoxin Seven studies found no difference in average heart rate between calcium antagonists verapamil or diltiazem and digoxin either at rest or during periods of normal daily activity. Studies have found calcium antagonists resulted in a lower heart rate during exercise, compared with digoxin2. Beta-blockers versus digoxin Three studies found no difference in average heart rate between digoxin and beta blockers while at rest or during periods of normal daily activity. However, the beta blockers atenolol and labetalol controlled heart rate during exercise more effectively than digoxin did2. Beta-blockers versus calcium antagonists One crossover study found no difference between the calcium antagonist diltiazem and the beta-blocker atenolol in terms of either the mean heart rate over 24 hours or during exercise2. Beta-blockers with digoxin versus beta-blockers One crossover study found no statistically significant differences in heart rate during periods of exercise. Some studies found the beta-blocker atenolol used in combination with digoxin to be associated with a lower heart rate over 24 hours than atenolol alone2. Calcium antagonists with digoxin versus calcium antagonists Four crossover studies found that calcium antagonists diltiazem or verapamil used in combination with Digoxin to be more effective in controlling heart rate over 24 hours, as well as during periods of exercise, than either diltiazem or verapamil alone2. Section 6: Many people whom suffer from AF suffer no symptoms, some have been diagnosed incidentally1. It is in these patients that concordance is a particular issue. Education as to the risks and complications of the condition are necessary to achieve optimum concordance. It is important that patients are aware the side effects (SE) as well as the dosage regimen. Many of the dugs used in the management of AF have common and serious side effects which patients should be trained to spot. Interactions and side effects of note. Further information can be derived from the British National Formulary (BNF) and a comprehensive analysis available in the most current Stockleys drug interaction. Classes of drugs have been mentioned although this does not mean that the entire class will interact Amiodarone Interactions: Anti-arrhythmic (rate and rhythm modulating), Antibiotics, Anti coagulants, Tricyclic antidepressants, mizolastine, thyroid hormones, diuretics and phenytoin10. it is of note that due to its long half life amiodarone may still interact several months after treatment is stopped particularly relevant in the switching over of treatments. Amiodarone reduces the clearance of warfarin, prolonging prothrombin times (PTs) and elevating international normalized ratios (INRs). To avoid bleeding complications, the patient being put on amiodarone must have their current dosage of warfarin reduced by at least one-third and PT and INR closely monitored until they are stabilized15. Although routine eye examinations should occur to asses the ocular effects of amiodarone, if a patient experiences any visual impairment the treatment should be stopped10. Patients should be aware for the signs of thyroid dysfunction (signs and symptoms of which included in appendix 1) Warfarin interactions: Alcohol, amiodarone, propafenone, analgesics, antibiotics, antidepressants, antiepileptics, thyroid hormones, ulcer healing drugs, lipid regulating drugs, hormones, corticosteroids Warfarin levels are easily effected by changes in diet, major changes in diet should be done in consultation with healthcare professional, commonly eaten foods that are known to interact with warfarin are cranberry, grapefruit and vitamin K rich foods16. bleed or bruise easily. Also, if you bleed, the bleeding may not stop as quickly as normally. For example, you may have: bleeding gums; nosebleeds; prolonged bleeding from cuts; blood in the urine. Beta blocker interactions: Antiarrhythmics (rhythm and rate modulating), antibiotics, antidepressants, mizolastine, antipsychotics and diuretics. Beta blockers should be avoided in people with asthma, or with chronic obstructive pulmonary disease13, Beta-blockers should not be stopped suddenly unless absolutely necessary; there is a risk of rebound in the condition13. Doses are titrated for patients and are gradually increased10. Digoxin interactions: Antiarrhythmics (rate and rhythm modulating), diuretics, anti biotics and anti epileptics. Signs and symptoms of digoxin toxicity are important to report promptly. Digoxin toxicity may cause drowsy, dizzy, and affect your vision, disorientation, confusion, headach or disyurbed vision14. Flecainde interactions: Antiarrhythmics (rate and rhythm modulating), antidepressants, antihistamines, antipsychotics, diuretics and tolterodine Roughly 1% of the general population and 10% of asthma suffers are allergic to aspirin12. Each drug has the potential for interaction with other medication and even food. Self help advice In order to minimise the risk of stroke and heart attacks it is important for patient to receive practical advise on diet as this will impact on blood cholesterol levels, weight management and blood pressure it is of particular importance when the patient is diabetic. Important components in a healthy diet are low fat and salt intakes, with an emphasis on complex carbohydrates found in vegetables. Advice on the sources of esstential fatty acids should be given (for example nuts and oily fish). Smoking cessation counseling and Nicotine replacement therapy should be offered, discussing the statistical significance smoking alone contributes to the Cardio vascular events. Section 7: Pharmacists have contact at various stages along a patients treatment. A specialist PCT pharmacist may manage patients, prescribe, review and monitior. A community pharmacist should attempt medicine use reviews and prepare to make interventions on prescriptions when appropriate. Clinical pharmacists are involved in monitoring and providing guidance on protocols and current evidence. In the future there will be an increased scope for pharmacists to play a larger role when full patient records become available, full clinical reviews may be conducted taking into account the persons history (familial, drug, treatment, condition) and make appropriate interventions and recommendations according to the most current evidence. Section 8: In order for the condition and the services to run effectively is necessary to run audits regularly. This will ensure the national standards are met. Nice guideline audit criteria: All people presenting to primary or secondary care with a hypertension, heart failure, diabetes made or stroke and noted to have an irregular pulse to be offered an ECG and any new diagnosis of AF recorded2. All AF patients in whom a rate-control or rhythm-control strategy is initiated to have their involvement in choosing a treatment strategy recorded2. All patients who are prescribed digoxin as initial monotherapy for rate control to have the reason for this prescription recorded where it is not obvious (e.g. sedentary patient presence of contraindication to alternative agents)2. All patients should be assessed for risk of stroke/thromboembolism and given thromboprophylaxis according to the stroke risk and have this assessment and any antithrombotic therapy recorded2. It is important for pharmacists to keep uodate and maintaining a high levels of competenacy. Advice should be evidence based and current. There are regular updates produced by nice NICE and the Guidelines for atrial fibriliation are a good source of information. Section 9: the National Service Framework for coronary heart disease has a chapter pertains to AF. Arrhythmias are of great importance Cardiac arrhythmia affects more than 700,000 people in England and is consistently in the top ten reasons for hospital admission, using up significant AE time and bed days. AFis the most common arrhythmia, affects up to 1% of the population (rising to 4% in the over 65s) and absorbs almost 1% of the entire budget of the NHS to the NHS16. Of the three quality requirements there are two relevant in AF. Quality requirement one: patient support. People with arrhythmias receive timely and high-quality support and information, based on assessment of their needs16. Markers of good practice People with arrhythmias receive a formal assessment of their support needs and those at significantly increased risk of anxiety, depression or a poor quality of life receive appropriate care16. People with long-term conditions receive support in managing their illness from a named arrhythmia care co-ordinator16. Good quality, timely information about arrhythmic conditions is given by appropriately trained staff16. Quality requirement two: diagnosis and treatment. People presenting with arrhythmias, in both emergency and elective settings, receive timely assessment by an appropriate clinician to ensure accurate diagnosis and effective treatment and rehabilitation16. Markers of Good Practice Initial Treatment All patients receive a hard copy of the ECG documenting their arrhythmia and a copy is placed in their records. Patients who survive out-of-hospital cardiac arrest and patients presenting with pre-excited AF are assessed by a heart rhythm specialist prior to hospital discharge. The following patients are assessed urgently by a heart rhythm specialist: Patients with syncope or any other symptom(s) suggestive of an arrhythmia and a personal history of structural heart disease or a family history of premature sudden death Patients with recurrent syncope associated with palpitations Patients with syncope and pre-excitation Patients with documented 3rd degree AV block (not associated with acute MI) Patients with recurrent syncope in whom a life-threatening cause has not been excluded Patients with documented ventricular tachycardia The following patients are referred to a heart rhythm specialist: Patients with a presumed diagnosis of ventricular tachycardia Patients with Wolff-Parkinson-White (WPW) syndrome or asymptomatic pre-excitation Patients with symptomatic regular recurrent supraventricular tachycardia which is unsuccessfully treated with one type of medication or who would prefer not to take long-term medication Patients with recurrent atrial flutter Patients with symptomatic AF despite optimal medical therapy First degree relatives of victims of sudden cardiac death who died below the age of 40 years Patients with recurrent unexplained falls Markers of Good Practice Ongoing Treatment Mechanisms are in place for urgent referral of patients with sustained or compromising arrhythmias for prioritisation of appropriate treatment. Implantable cardioverter defibrillators (ICDs) are considered in patients presenting with life-threatening ventricular arrhythmias and in those without demonstrable arrhythmia but identified as being at high risk. Catheter ablation is considered as the treatment of choice in patients presenting with sustained supraventricular tachycardia (SVT) other than AF, and cardioversion of recent onset AF is considered as early as is clinically safe. Where further hospital treatment is not recommended, a care plan is agreed between the patient, GP and the arrhythmia care team, including follow up and support as required. Management of long term conditions and elderly also have a priority in the governments plans and frameworks for the future. Section 10: Emphasis should be on patient centered care, projects such as near patient testing for warfarin have proved to be effective at managing patients and their potential complications. Primary care workers such as GPs PCT pharmacist should screen at risk patients. They shall be involved in the management of there condition frequently monitor patients. If required a referral can be made on lifestyle issues to manage the risk of stroke, e.g. if lipids are elevated may want to refer to a dietitian. Community pharmacists have a role in conduction medicines use reviews and be prepared to make inventions in prescribing, regimen concordance and side effect management/referral. It is of utmost importance that the specialist (cardiologist) makes clear recommendation and maintains communications with their counterparts in primary care.

The Igbo People †Origins and History :: Essays papers

The Igbo People – Origins and History Igboland is the home of the Igbo people and it covers most of Southeast Nigeria. This area is divided by the Niger River into two unequal sections – the eastern region (which is the largest) and the midwestern region. The river, however, has not acted as a barrier to cultural unity; rather it has provided an easy means of communication in an area where many settlements claim different origins. The Igbos are also surrounded on all sides by other tribes (the Bini, Warri, Ijaw, Ogoni, Igala, Tiv, Yako and Ibibio). The origins of the Igbo people has been the subject of much speculation, and it is only in the last fifty years that any real work has been carried out in this subject: ...like any group of people, they are anxious to discover their origin and reconstruct how they came to be how they are. ...their experiences under colonialsim and since Nigeria’s Independence have emphasized for them the reality of their group identity which they want to anchor into authenticated history. (Afigbo, A.E.. ‘Prolegomena to the study of the culture history of the Igbo-Speaking Peoples of Nigeria’, Igbo Language and Culture, Oxford University Press, 1975. 28.) Analysis of the sources that are available (fragmentary oral traditions and correlation of cultural traits) have led to the belief that there exists a core area of Igboland, and that waves of immigrant communities from the north and west planted themselves on the border of this core area as early as the ninth century. This core area – Owerri, Orlu and Okigwi – forms a belt, and the people in this area have no tradition of coming from anywhere else. Migration from this area in the recent past tended to be in all directions, and in this way the Igbo culture gradually became homogenized. In addition to this pattern of migration from this core area, other people also entered the Igbo territory in about the fourteenth or fifteenth centuries. Many of these people still exhibit different characteristics from that of the traditional Igbos – for example geographical marginality, the institution of kingship, a hierarchical title system and the amosu tradition (witchcraft). For some time some Igbo-speaking peoples claimed that they were not Igbo – the word was used as a term of abuse for â€Å"less cultured† neighbours. The word is now used in three senses, to describe Igbo territory, domestic speakers of the language and the language spoken by them.