A philosphical essay on Utilitarianism.

A philosphical essay on Utilitarianism. Utilitarianism is a way of looking at ethics, it focuses on trying to ensure the maximum happiness in many different ways. There are many different forms of utilitarianism, the four I will discuss are act, rule, naive and preference utilitarianism.Rule utilitarianism tries to give the greatest overall benefit to society, the best rule/law of conduct is found and everyone is found an a rule utilitarian will follow it. However, this can cause problems if you use this rule in a place where it is not generally followed as problems will be caused if you differ from the general population. Another difficulty is that all the best rules would be very complicated and this would make them hard to follow and many people would not bother to follow them at all.Examples of rule utilitarianism: A man needs a lot of money to get a lifesaving operation on his heart, he doesn't have the money and contemplates robbing a bank for it.From http://hypernews.ngdc.noaa.govBecause he follows rule utilitariani sm he decides to let himself die because robbing a bank is against the rules that he believe are for the benefit of society. Another example: A man from the USA comes to Australia to live, one of the rules he believes is for the greater benefit of society s driving on the right side of the road. He is forced to go against his rule utilitarianism because of the fear of a car crash.Preference utilitarianism tries to satisfy peoples' preferences. The best action is the one which satisfies the highest amount of peoples' preferences. These preferences must only count for preferences about oneself or people might have preferences that cancel out other peoples preferences (for example: A person wishing to be rich and a person wishing for everyone to be poor),

Definition and Examples of Epideictic Rhetoric

Definition and Examples of Epideictic Rhetoric Epideictic  rhetoric (or epideictic oratory) is ceremonial discourse:  speech or writing that praises or blames (someone or something). According to Aristotle, epideictic  rhetoric (or epideictic oratory) is one of the three major branches of rhetoric. Also known as  demonstrative rhetoric  and ceremonial discourse, epideictic rhetoric includes funeral orations, obituaries, graduation and retirement speeches, letters of recommendation, and nominating speeches at political conventions. Interpreted more broadly, epideictic rhetoric may also include works of literature. In his recent study of epideictic rhetoric (Epideictic Rhetoric: Questioning the Stakes of Ancient Praise, 2015),  Laurent Pernot notes that since the time of Aristotle, epideictic has been a loose term: The field of epideictic rhetoric seems vague and laden with poorly resolved ambiguities. EtymologyFrom the Greek, fit for displaying or showing off Pronunciation:  eh-pi-DIKE-tick Examples of Epideictic Rhetoric Daniel Webster in Praise of John Adams and Thomas Jefferson:Adams and Jefferson, I have said, are no more. As human beings, indeed, they are no more. They are no more, as in 1776, bold and fearless advocates of independence; no more, as at subsequent periods, the head of the government; nor more, as we have recently seen them, aged and venerable objects of admiration and regard. They are no more. They are dead. But how little is there of the great and good which can die! To their country they yet live, and live for ever. They live in all that perpetuates the remembrance of men on earth; in the recorded proofs of their own great actions, in the offspring of their intellect, in the deep-engraved lines of public gratitude, and in the respect and homage of mankind. They live in their example; and they live, emphatically, and will live, in the influence which their lives and efforts, their principles and opinions, now exercise, and will continue to exercise, on the affairs of men, not onl y in their own country but throughout the civilized world.(Daniel Webster, On the Deaths of John Adams and Thomas Jefferson, 1826) Oprah Winfreys Eulogy for Rosa Parks:And Im here today to say a final thank you, Sister Rosa, for being a great woman who used your life to serve, to serve us all. That day that you refused to give up your seat on the bus, you, Sister Rosa, changed the trajectory of my life and the lives of so many other people in the world.I would not be standing here today nor standing where I stand every day had she not chosen to sit down. . . . Had she not chosen to say we shall not- we shall not be moved.(Oprah Winfrey, Eulogy for Rosa Parks, October 31, 2005) Observations on Epideictic Rhetoric Persuasion and Epideictic Rhetoric:Rhetorical theory, the study of the art of persuasion, has long had to recognize that there are many literary and rhetorical texts where rhetoric does not aim directly at persuasion, and their analysis has long been problematical. To categorize speeches aimed at praise and blame rather than at decision-making, speeches such as funeral orations and encomia or panegyrics, Aristotle devised the technical term epideictic. It can readily be extended to take in literary and theoretical texts insofar as they also do not aim directly at persuasion.(Richard Lockwood, The Readers Figure: Epideictic Rhetoric in Plato, Aristotle, Bossuet, Racine and Pascal. Libraire Droz, 1996) Aristotle on Epideictic (Ceremonial) Rhetoric:The ceremonial orator is, properly speaking, concerned with the present, since all men praise or blame in view of the state of things existing at the time, though they often find it useful also to recall the past and to make guesses at the future.(Aristotle, Rhetoric) Cicero on Epideictic Orations:[Epideictic orations are] produced as show-pieces, as it were, for the pleasure they will give, a class comprising eulogies, descriptions, and histories, exhortations like the Panegyric of Isocrates, and similar orations by many of the Sophists . . . and all other speeches unconnected with battles of public life. . . . [The epideictic style] indulges in a neatness and symmetry of sentences, and is allowed to use well-defined and rounded periods; the ornamentation is done of set purpose, with no attempt at concealment, but openly and avowedly . . ..The epideictic oration, then, has a sweet, fluent and copious style, with bright conceits and sounding phrases. It is the proper field for sophists, as we said, and is fitter for the parade than for the battle . . ..(Cicero, Orator, trans. by H.M. Hubbell) Aims of Epideictic Rhetoric:If we speak in praise . . . if they do not know him, we shall try to make them [the audience] desire to know a man of such excellence since the hearers of our eulogy have the same zeal for virtue as the subject of the eulogy had or now has, we hope easily to win the approval of his deeds from those whose approval we desire. The opposite, if it is censure: . . . we shall try to make them know him, in order that they may avoid his wickedness; since our hearers are unlike the subject of our censure, we express the hope that they will vigorously disapprove his way of life.(Rhetorica ad Herennium, 90s BC) President Obamas Epideictic Rhetoric:Kathleen Hall Jamieson, the director of the Annenberg Public Policy Center at the University of Pennsylvania, noted that there were many forms of political discourse. . . . She said Mr. [Barack] Obama excels at speeches read from a teleprompter to a mass audience, not necessarily at the other forms. And his best speeches, she said, were examples of epideictic or ceremonial rhetoric, the kind we associate with conventions or funerals or important occasions, as opposed to the deliberative language of policymaking or the forensic language of argument and debate.They don’t necessarily translate to, say, selling major legislation, a skill mastered, for example, by Lyndon B. Johnson, hardly a compelling orator.It’s not a kind of speech that’s a valuable predictor of one’s capacity to govern, she said. I don’t mean to say it doesn’t forecast something. It does. But presidents have to do a lot more than that.(Pete r Applebome, Is Eloquence Overrated? The New York Times, January  13, 2008)

Managing Activities to Achieve Results Essay Example | Topics and Well Written Essays - 3000 words - 1

Managing Activities to Achieve Results - Essay Example Diffusion of innovations would also help in improving the core focus of the organization that would help it to sustain itself in the competitive and turbulent business environment. Techniques for Improvement In order to achieve diffusion of innovation in the organization, Apple must adopt a strategy that tends to integrate the different functionalities of the organization. This would also include aligning its organization culture and structure so as to bring about greater diffusion of innovation in the organization. A flat organizational structure with greater functional independence would go about towards generating innovations and would also reduce barriers of communications that would help bring about diffusion of innovations. A ‘zootechnical’ form of innovation which includes use of technology to integrate the organizational culture and the aspect of innovation could be adopted by the organization (Manrique et al, 2000, p.107). In addition the organizational culture must also implement an ERP (Enterprise Resource Planning) (what is ERP?) that would help it to integrate its different functional units that would help in better coordination and information sharing which would enable better diffusion of innovation in the organization. Apple must also incorporate the ‘Kaizen’ philosophy in the organization. Kaizen philosophy calls for a continuous improvement in the business process by inducing in a process of continuous learning. Adopting this philosophy would help the organization to achieve its objectives by enhancing the learning curve of the employees as well as the organization. This is important as innovations are largely based on learning and knowledge and enhancement of the learning curve can actually go about a long way in inducing employees to indulge in continuous improvement as employees would continuously develop new ideas for the betterment of the business. This in turn would lead to innovations which is the core competen ce of the firm. The importance of Kaizen philosophy is that it tends to include the organizational culture by helping the organization to continuously improve its culture that leads to innovation (Christensen, Betz & Stein, 2007, p.68). JIT and SPC The Just in Time approach is a part of the philosophy of operational excellence. The Just in Time approach envisages a situation in which organizations keep a minimum stock of inventory with them and stock minimal volume of goods. This helps in reducing the inventory carrying costs for a company as only a bare minimum inventory is stocked. This technique has been successfully employed by organizations like Dell and Toyota to derive competitive advantage. The implementation of Just in Time requires a close synchronisation with the suppliers of the organization. It has also been observed that incorporating a Just in Time approach would help foster a better relationship with the organization and the suppliers (Pride & Ferrell, 2010, p.329). is the whole paragraph from this reference? Organizational Issue : a little more detail is needed here. What happens due to this organisational issue. What affect does it have on the organisation? The main issue faced by Apple is with regards to the aspect of promoting innovations and its subsequent diffusion into

It has to be an international topic related to crime. ex prostitution Research Proposal

It has to be an international topic related to crime. ex prostitution in Thailand - Research Proposal Example In this research, I choose to focus on this specific aspect, with the intentions of finding a solution for the prevailing crime. Introduction The prostitution industry has been growing in Thailand for many years. The concentration for the industry has been on the city centers and in particular, the Bangkok and Pattaya (Van et al, 1993). The girls who have been directly involved in prostitution has been innumerable, and it is estimated that prostitution accounts for more than 3% of the total GDP in Thailand. A survey done in 2007and 2008 indicated that at least the industry yields in an annuals basis is 5 billion dollars (Elizabeth and Charlie, 2009). Another survey indicated that at least four thousand prostitutes are concentrated in Bangkok area alone. Clearly, the industry is huge, earning the country a lot of income. The girls have also benefited d from the business, which explains why they have continually increased in number every year. It is important to note that prostitution is illegal in Thailand. According to Bales, (1999) the criminalization of the act has been known to exist since 1960. It sis therefore puzzling to see the numbers growing every year, suggesting that the law is not being effected as it ought. Prostitution is always packaged with other related crimes, something that raises concerns in the global front. Many girls have been known to engage in human trafficking and child prostitution. Further, there are so many people within the population that have been recorded to be affected with HIV and AIDS. Whenever crime occurs, it is natural to turn to the policy makers for a solution. Therefore, it is possible that the issue of prostitution and related problems can be dealt with through effective policy by the government and its related bodies. The law making process and the people charged with the role of its implementation must concentrate on the subject of prostitution (Chambliss & Schutt, 2007). The law in Thailand bans prostitution but lea ves certain gaps that lead to serious consequences amongst its citizens. Further, the implementation process tends to be overlooked, which has led to more problems surrounding the issue This research concentrates on the gaps that have been left during the policy making process as pertains to the subject. The study further suggests change in policy by the concerned bodies to deal with the problem Literature review According to Hantrakul, (1984) prostitution does not occur in places where the government has made a lot of effort to develop the correct policy against the acts and the related crimes. However, in Thailand, n implementation of those policies has been ineffective. While prostitution is on hand said to be illegal, the government has passed bills that have left big gaps for it to thrive. The law implementation process is hindered mainly because of viewing the act as a national resource. Since the year 1960, the government has continued to pass bills that have been indicative that prostitution is illegal (Rhodes, 1999) However, many other bills have left big gaps for the business to continue being practiced in the region. For example, in the year 1966, a law was passed to allow for service provision to the American servicemen. The rest and recreation facilities were provided for the soldiers. This was a period when the Vietnamese war called for soldiers to be deployed in the region for protection and peace keeping. In 1996, a law was passe

Was Andrew Jackson Democratic Essay Example for Free

Was Andrew Jackson Democratic Essay Throughout time changes have been made to our country’s government in hopes of improving it, and reducing the flaws it has. Andrew Jackson made changes to our country in hopes of increasing its chances of longevity; however his methods in doing so are to this day very controversial. While Andrew Jackson was known as â€Å"the people’s president† his methods for improving America were quite ambiguous, and the concept of Jacksonian democracy is highly criticized. Andrew Jackson made contributions to our country while holding office; however his tactics were anything but democratic. Growing up on the frontier Andrew Jackson was the first president to not grow up wealthy, later in his life it proved to be useful in trying to appeal to voters, which proved to be successful. Yet in the race for presidency, even though he had won the votes, he did not win the election; John Quincy Adams, with the help of Jackson’s enemy Henry Clay, became president. In the next election to come Andrew Jackson had proved to be more successful, in acquiring the role of the president, both Jackson, and his ally Martin Van Buren, created a political organization, in what is now known as the democratic party. All seemed well, and politically Andrew Jackson had not made a mistake yet, However although he was known as a man of the people, Jackson believed in and promoted slavery. Jackson owned a plantation named The Hermitage. The Hermitage was a huge self-sufficient plantation that raised cotton and relied on the labor of African American men, women, and children. On his plantation there was rigorous labor that his slaves preformed daily. Due to the hard work of Jackson’s slaves, he continued to profit, and allowed him to acquire more land, thus he bought more men women and children to work his land, and help continue prosperity the Jackson family. Moreover, Andrew Jackson was skilled in military tactics; however he used his knowledge to take millions of acres of land from Native Americans. In 1814 he commanded the U.S. military forces that defeated a faction of the Creek nation. In their defeat, the Creeks lost 22 million acres of land in southern Georgia and central Alabama. As president, he continued to try and acquire more Indian land for white settlers who wanted to grow cotton, much like him. In 1830 Jackson signed the Indian Removal Act which allowed the government to move the Indians out of cotton rich land, and into Indian  reservations out west. This travel took a toll on many of the tribes, and the journey the Indians took came to be known as the â€Å"Trail of Tears†. In addition, there was the Supreme Court case of Cherokee Nation v. Georgia, where the Supreme Court ruled in favor of the Cherokee Nation. This ruling of the Supreme Court did not stop Jackson and his followers from driving the Cherokees off of their land, which people viewed unconstitional from Jackson’s part. Furthermore, Jackson was also known for many â€Å"injustices† while holding office, and criticized for expanding the power of the presidency. He was also known for rewarding his political supporters with government jobs. When it was brought up to his attention, he responded by claiming he was replacing aristocrats with the common man. Jackson stated To the victor go the spoils, and thus created the spoils system in government. Lastly, Jackson was portrayed as a sort of tyrant by his enemies, they even named him â€Å"King Andrew the First,† this was due to Jackson having the most vetoes out of all the presidents that came before him. With so many vetoes on Jackson’s part sometimes it seemed difficult to get anything done. His denial of a bill to re-charter a Second Bank of the United States was a significant event in Jackson’s term. To conclude, While Andrew Jackson did have a few positive outcomes for our country while he was president, it doesn’t ensure that he was completely democratic. In fact, his actions were quite opposite of democratic views. He did not respect Native Americans or African Americans. He used His military background to assist in the removal of Indians from their land, so that white Americans can raise cotton, while the Indians were moved westward so that they would not make obstacles for white colonists who wanted to expand. And he contributed in the creation of the spoils system. Andrew Jackson did strengthen the two-party system, he was not completely democratic. Work Cited â€Å"Jacksonian democracy and modern America† USHistory.org 06 Nov 2014 http://www.ushistory.org/us/23f.asp â€Å"Slavery at the Hermitage† Thehermitage.com 06 Nov 2014 http://www.thehermitage.com/mansion-grounds/farm/slavery â€Å"Trail of Tears† History.com 06 Nov 2014 http://www.history.com/topics/native-american-history/trail-of-tears â€Å"Jacksonian Democracy† History.com 06 Nov 2014 http://www.history.com/topics/jacksonian-democracy

Effects of Ultrasound Therapy on MCL Injuries

Effects of Ultrasound Therapy on MCL Injuries The medial collateral ligament (MCL) is one of the most frequently injured ligaments of the knee joint. Fortunately, most patients who sustain MCL injuries are able to achieve their previous level of activity without the need for surgical treatment. However, the most severe injuries, especially those involving multiple ligaments, may require operative repair. This study will explore the effectiveness of a conservative treatment, namely ultrasound therapy and exercise therapy, in the treatment of MCL injuries of the knee joint. In a review by Phisitkul, James, Wolf, and Amendola (2006), treatment with early range of motion (ROM) exercises and progressive strengthening has been shown to produce very good results. Ultrasound therapy has been a widely used and well-accepted physical therapy modality for musculoskeletal conditions for many years. Wong, Schumann, Townsend, and Phelps (2007) performed a survey about the use of ultrasound by physical therapists who are orthopaedic specialists, and found that ultrasound therapy is a popular adjunct in orthopaedic physical therapy and that it is perceived as important. However, the lack of studies confirming its benefits has led many to question this traditional view. Indeed, many studied which explored the effectiveness of ultrasound therapy failed in establishing a definite conclusion. Nevertheless, it cannot be assumed that this lack of evidence implies that ultrasound therapy is ineffective, and thus further research is needed to establish the adequacy of its use. This study aims at answering the following crucial questions: In patients with MCL injuries of the knee, can ultrasound improve pain, disability and general recovery? Is it more effective than exercise therapy in improving symptoms? An answer to these questions will help to better direct physiotherapy treatment for these patients, and thus optimize recovery. Subsequent chapters will discuss the current literature available on the subject, followed by the methodology used in this study. The results are then presented and analysed. The interpretation of results in the context of previous research will be discussed in the discussion chapter, including the strengths and limitation of the study. Literature Review Ultrasound therapy has become commonly used in soft tissue injuries (Speed, 2001). Research carried out in the past few decades regarding the effects of ultrasound on body tissues will be discussed below. My aim is to review the research available from the past years in attempt to find conclusive and consistent results regarding the effects of ultrasound, and thus to justify the use of ultrasound in the clinical setting, specifically to treatment of medial collateral ligament injuries. As will be discussed in this chapter, when ultrasound enters the body, it is thought to exert an effect on it through thermal and non-thermal mechanisms (Robertson, Ward, Low, Reed, 2006, p.266). Some of these effects may stimulate healing; however others may be dangerous and may cause damage. Thermal effects of ultrasound As ultrasound waves travel trough body tissues, they cause oscillation of particles, thus converting sonic energy into heat energy. The amount of heat produced will greatly depend upon the intensity given and the rate of energy absorption, but also on certain tissue properties, such as the heat capacity, efficiency of heat transfer, and the tissue distribution and space (Robertson, Ward, Low, Reed, 2006, p.266). Some authors have suggested pre-heating the area of treatment to achieve a greater increase in tissue temperature (Draper et al 1998a). Living tissue will be affected by an increase in temperature in various different ways. According to Speed (2001), the thermal effects of ultrasound include an increased extensibility in tissues, enhanced blood flow, pain modulation, decreased joint stiffness and muscle spasm, together with a mid inflammatory response. These could explain why a temporary increase in range of motion is observed after ultrasound treatment (Draper et al., 1998b; Knight et al., 2001). Hayes, Merrick, Sandrey and Cordova (2004) studied the extent of heating in tissue at 2.5cm depth and found that 3MHz ultrasound was more effective in heating the tissues at this depth than 1MHz, reaching a temperature of 40 degrees Celsius after 4 minutes. Unfortunately the production of heat may place the patient at risk of a skin burn if applied incorrectly (Robertson, Ward, Low, Reed, 2006, p.290). Physical effects of ultrasound Cavitation Cavitation is the formation of tiny gas bubbles in the tissues as a result of ultrasound vibration (Robertson, Ward, Low, Reed, 2006, p.267). Johns (2002) explains how as sound waves travel through the tissues, the characteristic compression and rarefaction causes microscopic gas bubbles present in the tissue fluid to contract and expand. Injury to the cell may occur when these gas bubbles expand and collapse rapidly. Nevertheless, cavitation has been found to occur only when using high intensities, and thus it is unlikely to occur in vivo with therapeutic levels (Nyborg, 2001). However according to a review by Baker, Robertson, and Duck (2001), there are a few studies which suggest the existence of in vivo cavitation. Baker and his colleagues argue that these studies were not replicated and that results obtained may have been due to difficulty with the analysis of B-scan imaging, which were used to measure cavitation. A recent study investigated the method by which cavitation is de tected. The wavelet approach was identified as a new tool for studying bubble cavitation (Zhou, 2008). Cavitation becomes clinically relevant during ultrasound applications in water, as bubbles that form between the skin and the treatment head may block transmission of ultrasonic waves (Ward Robertson, 1996). Acoustic streaming Acoustic streaming may be described as a flow of liquid caused by a generation of pressure along the axis of the beam of energy and on any other structures which reflect it (Robertson, Ward, Low, Reed, 2006, p.268). There are two types of acoustic streaming: microstreaming and bulk streaming (Duck, as cited in Baker, Robertson Duck, 2001). Bulk streaming occurs in any fluid and develops as the ultrasound beam is propagated, while microstreaming occurs at a microscopic level and is formed as eddies of flow flanking to an oscillating surface (Robertson, Ward, Low, Reed, 2006, p.268). Unfortunately bulk streaming is much less mechanically powerful, with microstreaming being the only type of acoustic streaming which is able to stimulate cell activity and change membrane permeability (Duck, as cited by Baker, Robertson, Duck, 2001). Microstreaming can produce stress on the cell membrane and wash away any molecules and ions which accumulate outside the cell membrane (Robertson, Ward, Low, Reed, 2006, p.268). According to Duck (as cited by Baker, Robertson, Duck, 2001), only bulk streaming occurs in vivo, because microstreaming only occurs secondary to cavitation. In vitro studies show increased growth factor production by macrophages (Young and Dyson, 1990a), increased calcium uptake (Mortimer and Dyson, 1988), increased secretion and degranulation of mast cell (Fyfe and Chahl, 1984) and increase cell membrane permeability (McCance and Huether, as cited by Baker, Robertson, Duck, 2001) by microstreaming. This however will have minimal relevance in the clinical se tting if one assumes that cavitation will not occur. Nevertheless, Manasseh, Tho, Ooi, Petkovic-Duran, and Zhu, (2010), suggest that microstreaming which occurs secondary to cavitation will play a role in the action of microbubbles in therapeutic ultrasound. Standing waves Standing waves are formed when reflected sound waves are superimposed with incident waves, and are characterized by high pressure peaks, the antinodes and zones of low pressure known as nodes (Robertson, Ward, Low, Reed, 2006, p.267-8). Ter Haar and Wyard (1978) put forward that blood cell stasis may occur with ultrasound, with cells forming at half wavelength intervals in the blood vessels at antinodes. These results match those by Dyson, Pond, Woodward, and Broadbent (1974). The latter studied the effect of a stationary wave on blood cell stasis and endothelial damage in blood vessels of chick embryos. The cells form bands half a wavelength apart inside blood vessels. They suggest that under optimum conditions, the minimum intensity of less than 0.5 Wcm-2 at 3 MHz with continuous irradiation is required for stasis to occur. Damage to some endothelial cells of vessels in which stasis has occurred was revealed by an electron microscope. Thus, it is suggested that the treatment head is continuously moved during the treatment to minimize the formation of standing waves (Robertson, Ward, Low, Reed, 2006, p.268). The effect of ultrasound on repair of body tissues According the following research, ultrasound therapy may have an effect on cells involved in repair of body tissues, including: Levels of prostaglandins and leukotrienes Leung, Ng, and Yip (2004) performed a randomized, case-control study to study the effect of ultrasound during the acute inflammation of soft-tissue injuries. They measured the levels of leukotriene B4 and prostaglandin E2 in the medial collateral ligament of rats and found that pulsed ultrasound (1:4) applied for five minutes at different durations and intensities may stimulate acute inflammation by increasing the levels of the above mentioned leukotriene and prostaglandin. Release of fibroblast from macrophages Young and Dyson (1990a) studied if ultrasound therapy can increase the release of fibroblast mitogenic factors from macrophages in vitro, and assessed fibroblast proliferation over five days. This study showed an increased secretion of already formed fibroblasts in macrophages at 0.75 MHz ultrasound, which may be caused by permeability changes. On the other hand, at 3 MHz frequency, ultrasound appeared to encourage both the synthesis and secretion of fibroblast mitogenic factors. The reason why these two frequencies cause different effects may be explained by the different physical mechanisms involved. Williams (as cited in Young, 2002, p. 217), argues that cavitation is more liable to occur at lower frequencies, while at a higher frequency heating is more likely. Platelets and ÃŽÂ ²-thromboglobulin Williams, Chater, Allen, Sherwood, and Sanderson (1978) investigated the effect of ultrasound on platelets and established that more ÃŽÂ ²-thromboglobulin, a platelet specific protein, was released by ultrasound therapy. They suggest that this protein is released both by the disruption of platelets by cavitation and by other aggregating agents liberated in parallel with it which cause a release reaction in the adjacent platelets. This however, has not been proved to happen in vivo. Histamine release from mast cells Fyfe and Chahl (1984) suggest that ultrasound applied in the therapeutic range causes a significant increase in degranulated mast cells and thus an increase in histamine release, in rats. They suggest the possibility that ultrasound increases the permeability of mast cells to calcium causing them to degranulate, resulting in an increase in local blood flow. On the other hand, when Hogan, Burke, and Franklin (1982) investigated the change in blood flow in rat muscle on insonation, they found that arterioles vasoconstrict transiently in response to insonation, but improve perfusion after long-term treatment. Increase membrane permeability to calcium Change in the permeability of membranes to calcium has been demonstrated when using therapeutic ultrasound. According to Al-Karmi, Dinno, Stoltz, Crum, and Matthews (1994), applying ultrasound for two minutes will cause a significant boost in ionic conductance in the presence of calcium ions, thus confirming that calcium ions influence the biological effects of ultrasound. Dinno et al. (1989) also used a frog skin model to study the effect of ultrasound on membranes. They argue that the increase in the concentration of calcium ions inside cells which occurs after the application of ultrasound, may decrease the permeability of gap junctions and uncouple cells in the way by which cells differentiate. Therefore, they concluded that ultrasound can affect cell differentiation and consequently histogenesis, and thus its use should be avoided over embryonic tissue. Growth factor secretion Ito, Azuma, Ohta, and Komoriva (2000) applied ultrasound to a co-culture system of human osteoblastic and endothelial cells and studied their effect on growth factor secretion. Their study showed that ultrasound increases the levels of platelet-derived growth factor. This may be the reason for improved fracture healing rate with ultrasound treatment, as discussed later. Fibroblasts and Collagen synthesis Ramirez, Schwane, McFarland, and Starcher (1997), conducted an investigation to determine the effect of ultrasound on the rate of cell proliferation and collagen synthesis by using cultured fibroblasts form the Achilles tendons of neonatal rats. They found an increase in collagen synthesis and rate of thymidine incorporation and DNA content after ultrasound treatment, suggesting that ultrasound stimulates the synthesis of collagen in tendon fibroblasts and cell division after injury. In a more recent study Chiu, Chen, Huang, and Wang (2009), studied the effect of ultrasound on the proliferation of human skin fibroblasts at different frequencies. They applied ultrasound for three minutes daily for three days and found an increase in fibroblast proliferation by both 1 and 3 MHz frequencies, with less stimulation when using 0.5 MHz frequency. Chiu et al., also took into account temperature changes and found a change of only one degree Celsius after insonation, thereby implying that the results observed where due to non-thermal effects. This can be explained by the increase in protein synthesis found to occur in fibroblasts after ultrasound treatment. Harvey, Dyson, Pond and Grahame (1975) suggest that therapeutic ultrasound at 3 MHz frequency and at an intensity of 0.5 2.0 Wcm-2, can directly stimulate protein synthesis in fibroblasts, without any other cells acting as mediators. In fact they attributed this to membrane-associated changes. Nevertheless, the increase in fibroblast proliferation may occur as a result of the effects of ultrasound on macrophages, which release fibroblasts mitogenic factors (Young Dyson, 1990a), as previously discussed. Ultrasound not only stimulates fibroblasts to produce more collagen (Ramirez et al. 1997), but the collagen produced also has a higher tensile strength and is better organized and aggregated. Okita et al. (2009) studied joint mobility and collagen fibril arrangement in the endomysium of immobilized rat soleus muscle, and showed that therapeutic ultrasound may prevent changes in joint mobility and collagen fibril movement which occur with immobility. In contrast, when Larsen, Kristensen, Thorlacius-Ussing and Oxlund (2005) studied the influence of pulsed ultrasound at 3 MHz frequency and different intensities, on the mechanical properties of healing tendons in rabbits, they found greater extensibility after insonation with higher intensities, however there was no significant change of the point of rupture when the tendons were loaded, suggesting that pulsed ultrasound did not improve the mechanical properties of the healing tendons. Angiogenesis Therapeutic ultrasound may also affect the rate of angiogenesis. Young and Dyson (1990b) considered the formation of new blood vessels in full-thickness lesions of flank skin in adult rats and found that by day 5 post-injury, ultrasound treated wounds had developed a greater number of blood vessels, and were thus at a more advanced stage in the repair process. However by the seventh day, there was no significant difference between the groups. Therapeutic mechanism On the basis of these conflicting results, two schools of thought were developed. The evidence-based or factual school considers heat as the only effect of ultrasound therapy and thus emphasise the use of high doses and give little value to low intensity and pulsed treatment. This view is found in most American writing about this subject. On the other hand, the other school of thought is largely European, and is more involved in the biological and mechanical effects of pulsed low-intensity treatments (Robertson, Ward, Low, Reed, 2006, p. 269). Robertson, Ward, Low, Reed, (2006, p. 269) suggest that clinical studies may be used to investigate which doses produce better outcomes. In vitro studies can provide a dose-response relationship which may provide information about the most effective dose. Nevertheless, effects demonstrated in vitro, such as cavitation and acoustic streaming have not yet been shown to occur in vivo, since it is difficult to produce doses in vivo which are comparable to dose in vitro. They argue that in vitro, ultrasound is applied to only a thin layer of cells, and thus the noted changes do not necessarily occur when applied to a much larger volume of tissue in vivo. Moreover, in vitro the energy is confined to a very small volume and thus the power density will be much higher than in vivo. Therapeutic effects of Ultrasound Ultrasound therapy has been claimed effective in a wide range of clinical conditions, however there are still difficulties in establishing the effectiveness of ultrasound with certainty and in identifying a dose-response relationship, if there is any. Some of the alleged effects of ultrasound include promotion of fracture healing, soft tissue healing, articular cartilage repair, pain relief, increase local blood flow, change the extensibility of scar tissue and for the diagnosis of a stress fracture, and will be discussed below. Fracture healing Ultrasound has been proposed to promote the processes involved in fracture healing and thus increase its rate. Sun et al., (2001) investigated the effects of low-intensity pulsed ultrasound on bone cells in vitro, and found a significant increase in osteoblast cell counts and a significant decrease in osteoclast cell count after stimulation, suggesting a positive effect on the bone-healing process. Nolte et al., (2001) also studied the in vitro effects of low intensity ultrasound. The latter used foetal mouse metatarsal rudiments and found an increase in length of the calcified diaphysis, which was significantly greater in the ultrasound treated groups compared to the untreated groups, after 7 days. Therefore they concluded that low-intensity ultrasound directly affects osteoblasts and ossifying cartilage, with consequential more active ossification. Cyclooxygenase-2 regulates the production of Prostaglandin E2 by osteoblasts, both of which are thought to be an essential part of fracture healing (Zhang et al., 2002). Ultrasound stimulation has been found to increase cyclooxygenase-2 expression and to promote bone formation in osteoblast via various signalling pathways (Tang et al., 2006). Together with prostaglandins, nitric oxide is a crucial mediator in early mechanically induced bone formation. Reher et al., (2002), investigated the effect of traditional (1MHz, pulsed 1:4) and a long-wave (45 kHz, continuous) ultrasound on nitric oxide induction and prostaglandin E2 production in vitro, on human mandibular osteoblasts. A control group was set which was treated with sham ultrasound. They found a significant increase in both induced nitrate and prostaglandin E2 production. Long wave ultrasound was found to be more effective than the traditional ultrasound. Other studies suggest that ultrasound may have an effect on the regulation of genes necessary for osteogenesis. Suzuki and his colleagues (2009) studied the typical osteoblastic cell line in the presence or absence of daily low intensity pulsed ultrasound stimulation at 1.5 MHz frequency, and 30 mW/cm2 intensity, for 20 minutes, for 2 weeks. They concluded that stimulation with these parameters directly affected osteogenic cells, leading to mineralized nodule formation, thus low intensity pulsed ultrasound therapy is likely to have an influence on the activities of osteoblasts in alveolar bone. Clinical studies gave controversial conclusions in this area. In a review, Busse et al., (2002) concluded that evidence form randomised controlled trials suggest that low intensity pulsed ultrasound therapy may significantly reduce the time of fracture healing for non-operatively treated fractures. Five years later, Walker, Denegar, and Preische, (2007) confirmed this finding through another review. Moreover, Della Rocca (2009) reviewed studies about the effects of low-intensity pulsed ultrasound treatment in fracture healing and found a large body of animal and cellular research which shows this to be beneficial in simulating faster normal fracture healing. However, from a review to of randomised controlled trials to determine the effectiveness of low intensity pulsed ultrasound in fracture healing, Busse et al., (2009), concluded that the evidence available has a moderate to very low quality and provides conflicting results. Pain relief There are a very small number of studies which investigate the effectiveness of ultrasound in pain relief. Nevertheless, assuming that ultrasound promotes healing and resolves inflammation, pain should consequently decrease. Levent, Ebru, and Gulis (2009), used a randomised controlled trial to study the effect of ultrasound therapy in knee osteoarthritis. They applied ten sessions of five minutes of continuous ultrasound at 1 MHz to the experimental group and sham ultrasound to the control group to act as a placebo. They assessed pain by a visual analogue scale (VAS) and found that the decrease in pain in the experimental group is statistically significantly more than the control group. Thus they concluded that therapeutic ultrasound can be used effectively as a pain relief modality in patient suffering from knee osteoarthritis. An earlier review by Brosseau et al., (2001), did not show ultrasound as clinically important for pain relief in people with patellofemoral pain syndrome. However, they were unable to draw a conclusion regarding its use due to methodological flaws and limitations in the studies included in this review. Soft tissue injuries Wilkin, Merrick, Kirby and Devor (2004) studied the effect of pulsed ultrasound applied once daily for a week, on the healing of skeletal muscle in eighty rats. The results suggest that pulsed ultrasound as administered did not accelerate or improve regeneration of skeletal muscle tissue after contusion. Similarly, Markert, Merrick, Kirby and Devor (2005), using a randomized controlled trial with rats, found no evidence that specific continuous ultrasound and exercises protocols enhance skeletal muscle tissue regeneration following contusion injury. Takakura et al. (2002) investigated the effect of low-intensity pulsed ultrasound on the rate of healing of injured medial collateral ligaments of rat knees and found a significant improvement in the mechanical properties on the twelfth day, which however was lost by the twenty-first day. Nevertheless they also observed a larger mean fibril diameter in the ligaments treated with ultrasound, concluding that low intensity pulsed ultrasound enhances the early healing of medial collateral ligament injuries. Ebenbichler et al., (1999) investigated the effect of ultrasound in the treatment of calcific tendinitis. This study suggests better outcomes with ultrasound treatment. Since only patients with calcific tendinitis diagnosed by diagnostic imaging were included in the study, results are more valid than if numerous shoulder pathologies with different cellular process were included. This study was included in the review by Alexander et al., (2010). The latter carried out a review from various electronic databases and identified eight randomised controlled trials out of a total of seven hundred and twenty seven, which met their inclusion criteria. All the studies reviewed focused on shoulder musculoskeletal disorders. They concluded that statistically significant improvements were observed generally in studies which used higher levels of total energy and those who used longer exposure times. They noted favourable outcomes when at least 2,250J per treatment session was applied. This is fur ther suggested by the frequency resonance hypothesis, which suggests that the mechanical energy produced by the ultrasound wave may be absorbed by proteins, altering the structure of individual proteins or changing the function of a multi-molecular complex. Thus it may affect enzymatic proteins, inducing temporary conformational shifts, and thus alter the enzyme activity and cell function. This hypothesis implies that different frequencies will cause unique resonant or shearing forces which will therefore have specific effects at cellular and molecular levels (Johns, 2002). Thus further reviews should address different parameters used in different studies, in attempt to establish effective doses. Blood flow Noble, Lee, and Griffith-Noble (2007) applied ultrasound at 3 MHz frequency and 1 Wcm-2 for 6 minutes to assess its effect upon cutaneous blood flow by laser Doppler flowmetry. They also measured skin temperature. They concluded that cutaneous blood flow increased significantly with ultrasound even though no significant changes in temperature had occurred. Nevertheless, blood flow changes in skeletal muscles have not yet been established. Robinson and Buono (1995), investigated the effect of continuous ultrasound on blood flow using 1.5 Wcm2 intensity for 5 minutes and found no significant change in skeletal muscle blood flow. Wound healing Other authors have studied the healing rates varicose ulcers by ultrasound and found more marked healing of insonated ulcers (Dyson, Franks, Suckling, 1976). However more recent studies suggest that ultrasound does not have an influence on the acceleration of healing or final stage of the wound healing (Dolibog, Franeki, Taradai, Blaszczak, Cierpka, 2008). Different findings may be attributed to the different nature of the injuries studied and the different way by which the effectiveness of ultrasound is assessed. Diagnosis of stress fractures Romani and his colleagues (2001), were some of the few people who investigated the effectiveness of ultrasound therapy in the diagnosis of stress fractures. They used 1 MHz of continuous ultrasound therapy in twenty-six subjects with pain in the tibia since less than 2 weeks. Each subject completes a visual analogue scale after each different intensity was applies to assess the pain response to ultrasound. An MRI was taken to ascertain the diagnosis. However none of those who were found to have a stress fracture by MRI were correctly diagnosed by ultrasound. Following this review of literature, it is suggested that there may be a specific therapeutic window for ultrasound therapy. Conflicting results were obtained, possibly due to the different doses and frequencies used in various studies, indicating the need for further future research to identify the most effective parameters. Fortunately, none of the studies reviewed mentioned any negative effects on patients, making ultrasound a relatively safe modality when precautions are taken, and thus would make an important physiotherapy modality if its use is justified.

Berkshire Hathaway Essay

Berkshire Hathaway Inc. is an American multinational conglomerate holding company, headquartered in Omaha, Nebraska, that oversees and manages a number of subsidiary companies. The company wholly owns Geico, BNSF, Lubrizol, Dairy Queen, Fruit of the Loom, Helzberg Diamonds, FlightSafety International, and Netjets. It also owns half of Heinz and has significant minority holdings in American Express, Coca-Cola Company, Wells Fargo, IBM, and Restaurant Brands International. I have done a lot of research into Berkshire Hathaway and CEO Warren Buffet but have been unable to find a vision or mission statement. If I had to make up a vision statement that suitably fit Berkshire Hathaway it would be the following: â€Å"Berkshire Hathaway strives to be the best-recognized, most highly respected, and most influential conglomerate company in the world.† The mission statement would be: â€Å"To provide top of the line services that significantly increase the growth of the company’s agents and affiliates.† I believe this fits this company perfectly because Berkshire Hathaway is notorious for its ingenious investing and services all thanks to a man named Warren Buffet who started out acquiring businesses. Buffet is one of the world’s wealthiest men and a key influencer in the financial market. He is Forbes’ number 33 most powerful people and ranked among Time Magazine’s most influential people. His company was ranked number 1 in Barron’s 2013 ranking of the world’s 100 most respected companies, number 8 in Fortune Magazine’s 50 most admirable companies survey, number 18 in Harris Interactive’s reputation study of the 60 most visible companies, and Forbes’ fifth largest company in the world. In his 2013 letter to shareholders, Buffet spoke of his joy for working for such a successful company. He noted, â€Å"No CEO has it better; I truly do feel like tap dancing to work every day.† My vision and mission statement align appropriately with what Buffet has done and envisions for Berkshire Hathaway. Stakeholders: Internal- Board Members: Warren Buffet, Charlie Munger, Walter Scott Jr., Thomas S. Murphy, Howard Graham Buffet, Ronald Olson, Donald Keough, Charlotte Guyman, Bill Gates, Steve Burke, Susan Decker, Susan Decker, and Meryl Witmer. Shareholders: â€Å"We think of our shareholders as owner-partners, and of ourselves as managing partners.† –Warren Buffet Employees: About 302,000 full-time employees. External- Customers: All over the globe, predominantly in North America. Media: Perceive the company in a certain way. Subsidiaries: Geico, BNSF, Lubrizol, Dairy Queen, Fruit of the Loom, Helzberg Diamonds, FlightSafety International, ect. Communities: Omaha, Nebraska and other local communities.  Government: Local and Federal Governments.