Women in business nowadays and the past Essay Example | Topics and Well Written Essays - 1750 words

Women in business nowadays and the past - Essay Example Stereotyping against women is a common trait around the business world. Yet, everybody should realize that a woman is in no way inferior to man and she can very well handle the pressures and stressful life of the business. Handling a family with the work is no easy job and many women in today's age are not just balancing work and family life, rather they are integrating it. The business world is getting infused with a diverse workforce day by day. The trend towards being an equal opportunity employer is rising. More and more women are being hired in today's corporate world. And the differences between men and women are being sorted out as women take on as many as 25% of top level managerial posts in successful organizations. Therefore, the composition of males and females in the workforce of a typical organization has changed. Yet men still possess a significant amount of decision making in their hands. Whether it is the power to hire and fire or to access financial resources, men are always given the advantage over women. But if businesses are to reach their highest potential, they need to make full use of women by accepting the fact that they are different from men and are not inferior to them in any way.1 Approaches to conflict: When it comes to a conflict, men usually consider it a healthy process and they use logic, bargaining and even anger to resolve it. Whereas, on the other hand, women tends to focus on the affective part by understanding each others feelings in a conflict. For women, conflict is undesirable and damaging in many ways. They have a negative view point of conflict and therefore, they would like to get it solved without exaggerating it thereby using less direct approaches. Research also suggests that men will tend to go for riskier solutions when it comes to resolution of conflict. Supervision and leadership styles: although leadership styles would look pretty similar on the core, they are quite different. Research has found that women tend to treat their subordinates more as colleagues than the men and women also encourage the participation of everyone in a decision making process. Men, in such positions, will go for a less collaborative style, and will give more directions and tend to be more dominating too. Relationship with others is an integral part of women's leadership styles than for men. A woman also tries to build a sense of community in the place where she is the leader, unlike men. Working in teams: men and women think differently in terms of what needs to be communicated when a team is in action. Women put a lot of importance to these team characteristics: competence, respect, fairness, knowledge of team member's roles, and team members should also provide extra help and support to each other when needed. Whereas, men do not place much importance on these characteristics. The Role of Women in the Society Women, more or less, assume a particular cultural and gender role that they have to fulfill. In pre-historic times, the women of the family used to help the man in doing whatever business they did out of the farms or by doing agriculture. The women used to gather products like fish or learn to

Orangutan's diet Essay Example | Topics and Well Written Essays - 1500 words

Orangutan's diet - Essay Example Orangutans are known to be solitary but occasionally aggregation form particularly in enormous large fruiting fig trees. The individual Orangutans tend to compete as the scramble for food. Therefore, the paper will partly study the kind and strength of food competition in huge fig trees amongst the Orangutans and also probe the impacts of fruits seasonality on the changes in diets and energy balance amongst these wild Sumatran Orangutans to help understand the diet of Orangutans. Studies have shown that over 50 percent of Orangutans diet is composed of fruits hence earmarked as frugivorous. Also, their diet is composed of young leaves approximated to be about 25%, as well as barks and flowers rated at 10%. Moreover, Orangutans diets have also been uncovered to contain about 5% of insect primarily ants, pupae, crickets, and termites. The studies have also pointed out the wild Orangutans are selective and opportunistic. Therefore, during the emergence of tasty and nutritious insects, O rangutans feed all day on them (Nellemann, United Nations Environment Programme & GRID—Arendal, 2007, 34). In case of unavailability of fruits and insects, previous studies have observed that Orangutans feed on trees barks and leaves that are less in nutrition to avoid starvation. Moreover, wild Orangutans have been noted to learn to feed on hundreds of various food types as youngsters through observing their mothers while being permitted to take foods from the mouth and hands of their respective mothers. This study seeks to investigate  and understand the Orangutans’ diet. The study will help the researcher to understand precisely what constitutes these primates diet. Moreover, the study will add knowledge to the already knowledge about these primates. Further, the study will help the researcher develop insights into changes in Orangutan caloric intake, energy balance, and ketones in

Literature Search on the effects of Overtime on Nursing staff

Literature Search on the effects of Overtime on Nursing staff PICO Question Numerous research studies have been completed in the last ten years linking higher nurse patient ratios to improved patient outcomes. A consequence of mandating nurse staffing levels is the use of mandatory and voluntary overtime which can lead to increased fatigue and adverse events. The use of overtime is not a solution to maintaining adequate nurse staffing levels and can have detrimental, unwanted consequences. The potential risk to nurses and patients must be explored through quality research. In an attempt to meet staffing ratios many organizations rely on the use of mandatory and voluntary overtime which leads to fatigue and adverse outcomes. P: Overtime I: Limit hours worked by RNs to 12 per 24 hours C: No limit on hours worked O: Decreased fatigue and adverse outcomes Search Strategies with Medline, CINAHL and Google Scholar Medline Using the Medline database the key words RN staffing and hour worked were entered. This resulted in 21,214 articles. To narrow this search the following limits were applied: publication years 2004-2009, English language, patient safety and medical errors. This resulted in 407 articles. To narrow to a manageable number of relevant articles the subheading of staffing: supply and distribution, and personnel staffing and scheduling were added to the previous search terms resulting in 26 current articles. A systematic review was completed using the terms RN staffing, overtime and patent safety, which provided similar results and articles. Final articles chosen were: International Experts Perspectives on the State of the Nurse Staffing and Patient Outcomes Literature by Van den Heede, et al published in the January 2007 issue of Journal of Nursing Scholarship and Correlates of medication error in hospitals by Wilkins and Shields published in the June 2008 issue of Health Reports. CINAHL Keywords entered into the CINAHL database included mandatory overtime in nursing and patient safety which resulted in 1,597 articles. By setting the parameters to articles published between 2004 and 2009 in the English language and adding the subheading of personnel staffing and scheduling and adverse outcomes a total of 31 articles were provided. Adding the subheading of quality of nursing care along with the keywords systematic review resulted in 17 final articles. The two articles chosen were: Nurse Staffing and Healthcare Outcomes: A systematic review of the International Research Evidence by Lankshear, Sheldon and Maynard published in the 2005 issue of Advances in Nursing Science and Factors Influencing the use of Registered Nurse Overtime in Hospitals, 1995-200 published by Berney, Needleman and Kovner in the second quarter 2005 issue of Journal of Nursing Scholarship. Google Scholar Keywords nurse staffing, medical errors, patient outcomes and hours worked were entered into the Google Scholar database. This search resulted in 1782 articles. Adding the parameters of articles published between 2004 and 2009 and medical, pharmacological and veterinary only yielded 442 articles. The addition of the terms mandatory overtime to the above selections resulted in 180 articles. Other variations of search terms did not yield less than 180 relevant articles. Many of these 180 articles were also found in the final Medline and CINAHL searches. The two chosen from this search included: The working hours of hospital staff nurses and patient safety published by Rogers et al in the July / August 2004 edition of Health Watch. The second article Scott et. al Effects of critical care nurses work hours on vigilance and patients safety published in the January 2006 issue of American Journal of Critical Care. Analysis of Articles from each Database Medline Analysis International Experts Perspectives on the State of the Nurse Staffing and Patient Outcomes Literature by Van den Heede et al., published in the fourth quarter 2007 issue of Journal of Nursing Scholarship is an article written to assess the variables used in research on nurse staffing and patient outcomes from the perspective of an international panel. A Delphi survey (November 2005-February 2006) of a selected expert panel from 10 countries consisting of 24 researchers specializing in nurse staffing and quality of care and 8 nurse administrators were sent a review of evidence related to 30 patient outcomes, 14 nurse staffing and 31 background variables and asked to rate the importance or usefulness of each variable for research on nurse staffing and patient outcomes. In subsequent rounds the group median, mode, frequencies, and earlier responses were sent to each respondent. The conclusions of this study provided a picture of the science on nurse staffing and patient outcomes researc h as of 2006. The findings showed a connection between human resource issues and healthcare quality based on empirical findings and opinion. While the article did focus on quality of care and nurse patient ratios, it did not provide relevant information regarding the effects of extended work hours on patient care outcomes. Correlates of medication error in hospitals by Wilkins and Shields published in the June 2008 issue of Health Reports examined associations between medication error and selected factors in the workplace of hospital employed registered nurses in Canada. Data was derived from the 2005 National Survey of the Work and Health of Nurses in Canada who deliver direct care to hospital patients. Correlates of medication error were considered in bivariate and multivariate analyses. Multiple logistic regression modeling was used to examine medication error in relation to work organization and workplace environment, while controlling for personal factors, including nurses general and mental health, job satisfaction, education years of experience, and clinical area of employment. The results of this study showed that nearly one-fifth of nurses reported medication error involving patients had occurred occasionally or frequently in the past year. In the fully adjusted multivariate model, medication error was positively associated with working overtime, role overload, perceived staffing or resource inadequacy. Working a 12 hour shift, compared with shorter shifts was negatively associated with medication errors. This article provided relevant information pertaining to the initial PICO question of hours worked and adverse outcomes. CINAHL Analysis The 2005 issue of Advances in Nursing Science contained the article Nurse staffing and healthcare outcomes: A systematic review of international research evidence by Lankshear et. al. The authors performed a systematic review of the literature and policy analysis and conducted interviews with key researchers in the filed in both the Untied States and the United Kingdom. The goal was to retrieve research on nurse staffing and healthcare outcomes published since 1990. A combination of electronic databases, internet and organizational web sites, and contacted researchers were queried. For each relevant study data were extracted systematically using a predesigned table to describe the type and feature of the workforce, the setting, the outcomes, the methods used, the results found, the quality of the studies and the limitations. A formal meta-analysis of the results was not able to be conducted due to the studies reporting different outcomes and use of different measure of staffing and w ays of summarizing the association between staffing and outcome. Instead, a qualitative synthesis to explore patterns in the data and possible explanations for inconsistencies such as study design, analysis, context and setting was used. The systematic review found that many of the studies were of poor quality, using data from only one unit or hospital or failing to control for case mix variations. Overall, there was found to be accumulating evidence of a relationship between nurse staffing, especially higher skill mix, and patient outcomes. However, the estimates of the nurse staffing effects are likely to be unreliable. There is emerging evidence of a curvilinear relationship that suggests that the cost effectiveness of using registered nurse levels as a quality improvement tool will gradually become less cost effective. This article addressed staffing issues and quality of care but focused little on the issue of increased work hours of nurses and patient care outcomes. Factors Influencing the Use of Registered Nurse Overtime in Hospital, 1995-2000 by Berney et al published in the second quarter 2005 issue of Journal of Nursing Scholarship, aimed to assess nurse overtime in acute care general hospitals and the factors that influenced overtime among various hospitals. Staffing data from 1995-2000 from 193 acute general hospitals in New York State were used to examine hospital characteristics to determine whether they were associated with nurse overtime. The study concluded that hospitals varied dramatically in their overtime use. Some categories, for example Government owned, used little overtime indicating that management can find substitutes for overtime to meet fluctuating staffing needs. Unionized hospitals worked slightly more overtime than did nurses in nonunionized hospitals. The finding that hospitals with similar characteristics varied greatly in their number of overtime hours also supported this conclusion. Statistical analysis was complete d with bivariate associations between nurse overtime and each hospital characteristic and independent nursing variables. The article provided valuable information on the various uses of overtime by hospitals, but did not specifically address the correlation between hours worked and adverse events. Google Scholar The July 2004 issue of Health Watch contained an article by Rogers et al, The working hours of hospital staff nurses and patient safety. A letter explaining the study and eligibility criteria was mailed to a random nationwide sample of 4,320 members of the American Nurses Association during the winter of 2002. 1.725 nurses expressed interest by returning the completed demographic questionnaire. The final sample consisted of 393 registered nurses working full time as unit based hospital staff nurses. Logbooks were completed by these participants who revealed they usually worked longer than originally schedule and that 40% of 5,317 work shifts logged exceeded 12 hours. The risk of making an error were increased when shifts were longer than 12 hours, nurses worked overtime, or when they worked more than 40 hours per week. The data from demographic questionnaires and logbooks were then summarized using descriptive statistics and frequency tables. The long and unpredictable hours document ed suggest a link between poor working conditions and treats to patient safety. This article provided relevant information pertaining to the initial PICO question. Scott et. al published Effects of Critical Care nurses work hours on vigilance and patients safety in the January 2006 issue of American Journal of Critical Care. The objectives were to describe the work patterns of critical care nurses, determine if an association existed between the occurrence of errors and the hours worked, and explore whether these work hours have adverse effects on the nurses vigilance. Data were obtained from a random sample of critical care nurses in the Untied States. Nurses eligible for the study were mailed two 14 day logbooks to fill out. Information collected included the hours worked, the time of day worked, overtime hours, days off and sleep wake patterns. On days worked, the respondents completed all work related questions and questions about difficulties in remained awake while on duty. The 502 respondents consistently worked longer than scheduled and for extended periods. Longer work duration increased the risk of errors and near errors and decreased nurses vigilance. The findings support the Institute of Medicine recommendations to minimize the use of 12 hours shifts and limit work hours to no more than 12 consecutive hours during a 24 hour period. This article contained information pertinent to the original PICO question. Article best addressing PICO Question Effects of Critical Care Nurses Work Hours on Vigilance and Patients Safety (Scott et. al., 2006) and Correlates of Medication Errors in Hospitals (Wilkins Shields, 2008) were found to be two articles that provided quality information regarding nursing hours worked and adverse patient outcomes. While the use of subjective measure of drowsiness, self report of errors and the relatively small sample of nurses used in the studies may limit the generalize-ability of the findings, the anonymity provided lends to more truthful responses. The methods allowed the nurses to disclose information that might have been unattainable if the use of standard categories for error reporting had been used. Although 12 hour shifts are popular among nurses, the findings in this study are congruent with previous reports that recommend minimizing the use of 12 hour shifts or at least limiting nurses work hours to more than 12 consecutive hours during a 24 hour period. Experience and extensive research in o ther industries has shown that accident rates increase when workers work 12 hours or longer. However, research pertaining to nurses has been relatively recent and data on accidents in healthcare facilities are not widely available. Conclusion Each database provided relevant articles containing research on the issue of the number hours worked by nurses and the effect of hours worked on patient care outcomes. Keywords nursing hours worked and patient outcomes delivered a large number of results. The methods to narrow results by placing additional parameters can be used across all databases. While there are minute differences among databases, basic search skills are universal by utilizing keywords developed in the PICO question. The final articles chosen provided data on the effects of hours worked by nurses and the potential effect on patient outcomes. While the articles addressed the limitations of the studies, the methods, data analysis and results were presented in a logical, reproducible format. The issue of the effects of long work hours has been studied extensively in other industries, such as air traffic controllers, leading to changes in work environment. Further research needs to be completed in the area of nursing regarding the effects of the long hours. These articles provide a solid basis for other researchers to build upon. The use of nursing informatics can provide databases with universal quality measures to provide more consistent, reliable data across healthcare facilities.

Comparing the Epic of Gilgamesh, Holy Bible and Huck Finn :: comparison compare contrast essays

Gilgamesh is a True Epic The story of the great hero, Gilgamesh, fulfills the requirements of an epic.   Gilgamesh is consistently relevant to society and it conveys timeless themes and messages.  It is in human nature for people to want to excel in life and strive to make a name in this world for themselves.   We want to be remembered by name or for something we have done.   Most, who actually succeed, are forgotten about in a matter of years. However, some are remembered for tens, hundreds, and even thousands of years, because of their great intellectual achievement to feats of outstanding skill.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Gilgamesh is not only a character of a story; he is actually a portrayal of people and how they act out of human nature.   He, like many of us, does not want his existence to end when he leaves this world.   He is not content with what he has, good looks, money, and power, and desires more in life.   The Epic of Gilgamesh is a story that we, as people, can relate to.   There are similarities between Gilgamesh’s journey and our own journey through life.   Some of the texts that will be compared with The Epic of Gilgamesh, are the Bible, and Mark Twain's The Adventures of Huckleberry Finn.   The characters of these stories are all have that burning desire to be successful in life, which we can relate to.   These texts span across different time periods and societies illustrating how human nature, particularly the desire to obtain more than one possesses, plays a significant role throughout written and present human h istory.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   It is in human nature to want to be recognized and receive what one think he or she may deserve.   In the Bible, one of many themes is the quest for something greater than what the seeker currently has, in terms of stature or wealth.   One of many examples is the theft of Esau's birthright by Jacob.   In Genesis 25: 27-34, Esau Sells His Rights as the First-Born Son, Jacob wanted more than his proper inheritance, he wanted the rights as the first born son.   His brother Esau was hungry and asked for some soup that Jacob was cooking.   Jacob answered, â€Å"I will give it to you if you give me your rights as the first-born son.†Ã‚   Jacob could not be content with what he already had.    He wanted a larger portion of the inheritance entitled to the one who is the first-born as well as the title.

History of Aluminum Essay

Aluminum as a metal came to its existence only 200 years ago. However, Dmitry Eskin noted that almost 2000 years ago, Pleny the Elder â€Å"mentions a strange, light, and silvery metal in his Historia Naturalis which might indicate that aluminum may have been discovered accidentally and then forgotten† (Eskin 2008, p. 1). Citing the work of Pleny the Elder, Eskin puts it: â€Å"One day a gold smith in Rome was allowed to show the Emperor Tiberius a dinner plate of a new metal. The plate was very light, and almost as bright as silver. The goldsmith told the Emperor that he had made the metal from plain clay. He also assured the Emperor that only he, himself, and the gods knew how to produce these metal from clay. The emperor felt immediately, however, that all his treasures of gold and silver would decline in value if people started to produce this bright metal of clay. Therefore, instead of giving the goldsmith the regard expected, he ordered him to be beheaded† (p. 1). The existence of this young metal was established by an Englishman H.  Davy in 1808 which he called â€Å"aluminium,† but this name was later changed to Aluminum (USA). Thus, both aluminium (U. K. ) and aluminum continues to be use to call this metal. Nevertheless, it was not until 1825 that pure aluminum was extracted by the Dane N. C. Oerested, though actually, he was only able to produce tiny amounts. Eskin pointed out that between 1827 and 1845, the German F. Wohler â€Å"developed the first process to produce aluminum powder by reacting potassium with anhydrous aluminum chloride† (p. ). It was also Wohler who determined some physical properties of aluminum such as its density which according to Eskin, â€Å"appeared to be the most remarkable characteristic of the new metal† (p. 1). Citing the description of Jules Verne about this newly discovered metal in his â€Å"From the Earth to the Moon† in 1865, Verne wrote: â€Å"This valuable metal possesses the whiteness of silver, the indestructibility of gold, the tenacity of iron, the fusibility of copper, the lightness of glass. It is easily wrought, is very widely distributed, forming the base of most rocks, is three times lighter than iron, and seems to have been created for the purpose of furnishing us with the material for our projectile† (p. 2) By 1854, a French chemist by the name of Henri Etienne Sainte-Claire Deville improved the method used by Wohler which facilitated the aluminum commercial production that resulted to the dropping of price from approximately $1200 per kilogram in 1852 to just about forty dollars per kilogram in 1859. But aluminum’s price remained costly for voluminous use. Not long when Charles Martin Hall discovered an inexpensive method for the aluminum production. Mary Bellis noted that extracting pure aluminum was not easy as it is never found free in nature. This difficulty made aluminum a precious metal during this period, but with Martin hall’s invention of aluminum processor which was patented in 1888 had made aluminum processing easy that brought aluminum price down to an even lower at eighteen cents a pound (Bellis, Mary). According to the American society for metals, aluminum is the most â€Å"abundant metal in the earth’s crust† (ASM, ASM International Handbook Committee 1990, p. 35) was a development of this century. It derives its name from the Latin alumen meaning bitterness. The ASM International stated that aluminum was first exhibited in 1855, but it was difficult to obtain during this period that it was more expensive than gold. During this time, companies producing aluminum had difficulty attracting buyers due to its high cost at $2 a pound. It was only after one manufacturer discovered, it made good, inexpensive tea kettles that the price declined at cents a pound, and by the 1900 it was down to 32 cents per pound (p. 35). Production of aluminum however, was low until World War II, but in 1963, the aluminum industry which was undreamed of during the 1900, employed 35, 970 people in 951 plants with payroll of $221, 567,000. Thus in the first seven months of 1968 alone, more than 412,000 Mg (450 tons) of aluminum were cast in the United States. John Gilbert Kaufman and Elwin L. Rooy pointed out that the first important market for aluminum were the castings following the commercialization of the Hall-Heroult electrolytic reduction process (p. 1). Kaufman and Rooy stressed that at first application were merely â€Å"limited to curiosities such as house numbers, hand mirrors, combs, brushes, tie clamps, and decorative lamp housings that emphasized the light weight, silvery finish, and novelty of the new metal† (p. 1). Furthermore, Kaufman and Rooy cited that cast aluminum cookware was invented and was a welcome alternative to cast iron and brass pots, pans, and kettles (p. ). As the production of aluminum increases, its cost steadily declined, and by the end of the 19th century, â€Å"important engineering application became economically viable† (p. 1). From this point onward, the use of aluminum in some industry features prominently. Kaufman and Rooy stated that the use of aluminum played important role electrification. Aluminum was well suited to the electrification demand of a low-density, corrosion resistant, and high-conductivity wire and cable. Aluminum was also suited to transmission towers and cast installation hardware, and was also in demand to automotive pioneers who â€Å"sought innovative materials and product forms to differentiate the performance and appearance of their products† (Kaufman & Rooy, p. 1). More importantly, Kaufman and Rooy noted that when the Wright Brothers succeeded in powerful flight, engine and other parts in cast aluminum â€Å"represented the beginning of a close collaboration with what would become the aviation industry† (p. 1). The earliest design rules for aluminum structures according to Randolph Kissell and Robert L.  Ferry were developed at Alcoa around 1930 and were used â€Å"to design the aluminum deck and floor beams installed on the Smithfield street Bridge in Pittsburg in 1933 (Ferry 2002, p. 217). After the publication of the American Society of Civil Engineers of an article entitled â€Å"Specification for Structures of a Moderate Strength Aluminum Alloy of High Resistance to Corrosion† in 1952 and similar other publications in 1956, major aluminum producers led by Alcoa as the number aluminum producer, followed by Reynolds and Kaiser began to developed structural design books for their product (Kissel & Ferry, p. 17). From this point on, aluminum has become important components of the construction manual series which included the following: Section 1: Specifications for aluminum structures; section 1A: Commentary on Specifications for Aluminum Structure; section 2 Illustrative Examples of Designs; Section 3: Engineering Data for Aluminum Structures; and, section 5: Specification for Aluminum Sheet Metal Work in Building Construction (p. 18). From its humble beginnings, the use of aluminum has evolve from simple curiosities such as house numbers, combs, pins, and other small items made from aluminum, to become an important material in almost business industries from automotive to aero space industry, to construction industry. Below is a classification table for aluminum which characterizes its description and its properties.

The Overuse Bone Injuries Health And Social Care Essay

Overuse bone hurts normally result in emphasis breaks. The first written history of emphasis breaks was by Breithaupt in 1855 who described ‘the syndrome of painful conceited pess associated with processing ‘ among Prussian soldiers ( Breithaupt 1855 ) . The highest incidence of emphasis breaks occurs in path and field jocks, with rates of 10 to 31 % ( Bennell, Malcolm, et Al. 1996 ) . Stress breaks are besides normally seen in gymnastic exercises, lacrosse, figure skating, concert dance, hoops and football ( Burr and Milgrom 2001 ) . Most stress breaks occur in the lower limbs with over 50 % happening to the calf bone and shinbone ( Figure 1 ) ( McBryde 1985 ) . Certain stress break sites tend to be associated with certain athleticss, e.g. Medial malleolus of the shinbone and tarsal scaphoid emphasis break are common in high jumpers ( Ivkovic, et Al. 2007 ) . Fibula Fourth and Fifth OTHER Figure 1: Distribution of the common sites of emphasis breaks. Adapted from McBryde, 1985. The chief feature of a stress break is localized, gradual hurting which increasingly increases with activity and is relieved with remainder ( Burr and Milgrom 2001 ) . There is normally a recent alteration in developing prior to the oncoming of hurting. A radionuclide scan is used to name a stress break. Radionuclide ‘s collect in countries where there is increased bone activity ( where bone cells are interrupting down or mending parts of the bone ) , looking as ‘hot musca volitanss ‘ on the image.PathogenesisStress breaks result from insistent burden and be given to non be associated with a history of injury. They are frequently considered to be a mechanical weariness driven procedure. They typically occur after a period of 4-6 hebdomads of increased activity. There are two hypotheses for the cause of emphasis breaks. The first, described in figure 2, is described as a biological procedure where bone remodelling is stimulated by mechanical lading doing porousness a nd decreased bone mass. Mechanical Loading Osteonal Remodelling Porosity ‘Focal transient osteopenia ‘ Local Strain MicrodamageStress FractureContinued Loading The 2nd hypothesis is that a emphasis break occurs from the development and growing of microcracks within the bone. Strain scopes of 5000-10000 microstrains are needed for a bone to neglect in weariness ( Caler and Carter 1989 ) . However, surveies indicate that the extremum strain in worlds is in the scope of 2000-2500 microstrains ( Burr and Milgrom 2001 ) . In order for this hypothesis to be right we would necessitate to lade our castanetss up to 10 million burden rhythms in to develop a emphasis break. Bone readily sustains microdamage from weariness during insistent burden but this would non take to a break in the clip class feature of emphasis breaks ( Burr and Milgrom 2001 ) . There must be other mechanisms involved in the development of emphasis breaks, which need to be explained, for this hypothesis to be valid.Figure 2: Hypothesised mechanism for the development of emphasis breaks. Adapted from Burr and Milgrom ( 2001 )Stress breaks occur as portion of a positive feedback m echanism. Increased mechanical burden stimulates bone turnover. Osteoclasts resorb preexistent bone, doing bone porousness which can last several months. Stiffness of the bone decreases quickly in response to little alterations in bone porousness. Once a threshold has been reached ( either through increased porousness or burden ) the bone becomes unstable and breaks occur ( Martin 1995 ) . Injury, cytokines, altered mechanical burden and weariness can all trip bone remodelling.There are a figure of factors that can straight or indirectly influence emphasis factors in jocks ( shown in figure 3 ) . There seems to be a complex interaction between these factors and some have contradictory grounds in surveies. The chief factors associated with stress break incidence are smaller castanetss, leg length disagreement, musculus weariness and preparation factors. Bone disease ( Pathology ) Hormone position and endocrines Exercise ( bone burden ) Diet and Nutrition Geneticss Joint scope and musculus flexibleness Foot type Lower appendage alliance Altered pace Complete Fracture Stress Fracture Stress Injury Stress Reaction Accelerated Remodelling Normal Remodelling Continuum of clinical responses to cram burden Body size and composing Training surfaces Footwear Magnitude of each strain rhythm Muscle strength Muscle weariness Entire figure of strain rhythms ( developing volume ) Frequency of strain rhythms ( developing strength ) Duration of each strain rhythm Bone disease ( Pathology ) Hormone position and endocrines Exercise ( bone burden ) Joint scope and musculus flexibleness Diet and Nutrition Geneticss Foot type Lower appendage alliance Altered pace Bone Response Impact fading Training Bone Health Gait Mechanicss Bone LoadingFigure 3: Contribution of hazard factors to emphasize fracture pathogenesis. Adapted from Brukner, Bennell and Matheson ( 1999 ) .Insistent mechanical burden from exercising contributes to emphasize break development. Training causes alterations in degrees of endocrines, such as sex endocrines, that may act upon bone indirectly. An addition in musculus mass could be protective against emphasis breaks. Military surveies have shown that intercessions such as remainder periods, riddance of running on concrete, the usage of running places and decrease of high impact activity can diminish the incidence of emphasis breaks ( Pester and Smith 1992 ) . An addition in preparation volume has been linked to an addition in stress break incidence in smugglers ( Brunet, et Al. 1990 ) and concert dance terpsichoreans, ( Kadel, Teitz and Kronmal 1992 ) and 86 % of jocks can place a alteration in developing prior to the oncoming of the break ( Sullivan, et Al. 1984 ) . However there is sma ll controlled research in jocks as to whether developing alterations can diminish the incidence. Foot construction determines the sum of daze absorbed and the sum of force transferred. A high arched pes is less able to absorb daze due to it being more stiff than a low arched pes. However a low arched pes tends to pronate which consequences in increased tortuosity on the shinbone and muscular weariness as they attempt to command the inordinate gesture ( Burr and Milgrom 2001 ) . A low arched pes is the most common pes type in jocks with stress breaks but both foot types could be at an increased hazard of emphasis breaks ( Sullivan, et Al. 1984 ) . A difference in leg length besides increases stress break incidence ( Bennell, Malcolm, et Al. 1996 ) . Stress break development has besides been linked to an addition in hep ageless rotary motion and a lessening in the scope of ankle dorsiflexion ( Burr and Milgrom 2001 ) . Persons with hapless physical conditioning tend to hold a deficiency of muscular strength and are prone to muscular weariness which increases the hazard of stress break ( Burr and Milgrom 2001 ) . Under normal conditions, musculuss act protectively by undertaking to cut down strains on bone surfaces. Once fatigued, there is increased strain at the site of musculus fond regard ( Yosjikawa, et Al. 1994 ) . Changes in Ca metamorphosis may predispose persons to emphasize breaks by impacting bone remodelling and bone denseness, although there is no grounds to back up this as yet ( Burr and Milgrom 2001 ) . Other factors that influence bone wellness and perchance stress break hazard include glutocorticoids, growing endocrine and tetraiodothyronine. Nutritional surveies have by and large failed to happen a relationship between low Ca consumption and stress break incidence. However one survey found that Ca consumption was much lower in the group with emphasis breaks ( Myburgh, et Al. 1990 ) . The consumption of salt, protein, P, caffeine and intoxicant all disrupt the balance of Ca, but there are no studies of any association with these factors and stress factors as yet. The jocks at each appendage of the preparation spectrum are at most hazard. Novice athletes or ‘weekend warriors ‘ are more likely to prolong stress breaks. High public presentation jocks are besides at hazard. Although their physical conditioning is good, the demands on them are so high that an overuse hurt may happen.GenderThe chief factor finding stress break hazard in adult females is genetic sciences. Familial factors affect bone geometry, bone alliance, hormonal environment every bit good as act uponing psychological traits which can impact developing wonts and eating and catamenial perturbations. Women besides seem to be more susceptible to environmental influences such as the ‘ideal ‘ organic structure portrayed by the media ( Hausenblas and Carron 1990 ) . Women by and large have higher incidence of emphasis breaks, with amenorrhoeic adult females holding a higher incidence than normally-menstruating adult females ( Feingold and Hame 2006 ) . The ground why amenorrheic adult females develop more emphasis breaks is ill-defined but may non be related to low bone denseness ( Ivkovic, et Al. 2007 ) . The shinbone is the most normally affected site in both males and females, with breaks of the tarsal scaphoid, femoral cervix, metatarsal and pelvic girdle preponderantly associated with the female jock ( Bennell and Brukner 1997 ) . Womans tend to devour unequal sums of micro and macro foods. Boness contain a high sum of Ca and if there is dietetic inadequacies this Ca is used by the organic structure and could compromise bone strength. This is rare in western society and merely terrible dietetic limitation will do mineral depletion. However, amenhorrheic and postmenopausal adult females lose Ca during urinary elimination due to low oestrogen degrees and hence necessitate an increased Ca consumption. The grounds for a relationship between Ca and emphasis breaks is inconclusive. Studies conducted on concert dance terpsichoreans and female path and field jocks found no important difference in the Ca consumption of those with stress breaks and those without ( Kadel, Teitz and Kronmal 1992 ) ( Bennell, Malcolm, et Al. 1996 ) . Childhood Ca consumption could be a deciding factor, but merely one survey has assessed this and no relationship was seen ( Grimston, et Al. 1991 ) . Disordered eating forms have been associat ed with increased emphasis break hazard. Track and field jocks and concert dance terpsichoreans with emphasis breaks are more likely to curtail their Calories intake and avoided high fat nutrient ( Frusztajer, et Al. 1990 ) ( Bennel, et Al. 1995 ) . Sexual activity endocrines play an of import portion in act uponing stress break hazard. Athletic adult females tend to hold a higher prevalence of catamenial perturbations than the general population ( Burr and Milgrom 2001 ) . This is normally seen in athleticss such as concert dance, gymnastic exercises and distance running. This relationship causes a two to four crease increased hazard of stress break, but the mechanism of increased hazard is non known. It could ensue in lower bone denseness or decreased peak bone mass. Oral Contraceptive pills have a major impact on skeletal wellness in female jocks. They are normally prescribed as a stress break intervention to better bone mass. Some research workers claim that unwritten preventives can forestall stress break development by supplying a beginning of oestrogen that increases bone denseness ( Burr and Milgrom 2001 ) . Current and past users of unwritten preventives have been found to hold greater bone mass than non-users ( Recker, et Al. 1992 ) . However there are some conflicting informations which show no consequence on bone mass with unwritten preventive usage, and some that show a possible damaging consequence. Smaller castanetss in males are associated with the greatest hazard of break. Since adult females have smaller castanetss than work forces, you could presume that this would predispose adult females to breaks ( Burr and Milgrom 2001 ) . However, no survey has shown any association between bone size and emphasis breaks. There is grounds that lower bone denseness may play a function in stress break development in adult females. A survey showed that athletic adult females with lower bone mineral content and denseness sustained emphasis breaks ( Bennell, Malcolm, et Al. 1996 ) . These adult females nevertheless had higher degrees of bone denseness than the general population. This implies that the degree of bone denseness required for active adult females needs to be much greater than non-athletes.AgeBone disease ( Pathology ) Hormone position and endocrines Exercise ( bone burden ) Joint scope and musculus flexibleness Diet and Nutrition Geneticss Foot type Lower appendage alliance Altered gaitPeak incidence of emphasis breaks is seen in 16-25 twelvemonth olds, but may happen at any age. Kadel, Teitz and Kronmal ( 1992 ) found no relationship between age and stress break incidence in concert dance terpsichoreans and Brunet, et Al. ( 1990 ) came to the same decision for smugglers.Traumatic Bone InjuriesMost breaks of bone tend to happen from a individual important force to a healthy bone such as during engagement in athletics. Weaker forces can fracture a bone that has been weakened by upsets such as malignant neoplastic disease, cysts or osteoporosis. Traumatic injures of bone are summarised in table 1. Dislocations of castanetss can besides happen during featuring activities. The most normally dislocated limb articulation is the shoulder. A disjointed shoulder is a common shoulder hurt in contact athleticss such as rugger and soldierly humanistic disciplines. Type Description Transverse Complete break that is perpendicular to the bone axis. Can be cause by a direct blow to the bone or as a consequence of a insistent action, such as running. Oblique Broken at an angle across the bone. Resulting from an angled blow. Frequently found in long castanetss. Coiling Occur when a portion of the organic structure is trapped and the bordering bone is twisted. Rare but are can be seen in athleticss such as arm wrestle and skiing. Comminuted Bone is fractured into several pieces with suppression or chip. Occur as a consequence of great force, normally auto accidents. Segmental Consequences in several big bone fragments. An unfastened break can happen if the fragments pierce the tegument. Avulsed A fragment of bone is torn off at sites of sinew and ligament interpolation. Occur when the external forces are greater than the forces keeping the bone together. Common in kids and during jumping and throwing actions. Impacted Bone fragments are driven into each other, shortening the bone. Normally occur when seeking to interrupt autumn by making out with the weaponries or legs. Torus One side of the bone may clasp upon itself. Common in kids because they have ‘softer ‘ castanetss. Greenstick Bone is cracked on one side. Common in kids by a blow to the forearm or shinbone. Table 1 ; Summary of the different types of bone breaks. Images used from Roberts ( 2010 ) . A comparatively unsophisticated break can mend within hebdomads or months via bone remodelling. New tissue can be produced within hebdomads and a gradual addition in mechanical burden will guarantee optimum remodelling ( Roberts 2010 ) . Serious complications from a break are rare. Arteries could go injured in closed supracondylar breaks of long castanetss along with compartment syndrome ( the compaction of nervousnesss, blood vass, and musculus inside a closed infinite ) and nerve hurt ( Roberts 2010 ) . Open breaks could ensue in infections that can take to osteomyelitis. Osteomyelitis is characterised by redness and devastation of bone by bacteriums such as staphylococci aureus. Some breaks can ensue in the release of fat that can blockade the lungs and do respiratory jobs ; this is known as fat intercalation syndrome ( Odegard 2005 ) . Misalignment of articular gristle by a bone break can do degenerative arthritis and joint motion damage.Traumatic Bone Injuries in ChildrenApproxi mately 15 % of all breaks in kids involve the physis ( Caine, DiFiori and Maffulli 2006 ) . Mechanical emphasis from athleticss such as football and hockey or by insistent burden required in athleticss such as long distance running, gymnastic exercises and baseball can do exceedance of the tolerance bounds of the physis ( Caine, DiFiori and Maffulli 2006 ) . Injury can do a perturbation to physeal growing and can take to length disagreement, angular malformation or altered joint mechanisms which may do important long term disablement ( Caine, DiFiori and Maffulli 2006 ) . Physeal hurts can ensue in irreversible harm to turning cells ( Caine, DiFiori and Maffulli 2006 ) . The growing home base gristle is more vulnerable to emphasize and forces than grownup gristle and next bone ( Micheli 1986 ) . The physis can besides be up to 5 times weaker than the environing hempen tissue. An hurt that could rupture a ligament or dislocated a joint in an grownup may bring forth a separation of the growing home base in a kid due to the above grounds ( Caine, DiFiori and Maffulli 2006 ) . Figure 4 summarises the different types of physeal hurts. The susceptibleness for break is far more outstanding during periods of rapid growing such as during pubescence ( Benton 1982 ) . Increased growing rates and structural alterations result in a thicker and more delicate home base. Bone mineralisation besides lags behind bone growing which renders the bone porous and more susceptible to injury. Micheli ( 1983 ) proposed a controversial construct that rapid growing may do an increased hazard of hurt due to muscle-tendon stringency around the articulations and a loss in flexibleness. Long castanetss or the appendages usual grow longitudinally ab initio with muscle-tendon units reacting to the alteration by stretching, which may do an instability ( Caine, DiFiori and Maffulli 2006 ) .Figure 4: Types of growing home base hurts seen in kids. Adapted from Caine, DiFiori and Maffulli ( 2006 )A – A complete separation of the epiphysis from the metaphysis with the originative cells of the growing home base staying with the epiphysis. B – Most common physeal hurt. Separation on the epiphysis and metaphysis along the growing home base accompanied by a break of a triangular molded metaphyseal fragment. C – Fracture extends through the epiphysis from the joint and along the growing home base. D – Fracture extends from the joint surface, across the growing home base and through the metaphysis. E – Uncommon hurt. The growing home base is compressed which prevents farther bone growing. Metaphysis Epiphysis Growth Plate Tocopherol Calciferol C Bacillus A Skeletal hurts are common in athletics, particularly contact athleticss, gymnastic exercises and skiing. A break amendss non merely bone but besides soft tissues environing the country, such as sinews, ligaments, musculuss, nervousnesss, blood vass and tegument. Overuse hurts of bone occur as a consequence of repeated burden over a long period. They are common in athleticss such as running, concert dance and football. Word Count – 1987