Friday, August 21, 2020

personal finances Essays - Economy, Finance, Money, Personal Finance

1 - Financial Position: this territory is worried about understanding the individual assets accessible by looking at total assets and family income. Total assets is an individual's monetary record, determined by including all advantages under that individual's control, short all liabilities of the family unit, at one point in time. Family unit income sums up all the normal wellsprings of pay inside a year, less totally anticipated costs around the same time. From this investigation, the budgetary organizer can decide to what degree and in what time the individual objectives can be practiced. 2 - Adequate Protection: the investigation of how to shield a family unit from unanticipated dangers. These dangers can be partitioned into obligation, property, demise, inability, wellbeing and long haul care. A portion of these dangers might act naturally insurable, while most will require the acquisition of a protection contract. Deciding how much protection to get, at the most practical terms requires information available for individual protection. Entrepreneurs, experts, competitors and performers require specific protection experts to sufficiently secure themselves. Since protection likewise appreciates some tax breaks, using protection speculation items might be a basic bit of the general venture arranging. 3 - Tax Planning: regularly the annual assessment is the single biggest cost in a family unit. Overseeing charges isn't an issue of in the event that you will make good on charges, however when and how much. Government gives numerous motivations as duty derivations and credits, which can be utilized to diminish the lifetime taxation rate. Most present day governments utilize a dynamic duty. Regularly, as your pay develops, you pay a higher minimal pace of assessment. Seeing how to exploit the bunch tax cuts when arranging your own accounts can have a huge effect upon your prosperity. 4 - Investment and Accumulation Goals: arranging how to amass enough cash to get things with a significant expense is the thing that a great many people consider to be money related arranging. The significant motivations to gather resources is for the accompanying: a - buying a house b - buying a vehicle c - beginning a business d - paying for training costs e - collecting cash for retirement, to create a flood of pay to cover way of life costs. Accomplishing these objectives requires anticipating what they will cost, and when you have to pull back assets. A significant hazard to the family unit in accomplishing their amassing objective is the pace of cost increments after some time, or expansion. Utilizing net present worth number crunchers, the budgetary organizer will propose a mix of advantage reserving and standard reserve funds to be put resources into an assortment of ventures. So as to defeat the pace of expansion, the speculation portfolio needs to get a higher pace of return, which commonly will expose the portfolio to various dangers. Dealing with these portfolio dangers is regularly cultivated utilizing resource distribution, which looks to differentiate venture hazard and opportunity. This benefit allotment will endorse a rate distribution to be put resources into stocks, securities, money and elective speculations. The designation ought to likewise think about the individual hazard profile of each financial spe cialist, since chance perspectives fluctuate from individual to individual. 5 - Retirement Planning: retirement arranging is the way toward seeing the amount it expenses to live at retirement, and thinking of an arrangement to circulate advantages for meet any salary deficiency. can leave your resources for family, companions or magnanimous gatherings.

Tuesday, July 14, 2020

Business Model Canvas Alternative Lean Plan Template

Business Model Canvas Alternative Lean Plan Template If you have been thinking of starting a business, you have obviously heard and read about the importance of a business plan. While business plans are quite useful, that’s not to say they don’t have their problems. Business plans take too long to write, yet most of those you will share your business plan with probably won’t read it end to end.Updating your business plan regularly as your business grows is also quite difficult. For many entrepreneurs, the business plan is simply a document that they have to present to the bank or investors in order to secure funding.While writing a business plan is hectic, planning your business is still critical. Starting a business without planning out key activities is a recipe for failure. What if you had a way to capture the essence of your business in a simple, one page template instead of having to write and format a 10 page business plan?Fortunately, you can do that using a template known as the Business Model Canvas, which was developed by Alexander Osterwalder.WHAT IS THE BUSINESS MODEL CANVAS?The Business Model Canvas is a planning tool that allows business owners to make a graphic representation of the different variables involved in starting a business. It provides an easy way to visualize a business without having to worry about all the details that go into a business plan.A Business Model Canvas can also be used to analyze the current situation of an existing business. Below is an example of what the Business Model Canvas looks like. While the Business Model Canvas provides a quick and easy way of visualizing a business, it has one major flaw. It does not focus on the product/market fit. In other words, the Business Model Canvas does not care whether the business solves any real problem for its customers.Why is this so much of a problem?Think about the last time you went to buy something from the supermarket. What did you buy? More importantly, why did you buy it? My guess is that you did not buy whatever you did just because the supermarket had it in stock, or because you had some money to spend, or because you saw the product being advertised on TV. Instead, you bought it because you needed it, because it helped you solve a certain problem.For example, if you bought a set of batteries for your TV’s remote control, you bought them because you needed to use the remote control but could not because the batteries had run out. If you bought a refrigerator, you bought it because you needed to preserve food.If you b ought a lawn mower, you bought it because you need to mow your lawn. The point here is that each of your buying decisions is determined by a need or a problem.What the above tells us is that for any business to attract customers, it needs to solve a certain problem for the customer. It also needs to solve the problem in a unique way in that convinces customers to buy its products instead of available alternatives. Not only does the business need to solve a problem, it also needs a unique solution to the problem.Without that, the business is bound to fail.Unfortunately, the Business Model Canvas does not consider on this crucial aspect of a business.To ensure that this very important aspect of your business is not forgotten, the solution is to use another business planning tool known as the Lean Plan Template.WHAT IS THE LEAN PLAN TEMPLATE?Just like the Business Model Canvas, the Lean Plan Template is a simple tool that allows you to quickly and easily capture the essence of your bus iness. The major difference is that the Lean Plan template places more focus on the problem your business is trying to solve.The premise behind the Lean Plan Template is that it is impossible to create value and make your business model work without first understanding your customer’s problems.Once you know what your customers’ problems are, it becomes a lot easier to define solutions, come up with a unique value proposition, determine the sources of revenue, and so on.On the other hand, without a clear understanding of your customer’s problems, it becomes challenging to articulate some aspects of your business, such as the key resources, key activities, and key partners, all of which are part of the Business Model Canvas.Some of the elements that make the Lean Plan Template better suited to planning your business compared to the Business Model Canvas include:Problem:  The number one reason most businesses fail is that they set out to solve the wrong problem. According to CB I nsights, majority of business (42%) fail because they solve problems that are interesting rather than problems that serve a market need. This leads to building of the wrong product that customers are not interested in. By including a description of the problem, the Lean Plan Template ensures that entrepreneurs do not end up making this costly mistake.Solution: Apart from understanding customer problems, a business also needs to ensure that it is offering the best possible solution. By including this section, the Lean Plan Template ensures that the business is focused not on providing a solution the owners are obsessed with, but a solution that actually works.Competition: A business also needs to think about the other players offering solutions to its prospective customers. The aim of this section is not to discourage you from working towards your vision, but rather to encourage you to think about how to give your business a competitive edge. Without thinking about this, your busines s has no way of grabbing a portion of the market share from already existing players within the market.Milestones: Starting a business is a very chaotic undertaking. There are hundreds of things to be done. If you are not careful, you can easily end up devoting your time and effort to activities that do not move your business forward. To avoid this, you need to decide beforehand what important activities you need to undertake and the key metrics that you will use to evaluate your business’ performance. This helps you to stay on course and prevents you from chasing the wrong goals.As you can probably tell so far, the Lean Plan is designed to help entrepreneurs test their business. It is not meant for investors, customers or consultants. Still, the entrepreneur can use the Lean Plan template to engage with all these people and validate their business idea.ELEMENTS OF THE LEAN PLAN TEMPLATEThe Lean Plan Template is made up of 12 elements, which fall under 5 main segments.Brought toge ther, these 12 elements give the entrepreneur a comprehensive overview of the business and helps to ensure that the business has a product/market fit.Below is a quick overview of all the sections and elements that are included in the Lean Plan Template.1. StrategyThis section of the Lean Plan Template outlines gives an outline of your business and explains what the business intends to do. The strategy section is comprised of five key elements:Business Identity: This gives a one sentence overview of your business. Who are you? What does your business do? What value do you provide to your customers? You can think of this as your unique value proposition. For example, a content marketing agency’s might have their business identity as “Droidcontent helps businesses attract, nurture and convert leads through valuable, in-depth content that speaks and sells to your target customers.”Problem: This gives a brief description of the problem you are trying to solve for your customers. Go ing with our content marketing example from above, the problem can be stated as “Small businesses do not have enough manpower to exclusively dedicate to their content marketing efforts.”Solution: This is a brief explanation of how you are solving the problem you described above. Here, you will essentially give a description of your products and services. Our content marketing agency can have their solution as “Droidcontent offers monthly content packages. Business owners can focus on other aspects of their business knowing that we are handling all their content needs.”Target Market: Here, you should give a description of the customers your products and services are targeting. What is the size of the market? Are you targeting one or multiple segments within the market? Remember, the aim is not to conduct in-depth market research at this stage. You just want to get a rough idea of who your customers are and whether the size of the market is enough to sustain your business.Comp etition: Here, you should describe other business who are trying to solve the same problem as you. Don’t just think about businesses that are offering the offering the same products and services as you. Instead, think of any other alternatives that your customers might use instead of your products, even if they are not within the same industry.For instance, if your business is a hotel, you are in competition not only with other hotels, but also with individuals letting out their apartments and condos on Airbnb. In addition, you should also include a brief description of any factors that differentiate your business from your competitors.2. TacticsThis section describes the tactics you will use to implement your strategy. This section comprises four key elements:Sales channels: This should give a description of the channels you intend to sell your products and services. Are you going to open a brick and mortar store? Will you sell online? Or will you sell your products through a dis tributor? Explain the channels you are going to use to get the product to the market.Marketing Activities: Here, you should give a brief explanation of the key things you will do in order to reach your customers. Will you advertise online or through traditional mass media? Will you attend trade shows to promote your products? Will you hold a grand opening? Or will you partner with other businesses?Team: This should give a list of the key team members and their roles. This is important because your team can be the difference between success and failure. If there are some key roles that you intend to hire once the business is running, you should also list them here.Partners and resources: If your business needs to work with other businesses in order to be successful, you should list these businesses here. If your business needs any key resources, you should also list them here.3. Business ModelWithout money, you cannot claim to be in business. In this section, you need to describe how money will flow into and out of your business. This section has two key elements.Revenue: Here, you need to describe how your business will make money. The aim is to give you a general idea of revenue, so there is no need to come up with detailed financial forecasts at this stage. Simply write down a bulleted list of your primary revenue streams and you are good to go.Expenses: Here, list down the expenses you will incur when running your business. Once again, don’t be so concerned with detailed forecasts and numbers. You just want to make sure that you understand all the costs that will be associated with running your business.4. ScheduleThis is the last section of the Lean Plan Template. It contains only one key element:Milestones: This section contains a list of tasks, activities, responsibilities and key milestones that you need to undertake and achieve as you set out building your business. These include tasks like registering your business, getting licenses and permits wher e necessary, launching the business, and so on, as well as milestones such as getting the first 100 customers, reaching a certain number of app installs, hitting a certain revenue target, and so on.Now that you know all the elements that make up the Lean Plan Template, let’s take a look at a sample Lean Plan Template to see what it actually looks like.Business IdentityDroidcontent helps businesses attract, nurture and convert leads through valuable, in-depth content that speaks and sells to your target customers.ProblemSmall businesses do not have enough manpower to exclusively dedicate to their content marketing efforts.SolutionDroidcontent offers monthly content packages. Business owners can focus on other aspects of their business knowing that we are handling all their content needsTarget MarketSmall business owners with an online presenceBusinesses without a dedicated content marketing departmentThe CompetitionOther content marketing agenciesFreelancersContent millsSales Chann elsWe sell directly through our websiteMarketing ActivitiesEmail marketing campaignSocial media marketingPPC marketingSEORevenueContent writing packagesExpensesPayrollMarketing and advertisingWeb hosting and domain registrationMilestonesBuild website (Jan 2019)Launch (Feb 2019)Reach out to social media influencers (Feb 2019)Team And Key RolesAndy: OwnerPeggy: Sales and marketingErick: OperationsPartners And ResourcesDylan: InfluencerKerr: SEO consultantAs you can see, the Lean Plan helps an entrepreneur to flesh out the most important aspects of their business in one page and to come up with all the assumptions on which the business will be based.Keep in mind that, while the Lean Plan Template is designed to enable you distill the essence of your business easily and quickly, there are some considerations you need to follow in order for it to be useful.Specifically, you should use sentences that are simple, specific and concise, but at the same time, they need to be meaningful. For i nstance, instead of writing “content” as a problem, write “Small businesses do not have enough manpower to exclusively dedicate to their content marketing efforts.”In addition, after creating your Lean Plan, you should go through it and try to see whether it tells a complete story about your business. A great Lean Plan should tell a story about your business. For instance, using the content marketing agency example, here is the story from their Lean Plan.Droidcontent helps businesses attract, nurture and convert leads through valuable, in-depth content that speaks and sells to your target customers (identity). Our aim is to help small business owners with an online presence (target market) to create content even if they don’t have a dedicated content marketing department (problem) by providing monthly content packages, allowing them to focus wholly on running their business (solution).They will know about Droidcontent through email, social media, PPC marketing and organic search (marketing activities) and will buy the packages directly from our website (sales channels).  Our packages will offer a hands-free content marketing approach that will make our services stand out from those of other content marketing agencies, freelancers and content mills (competitors). We will charge our customers depending on their chosen package (revenue streams).We believe this will help to cover our payroll, web hosting and domain registration and marketing costs (expenses). We hope to start building the website in January 2019, launch the business in February and reach out to social media influencers in February (milestones). The business will be led by Andy, Peggy and Erick (team). Dylan and Kerr will help us with our marketing efforts (partners and resources). If your Lean Plan tells such a story, good job!TESTING YOUR IDEADeveloping a Lean Plan is only the first part of the work. Just because your Lean Plan is complete does not mean that you have a business that is ready to launch.Remember, the Lean Plan was only meant to help you come up with the main assumptions about your business idea. Before you launch the business, you need to validate these assumptions. This helps you reduce risk by confirming that your idea is viable.To test your assumptions, you need to go out and talk to your potential customers. Find out whether they actually have the problem you think they do, what they think of your potential solution to these problems, how much they are willing to pay for the solution, what alternatives they currently use, and so on.Talking to potential customers will also help you figure out the best way to market and sell to them. Don’t skip this step. Many businesses have failed because of launching before testing their idea.REVIEW YOUR RESULTS AND REFINE YOUR PLANTalking to potential customers as you test your idea might reveal some things you might have overlooked while coming up with your Lean Plan.For example, you might find out that whi le the potential customers have the problem you think they have, they do not prefer your potential solution. In this case, you might need to refine your Lean Plan in accordance with the preferences of your customers.The good thing here is that making revisions to your Lean Plan is a lot easier than making revisions to a detailed business plan. You can continue making more revisions to your Lean Plan as you learn more about your customers.WRAPPING UPThe Lean Plan Template is a great tool that allows you to quickly and easily capture the essence of your business. Unlike a business plan, the Lean Plan takes just a few minutes to write and is a lot easier to update. The Lean Plan allows you to flesh out all the important elements of your business in a single page that you can easily view and share.The Lean Plan is also much better than the Business Model Canvas because it places more focus on the problem you are trying to solve for your customers, which is a very critical aspect of ever y business.The Lean Plan helps you to easily test your business idea for viability before investing a lot of time, effort and money into the idea. The Lean Plan is a live document, which means that it should be constantly updated as you interact with your customers and learn more about them.

Thursday, May 21, 2020

Recent Changes in the Nursing Profession Essay - 813 Words

There have been many changes (major and minor) in the nursing profession and the medical field, as a whole, over the years. Some of these changes include changing demographics and increasing diversity, technological explosion, the cost of health care, and significant advances in nursing science and research. Major socioeconomic changes created this drive to make transformations in nursing and institutions. These institutions are the ones that are responsible for educating the next generation of nurses, such as West Coast University. Over the years, there have been major shifts within the United States in regards to its population. Statisticians have estimated that 20% of the population will be 65 years of age and older. There is an even†¦show more content†¦Heller, Marla T. Oros, and Jane Durney-Crowley, 2013, para. 5).† Due to these amazing and drastic technological changes, there have been improvements in both the outcomes and patient care management areas. Information is now just a webpage away and readily available for clinicians and their patients. For all of mankind, the cost of health care is a major daily stressor. This article stated an interesting fact that, â€Å"A concern of businesses and governments for at least 30 years, the cost of health care in the United States has approached 15 percent of the total gross national product (Barbara R. Heller, Marla T. Oros, and Jane Durney-Crowley, 2013, para. 19).† Even with that fact, there are over 40 million individuals living in the United States that do not have health care coverage. The total health care spending in America surpasses that of any other developed country. This is due to technological advances that are readily available and breakthroughs in medicine. Still, there are present concerns in nursing practices, such as: the affects on the nursing profession, treatment options for their patients, and the patients participation in their own care. This article stated, â€Å"Nursing professionals, who have historically taken the lead in health education and healt h promotion, are disappointed by the lack of financing and reimbursement available through managed care organizations forShow MoreRelatedNursing As A Noble Profession1282 Words   |  6 Pages INTRODUCTION: Nursing has been radically changed throughout the past years however, this profession profoundly corroborates with care and compassion. Moreover, nurses have to demonstrate lot of empathy and sympathy while delivering care for someone. Especially, when someone is facing challenges with physically inaptness and not susceptible with the medical intervention due to suffering of diseases. Indeed, nursing is considered as a noble profession owing to the care and sympathy with greaterRead MoreNurses as the Most Highly Trusted Health Professionals: A Discussion692 Words   |  3 PagesQuestion: Recent studies indicate that nurses are the most highly trusted health professional group. Question: Recent studies indicate that nurses are the most highly trusted health professional group. Discuss the components of nursings contemporary image that places nurses in this position of trust The image of the nursing profession is on the rise due to development in political, environmental, cultural, and social areas. This involves addition of women into the profession of nursing to instillRead MoreThe Media Portrayal Of Nurses1222 Words   |  5 Pagesare sometimes perceived as life savers and angels of mercy, the profession is often sexualized, stereotyped, and undermined in its importance (Hoeve et al., 2014). 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The healthcare profession is fast paced and constantly changing so it is important to stay educated on those changes. Luckily there are many journals, websites, and social media pages that do just that. Since the healthcare field is so fact based it is important that sources of information are trustworthy, reviewed, and factual. Also referred to in the writing world as authoritative. One authoritativeRead MoreNursing and Health Care1204 Words   |  5 PagesImpact of Institute of Medicine on Nursing Ermina Rosic Grand Canyon University: NRS-430V December 14, 2014 The Institute of Medicine Report On Future of Nursing The Institute of Medicine (IOM) is a national, independent, non-profit organization whose purpose is to provide guidance, advice, and analysis of the field of medicine. The recent IOM report regarding the future of nursing gives us a glimpse of the dynamic and progressive changes that the field of nursing will experience in the coming decade

Wednesday, May 6, 2020

Essay on Global Warming Impact of Climate Change on the...

Every place, country, city, region has its own climate. Climate plays one of the important roles in people’s life. Climate is defined as the average weather, which means variety of weather conditions as rain, snow, hail, sun, and wind over period of time about 30 years that can be measured in any particular place.( IPCC Third Assessment Report - Climate Change 2001; editor:A.P.Baede) Climate change is a variation of average weather. There are 2 causes of climate change. The first is human activity which includes deforestation, burning fossil fuels, agriculture, transportation and infrastructure. The second is natural causes which include volcanic eruptions and variations in solar outputs. These causes have negative effect on the natural†¦show more content†¦By climatologists’ evidence there are two causes with several factors that have a response for the Earth’s climate. 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Oil Gas Management Free Essays

Abstract The Gulf of Mexico incident is an occurrence that many people in the United Kingdom and Mexico, who were affected, would like to forget as it had immense environmental and economic impact to them. This paper is going to describe the extent to which the Deepwater Horizon disaster in the Gulf of Mexico is considered to have led to a meaningful reform of the regulation of the offshore oil and gas industry on the UK continental shelf. These include well planning and control, environmental protection, emergency response, authority for stopping operations off, catastrophic BOP’s failure, the significance of simple checks, protection of the whistle-blowers, and a summary or conclusion of the described measures. We will write a custom essay sample on Oil Gas Management or any similar topic only for you Order Now Introduction An explosion took place on the Deepwater Horizon drilling rig on 20 April 2010 leading to the death of 11 workers. The region is in the Gulf of Mexico and was under contract to the British petroleum. It is still not yet known the extent of the damage that took place both on the environment and the communities around. Among the errors that led to the incident is the fact that the two pods of control on the BOP of the Deepwater Horizon showed that there was an error in a vital valve in one of the pods of control, and that the other pod of control did not have adequate charge on the batteries; it is believed that these faults were there during the time that the accident happened. There was at least a single working control pod needed to run the automatic mode function that would have helped in closing up the BOP. The automatic mode function should have taken place in an automatic manner, without being aided, when the hydraulic line together with the electric cables were destroyed in the explosion. The automatic mode function is a very important system of backup. This paper is going to describe extent to which the Deepwater Horizon disaster in the Gulf of Mexico is considered to have led to a meaningful reform of the regulation of the offshore oil and gas industry on the UK continental shelf. Well planning and control The reforms that were recommended by the panel included making sure that the Well Life Cycle Practices Forum remained in place permanently. It is also required that the professional, influential representatives from the HSE and the industry meet on a regular basis to decide, review and always improve values and standards for good practice in the well integrity as well as management of application in the UKCS. The Macondo blowout is taken into consideration by the standards and consists of operating practices, sufficiency and consistency of the safety vital equipment (particularly BOPs), testing and maintenance of hardware; proficiency and training of personnel; organizational and human features. They share these standards with the partners in the industry and international regulators and the organizations that set the standards. In consideration of the Macando, it was also required that the following are considered; Whether a change in the control of well standards it essential to necessitate at least two barricades to be in place (besides the BOP) during the moving of a well to a situation that is not balanced with the zone of production, and; Whether there is any change required to make the operators provide notice warning about each time a situation is arrived at where the BOP together with one other barricade to a release is attained. Protecting the Environment The DECC and the industry are required to work hand in hand for the purposes of developing and adopting improvements like: The concept of Environmental Assurance plan that possibly uses the Environmental Management System or the Environmental Statement as living equipment for engendering a concept of goal-setting to environmental policies intended to continuously improving, especially in relation to the low-frequency incidents that have high impact. The identification and cohesive treatment of the generic features of documents of environmental assurance to enable the devotion of more effort to some other more localized or particular areas of possible risk and impact, via more rigorous use of internet systems. The industry has also been challenged to take greater ownership of the available regulatory requirements of the environment, which include appraisal of the contractual arrangements for the preparation and keeping up-to-date the required documents making them into tools for driving improvements in the environmental evaluation and protection. The regulator is also required to continue working with the industry so as to make identifications of the ways in which the available requirements of reporting, particularly about compliance to the environmental requirements, may be rationalized or even simplified. Additionally, there might be more that should be done to show the need for, and resultant value of the comprehensive environmental evaluations that is required of them, with a need and aim of offering increases scope for approaches that are innovative to the improvement of the standards of the environment. It has also been recommended that the documents of guidance that relate to the offshore environmental effect evaluation, regulatory activities and enforcement should be revised and reviewed on a regular basis, initially following the changes in the procedures that came up from the Macando and consequently taking into consideration any other applicable or relevant occurrences, for the reinforcement of the continuous culture improvement of the UKCS and ensuring that operators are well acquainted with the present requirements and expectations of environmental best practice. In addition, since the incident of the Deepwater Horizon, some other interim environmental regulation and inspection steps that have been taken by the United Kingdom include the increasing of the number of yearly environmental inspections to the drilling rigs, besides hiring three more inspectors. This consequently increased the total number of the inspectors of the drilling rigs to ten, and this includes one inspector who is senior. Considering the less widespread areas of responsibility of the DECC in comparison to the HSE, it together with its prototype agencies have all worked with fewer inspectors as compared with the HSE. The HSE has 114 professional inspectors, whereas the DECC has about ten inspectors. The onshore offices and offshore installations are visited by DECC inspectors for the inspection of the management systems and records. They also go there to interview individuals and appraise the conditions of the site, practices and standards. The increased number of the site inspectors is expected to enable the DECC raise the number of inspections on the environment done on the mobile drilling rigs across the country from an average of seven to at least 16 on yearly basis immediately. The Cabinet Secretary referred to the inspectors’ movement between the private and public sectors. This might render it very difficult for the recruitment and maintaining of inspectors that are highly qualified in the future. The offshore inspectorate of the DECC describe their strategy of environmental inspection as one that is risk-based. This means that of the rigs that are presently carrying out activities of drilling, nearly twenty four of them, which translates to about twenty percent are on gas reservoirs; however, the DECC argue that this inherently does not pose much risk to the environment in comparison with those that operate on oil reservoirs. Hence, this is taken into consideration, together with the site of the rig and t he well’s nature, the DECC aims to inspect the rigs that carryout drilling activity on particular oil reservoirs. Responding to Emergencies Arrangements for giving response to the incidents of oil spilling that pose potential danger to the marine environment were established by the Oil Pollution Emergency Plans. The plans intend to prevent pollutions as such and minimize or decrease the effect that might come with it. The Oil Pollution Emergency Plans are risk evaluations that are applicable to a particular installation or field. Their focus is on the worse-case instance; as a result of the incident at the Gulf of Mexico, the United Kingdom operators are not expected to do extra modeling for the installations of deepwater, which include a more appraisal of the predictions of oil spill beaching. These plans are also appraised by the Maritime Coastguard Department and some other related consulters like the Maritime Management Agency and the related inshore statutory agency. Witnesses were asked about the way they had changed their ways of operation in the United Kingdom deepwaters since the occurrence in the Mexican Gulf. Some of them said that they do not believe they had basically changed in any manner. This was due to the strong regulatory era that was the Cullen’s legacy of inquiry into the incident of Piper Alpha. However, with regard to establishing any changes in regulation in reaction to the tragedy of the Deepwater Horizon, they were wary of making universal and global changes that might not be proper for them from incident to incident, the kernel of what is in the safety case era. There is a feeling that the industry appears to be reacting to incidences after they have occurred instead of having anticipations and making proper planning for the high-consequence events that are low in probability. It is beyond reasonable doubt that the industry and BP’s inability to respond because it was not prepared in a proper manner was not acceptable. The black swans’ occurrence appears to be more frequent nowadays. The United Kingdom has high regulatory standards of offshore, as shown by the Safety Case Regime, which was established in reaction to the 1998 Piper Alpha incident. The regulatory framework of the United Kingdom is on the basis of flexible and goal-getting approaches that are stronger than those that the Deepwater Horizon operated under. Despite the high standards of regulation in the United Kingdom, they are concerned that the industry of offshore gas and oil is giving a response to disasters instead of anticipation worst-instance cases and makin g proper planning for the high-aftermath, low-probability occurrences. Role of the Offshore Installations Manager We are informed from both the industry and the regulator that there were individual offshore installations that always have the power to shut down the well. Bridging documents were created between the systems of the owner of the rig and the operator systems of the well to ensure that issues like who has the final word or say are properly agreed before any operation is commenced. The HSE stated that there will normally be one individual who is actually responsible for matters safety on the rig, which is the Offshore Installations Manager, the contractor of drilling. There are huge financial implications of delaying the operations of drilling even just for very short periods. In the instance of the Deepwater Horizon, we find that the BP had the aim of drilling the Macondo well for a period of 51 days only, at about 96 million dollars. It was expected that the platform of drilling would be taking off as early as 8 March 2012; however, the Macando well unexpectedly took a longer period. By the 20th April, the day that there was the blowout, which killed eleven individuals, the rig was already late by 43 days, and this would have led to an extra cost of 21 million dollars in lease fees only. There is a danger that those who are responsible for making decisions to stop operations could feel economic pressure not to do so if was possible. Catastrophic BOP’s failure The last defense line against the Macondo incident was a device known as the ‘blind shear ram’, which is part of the BOP found on top of the wellhead, and more than a mile below the ocean floors’ surface. If the oil’s upward pressure and the gas that is in the reservoir became more than the heavy drilling fluid’s downward pressure, and all the other resources for controlling the well failed to operate, the two blades of the blind shear ram, were expected to slice through the pipe of the drill and then help in sealing the well. If the BOP had worded as expected, the whole incident would not have occurred and all the lives would not have been lost. Taking into account the single blind-shear ram’s failure to run the blowout preventer of the Deepwater Horizon, which appeared to be one of the major causes of the blowout of the well of Macondo, it was recommended that the Safety and Health Executive particularly review the case for prescription that the United Kingdom Continental Shelf’s blowout preventers are well equipped with the two blind shear ram. Whereas the flexibility of the safety regulation regime of the United Kingdom seemed to have performed properly, it was also been seen that for fail-safe devices like blowout preventer, the administration or the government has adopted minimum, strict standards of safety or show that these would not actually be an economical, last-resort against catastrophes. Importance of simple checks An appraisal of the two pods of control on the BOP of the Deep-water Horizon as a result of the incident showed that there was an error in a vital valve in one of the pods of control, and that the other pod of control did not have adequate charge on the batteries; it is believed that these faults were there during the time that the accident happened. There was at least a single working control pod needed to run the automatic mode function that would have helped in closing up the BOP. The automatic mode function should have taken place in an automatic manner, without being aided, when the hydraulic line together with the electric cables were destroyed in the explosion. The automatic mode function is a very important system of backup. It is of great concern that the simple failures of various systems were not identified during the process of inspection. As a consequence, a programme has been implemented across the global drilling operation to make sure that the equipment operates the way it is designed to do. Another thing that has been done to ensure that such preventable incidences do not repeat include fundamentally improving the testing procedures of the blowout preventers, which consists of making sure that the systems of backup work and are properly tested in the process of drilling a well. This is another instance of the industry giving a response to an accident instead of anticipating a possible problem, even though the new regime is highly welcome. It is believed that the authorities have to make sure that the offshore inspection regime of the United Kingdom could not be susceptible to simple faults like having a battery that does not have sufficient charge, to go without being noticed. Need to protect the whistle-blowers Owing to the immense economic pressure of keeping a drilling rig functional, it is of great concern to various stakeholders that the workers who attempt to talk about safety matters might be or even feel like they are intimidated by their seniors. The whistle-blowers are not in a position of calling a halt or bringing to a stop some things and the managers and clearly attempting to make money for the organization. Their primary responsibility is not protecting the environment. Some contradicting reports were found from the HSE regarding harassment and aggravation on the rigs as well as the industry’s assurances that honest whistleblowers will be given a hearing and protection. The government has also ensured that there are discussions with the unions and industry about the further actions that are required for the prevention of representatives of safety from feeling or being intimidated by their seniors such that they do not report a danger. Conclusion Following the fatal incidence that occurred in the Mexican Gulf, it is important that there is clarity on the hierarchy and identity of the liable stakeholders to make sure that the government, and thus the taxpayers, doe not need to pay for the outcomes of the offshore accidents. Any lack of hierarchy and clarity on the liability will hamper the compensation payment to those that are affected by the incident of the offshore. It is recommended that it needs to be a requirement of the process of licensing that it proves their capability to pay for the outcomes of any incident that could happen. It is recognized that these measures could actually be added to the cost of investment in the new United Kingdom gas and oil production and encourage the Treasury to consider this during incentives to investments as such. Bibliography A. Hopkins, ‘Risk-management and rule compliance: Decision-making in hazardous industries. Safety Science,’ (49, 110-120, 2011). B.P. Deepwater Horizon accident and response. Retrieved on 21/1/2014 from G. S. Braut, P. Lindoe, ‘Risk Regulation in the North Sea: A common law perspective on Norwegian legislation.’ (Paper presented at the WorkingonSafety, 2009). G. S. Braut, P.H. Lindoe, ‘Risk Regulation in the North Sea: A Common Law Perspecitve on Norwegian Legislation.’ (Safety Science Monitor, 14(1, Article 2), 2010). Great Britain. UK deepwater drilling: Implications of the Gulf of Mexico oil spill. (London: The Stationery Office, 2011) J. Kringen, Culture and control. Regulation of risk in the Norwegian Petroleum Industry, (University of Oslo, 2011). J. Vinnem, ‘Risk indicators for major hazards on offshore installations.’ (Safety Science, 48, 770-787, 2010). M. Baram, Self Regulation and Safety Management. (WoS, Roros, 2011). O. E. Olsen, P.H. Lindoe, ‘Risk on the ramble: The interntional transfer of risk and vulnerability.’ (Safety Science, 47, 743-755, 2009). Ocean Portal Team. Gulf Oil Spill. Retreieved on 21 Jan 2014 from P. Lindoe, O.E. Olsen, ‘Conflicting Goals and mixed Roles in Risk Regulation: a case study of the Norwegian Petroleum Directorate.’ (Journal of Risk Research, (12(3-4), 1-15, 2009). R. Steizor, Lessons from the North Sea: Should â€Å"Safety Cases† Come to America. (School of Law, University of Maryland, Paper no. 2011-3, 2011). P. Lindoe, O. A. Engen, O.E. Olsen, ‘Reponses to accidents in different industrial sectors.’ (Safety Science, 49, 90-97, 2011). How to cite Oil Gas Management, Essay examples

Friday, April 24, 2020

Osteoporosis in Human Physiology Essay Sample free essay sample

Introduction Osteoporosis is a upset of the skeleton ensuing from an change in bone remodeling. the procedure in which bone is broken down or reabsorb and replaced with new bone. It is characterized by increased osteoclastic activity and accelerated decrease in bone mass ( Figure 1 ) and a attendant impairment in the microarchitecture of bone taking to heighten bone breakability and an increased hazard of break. ( Sheldon J. Segal Ph. D. . Luigi D. Mastroianni Jr. . M. 2003 ) . Osteoporosis is the 4th most common and the 8th most expensive disease to handle in the United States. Annually. 1. 3 million breaks related to osteoporosis occur. the most frequent being 300. 000 hip and 700. 000 vertebrae breaks. The cost of this untreated disease is about $ 14 billion yearly. but seldom do primary attention suppliers talk about this disease to their patients. Although many adult females report believing about osteoporosis frequently. few ask inquiries about it. Osteoporosis is a disease that increases in frequence with progressing age. We will write a custom essay sample on Osteoporosis in Human Physiology Essay Sample or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page particularly in the female population. In adult females 13 % to 18 % ( 4 to 6 million ) have osteoporosis. and 37 % to 50 % ( 13 to 17 million ) have osteopenia. In work forces 3 % to 6 % ( 1 to 2 million ) have osteoporosis. and 28 % to 47 % have osteopenia. Thirty-seven per centum of visits for osteoporosis occur between the ages of 71 and 80. 28 % between the ages of 61 and 70. 20 % after age 80. and merely 10 % between the ages of 51 and 60. Fifty-nine per centum of the visits for osteoporosis are to primary attention doctors. but it is by and large other specializers who prescribe therapy for osteoporosis. ( Shari Munch. Sarah Shapiro. 2006 ) . FIGURE 1. Bone is invariably remolded during osteoblastic and osteoclastic activity. ( Mary P. Sutphen. Bridie Andrews. 2003 ) . Osteoporotic breaks occur most often in the hips. vertebrae. and carpuss. Hip break. normally the consequence of a autumn. is a major cause of mortality and morbidity in older adult females. The incidence increases with age. and between 12 % and 20 % of all persons with hip break dice in the infirmary of complications. Approximately one-third of subsisters are left with some disablement. which limits their independency. Wrist breaks. which are besides normally incurred during a autumn. by and large heal wholly with few permanent effects. Vertebral breaks are frequently called â€Å"crush fractures† because they can take to vertebral compaction and a loss of tallness. When several vertebrae are involved. compaction can falsify the spinal column. taking to â€Å"dowager’s hump† ( Figure 2 ) . As spinal curvature additions. the rib coop sinks toward the pelvic girdle. doing internal variety meats to go cramped and accordingly making troubles with external respiratio n and GI uncomfortableness. ( Stephen H. Jenkins. 2004 ) . FIGURE 2. Compaction breaks of the vertebrae lead to loss of tallness and frontward bending of the upper spinal column. ( Mary P. Sutphen. Bridie Andrews. 2003 ) . PHYSIOLOGY OF OSTEOPOROSIS After peak bone denseness is reached. bone denseness remains stable for old ages and so diminutions. Considerable grounds suggests that bone loss begins before climacteric in adult females and in the 20s to 40s in work forces. Once the climacteric is established. the rate of bone mass is accelerated several creases in adult females. During the first 5 to 10 old ages of the climacteric. trabeculate bone is lost faster than cortical bone. with rates of about 2 to 4 % and 1 to 2 % per twelvemonth. severally. A adult female can lose 10 to 15 % of her cortical bone and 25 to 30 % of her trabeculate bone during this clip. a loss that can be prevented by estrogen replacing therapy. Furthermore. rates of bone loss vary well between adult females. A subset of adult females in whom ostopenia is more terrible than expected for their age are said to hold type1 or â€Å"post-menopausal† osteoporosis. Clinically type I osteoporosis frequently presents with vertebral â€Å"crush† breaks or â€Å"Colles† breaks. The mechanism whereby estrogen lack leads to cram loss is still non established. Recent grounds suggests that estrogen lack may increase local production of bone-resorbing cytokines such as interleukin ( IL ) 1. IL-6. and tumor mortification factor. Because estrogen besides increases local production of growing factors. such as insulin like growing factor1 and transforming growing factor beta that stimulates bone formation. estrogen lack might decrease bone formation. Estrogen lack increases the skeleton sensitiveness to the resorbtive effects of parathyroid endocrine. Estrogen lack hence leads to a little addition in serum Ca degree. Harmonizing to one hypothesis. increased Ca degrees suppress parathyroid endocrine secernments. thereby diminishing nephritic 1. 25- dihydroxy vitamin D formation. which so limits enteric Ca soaking up. Finally the find of estroge n receptors on bone-forming cells suggests that estrogen lack may besides change bone formation straight. ( Linda K. Larkey. Sharon Hoelscher Day. Linda Houtkooper. Ralph Renger. 2003 ) . Once the period of rapid station menopausal bone loss ends. bone loss continues at a more gradual rate throughout life. The osteopania that consequences from normal aging. which occurs in both adult females and work forces. has been termed type II or â€Å"Senile† osteoporosis. Because type II osteoporosis is associated with a more balanced lessening in cortical and trabeculate bone mass. breaks of hip. pelvic girdle. carpus. proximal humerus. proximal shinbone. and vertebral organic structures all occur normally. Factors that may be of import in the pathogenesis of type II osteoporosis include ; ( Marc H. Bornstein. Lucy Davidson. Corey L. M. Keyes. Kristin A. Moore. 2003 ) . Finally the differentiation between the type I and type II osteoporosis are frequently rather arbitrary. and there may be considerable convergence between these syndromes. ( Henry B. Biller. 2002 ) . Many of the upsets that can take to osteoporosis independent from the normal procedure of the climacteric in adult females and aging in both adult females and work forces should be considered when measuring patients with osteoporosis and include endogenous and exogenic glucocorticoid surplus. hypogonadism. thyrotoxicosis. hyperparathyroidism. vitamin D lack. GI diseases. bone marrow upsets. immobilisation. connective tissue diseases and certain drugs. ( Kate Terrio. Garry W. Auld. 2002 ) . Detection There are several techniques for gauging bone denseness. Single photon absorptiometry ( SPA ) and individual x-ray absorptiometry ( SXA ) are used to measure mineral content of the forearm. They measure chiefly cortical bone in which tissue loss is non evident until late in the class of the disease. Double x-ray absorptiometry ( DXA ) gives a more accurate estimation of hazard. mensurating the mineral content of the entire cortical and trabeculate castanetss of the hip and spinal column and entire bone mass. Radiation exposure for this process is less than that of a standard spinal column X ray. ( Mayur M. Amonkar. Reema Mody. 2002 ) . PREVENTION AND TREATMENT Actual bar of osteoporosis must get down in the adolescent old ages. As adult females progressively live into their 80s and 90s the intervention of osteoporosis is going large concern. Mundy ( 1995 ) notes that though we soon have several effectual drugs for osteoporosis. clinical tests show that even better 1s are needed. At this clip osteoporotic harm can non be repaired. but bar of the reabsorption of bone with assorted pharmaceuticals is an of import end. ( Carol Lewis. 2002 ) . Hormone Replacement Therapy:Many surveies have shown that estrogen intercession. or hormone replacing therapy ( HRT ) . reduces the rate of bone loss. The effects of estrogen in forestalling bone loss can be seen instantly after climacteric. in adult females over 70 old ages old. and in those with established osteoporosis. Long-run estrogen usage ( more than 5 old ages ) . is associated with a decrease in the hazard of breaks of the hip and distal radius every bit good as of vertebral crush break. ( Milos Jenicek. 2002 ) . The manner of action of estrogen on bone is ill-defined. Recently estrogen receptors have been found in osteoblastic cells. proposing a stimulation of bone synthesis. Estrogens may besides act upon Ca homeostasis in the organic structure by increasing the hydroxylation of 25-hydroxy vitamin D to its active 1. 25 signifier. ( Jay Herson. 2007 ) . Calcitonin:is a thyroid endocrine that. with the parathyroid endocrine. regulates calcium metamorphosis. Several surveies have demonstrated that injections or intranasal spray of this endocrine inhibit trabeculate bone loss and may cut down the incidence of osteoporotic break. In 1995. FDA approved the intranasal spray of calcitonin for intervention of osteoporosis. ( Michele C. Md Moore. Caroline M. De Md Costa. 2004 ) . Aminobisphosphonates:are a category of new drugs that are powerful inhibitors of bone reabsorption that do non retard bone formation. They are being tested in adult females with osteoporosis and look to increase trabeculate bone mass significantly without damage of cortical bone. A recent 3-year survey with this drug and 500-mg addendums of Ca found a lower rate of break in treated versus placebo-controlled topics. Application has been made to the Food and Drug Administration for blessing in intervention for osteoporosis. ( Simon J. Williams. Lynda Birke. Gillian A. Bendelow. 2003 ) . Calcium:Osteoporosis is non a disease ensuing from obvious lacks in vitamin D. Ca. and phosphate. but elusive lacks may account for the ability of Ca and vitamin D addendums to hold a good consequence on bone. Reduced Ca intake clearly can do bone loss by asking the usage of skeletal Ca to keep a changeless serum Ca degree. Although less effectual than HRT. day-to-day consumptions of 1500 to 1700 milligram of Ca with 5 to 10 milligram ( 400 to 800 IU ) of vitamin D in the early postmenopausal period have been shown to significantly retard bone loss from the lumbar spinal column and proximal thighbone and to cut down the hazard of hip and other nonvertebral breaks. Vitamin D:Recently. Dawson-Hughes and coworkers found that although consumptions of 5. 0 ?g of vitamin D are sufficient to restrict bone loss from the spinal column and the whole organic structure. sums every bit high as 20 ?g were needed to cut down bone loss from the hip ( femoral cervix ) . Recommendations from the Consensus Development Conference are for 5 to 10 ?g of vitamin D consumption. ( Ivar Sonbo Kristiansen. Gavin Mooney. 2004 ) . A man-made signifier of calcitrol ( 1. 25-dihydroxyvitamin D 3 ) . the most physiologically active metabolite of vitamin D. has been used pharmacologically in intervention of post-menopausal osteoporosis with conflicting consequences. One clinical test of 622 adult females with mild to chair disease reported a significantly lower rate of new vertebral breaks after 3 old ages of intervention. Fluoride:stimulates bone formation by publicity of osteoblast proliferation ensuing in additions in trabeculate bone compared to cortical bone and additions in spinal bone denseness. Recent research makes fluoride intervention expression promising. but optimum dosage and regimens remain to be established. ( A. Alonso Aguirre. Richard S. Ostfeld. Gary M. Tabor. Carol House. Mary C. Pearl. 2002 ) . The NIH Consensus Development Conference concluded that fluoride did non look to take down the rate of vertebral break and may increase cortical break. However. preliminary surveies of a 2. 5-year intervention regimen of slow-release Na fluoride and 400 milligram of Ca citrate twice daily reported improved lumbar bone mass. improved cancellate bone quality. and a important decrease in vertebral break rates. However. other tests. which administered Na fluoride and Ca carbonate to adult females with postmenopausal osteoporosis for 4 old ages. found no important lessening in vertebral break rate with the fluoride intervention. ( Carole A. Carson. 2005 ) . Exercise:Physical activity plays an indispensable function in bar of osteoporosis by keeping bone mass. Weight-bearing activity such as alert walking 20 proceedingss or more day-to-day is first-class. It provides non merely mechanical force. spinal column and long bone motion. but besides sunlight exposure and vitamin D. ( Ernie Hood. 2003 ) . The skeleton is subjected to burden bearing emphasis of gravitation and forces from musculus contraction. These forces change the form of the bone. Bone mass additions in response to mechanical emphasis. Physical exercising enhances bone development. and vigorous exercising augments bone mineral denseness. Physically active people appear to hold higher bone denseness than those who are sedentary. and some surveies have reported a positive association between musculus strength and bone mass. particularly in premenopausal adult females. In add-on. there is grounds that a assortment of exercising plans have been associated with decreased hazard of falls in older grownups. ( Tobias Alfven. Lars Jarup. Carl-Gustaf Elinder. 2002 ) . Lifestyle alterations:are necessary for those with osteoporosis. particularly when there is grounds of feeding and imbibing forms of inordinate intoxicant. protein. salt. and caffeine. Decrease of coffin nail smoke is another alteration that becomes necessary. All of these surpluss cause bone to lose Ca. ( Angela J. Koestler Ph. D. . Ann Myers M. D. 2002 ) . Education/knowledge:is possibly the most of import issue in bar and intervention of osteoporosis. Knowledge about the sites most vulnerable to fracture through accidents. falls. back strain. and hapless position should be provided. Explanation should be given about alterations in the upper spinal column that occur when vertebrae are weakened. and the hurting that consequences from strain on the lower spinal column to counterbalance for balance and height alterations due to change of the upper spinal column. ( Terry Robson Diped Nd Ba. 2003 ) . Personal safety:should be addressed for those with osteoporosis to avoid falls. Places with good support should be worn. Bannisters should be used and walking in ill lighted countries should be avoided. Basic organic structure mechanics such as non flexing or raising heavy objects should be learned. Use of measure stools or chairs for making things in high topographic points should be discouraged. Home safety should include good lighting. railings. and other AIDSs as needed. Walks should be kept free of obstructions ; loose carpets and electrical cords should be arranged so that they do non do falls. ( Myrna Chandler Goldstein. Mark A. Goldstein M. D. 2002 ) . Decision It is neer excessively early or excessively late to originate lifestyle alterations to cut down loss of bone mass. Adolescents and immature grownups can construct maximum extremum bone mass with exercising and a balanced diet incorporating 1200 milligram of Ca and 5 ?g of vitamin D. For older adult females. HRT can minimise bone loss and. in some cases. advance osteogenic activity. Weight-bearing physical activity has the potency non merely to protect from farther bone loss but besides to better strength. mobility. flexibleness. legerity. and musculus strength. which may indirectly diminish the incidence of osteoporotic breaks by decreasing the likeliness of falling. Calcium and vitamin D are cardinal dietetic ingredients. Current recommendations ( 1500 milligram Ca. 10 to 20 ?g vitamin D ) for these alimentary sums exceed the RDA and may be hard to obtain through nutrient entirely. Addendums should be used with cautiousness. though. because extra vitamin D can do bone loss and neuro logic jobs. Other therapies. including fluoride. vitamin D parallels. and calcitonin. will doubtless has greater potency in the hereafter. ( V. Minichiello. I. Coulson. 2005 ) . Mentions: Angela J. Koestler Ph. D. . Ann Myers M. D ( 2002 ) . Understanding Chronic Pain ; University Press of Mississippi Carol Lewis ( 2002 ) . Osteoporosis and Men ; FDA Consumer. Vol. 36. September Carole A. Carson ( 2005 ) . The Importance of Bone Mineral Density in Women ; JOPERD–The Journal of Physical Education. Recreation A ; Dance. Vol. 76 Ernie Hood ( 2003 ) . Toward a New Understanding of Aging ; Environmental Health Perspectives. Vol. 111 Henry B. Biller ( 2002 ) . Creative Fitness: Applying Health Psychology and Exercise Science to Everyday Life ; Auburn House Ivar Sonbo Kristiansen. Gavin Mooney ( 2004 ) . Evidence Based Medicine: In Whose Interests? Routledge Jay Herson ( 2007 ) . The Coming Osteoporosis Epidemic: Trend Analysis ; an Aging Society Is About Certain to Be Characterized by a Weakening Population as the Ravages of Thin-Bone Diseases Affect More Peoples. A Health Futurist Analyzes the Trend’s Coming Impacts on Families. the Economy. Public Policy. and Social and Technological Innovation ; The Futurist. Vol. 41. March Kate Terrio. Garry W. Auld ( 2002 ) . Osteoporosis Knowledge. Calcium Intake. and Weight-Bearing Physical Activity in Three Age Groups of Women ; Journal of Community Health. Vol. 27 Linda K. Larkey. Sharon Hoelscher Day. Linda Houtkooper. Ralph Renger ( 2003 ) . Osteoporosis Prevention: Knowledge and Behavior in a Southwestern Community ; Journal of Community Health. Vol. 28 Marc H. Bornstein. Lucy Davidson. Corey L. M. Keyes. Kristin A. Moore ( 2003 ) . Well-Being: Positive Development across the Life Course ; Lawrence Erlbaum Associates Mary P. Sutphen. Bridie Andrews ( 2003 ) . Medicine and Colonial Identity ; Routledge Mayur M. Amonkar. Reema Mody ( 2002 ) . Developing Profiles of Postmenopausal Women Being Prescribed Estrogen Therapy to Prevent Osteoporosis ; Journal of Community Health. Vol. 27 Michele C. Md Moore. Caroline M. De Md Costa ( 2004 ) . Do You Truly Necessitate Surgery? A Sensible Guide to Hysterectomy and Other Procedures for Women ; Rutgers University Press Milos Jenicek ( 2002 ) . Foundations of Evidence-Based Medicine ; Parthenon Publishing Myrna Chandler Goldstein. Mark A. Goldstein M. D. ( 2002 ) . Controversies in Food and Nutrition ; Greenwood Press Shari Munch. Sarah Shapiro ( 2006 ) . The Silent Thief: Osteoporosis and Women’s Health Care across the Life Span ; Health and Social Work. Vol. 31 Sheldon J. Segal Ph. D. . Luigi D. Mastroianni Jr. . M ( 2003 ) . Hormone Use in Menopause A ; Male Andropause: A Choice for Women and Men ; Oxford University Press Simon J. Williams. Lynda Birke. Gillian A. Bendelow ( 2003 ) . Debating Biology: Sociological Contemplations on Health. Medicine. and Society ; Routledge Stephen H. Jenkins ( 2004 ) . How Science Works: Measuring Evidence in Biology and Medicine ; Oxford University Press Terry Robson Diped Nd Ba ( 2003 ) . An Introduction to Complementary Medicine ; Allen A ; Unwin Tobias Alfven. Lars Jarup. Carl-Gustaf Elinder ( 2002 ) . Cadmium and Lead in Blood in Relation to Low Bone Mineral Density and Tubular Proteinuria ; Environmental Health Perspectives. Vol. 110