Strategic Crisis Management in Enhancing Business Continuity and Research Paper

Strategic Crisis Management in Enhancing Business Continuity and Stability - Research Paper Example This research will begin with the statement that organizations in different sectors encounter the risk of disruptive events. The effects vary from simple or minor inconvenience that briefly disrupts the usual activities to the closure of the business. This problem necessitates crisis management. Crisis management is an enterprise’s pre-established strategies and activities that are intended for planning, responding as well as rectifying significant disastrous incidents or events An organization’s success is greatly associated with its formulation of crisis management programs which incorporate risk management, disaster recovery, communication and emergency response programs. The organization should develop the competence to respond flexibly and promptly as soon as crisis occurs. Crisis management may include rehearsal and teamwork in the attempt to establish the most appropriate response to unforeseen, detrimental occurrences. If an enterprise is adequately equipped for the most detrimental circumstances, then it is capable of handling other scenarios as well. Businesses can be better equipped to solve sudden events that may possibly result in stern or severe damage, jeopardizing their stability as well as continuity. In respect to business continuity, crisis management will facilitate recognition of potential issues which threaten an enterprise, and provide strategy for establishing resilience as well as the capacity for an efficient reaction. Crisis management facilitates business stability by eliminating or reducing losses associated with unforeseen, negative incidents. Managers encompass a strategic duty and a role to ensure their businesses or organizations are conscious of all aspects of business crises as well as planning in advance so as to minimize their effects. Thesis Statement In respect to business stability, several aspects that are likely to weaken the operations of an organization are emphasized. The essential and fundamental strat egy that various businesses implement to respond to business crisis in an attempt to enhance their stability will be considered. Contributions of crisis management in ensuring continued existence of businesses will also be studied. Speight defined business continuity as the procedure that indicates potential factors that intimidate an enterprise and offers a stratagem for creating flexibility as well as the aptitude for responding to business-related risks effectively. During a business crisis, a response should essentially safeguard stakeholders’ interests, and organization’s brand, reputation, long-term survival as well as value-creating actions. In the article, Speight provided a detailed perspective of crises, emergencies as well as disaster mitigation in an enterprise. The chief business disaster is considered to be an incident that extremely affects business operations with the highest chance of terminating its entire activities. An organization should formulate and adopt several procedures or strategies that it may be used to respond to disasters. Modern techniques used in business continuity management, include business continuity and risk assessment plan which ensures that businesses are resilient as well as prepared to offset risks. These techniques are significant in crisis management since they not only facilitate the assessment of risks but also assist in formulation of risk management plans. The issue of business continuity is identified to be of critical concern which has continuously being researched and enhanced over time. Business continuity aspects are upheld by safety standards or legislation.

Husband, Lover and Friend Essay Example | Topics and Well Written Essays - 750 words

Husband, Lover and Friend - Essay Example The husband and the wife are just like a vine intertwined or a branch grafted to another branch, with both branches sustaining one another. A man must also realize the implication of two people spending a lifetime together and sharing a life together even when it entails tremendous amount of tolerance and self-sacrifice. Both husband and wife must fulfill the human needs for love, friendship, family, and companionship the need for affection, recognition, and appreciation. All of these are plain and simple manifestation of love. The role that a husband plays could also be defined by what we expect him to be. Everybody expects a husband to be faithful, dependable, tough, yet tender. A man's faithfulness means so many things. It could mean loyalty, devotion, reliability, and fortitude. A man is faithful not only to the woman but he should also be faithful to his obligations and the tasks that go with being a good husband. A man is devoted to the woman not only with his attention but also in the time that he spends with her. The husband also provides security at home. It is quite burdensome for a man that he must provide all the needs at home. However, in many ways doing this is what really makes a man a man. He was made the stronger sex, physically so that he could protect the woman and spare her from the cumbersome tasks. Most of the time, husbands measure themselves up on the power or authority that they wield in the family. However, a husband needs not a commanding voice or any rule or law because a woman does not adhere to any other kind of influence but love. A woman would surrender her spirit to the man who knows how to love. Bayless Conley could not have been so right when he quoted that "husbands must go all out in love for their wives - a love marked by giving, not getting." He further stated that wives are a reflection of the words husbands speak to them. Conley explains: I can learn a whole lot about a man by just looking at his wife's countenance. I find out what kind of man you are by looking at your wife's face. She is a reflection of the way you treat her and of the words you speak to her. It is written, not all over your face. It is written all over her face. If you are going to be a good lover, you first have to learn to love with words. Compliment rather than criticize. ( 2 ) If it is true that a good wife brings joy and honor to the husband, it must also be true either way for it is the person whom we love and value the most who could shape our character and affect us the most. A woman would look good and look happy if she is treated right. If a husband fulfills the woman's needs, it makes her happy. Finally, the husband was charged to: Live joyfully with the wife whom thou lovest all the days of the life of thy vanity, which he hath given thee under the sun, all the days of thy vanity: for that is thy portion in this life, and in thy labor which thou takest under the sun.

Advanced breast cancer

Advanced breast cancer Background Cancer accounts for 13% of all deaths in 2007, making it the largest cause of mortality worldwide and is the leading cause of premature death in Scotland. 2,22 Out of the staggering figure of 27,500 new cases that were diagnosed on that same year in Scotland, 4044 of them are breast cancer cases, making breast cancer the most commonly diagnosed cancer among Scottish women.3 In the UK, 16-20% of women have advanced breast cancer and approximately 40-50% of those diagnosed with early or localised breast cancer may eventually develop metastatic disease. Breast cancer is usually defined using a staging system known as the Tumour, Node and Metastasis Staging System (TNM) and stage III and IV are known as advanced stages of the disease with stage III being locally advanced and or has spread to regional lymph nodes and stage IV describing the presence of metastases at distant sites such as the bone, brain, or lung.23 In the elderly group of female cancer patients, the prevalence of breast cancer is highest at 4% and these post-menopausal women make up 80% of all breast cancer patients, hence proving that the risk increases with age.1 Apart from age, other factors like family history, uninterrupted oestrogen exposure, early menarche, late menopause, late first pregnancy, hormone replacement therapy, obesity, not breast feeding, taking oral contraceptives and past breast cancer may all attribute to a higher risk of developing breast cancer.9 Over the last decade, mortality rates from breast cancer have dropped by almost 14%, despite having more women diagnosed with the disease. In 2000-2004, the survival rate for breast cancer patients has also bumped up to 84% compared to a mere 64% 20 years earlier.4Improvement in prognosis, screening techniques such as mammography, ultrasound and Magnetic Resonance Imaging(MRI), earlier diagnosis of cancers in women participating in the Scottish Breast Screening Programme, a myriad of new hormonal and chemotherapy treatments, and better organisation and patient care plans has attributed to the substantial increase in incidence and survival rate of breast cancer patients. Women today are also encouraged to perform self breast examinations, hence are familiar with the shape and feel of their breasts, as well as to look out for abnormities like a new discrete lump, nipple discharge, unilateral persistent pain especially in post-menopausal women or pain associated with a lump and skin changes comprising of skin tethering, ulceration, abscess or inflammation.However, there is still a disparity between women from different social classes in terms of combating this disease. Women from more affluent backgrounds are more likely to have their breast cancer diagnosed earlier, have slower disease progression from the time of diagnoses and higher survival rates compared to women from poorer socioeconomic backgrounds. Women from more deprived communities are more likely to be diagnosed with the advanced stage of the disease. Pathogenesis Cancer or malignant neoplasm which literally means new growth is a disease manifested in the form of uncontrolled cell proliferations, dedifferentiation and loss of function, invasiveness and metastasis.6 Breast cancer usually forms from the inner lining of milk ducts or the lobules that supply the ducts with milk. In patients with Breast Cancer, women who inherit a single defective copy of tumour suppressor genes BRCA1 or BRCA 2 have a marked higher risk of developing breast cancer in their lifetime. The presence of a defective BRCA1 or BRCA 2 gene can invoke changes in several cellular systems including the signaling pathways and receptors of growth factors and cell cycle tranducers, the apoptotic machinery which responsible for programmed cell death that normally disposes of abnormal cells, the secretion of telomerase, and local blood vessels which results in tumour-directed angiogenesis to supply nutrients to these tumours both aids the proliferation of cancer cells.7,8 Breast cancer cells are able to invade other tissues like the lymph nodes as they no longer exercise the same restraints as the normal cells and they also secrete enzymes like metalloproteainase to break down the extracellular matrix, conferring them mobility. Metastases are secondary tumours normally found in the advanced stage of breast cancer formed by cells released from the primary tumour and have reached and have established themselves at other sites like the lung brain or the bones which are common sites for metastatic cancers of breast origin through blood vessels and lymphatics. The tissues of lung, brain and bone origin express high levels of CXR4 chemokine receptors produced by the breast cancer cells, facilitating the selective accumulation of the cells at these sites.6 Treatment Options There are three main approaches to treating breast cancer, namely surgical excision, irradiation and a host of systemic disease-modifying therapies or a combination and is chosen based on the stage of breast cancer. However, when caring for patients with advanced breast cancer, the goal of treatment of advanced breast cancer is to palliate symptoms, improve survival and quality of life. There are notably three types of systemic disease-modifying therapies to treat advance breast cancer namely endocrine therapy, chemotherapy and biological therapy. Endocrine Therapy Oestrogen exposure has been instrumental in inducing mutations that can lead to breast cancer as they can stimulate cell growth in most of human breast cancer cell lines expressing Oestrogen Receptor (ER) ÃŽÂ ± .8 Clinical studies have proven that more than half of breast carcinomas are ER ÃŽÂ ± positive and respond fairly well to endocrine therapy. Drugs are aimed either to change the ER signaling pathways or prevent estrogen synthesis.7 Tamoxifen and 3rd generation Aromatase Inhibitors (AI) have been used for advance breast cancer with the former being effective in premenopausal, perimenopausal and post menopausal women. Pre-menopausal and perimenopausal cancer patients with ER positive tumours should be offered Tamoxifen tablets 20 mg daily, an oestrogen -receptor antagonist and ovarian ablation or the administration of LHRH agonists such as Buserelin or Goserelin as first-line treatment.5,12 Both options are just as effective in terms of tumour response and overall surviva l rates. The latter group of drugs, AI, are the preferred choice for post-menopausal women only with no prior history of endocrine therapy or have been previously been treated with Tamoxifen. AI work predominantly by suppressing oestrogen levels in post-menopausal women by blocking the conversion of androgens to oestrogens in the peripheral tissues. However, they do not inhibit ovarian oestrogen synthesis, hence can cause an elevation in oestradiol levels in pre-menopausal women. Anastrozole and Letrozole are non-steroidal AIs are known to be as efficacious as Tamoxifen as first -line treatment of metastatic breast cancer. 14Exemestane is a steroidal AI used as second-line treatment in advanced breast cancer in post-menopausal women in whom anti-oestrogen therapy has failed. Fulvestrant, an oestrogen receptor antagonist also confers short term benefits in the clinical setting for post-menopausal women who was previously prescribed a non-steroidal AI, delaying the need for chemotherapy. 13AI h ave been associated with an increased progression-free survival and 13% decrease risk of mortality and lower incidence of vaginal bleeds and blood clots. However, patients given AI are more prone to hot flushes and gastro-intestinal symptoms. 5 Other endocrine therapies available include older and less popular therapies such as progestogen and androgen for pre-menopausal women and stilboesterol and trilostane for post-menopausal women. 5 Chemotherapy Both ER positive and negative patients with advanced breast cancer would benefit from either a choice of two or three regiments of chemotherapy and classes of drugs commonly prescribed includes antharacyclines, taxanes, capecitabine, vinorelbine, gemcitabine, alkylating agents like cyclophosphamide and platinum based drugs like carboplatin.5 Anthracyclines such as Epirubicin, Mitoxantrone and Doxorubicin are prescribed as first line chemotherapy as they boost modest survival advantage in patients with advanced breast cancer and are superior to non-anthracycline regimens.1,5Doxorubicin is commonly given via injection into a fast running infusion at 21 day intervals as extravastation can cause severe tissue damage. It exerts a cytotoxic effect by interfering with DNA and RNA synthesis by inhibiting DNA toposiomerase II action. The metabolites are excreted through the bile, hence elevated bilirubin levels are indicative of a need to reduce the dosage. 6,12 Higher accumulation of doses may result in cardiopathy precipitating to heart failure, hence cardiac monitoring is deemed important in managing cancer patients taking it and a limit of total cumulative doses is set at 450 mg/m2.Other symptoms of toxicity includes myelodysplasia and neutropenic sepsis. Doxorubicin is also available in liposomal formulations which are safer in terms of reduced incidents of cardiotoxicity and local necrosis but is not recommended by the Scottish Medicines Consortium for treatment of metastatic breast cancer.1,12 Both Epirubicin,an anthracycline derivative, and Mitoxantrone ,an anthracenedione derivative,are structurally related to Doxorubicin, hence similar drug activity could be predicted for all three drugs.12 Mitoxantrone given intravenously is licenced to treat metastatic breast cancer and has been well tolerated by patients.However, side effects like myelosuppression and cardiotoxicity are evident and cardiac examinations are recommended after a cumulative dose of 160 mg/m2.12When both drugs are compared in a clinical trial, Epirubicin boosts higher response rates despite demonstrating a higher percentage of toxicity related side effects.20Clinical trials suggest the efficacy of Epirubicin in treating advanced breast cancer is comparable to Doxorubicin as similar response rates were recorded when equal doses were given. These trials also indicated that patients taking Epirubicin had fewer episodes of congestive heart failure and other complications resulting from cardiotoxicity. Therefo re, it could be surmised that Epirubicin is the drug of choice in this regimen .However,a limit of 0.9-1 g/m2 was still imposed when Epirubicin is given to avoid cardiotoxicity. 1,12 Due to the ineffectiveness of single-agent anthracycline therapies in impeding disease progression, combination therapies are often considered for the treatment of advanced breast cancer after failure of with anthracycline monotherapy, provided that the patient is able to tolerate additional toxicity and have a higher chance of response.5 There are clinical evidence suggesting that a combination of anthracycline and taxanes like Doxorubicin and Docetaxel have resulted in better tumour response, delayed progression time compared and reduce risk of mortality to anthracycline monotherapy. The benefits of this synergistic combination, however, did not include improved survival and side effects experienced were more numerous such as thrombocytopenia, alopecia in 75% of these patients,a 10% increase in peripheral neuropathy and neutropenia in 40 to 68% of these patients.1,5 A combination of Epirubicin and Docetaxel would be a better choice as it is just as potent as the Doxycycline and Pac litaxel combination but deemed free of side effects like cardiotoxicity and fluid retention whereas neutropenia was the dose-limiting toxicity .21 Systemic chemotherapy should be offered to patients whom antrhracyclines are contraindicated in cases of cardiac disease hypertension,the elderly, those who have received myocardial irradiation ,those receiving radiotherapy for breast cancer or had receive prior adjuvant treatment with anthracycline. Docetaxel monotherapy is prescribed as the first-line drug followed by single-agent Vinorelbine or Capecitabine as the second-line treatment. Third-line treatment encompasses the use of either Vinorelbine or Capecitabine of which was not offered previously.5 Docetaxel, a member of the taxane group derived from a naturally occurring compound from the bark of yew trees, is licensed to treat locally advanced or metastatic breast cancer. It acts by stabilizing microtubules in the polymerized state, preventing cell division. Side effects associated with Docetaxel are myelosupression, peripheral neuropathy, cardiac conduction defects with arrhythmias, alopecia, muscle pain, nausea and vomiting . Patients currently on Docetaxel are also susceptible to leg oedema and hypersensitivity reactions, which can be ameliorated by taking Dexamethasone orally.1,6,12 Antimetabolites like Capecitabine is a rationally designed tumour-activated and tumour-selective fluoropyrimidine carbamate thatis metabolized to generate 5-fluorouracil at the tumour site which would then be converted to fluorodeoxyuridine monophosphate (FDUMP), a fraudulent nucleotide and interact and inhibit thymidilate synthetase,preventing the synthesis of 2-deoxythymidilate (DTMP),which is vital for DNA synthesis.17Capecitabine has a role in second-line or third-line treatment of chemotherapy for patients of locally advanced or metastatic breast cancer either in combination with Docetaxel or given orally alone at a dose of 1250 mg/m2 twice daily for a forthnight and subsequent courses are repeated after a 7-day interval. Vinorelbine is a semi-synthetic analogue of vinblastine, a vinca alkaloid derived from Madagascar periwinkle. Unlike taxanes, it is targeted at tubulin of mitotic microtubules to form tubulin dimers which prevents spindle formation in dividing cells leading to mitotic arrest at metaphase resulting in cell death. 6 Besides inhibiting mitosis, its effects are also significant in inhibiting leucocyte phagocytosis, chemotaxis and axonal transport in neurons. Hence, side effects includes neutropenia which was found to be the dose-limiting, peripheral or autonomic neuropathy which manifests as peripheral paraestesia, loss of deep tendon reflexes and motor weakness,constipation and abdominal pain. Neurotoxicity caused by Vinorelbine is considered relatively mild compared to other vinca alkaloids even at maximum tolerated dose as it preferentially binds to mitotic over axonal microtubules. 6,12 Vinorelbine is an option to anthracycline or taxane pre-treated patients with advanced breast canc er as second-line or third-line chemotherapy given via intravenous administration at a dose of 30mg/m2 in 250 ml of normal saline over 1 hour. Alternatively, Vinorelbine can be given orally at a dose of 60 mg/m2 for 3 weeks and can be increased if the patient shows good tolerance to the regime to maximum dose of 160 mg once weekly. A clinical response rates of 16-60% was seen with Vinorelbine as a single agent, 28-77% in combination chemotherapy.5, 16 A study comparing Vinorelbine in intravenous(i.v.) form used in combination with Capecitabine given orally and a combination therapy of Vinorelbine and Capecitabine both in oral formulations was done to observe the efficacy of both combinations in anthracycline and taxane pretreated patients with metastatic breast cancer. Despite showing a marginally higher percentage in control of the disease in the oral group,improved survival rates and lower incidence of neutropenia and thrombocytopenia were associated with the i.v. group.17 This study has also shown that a combination of Vinorelbine with Capecitabine therapy may confer advantages as both have unique mechanisms of action, different proposed mechanism of drug resistance and relatively non-overlapping toxicity profiles. However, this combination has yet to be recommended by the NICE or SIGN guidelines as it has yet to be proven to be cost-effective. The recommendation for systemic chemotherapy by NICE is done following a cost-utility analysis which compares chemotherapy regiments in terms of survival, quality of life and associated costs of 17 different strategies drawn up. From the table below, strategies that gives the best survival rates and quality of life are combinations 3,4,13 and 15.However,combinations 3 and 4 that offer Gemcitabine and Docetaxel as the first line are somewhat more costly by approximately  £ 10 000 in total costs compared to combinations 13 and 15.It is also proven here that offering Docetaxel as a first-line drug is also superior to Paclitaxel as survival rates and quality of life are slightly poorer in combinations 8 and 10. 5 Biological Therapy New agents to specifically target molecular processes have been developed over the last decade like Tratuzumab, Bevacizumab and Lapatinib which are all used to treat advanced breast cancer. Tratuzumab, the sole drug of its kind recommended by NICE for use in the UK, is a recombinant humanized monoclonal antibody which binds to Human Epidermal Growth Factor (HER2) on the cancer cells with HER2 over expression and impedes the growth. Hence, HER2 status should be assessed before commencing this therapy as only a quarter of patients with advanced breast cancer have HER2 positive tumours. Tratuzumab is given intravenously in combination with Paclitaxel, Docetaxel or Vinorelbin has been well tolerated. 5,11However, once disease progression occur outside the central nervous system, Tratuzumab should be discontinued. Bevacizumab is another monoclonal antibody aimed at affecting the growth of tumour blood vessels and Lapatinib affects the metabolic pathways of the HER2 and Epidemal Growth Fac tor Receptor (EGFR). 5,23. Surgery Surgical intervention comprises of conservation surgery which involves the removal of the tumour with a rim of surrounding breast tissue with retention of the breast followed by radiation therapy and mastectomy which is usually followed by breast reconstruction. However, these surgical procedures are limited to patients diagnosed with primary operable breast cancer or as palliative surgery for locally advanced breast cancer as they may not confer much benefits to patients diagnosed with later stages of breast cancer.1,11,19 Some patients may have already underwent surgery which was not very successful in eliminating the disease.1 Treatment Recommendation Hormonal therapies are the recommended first-line therapy for patients with an ER positive tumour, are widely used and are said to be appropriate for 70 % of patients who have hormone receptor -positive advance breast cancer. However, in circumstances whereby the disease is life-threatening or the patient has an ER negative tumour, the hormonal therapy would be of no benefit to these patients. At the time of initial diagnosis, the oestrogen receptor (ER) was accessed and the results came out positive before considering commencing on endocrine therapy. Several factors like previous endocrine therapy including adjuvant therapy, the extent and period of response to the therapy and menopausal status have to be taken into account before prescribing hormonal therapy. 5The patient is 62 years of age and is considered to be post-menopausal, hence would benefit tremendously when given aromatase inhibitors(AI),regardless of whether she is tamoxifen naÃÆ' ¯ve. A choice of non-steroidal AIs o f either Anastrozole 1 mg daily or Letrozole 2.5 daily could be given orally. However, if she has a prior history of non-steroidal AIs and she failed to respond well to it, she should be given either Exemestane 25 mg orally or Fulvestrant 250 mg via intramuscular injection into the gluteal muscle every 4 weeks.5,12 Chemotherapy would be the second choice of treatment following failure to respond to hormonal therapy. If anthracyclines are not contraindicated for this patient, Epirubicin would be a good choice. Initial doses of 75 mg/m 2 of Epirubicin could be given intravenously every three weeks.20The addition of Docetaxel 75 mg/m2in combination with Epirubicin 90 mg/m2 both by intravenous infusions could be given should Epirubicin monotherapy fails. Docetaxel monotherapy could also be given as an intravenous infusion at a dose of100 mg/m2 as a 1-hour intravenous infusion every 3 weeks should anthracyclines be contraindicatedas first-line chemotherapy. Vinorelbine monotherapy could be given intravenously at a dose of 30 mg/m2 for days 1 and 8 of a cycle or whereares Capecitabine monotherapy could be given orally at a dose 1250 mg/m2 twice daily for two weeks. If the patient fails to respond to the entire treatment, the last resort would be to offer support and palliative care to this patient. Pain Management Pain is usually associated with progression of cancer with three quarters of patients with advanced cancer reporting pain during treatment. The principles for treating pain in cancer patients are outlined by the World Health Organisation (WHO) analgesic ladder: Patients are the prime assessor of pain and should have treatment outcomes monitored regularly using visual analogue scales, numerical rating scales. Patients usually start with non-opioids and then progress stepwise to step 2 and step 3. However, critics have debated that the progression to step 2 analgesics was obsolete as inadequate pain control was an issue despite having to endure similar adverse effects when given step 3 analgesics and recommended a immediate step up to step 3. Most patients with advanced breast cancer will be on step 3 for pain control. Oral morphine with an initial dose of 5-20 mg every four hourly, adjusted according to patients response, would be the first-line therapy to treat severe pain in cancer before switching to a modified release preparation once the patient is stabilized on it. Breakthrough pain should be managed while on a modified release preparation by prescribing oral morphine at 1/6th of the total daily dose to be taken when necessary. The use of adjuvants such as antidepressants like Venlafaxine and anticonvulsants like Gaba-pentin are recommended for neuropathic pain. 18 Managing Complications Complications that may arise from treating patients with advance breast cancer includes lymphoedema,cancer-related fatigue,uncontrolled local disease,bone metastases and brain metastases. Lymphoedema may occur due to damage to lymph nodes and vessels following surgery and radiotherapy or as a sign of loco-regional disease progression. This condition can be managed through manual lymphatic drainage, multi-layer lymphoedema bandaging,goos skin care and remedial exercise. Cancer-related fatigue may be well managed by identifying the factors causing lethargy which may be a host of psychological, nutritional and cognitive factors apart from the cancer itself and them treating them accordingly. Patients may also develop local disease characterized by ulceration on the chest wall and axilla, fungating tumours that may bleed and exude discharge, causing pain and giving off repulsive odours. Hence, good wound management should be adopted in relation to preventing dire consequences when wounds are left unattended. Out of the three categories, cancer with distant metastases is the hardest to treat and is considered an incurable disease with palliative care being the sole priority in treatment plans. A diagnosis of metastatic disease could be confirmed with the use of positron emission tomography fused with computed tomography (PET-CT) and bone scintilography.1As bone metastases may be a long-term condition, management involves prevention of skeletal events, pain control with Biphosphonates,radiotherapy and cementoplasty and treating complications such as fractures,immobility and spinal cord compression.5,18 Brain metastases may develop in multiple sites in these patients as most drugs used in chemotherapy cannot penetrate the blood brain barrier, especially in women with HER2-overexpressing tumours. Diagnosis of brain tumours ultimately mean a loss of independence, physical deterioration, communication difficulties,psychological distress and issues regarding body image.Treatment regimens includ es surgery for patients who have solitary metastasis, corticosteroids for symptomatic relief of inflammation and radiotherapy.

Things Fall Apart by Chinua Achebe :: essays research papers

Question: In essay form, explain what this paragraph reveals about Okonkwo. Work specifically with the language proceeding through in an organized fashion. Structure of section †¢Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Achievement o  Ã‚  Ã‚  Ã‚  Ã‚  What he wanted out of life o  Ã‚  Ã‚  Ã‚  Ã‚  Becoming a clan leader ï‚ §Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Fear – didn’t want to be weak ï‚ §Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Shame of childhood ï‚ §Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Affirmation of his masculinity ï‚ §Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Harsh self judgment †¢Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Loss (fish) o  Ã‚  Ã‚  Ã‚  Ã‚   †¢Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Loss (chi) In the paragraph on page 94 near the bottom, Achebe reveals the desperation that Okonkwo has fallen into because of his banishment. Okonkwo up to this point in the book has proven to be warrior-like in his approach to all things in life, but now we see that he has lost the battle of achieving the greatness, leaving him with a broken spirit. In the first section of the paragraph it is made known that Okonkwo was â€Å"†¦ruled by a great passion - to become one of the lords of the clan.† This was evident at the very beginning of the book by his fear of failure. The loathing he had for his father and what he stood for had driven Okonkwo to work hard through his entire life. This commitment help confirm the manliness that he had be seeking for, the one thing that could separate him from the shame of his childhood. However his strong will and determination has left him with a very egomaniacal self-image that leaves Okonkwo helpless when he actually fails in something. His banishment to Mbantu was a very hard blow to his self-image, leaving him weak and broken while trying to live there. The way Okonkwo refers to his banishment was that he â€Å"†¦had been cast out of his clan like a fish on to a dry, sandy beach, panting.† This pitiful image shows Okonkwo’s personal disgust, comparing himself to a lowly creature like a fish. The image of the fish out of water shows his suffrage, that a fish cannot live without water as Okonkwo cannot live without his clan and honour. The fact that the fish is panting shows that he is still alive but most likely suffering a slow and painful death. The analogy of a slow death shows how much Okonkwo sees the banishment as something that has completely destroyed his life and legacy and that his god had turned against him. In the Ibo tribe the chi or â€Å"personal god† plays a pivotal role in each person’s life. In this section we see that Okonkwo has lost faith in his chi saying that â€Å"†¦his personal god or chi was not made for great things.

The role of communication in an organization performances

The specific issues bother on employee compensation and welfare while managers prefer the compromise, problem solving and dominating strategies to minimizing the Incidence of organisational conflicts. Based on the findings of the study, it was recommended that strategies which promote industrial democracy should be chosen by management as the preferred option In dispute resolution.In addition, the Ideal level of conflict resolution required to attain optimum performance for every organisation is unique and situational hence managers are duty bound to establish the best maintainable by the organisation. Keywords: conflict, management, productivity, strategy The establishment and continuous existence of organisation through the realization of set goals and objectives requires the continuous and effective functioning of Its material input with the human element being indispensable.However, the human elements required to facilitate goals attainment often engage in disagreement and arianc e over factors such as Interest, views, style of management among others, The reactionary effect is due to the perceived incompatibilities resulting typically from some form of interference or opposition is term conflict. Azamosa (2004) observed that conflicts Involve the total range of behaviours and attitudes that Is In opposition between owners/managers on the one hand and working people on the other.It is a state of disagreement over issues of substance or emotional antagonism and may arise due to anger, mistrust or personality clashes. Irrespective of the factors esulting in conflict, it has been observed that industrial conflicts produce considerable effects on organisations and should be consciously managed as much as possible. For people to progress at work and other aspect of life, there must be cooperation which is essential to ensure task attainment and stability in life.However, it would be wrong to reach the conclusion that cooperation is good while conflict is bad, thi s Is because both concepts are pervasive and co-exlst In our social life. Conflict is inevitable given the wide range of goals for the different stakeholder n the organization and its absence signifies management emphasizes conformity ana stlTles Innovatlon. Ranlm ) oplnea tnat conTllct may De Interpersonal or inter group with Interpersonal conflicts occurring between a supervisor and his subordinate or between two individuals at the same level of the organizational hierarchy.Inter group conflicts often occur between two trade unions, between two departments or between management and workers while attempting to implement the policies and programme of the organization Hence, this paper reviews the sources, types, causes and consequential effect of onflict and its effective management on corporate productivity with the aim of suggesting a valid, objective and transferable conclusion to the banking industry using First Bank of Nigeria as a case study.

Demonstrative Communication Which Includes Nonverbal and Unwritten Communication Essay

Demonstrative Communication is a type of communication that observes non verbal cues. Examples of non-verbal cues include tone of voice, facial expressions, and body language. Demonstrative communication is one where gestures are employed. Better known as non-verbal communication, it deals with the sending and receiving of messages. Demonstrative communication can be formatted by one’s body language, written language, and some non verbal communication that can cause the main point of observe sing the key words of communication which deals with grasping the tone, facial expressions, voice communication which is the main part of communication. When interring the wrong concepts of communication that we all call listen which we do not when it comes to communication. Listen is a nonverbal communication which we all take as misunderstand of communication when sending, and receiving the main point of a message. Demonstrative communication can be ways of success by how well a person communicate with one’s views, and how people use their verbal, or nonverbal communication. The message of demonstrative communication encounters a person’s thoughts of communication that involves the way a person gasps the main points of the sender and the receiver. People have their own ways of processing one’s examples of communication such as listening; asking question to what is verbal or nonverbal of the sender and the receiver. Views has to be very sure of what the sender has produce of the main point of the message, and how well the receiver has listening to the meaning of the message to ensure that there is no misunderstanding of the concepts of the message. Receivers and senders can have positive, and negative meaning of how a message is giving and received because the sender who is producing the message can give some mislead information and the receiver can be mislead also by the wrong information. Using your body sing can also give off wrong sing of the way a person sending a message across to the receiver. The main and most important body sing a person can use when giving a direct message is eye contact so That the views are taken you serially about the most important message of what you are saying.