Quit Now Essay Example | Topics and Well Written Essays - 500 words

Quit Now - Essay Example On the other hand it is a deadly poison and when taken in large doses can lead to death. It is of prime importance to take the issue seriously and help smokers get rid of their smoking habits. This requires discipline and dedication from the smokers and everyone around him. The smoker must be convinced that quitting is the only option to avoid injuring his health and those around him. Cigarette smoking involves inhaling nicotine a tobacco extract. This is directly absorbed by lungs. The harmful effect of nicotine on lungs is the high risk of contracting lung cancer. 90% of all the cases of lung cancer are caused due to cigarette smoking. This is because contains carcinogenic factors. The risk of death due to lung cancer is high and is coupled with huge amount of suffering for the patient for long time. The damage to the respiratory system is largely irreversible if smoking is continued for large periods of time. The oxidative stress generated by smoking mutates DNA and promotes atherosclerosis. The long term injury to lungs can be lethal if the smoker does not quit. In addition to lung cancer smoking increases the risk of contracting oral cancer, chronic bronchitis, asthma, and degeneration of all organs involved in respiratory system. The person often feels tired and fatigued.

Wagmatcook culture & hartige centre, Cape Breton,canada 866-295-2999 Research Paper

Wagmatcook culture & hartige centre, Cape Breton,canada 866-295-2999 - Research Paper Example This centre was opened in the year 2001 and is dedicated in reviving the Mi’kmaq culture. An ancient tools collections, A wigwam of real size, photos of the Mi’kmaq people while catching salmon, hunting for caribou, and making baskets portray the Wagmatcook Culture & Heritage Centre’s theme, which is, â€Å"The Way a Mi’kmaq Lives.† Wagmatcook Culture & Heritage Centre is home to a display and heritage exhibition of Mi’kmaq cultural artifacts. There are special activities in this great facility’s hall which include dancing, drumming, and storytelling which are done by the community’s elders. Tourists and visitors get a chance to sample the traditional Mi’kmaq foods including â€Å"four cent cake,† roasted venison, and eel stew which are offered at the Centre’s restaurant. Visitors can also shop for beadwork, baskets, Mi’kmaq regalia, quill-work, and original artwork and paintings. The Wagmatcook Cultu re & Heritage Centre opens daily, all year-round (Wagmatcook.com, 1). Cape Breton Island, where Wagmatcook Culture & Heritage aboriginal site is located, is in the Nova Scotia province of Canada. It is a 3,981  sq  mi (10,311  km2) island, which is 18.7% of Nova Scotia’s total area. Even though, the Strait of Canso physically separates it from the Nova Scotia peninsula, they are artificially connected by the Canso causeway for easy transport. Cape Breton’s landmass upwardly slopes from south to north, hence culminating in the Northern Cape islands. The first residents of the Cape Breton Island were the Maritime Archaic natives who are ancestors to the Mi'kmaq people who were the island’s inhabitants at the time of discovery by the Europeans (Wagmatcook.com, 1). The Wagmatcook people history dates back many centuries. The reservation was, however, not established officially until May 2nd, 1834 by Sir Peregrine Maitland. He has been referred as the gentleman who refused to accede to the Scottish settler’s wishes of removing the Native people from the West-Side Middle River’s mouth. The centre’s operation is part of the five year development strategy by the Wagmatcook Band Council. The Wagmatcook Culture & Heritage Centre’s future plans include featuring an interpretive village offering marine opportunities and outdoor activities and travelling exhibits (religious and medicinal themes). The Smithsonian Institute possesses some four thousand artifacts collected from the Wagmatcook First Nation community (Wagmatcook.com, 1). A tour inside the Wagmatcook Culture & Heritage Center entails visiting interpretive exhibits with available guides, and witnessing first-hand the Mi'kmaq people way of life over the past centuries. The centre offers craft shops where local artisans demonstrate their craftsmanship which has been passed over for generations. You can experience the Mi'kmaq culture through story-telling, drumm ing, and dancing. Traditional foods of the Mi'kmaq people are available at the Clean Wave Restaurant inside the museum. These include eel stew, stewed venison or roasted, rabbit, deer, moose, poached salmon, four-cent cake, lis'knikn, and bannock. There is a variety of souvenirs available for sale including; beadwork (bookmarkers, necklaces, etc.), baskets, earrings, bracelets

DU (The Emirates Integrated Telecommunications Company that operates Research Paper

DU (The Emirates Integrated Telecommunications Company that operates in the United Arab Emirates) - Research Paper Example Consumer segment focuses on people and households who are provided with mobile as well as fixed voice calling, apart from internet and related data services and television services. The business segment focuses on small scale as well as large scale businesses and corporations and government agencies. The company provides them with integrated fixed and mobile business solutions such as voice, contents, data and mobile or otherwise applications. Carrier segment focuses on providing carrier and international data networks as well as wholesale services to international companies and multinational corporations (Gulfbase.com, 2015). Emirates Integrated Telecommunications Company is ranked as first in the telecommunication sector, and is ranked as fourth in the service market. The company holds 11.37 percent of the share in the telecommunication sector, and 7.56 percent of the market share in the service industry (Gulfbase.com, 2015). It employs 2000 workers throughout UAE and ensures a great working environment for both its home and expatriate staff. The company was late entrant to the telecommunication sector in the GCC, but it successfully competed against great players in the market such as Etisalat and managed to achieve 8.5 million prepaid mobile and data subscribers (Oracle.com, 2015). Solvency ratios give a significant metric to measure a company’s ability to meet its debts as well as other financial obligations. This ratio shows whether the cash flow is sufficient for the company to meet its financial liabilities of both short and long terms (investopedai.com, 2015). This paper presented a brief company profile of Emirates Integrated Telecommunications Company, which is the leading provider of mobile and telecommunication services in UAE, and has been ranked to be the number one in the sector in UAE. This paper presented the income statement and balance sheet of the company and analyzed various ratios related to short term solvency or

Multilateralism and Regionalism Essay Example | Topics and Well Written Essays - 5000 words

Multilateralism and Regionalism - Essay Example Most of these regional agreements remained within the concept of free trade areas and most of them were based on a multilateralization of bilateral agreements or unions. The mushrooming of initiatives gave birth too many treaties and institutions of economic integration which still exist, but never were a success, because regional areas were conceived as likelier sites for import-substituting industrialization than small national markets. Few of these regional groupings were successful in furthering freer trade or deeper economic integration between partners. In the developing world regional agreements were seen as a means of reducing dependence on economic ties with the capitalist core region. The theory of comparative advantage, certainly, argues that unobstructed exchange between countries will augment the total amount of world output if every country tends to focus in those goods that it can generate at a comparatively lower cost compared to possible trading partners. Every country then will trade several of those lower-cost goods with other nations for goods that can be formed elsewhere more economically than at home. In the end, with free trade amongst nations, all countries will discover that their consumption potential recline outside their domestic production potential. Comparative advantage and its expansions from a theoretical perspective have not resulted in any considerable weakening of the general strength of this body of theory nor of its consequence, a free trade system. The rationale for free trade is thus quite old. Building his case on the gains from trade to be had from specialization reflecting the division of labor, Smith had the essence of the argument right. But it was left to David Ricardo (building on James Mill) to clinch the case formally. Ricardo used a stripped-down model- only one factor of production with constant productivity of labor in two goods, but with relative productivity between the goods different across two countries-to show that both countries could gain from trade via specialization. The Ricardian analysis implied that this "technical possibility" of gaining from trade would be realized if a policy of free trade were adopted in an institutional setting where prices guided resource allocation. But the analytically satisfactory proofs of trade's benefits that we modern economists demand are the handiwork of theorists working in the twentieth century. David Ricardo armed advocate of free trade with the theorem of comparative advantage. His basic assumption was that every economic value was created by labor (the labor theory of value) and a belief that the three basic factors of production (land, labor, and capital) could not move across national boundaries. Ricardo and other economists, however, were interested in learning what law governs the distribution of national income among the factors production, and what the determinants of international trade patterns are. Heckscher - Ohlin approach The classical Ricardo assumed, literally or in effect, a single factor of production. Obviously, that assumption precluded considerations such as the consequences of varying input proportions and of changes in trade on the distribution

Main functions of GO4IT Sports Essay Example for Free

Main functions of GO4IT Sports Essay * The company has a warehouse which supplies goods to shops as well as to sports teams by mail order * The company sells a wide range of sports goods in it shops this includes clothing, footwear and equipment for sports. * The shops also sell exercise equipment; however these large items are not kept in stock but are ordered from the supplier as required. * The company supplies match strips, to order, in team colours for different sports * The company supplies other team merchandise with team logo; these are supplied through a mail order service. * Sell sports trophies which can be engraved if required. * The company also supplies sports clothing in bulk to schools Different types of customers for GO4IT Sports The companys customers include: * Schools * Sports teams for all sports such as football, rugby, tennis, athletics and golf * General customers * The shops which are supplied by the companys warehouse Describe the functions of each section within the shops and Head Office, paying particular attention to Administration in shops and Human Resources in Head Office Functions of each section within the shops Administration * Each shop has a Branch Manager who has overall responsibility for the running of the shop. * The assistant manager and head of administration section report directly the branch manager. * The staff keeps account of the money taken through the EPOS terminals by comparing money received with EPOS records. * The administration staff produce and send correspondence from the shop as well as receiving correspondence. * Organise for a trophy to be engraved by contacting the local engraver. * Emailing weekly orders for goods to the warehouse * Producing confirmation purchase orders for goods and services * Checking invoices against goods received and work done and passing these to Head Office for payment Clothing sales * The clothing sales section has a clothing sales manager who the clothing sales staff and footwear sales staff report to. * Clothing Sales staff assist customers in choosing appropriate clothing and provide advice for those who wish to purchase clothing * The footwear sales staffs assist customers and provide advice for those who wish to purchase footwear. Equipment sales * The Equipment sales section has an Equipment sales manager. The general sales staff and specialist sales staff report to the Equipment sales manager. * The General sales staff operate the EPOS terminals, they scan the barcodes of every items during purchase and handing of receipts. * The Specialist sales staffs provide assistance and specialist advice and information for customers purchasing more advanced equipment. Functions within the Head Office * The Managing Director of GO4IT sports is responsible for all aspects of the day to day running of the business. The two directors which are: sales marketing director and the finance and administration director report to the managing director Sales and Marketing * The sales and marketing director is responsible for the mail order operation as well as advertising and promoting the business * A buying manager is responsible for locating the goods to be sold and negotiating contracts for their supply. * The buying manager ensures the right volume and type of goods are supplied at the right time to maximise profit. Finance and Administration * The Finance and Administration director is responsible for all other functions within the Head Office. This includes administration, Human Resources(HR) and finance * The Administration assistant, HR executive, chief accountant and ICT support executive report to the Finance and Administration director Finance * Keep records of all financial transactions on the head office server, including the income from sales for each shop and mail order, payments for goods purchased, payments for engraving contractors and staff wages. * Records are used to produce monthly and annual accounts for shareholders and Inland Revenue. * Generate VAT (value added tax) returns once a quarter for customs and excise. * Arrange for the amount due to be paid. Human Resource (HR) The functions of the HR Department are; * Staff recruitment and training * Place advertisements for staff * Send out and receive application forms * Organise interviews and provide contracts for successful applicants * Keeping standard personnel records on a database along with records of training courses attended by members of staff and any qualifications they obtain. * Determine what further training each staff member requires and how best to provide it * Book the member of staff on an external training course/ if many members require training organise for a trainer to deliver the course in house. Task1 Identify different types of supplier to the shops and warehouse and describe relationships between these suppliers and the departments/individuals within the company Warehouse Supplier What is supplied Who orders it How and when it is ordered Wholesaler Clothing and footwear Warehouse manager Order is made by fax once a month but can place special order by telephone if stocks of a particular item falls faster then expected Specialist manufacturers Sports equipment Buying Manager The buying manager negotiates contracts at the beginning of each season either by telephone or visit, for the supply of a certain quantity. Shops Supplier What is supplied Who orders it How and when it is ordered Local Engraver (external Contractor) Engraved Trophy Administration Assistant Administration Assistant telephones local engraver. The engraver collects the trophy from the shop with a confirmation purchase order detailing work the required. Warehouse Clothing and footwear Administration staff Branch manager hands an annotated stock list to Administration staff who e-mails warehouse Task 2 An analysis of the processes for recording sales in a shop and for mail order sales in Head Office. Shop Information Required * Product bar code or numerical code if bar code unreadable * Quantity bought * If sale is to be paid by credit card * If paying by cash the Amount to be tendered From where this is obtained and how it is captured * product code by barcode scanner * numerical code keyed in using a keypad * quantity keyed in by till operator * credit card yes/no keyed in The processing and calculations required * look up item in computer * display item name and price on screen * multiply price by quantity * if on sale, reduce total price by 50% * display total on screen * if credit card = yes, generate credit card receipt for signature The form and content of any output * on-screen / display message * paper till receipt * paper credit card receipt * Contains prices. items, sales items highlighted with words ON SALE, store address, time of sale, till operator name Mail Order in Head Office Information Required * Team details e.g. team name, name and address of contact person, the sport, the colour(s) and design of shirt/vest, position of logo e.g. VTL(vest top left), picture of team logo and team number * Product colour * Product quantity required * Product code * Colour code/ X is entered If a non standard colour * Size and number of colours in logo * Amount of deposit paid From where this is obtained and how it is captured * Team details from completed order form from a mail order brochure entered onto data screen on computer using input devices such as keyboard and mouse * Product colour from completed order form from a mail order brochure entered onto data screen on computer using input devices such as keyboard and mouse * Product quantity required from completed order form from a mail order brochure entered onto data screen on computer using input devices such as keyboard and mouse * Product code from completed order form from a mail order brochure entered onto data screen on computer using input devices such as keyboard and mouse * Colour code/ X is entered If a non standard colour from completed order form from a mail order brochure entered onto data screen on computer using input devices such as keyboard and mouse * Size and number of colours in logo from completed order form from a mail order brochure entered onto data screen on computer using input devices such as keyboard and mouse * Amount of deposit paid from completed order form from a mail order brochure entered onto data screen on computer using input devices such as keyboard and mouse * Team logo captured using a scanner and stand alone computer The processing and calculations required * look up item in computer * display item name and price on screen * Calculate price of embroidery by multiplying number of logos by price * multiply price by quantity * Calculate sub total if less than à ¯Ã‚ ¿Ã‚ ½100, à ¯Ã‚ ¿Ã‚ ½5 is added for postage and packaging * Calculate and add VAT to give total price The form and content of any output * on-screen / display message * Invoice * Contains prices. items, store address, store phone and fax number, date of sale, invoice number, team contact person details, sub total, VAT, total, Less deposit, total due. Task 3 Outlining the current ICT systems used by GO4IT Sports, in particular, Finance within Head Office and Administration within a Shop Administration within a shop * Each shop has a number of Electronic Point of Sales (EPOS) terminals with barcode readers and card readers. * Telephone connection to banking system * Small Local Area Network (LAN) of three computers * Laser Printer * Branch managers computer acts as a server * Dial up modem Software used includes * Word processing * Spreadsheet applications Finance within Head Office * Number of workstations * Local are network (LAN) * Single Server * Fast laser printer * Slower laser printer * Bar code reader * ISND line Software used includes * Word processing * Spreadsheet applications * Database management software * Stock control software Task 3 Analysing the purpose and operation of the main ICT systems used for sales in each shop and the ICT systems using within the warehouse Shops * Each shop has an EPOS terminal with barcode readers and card readers. Stock data is held on dedicated server connected to the EPOS terminals. * There is also a telephone connection to the banking system for authorisation of the card payments. * The barcode reader is used to scan the barcode of each item and the product code it contains is used to look the product description and price from stock database * When items are scanned total price is calculated. This includes the VAT, the system calculates the net value of the items, and all of this is printed on the receipt. * If customer pays by cash, member of staff enters the amount tendered; the EPOS terminal calculates the change due. This is printed on receipt and given to customer * If customer wishes to pay by credit or debit card the member of staff swipes the card through the card reader. The card details are checked by the banking system and if the transaction is approved an authorisation code is transmitted to the EPOS terminal. * The authorisation Code and card details and amount debited are printed on receipt which is handed to customer to sign with card and items purchased. Warehouse * Stand alone computer * Scanner * Computer controlled embroidery machine * Workstation * Laser printer * Stock control software has separate screens for incoming and outgoing goods. * All goods have a product code which is contained in a barcode. When goods arrive in the warehouse the barcode of each product is read and the quantity entered via the keyboard. * This data is used to update stock database. * For every order picked up the staff use the barcode reader to input the product code and the keyboard to enter the quantity removed from stock. These items are deducted from stock database. Task 3 Recommending and explaining improvements/ extensions to shop systems Methods for improving stock control and the re-ordering of stock, as well as integration of systems within GO4IT sports. * A dedicated server could be used instead of the branch managers computer acting as a server, if the branch managers computer crashes then that would leave the other computers stranded without a printer and no access to the internet. * ISDN connection would improve communication giving workers a faster connection to send e-mails internally. Dial up connections are not as reliable and are slower so information being sent will be limited due to connection speed of dial up. * There should be a centralised database put into place. This is where all the companys data is held in one place and the computers in the company are networked. This central database can be used by anyone within the company provided they have been given access through a password. This will be a very resourceful way of storing company data, as it will prevent the problem of data duplication. * Sales based ordering where automatic re-ordering takes place of goods from the warehouse using the sales information from the checkouts. * To increase the efficiency of communication between the supplier and GO4IT sports I would recommend the introduction of EDI (electronic data interchange); the system is similar to email and allows users to exchange invoices, delivery notes, orders and receipts over the telephone network. Security * Log in pages requiring a specific unique user name requiring a private password to track who logs on and off to restrict users Possible problems for suggested improvements * One of the problems that may arise is the finance to cover the costs for the installation of the systems in place. * Also addition of new feature will mean that staff are not familiar with it and training for staff will be required. Benefits of using new technology EDI Advantages * It is much faster, as work does not have to be printed, it is on the screen * The EDI system is easy to use and work can be sent off very easily * Information can be sent to other companies, in less then a few minutes instead of days. * The company can be linked up with their bank, suppliers and customers. * Will minimize the amount of paperwork and business can be transacted much faster and more efficiently then is possible through the normal post. Disadvantages * For EDI, computers are relied on, therefore if the systems go down; it will have a huge of affect on the company. * It is very costly for the installation of EDI * The organization has to research into which system would be best for the company Ecommerce Advantages * Majority of the work of GO4IT sports can be done just through the internet, making it much easier. * This would means a lot less people will have to be employed this will result in huge savings for the company as most transaction will be electronic. * Currently GO4IT sports uses a lot of time to get into contact with suppliers by using the telephone, which can be tedious due to the telephone being engaged; by using e-commerce orders could be automatically electronically sent straight to the suppliers. * Team contacts currently have to post the payment to the company, which is very time consuming and not very secure and with using ecommerce an electronic funds transfer could be made. * Promotion of the company can be improved as it is all online presentation of online advertising can be enhanced. * This will also enable the company to advertise their products online and also allow customers to purchase the products directly from the site using their debit/credit card. They can place the desired items in the virtual shopping trolley. The company can be fully based on the internet, making it easier for the company and also for customers. Disadvantages * A close relationship between the retailer and supplier is required in order for the system to work * Returning products online will prove to be difficult. The customer may be put off when these areas are taken into account. As the customer will question how to send the goods back to their source? Who pays for the return postage? Will the refund be paid? Will I be left with nothing? How long will it take? Compared to offline experience of returning goods to a shop and it is frustrating for the customer. * Privacy, security, payment, identity, contract. Many issues arise privacy of information, security of that information and payment details, whether or not payment details (eg credit card details) will be misused, identity theft, contract, and, whether we have one or not, what laws and legal jurisdiction apply. MIS(management information systems) For the Buying Manager I would recommend the following improvements: * MIS could produce an analysis of patterns of sales in the company * MIS would be able to identify peak production needs * What if type questions could be applied to different patterns of sales The features of the MIS system that could be used by the branch manager are: * Production costs can be based on raw material costs * MIS could be used to carry out analysis automatically * Results could be displayed in graphs which are easy to understand * Monthly graphs could be produced of price comparison with competitors goods or services resulting from regular market research. * Planning, directing, controlling and forecasting decisions. Both managers would benefit from the following points of the MIS system: * Warnings could be set if production costs exceed budget. * Warnings could be set if stocks fall below fixed level.

The Effects Of Electronic Waste Management Environmental Sciences Essay

The Effects Of Electronic Waste Management Environmental Sciences Essay Electronic waste known as E-waste is one of the growing and emerging problem in this world. E-waste consists of many components as toxic substances which have adverse affects on human health and environment if not properly handled. Developing countries have several dumping of e-waste that assumes the importance of management. This concise paper provides EPR legislation to reduce the hazards of E-waste, managing the concerning problems, recycling operations and NGOs participation to combat it. It also focuses on the emerging issues and their strategic solutions. Introduction Waste of electrical and electronic material was considered as cost factor in past. Easiest and cheapest way of disposal was selected to put at the nearest distance. At national level the practices of disposal are not allowed in many courtiers. Waste of the municipal solid consists in electronic and electrical equipments. Waste management has been developed for the all institutions involved in the end of life management of electronic management. Waste of electronics and electrical equipments increases the mass of the toxic inputs into local waste streams. If the volume of the E-waste exceeds to that of processed in manufacturing of products from the mining operations, then no matter it will be an ore located on the globe. On the one hands this E-waste is used as raw material to shape new products while on the other hand it has very harmful potential impacts on the ecosystem. An analyst looks the end of life processes as well as the chain values that are sorting, logistics and collecti on strategies. Many strategies were taken in hands for the treatments of this E-waste like incineration and landfill. Previously the reuse, recycling and remanufacturing of the E-waste is strongly recommended to reduce the volume of these E-waste. Recycling is also emphasized that is linked with the improper disposal of materials. The loop of the industrial waste can be closed by recycling of these waste materials as to sustain the economy of that particular industry. In industrialized countries recycling has become a common practice in the end of life processes. Recycling strategies also differ in yielding the standard quality products. Several features are taken into account to recycle the E-waste for useful purposes. An important feature of recycling process is to handle the situations arising during processes as handling of hazards materials, safety and health care of workers, rates of recycling and levels of recycled material. It is observed that a long scale progress of recycl ing of E-waste is achieved in industrialized countries like U.S, Asia and Europe. Extended producer responsibility is a main policy to tackle this kind of issue. EPR plays main role for the producers to incorporate the end of life facets to design new products. It is important to provide the necessary incentives to all those involved in making the regulatory policies. This can be supported by the study of two Norwegian scientists those who revealed the crucial role of regulatory policies. They put the facts of their survey and survey participants answered that main green technological changes occur from the environmental regulations in EU. Fig 1: Showing the main driving forces for green technology changes EPR feasibility has been shown in Asia and Europe. At earlier stages of infancy in last decade E-waste started in Switzerland in 1992 and it became widespread in other countries due to pressure of environmental authorities. Environmental Effects of E-waste E-waste has many toxic substances which are dangerous at high level if not handled properly. Why are these risks and dangers produced? These are the concerning issues and need the attention of analysts and industrialists to minimize the dangers. On the industrialist end the equipments and feasible machinery is not provided to workers at workplace. There are concerns of workers that their analysts do not guide them in proper way to recycle the E-waste and complete the disposal processes. Serious repercussions arise due to proximity to those places where E-waste materials are recycled or burnt. Grey goods have very toxic chemicals as compared to white and brown goods. For example a computer has very toxic chemicals like mercury, beryllium, cadmium, PVC and Phosphorous compounds. Central nervous system, Reproductive system and Urinary system are badly affected by the lead absorption in human body. Mercury also affects the CNS, Reproductive system and Urinary system of humans. If it is m ixed in water used for living animals and on transportation of the water into water living animals can become the cause of death of those animals. Cadmium and Poly cyclic aromatic hydrocarbons affect the human body organs specially kidneys, lungs, skin and bladder respectively. E-waste has caused serious consequences to environment and human health. For example location near to recycling and burnt places of e-waste has many components of e-waste which directly affect the living of that area. When recycling plants are installed near rivers, it is found that river water is contaminated by the e-waste components and water livings are badly harmed by these e-waste materials. Extended Producer Responsibility EPR is a new tool of market and focuses on the background and responsibility of the producer. WEEE recycling regulation after the necessary analysis and evaluation of EPR with new approaches is provided. Question arise that why we need the regulatory action. E-waste is a big challenge in 21st century. Initial study of industrial ecology reveals that cycle economy is the big source to make contribution to sustainable development of economy. The growth in new electronic products needs new large resources and E-waste is increasing the inputs into local stream flows. We address the two basic needs of the closing the material loops and treatment of the hazards materials. These features are addressed by applying the regulatory actions. An analysis of existing economic or market incentives is required in order to come to a conclusion where regulations necessary and where market forces already achieve favorable results (Costanza et al. 1997). As the growth rate of the new products increase we require to recycle the E-waste with the same extent as shown in the figure. Volume of E-waste New Product Fig 2: Showing the proportionality between Volume of E-waste and New E products To answer the issues concerning the new product growth and recycling of E-waste EPR is new technology with better results in marketplace. à ¢Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒâ€¦Ã¢â‚¬Å"An environmental protection strategy to reach an environmental objective of a decreased total environmental impact from a product, by making the manufacturer of the product responsible for the entire life-cycle of the product and especially for the take-back, recycling and final disposal of the product.à ¢Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ã‚  (Lindquist et al. 1990). EPR is considered as an approach to take the E-waste to industries for the purpose of re-engineering of the material to improve the mechanism of processes and products. Goals of the EPR: Major contribution of EPR is in environment and industrial zone. Hazardous materials are treated appropriately to reflect sound E-waste hazardous components to be disposed to provide the safety and health standards to workers. Closing of material loops is possible by recycling of E-waste which is base on the rate of recycling and material reapplication levels. The environment must meet the reward design including the avoidance of hazardous material and materials to be cycled optimized in general design. In economic goals it is ensured that fair allocation of burdens for the stakeholders and producers must count all the economic areas. Always keep in mind to avoid financial burdens which are not supporting the environmental cause. The EPR must be clear, transparent and feasible in controlling the monitoring of the systems. The EPR policies must be implemented in order to amend the incentives to create the favorable consequences for the system. We have studied the EPR importance to achieve the specified goals. Now we have to evaluate and make analysis of EPR policies. The evaluation process of EPR policies for the achievement of goals is dependent on both qualitative and quantitative analysis. It is observed that environmental effectiveness through the implementation of the regulatory policies does not yield required results until it is not controlled in a viable way. It is estimated that incentives to collect the E-waste and recycling is totally according to the EPR or take the alternative approaches to complete the process like collection and recycling. There are many practical problems which are related to EPR. For example it becomes difficult to allocate actual cost of recovery after a decade. Many products are so comprehensive for their disposal that increases the global market. The product is chan ged in many hands and it becomes difficult to decide that when and where the end of life stage is reached. It is not clear that who is responsible for the collection and recovery of the product when product is exported in other countries. What stands out most is that, even when practical problems are solved, doubts remain about the effectiveness of EPR in its current form because it mainly leads to global low-quality solutions. Alternatively, the application of high-level recovery in many cases reduces the eco-footprint through substitution. (Hischler, 2005). EPR in current form has many impacts on the E-waste flows and it has promoted many low level recycling processes. Therefore high rate of recovery for which a local industry is optimal is set to achieve in less budget. Industries following theses approaches may benefit their owners and countries where they are installed. Governments are the responsible to provide the legal and financial incentives to promote the business. It is now required to present the estimates of the production, recycled and import export. Region/country Production in million tons per year Land filling storage in million tons Recycling in million tons Export in million tons per/year Import in million tons per/year EU-25 7 1.5 3.43 1.9 USA 6.6 5.1 0.12 1.4 China 3.2 3.7 1.5 - 2.10 Japan 3.1 0.5 1.84 0.63 - West Africa 0.06 0.44 0.18 054 India 0.35 0.84 0.35 - 0.85 Total 20.31 12.08 5.85 3.76 3.49 Table 1: Global E-waste production, disposal, recycling and import/export estimates in 2005 This data in table tell us about the emerging powers of the world in industrial zone. Many other countries like Canada and South America continent are not included in it. In Europe alone the production is 7 million tons per year. China has made rapid progress in production as it equals its production to Japan. China is the second country in land filling after the USA and E-waste recycling is in largest volume in EU followed by Japan. All of above discussion finds the lack of the awareness of our citizens about E-waste and EPR. The E-waste management depends upon the active role of local or city governments and attitudes of the citizens. Producers, stakeholders and consumers also play role to shape the development. It will be very disappointing to keep the citizens away from the management deeds to take benefits of EPR policy. It hardly required involving the common people in process of recycling of electronic goods. Consumers must be informed about the goods by labeling the consumerà ¢Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒ ¢Ã¢â‚¬Å¾Ã‚ ¢s requirements for those items. Consumers are educated to use only those products which utilize the modern emerging technologies. For example halogen free, lead free and from the authenticated retailers or manufacturers. Different training programs for the training of the citizen must be arranged to make them aware of the impacts of the E-waste and on their health and possible ways to minimize its haza rdous affects. Due to these training programs our consumers are able to purchase the environmental friendly products and maintain the environmental operational processes of the products via careful disposal. On the hand suppliers provide only those items to manufacturers which are containing the friendly components in materials. Manufacturers can reduce the impacts of their products by making a compatible design products, raw material choices and manufacturing and delivery processes. To get rd of free riders check and balance of system must be ensured. Economic Viability: The EPR policy has given us knowledge to boost up the economy of that particular manufacture ring company by recycling process of E-waste. It can be achieved by direct reuse of the E-waste. The processes of the parts cannibalization and remanufacturing do a lot for the owner of the company. Main advantage of these processes is shown as it recovers more value than just materials. The value of the discarded products is used when the equipments and parts are left mostly in their original forms. The price of the product includes the administrative labor and logistic charges. In this way 90% of the total original cost is recuperated. New labor is cheaper to the costs of the collecting, disassembling cleaning, repainting and controlling of E-waste material. However this remanufacturing process takes less work and yields high level recovery as compared to start new product from scratch. Remanufacturing can be as efficient as virgin production and assembly, if not better. Practice proves that even cheap (à ¢Ãƒ ¢Ã¢â€š ¬Ã… ¡Ã‚ ¬15/piece) and somewhat complicated electrical motors can be refurbished and adapted for 50% of the new price (Comperen, 2006). Parts manufacturing with less work and high value, this condition is more advantageous. If other cost of disassembling is kept low then reuse is very profitable for many companies. Ecological Viability: The high level closed loop recovery is also environmental friendly as we have studied in our discussion. There is clear evidence from the studies mentioned that high-level closed-loop recovery is also more environmentally-friendly then most present practices as energy efficiency improves compared to virgin production (Krikke Zuidwijk, 2008; Hischler 2005). It is seen that process of remanufacturing reduces the much resource consumption. The main advantage of this process is that much of energy is saved that cut the amount of CO2 emissions. It is also observed that remanufacturing of goods requires only 15% energy as compare to manufacture new product from scratch. There are many environmental indicators as water use, land filling and CO2 emissions. As the number of the indicators increases it becomes difficult to handle the data and it creates serious concerns of closed loop supply chain for management and others. In this paper we have discussed the E-waste materials and its hazardous effects on human. The impacts of the regulatory policies on economic and environmental are significant. These both aspects combine together to allow the resultant analysis of the regulatory policies and their developments. This EPR tests the already existing economic incentives in a system. These regulations must amend the structures in a way that favors the main player of that system to achieve the set goals. The recycling process must be in control according to the regulatory policies. Drafting of the regulations ask all the participants to shape it in a style to get maximum benefits from the reuse and avoid the hazardous affects of the toxic materials. It is essential for the EPR that it is defined in a way to establish an effective management framework in that particular region. In this paper we have focused on the possible consequences that may arise due to E-waste materials. What amount of electronic produc ts is produced in many developed countries of the world? It has provided us to find the facts behind the E-waste material. The recycling and reuse of the E-waste is briefly discussed in this paper. EPR makes its lot of contribution in our whole studies. It has given the answers of our basic questions concerning to its impacts on economy and environments. Environmental regulations are the driving force in Europe as estimated in survey conducted to bring the green technology changes.

Nerve And Tendon Gliding Exercises Health And Social Care Essay

Nerve And Tendon Gliding Exercises Health And Social Care Essay Carpal Tunnel Syndrome was first described by Sir James Paget in 1854 but the term was coined by Moeirisch. It is a syndrome of compression neuropathy of median nerve at the wrist. Carpal Tunnel Syndrome results in considerable discomfort and pain, limitation of activities of daily living, loss of sleep and work disability. (Levine et al., 1993). Twenty percent of symptomatic subjects with symptoms of pain, numbness, nocturnal parasthesia and tingling sensation in the hand would be expected to have Carpal tunnel syndrome based on the clinical examination and electro physiologic testing. CARPAL TUNNEL SYNDROME IN PREGNANCY Carpal tunnel Syndrome is more frequent in pregnancy because the systemic process increases the extra capsular fluid retention by the hormone Prolactin and produce soft tissue swelling in the later stages (third trimester) of their pregnancies. The Carpal Tunnel Syndrome can thus be produced by compression or swelling of the median nerve in its synovial sheath (Gelberman et al., 1981; Snell, 2000; Szabo, 1989; Primal Pictures, 2001; Rempel et al., 1999). Many therapies have been advocated for treating the carpal tunnel syndrome including Mobilizations, nerve gliding, tendon gliding, etc. Therefore the presence study was focused on the Effect of Nerve and Tendon gliding Exercises in the functional recovery of the carpal tunnel syndrome during pregnancy. Tendon gliding Exercises were mostly performed at the end range of motion at small amplitude are performed at the limit of available motion and stressed into the tissue resistance. These exercises are thought to relieve pressure on the median nerve and stretch the carpal ligaments, which also helps decrease pressure. They are also thought to help blood flow out of the carpal tunnel, which can help decrease fluid pressure. INCLUSIVE CRITERIA Pregnant Women with pain and swelling in the wrist for at least 1 month. Pregnant women with both unilateral and bilateral carpal tunnel syndrome. Pregnant women with age group between 25years and 32years. EXCLUSIVE CRITERIA Non-pregnant women with carpal tunnel syndrome. Pregnant women having other complications like hypothyroidism, diabetes that may lead to carpal tunnel syndrome. Any other trauma related injuries in hand. Males. MATERIALS AND METHODS Nerve and Tendon Gliding Exercises. Functional Status Scale for measuring functional activity. HYPOTHESIS Nerve and Tendon Gliding Exercise programme will be effective in the treatment of carpal tunnel syndrome during pregnancy. NULL HYPOTHESIS There may not be any significance between the nerve and tendon gliding exercise programme and carpal tunnel syndrome during pregnancy. OBJECTIVES The aim of this study is to determine from the available evidence the effectiveness of Nerve and Tendon gliding exercises programme in carpal tunnel syndrome during pregnancy using Functional Status Scale for performance and Symptom Severity Scale for wrist pain. STUDY DESIGN A total of 20 patients having carpal tunnel syndrome during pregnancy are selected to find out the effectiveness of nerve and tendon gliding exercises on them. The duration of study per patient 4 weeks Treatment session 10 minutes per session / 2settings Treatment per week 7 days DURATION OF STUDY: 6 months OUTCOME Relief of pain and swelling in hand. An improvement in the functional ability of hand. Awareness is created for the working pregnant women especially with computers, typewriters, cake decorators, postal workers, dentists, and dental technicians virtually, who use their hands and wrists repetitively. Avoiding the severity of median nerve injury, which may lead to claw hand if unnoticed. INTRODUCTION Sir James Paget first described carpal Tunnel Syndrome in 1854 but Moeirisch coined the term. It is a syndrome of compression neuropathy of median nerve at the wrist. INTRODUCTION: Carpal Tunnel Syndrome results in considerable discomfort and pain, limitation of activities of daily living, loss of sleep and work disability. (Levine et al., 1993). The Carpal Tunnels floor is made up of the 8 tiny wrist bones. Its roof is a thick ligament called the transverse carpal ligament. 9 tendons pass through this tunnel. 4 of the 9 tendons bend the tips of the finger, another 4 of the 9 tendons bend the middle joints of the finger, and the 9th tendon bends the thumb tip. The median nerve passes through this tunnel. When there is swelling or if there is thickening of the ligament the nerve gets pinched or compresses. With enough compression carpal tunnel symptoms occur. If the compression is severe or occurs over a longer period of time the nerve may change shape and flatten causing some permanent damage. Carpal Tunnel Syndrome occurs due to many causes like Wrist injury CARPAL TUNNEL SYNDROME IN PREGNANCY Carpal tunnel Syndrome (CTS) is more frequent in pregnancy because the systemic process increases the extra capsular fluid retention by the hormone Prolactin and produce soft tissue swelling in the later stages (third trimester) of their pregnancies. The Carpal Tunnel Syndrome can thus be produced by compression or swelling of the median nerve in its synovial sheath (Gelberman et al., 1981; Snell, 2000; Szabo, 1989; Primal Pictures, 2001; Rempel et al., 1999). CTS have been recognized as a common complication of pregnancy (HeckmanSassard, 1994). The pathophysiology of pregnancy related CTS (PRCTS) has been mostly attributed to redistribution of fluids (Ekman-Ordeberg et al., 1987; Wand, 1990; Pauda et al.,2001). Signs And Symptoms 1.Pain that shoots from the hand up the arm as far as the shoulder. 2.Tingling in the hands during the day or the night that disrupts sleep and limits the ability to grasp objects with the hands. 3.Weak feeling in the hands, and the inability to pick up small objects. 4. The feeling that the hands are swollen, even if they do not appear to be so. 5.Burning numbness and tingling sensation in the thumb and first three fingers. 6.Weakness in the muscle at the base of the thumb, near the palm. Motor weakness will be seen in abductor pollicis brevis, flexor polices brevis and opponens policis brevis. Passive flexion or hyperextension of the affected hand at the wrist for more than one minute may worsaen symptoms.(Phalen.G.S.,1966). Percussion of the median nerve at the wrist causes paresthesis of the digits (Steward.J.D.,1978). Early Treatment 1.Splinting the wrist in a neutral position. 2.Avoiding the activities which causes pain if possible 3.Tendon and nerve gliding exercises. 4.Massaging 5.Elevating the arm or flicking 6.Neural mobilization 7.Ultrasound, icing, as pain relieving modality etc. Non operative treatment s is more effective in early stageas such as NSAIDS and local corticosteroids injections.If the probl;em is severe surgery is made to release the carpal tunnel. Diagnostic criteria Harrington etal suggested surveillance criteria for carpal tunnel syndrome should be pain or parasthesia or sensory losss in the median nerve distribution and one of the following: Tinels sign positive Phalens test positive Nocturnal exacerbation of symptoms Motor loss with wasting of the abductor pollicis brevis Abnormal nerve conduction studies. Nocturnal and exertonal dyesthesias in the radial half of the palm occur in 10% to 25% of pregnant women. When the carpal tunnel syndrome occurs, the symptoms area more often bilateral. Onset of symptoms is typical during the third trimester. Because of itas trnsient nature carpal tunnel syndrome during pregnancy is best treated by using conservative measures, such as tendon and nerve gliding exercises. That subsequent pregnanciesaraae frequently associated with repeated episodes of carpal tunnel syndrome confirms the association of carpal tunnel syndrome and pregnancy. Gliding Exercises Tendon gliding and median nerve-gliding exercises are two types of exercises that may help with carpal tunnel syndrome. These exercises are thought to relieve pressure on the median nerve and stretch the carpal ligaments, which also helps decrease pressure. They are aolso thought to help blood fow out of the carpal tunnel, which can help decrease fluid pressure. Fist Flexion Exercises Fist Flexion Exercises(also known as tendon gliding exercises) move your fingers through five positions while your wrist stays in a neutral position(meaning it is not bend). To perform this exercise, do the following: 1.Start with your fingers straight. 2.Make a hook fist and then return to a straight hand. 3.Make a straight fist and then return to a straight hand. 4.Make a full fist andthen return to a straight hand. Hold each positons for seven seconds amd do 10 repetitions. Repeat three times to five timeas a day. Median Nerve Gliding Exercises For median nerve gliding exercises ou move yout thumb through 6 positi0nswhile your wrist stays a neutral position. To perform this exercise, do the following: 1.Begin by making a fist with your wrisat in the neutral position. 2.Straigthen your fingers anad thumb. 3.Bend your wrist back and move your thumb away from your palm 4.Turn your wrist palm up 5.Use your other hand to gently pull uyout thumb farther away from your palm. Hold each position for seven seconds, and do five repetitions. Repeat three ti five times a day. Effectiveness of the Tendon and nerve gliding exercises used as conservative treatment approachesd in relieving the symptoms of the carpal tunnel syndrome during pregnancy.(Lamia Pinar, Asgel Enhos et al.,) Definition Carpal tunnel syndrome is a condition caused by compression of median nerve within the carpal tunnel leads to sensory changesover the lateral side of the hand and muscle weakness in thenar eminence, results in pain, numbness and tingling of fingers. It usually occurs in the third trimester of pregnancy. Aim of Study A STUDY OF EFFECTIVENESS OF NERVE AND TENDON GLIDING EXERCISES AS TREATMENT APPROACH TO CARPAL TUNNEL SYNDROME DURING PREGNANCY. OBJECTIVES The aim of this study is to determine from the available evidence the effectiveness of Nerve and Tendon gliding exercises programme in carpal tunnel syndrome during pregnancy using Functional Status Scale for performance and Visual Analogue scale for wrist pain. HYPOTHESIS NULL HYPOTHESIS There may not be no significance between the nerve and tendon gliding exercise programme and carpal tunnel syndrome during pregnancy. Alternate Hypothesis Nerve and Tendon Gliding Exercise programme will be effective in the treatment of carpal tunnel syndrome during pregnancy. Review of literature 1.Lamia Pinar, Asgel Enhos et.al Conducted an experiment study on total of 26 patients with caroal tunnel syndrome were divided into two groups. In one group the volar splint were applied and trained to modify their functional activities in accordance witrh conservative treatment. In group two tendon gliding exercises were continued for 4 weeks with numeric rating scale and Gonuiometry. It comcluded that group two reported excellent results in pain reduction and functional improvement than gropup one. 2.Akaline.E.,et.al.,(2002) Conducted an experimental study on carpal tunnel syndrome with a total of 28 patients with 36 hands of CTS, which were divided into two groups, with 14 patients each. One group was treated with nerve and tendon gliding exercises along with custom made neutral volar splint, and another group was treataed with only neutral volar splint for 4 weeks continuously. Patientas satisfaction was invesatigated during the follow up ranging from 5-11 month, with a mean of 8 month. The study explained that, of those patients who performed nerve and tendon gliding exercise with wearing custom made neutral volar splint, 93% reported good results, and of those patients who have only wearing neutral volar splint, 72% reported good results. American Journal of Physical Medicine Rehabilitation, 2002, Feb;81(2), Pp:108-13). 3.Rosemaryn .L.M., et.al.,(1998) Conducted an experimental study on carpal tunnel syndrome with 240 hands, from 197 patients. They were divided into two groups. Patients in both groups were treated with standard conservative methods, and those in one group were also treated with a program of nerve and tendon gliding exercise of those who did not perform the nerve and tendon gliding exercise, 71.2% underwent surgery compared with only 43.0% of patients who did perform them. Patient in experimental group, who did not undergo surgery were interviewed at an average follow-up time of 23 months (range, 14-38 months), of these 53 patients, 47(89%) responded to this detailed interview of those 47, who responded, 70.2% reported good or excellent results, 19.2% remained symptomatic, and 10.6% were non-complaint.(Journal of Hand Therapy, 1998, Jul-Sep:11(3),171-9). 4.Dakowick.A.,(2005) the purpose of the study was to evaluate the usefulness in conservative treatment of carpal tunnel syndrome. 40 Patients aged 30-72 years, with unilateral CTS cofirmed by EMG examination were included. The patients were divided into 3 groups based on clinical symptoms according to Whitley. The character of pain, its frequency and intensity (VAS Scale) were determined using parameter. Decrease in pain was observed by the usae of VAS. (Rock Akad Med Bialmyst, 2005:50-suppi:196-8). 5.Bonebrake.A.R.,et.al.,(1990) the study was designed to assess the efficacy of a proposed new and unique programme relative to treatment. The patients diagnosed as CTS were compared to control to a control population showing no symptoms. Prior to undergoing treatment and following completion of the treatment programme. Results indicate that individuals with CTS had significantly lower values in strength, ROM, and slower task performance than did the control;ratings of pain anad distress were also significantly higher than the control groups. Analysis of the post treatmaent cases revealed statistically significant improvements in several measures of up to statistically significant improvements in several measure of up to 25% over post treatment values. Significant improvement was also shown to several ROM measures of upto 22%. Finally, a significant reduction of 15% pain and distress ratings was demonstrated in the post treatment cases. (Journal of Manipulative Physical Therapy, 1994 (May);17(4):246-249). 6.Scrimsha.S.R.,et.al.,(2001) Conducted a comparative study between the responsiveness of Visual analogue scale and McGill pain questionnaire. Measures in 75% patients and concluded that the VAS was a better tool than the McGill pain questionnaire for measuring pain in clinical practise. 7.O.Baysal, Z.Altay et.al Conducted a study in 28 female patient with clinical and electrophysiologic evidence of bilateral carapal tunnel syndrome. They were divided into two groups. Group 1 received tendon gliding exercise with splinting. Group 2 received splinting with ultrasound for a period of 4 weeks with Visual analogue scale and Functional status scale. 8.Bringer TL.,Roger IC et.al conducted a randomized trial in totoal of 61 patients with carpal tunnel syndrome. They were divided into four groups. Group 1 received neutral wrist and MCP exercise group. Group 2 received neutral wrist MCP exercise along with splint. Group 3 received wrist cock-up exercise and Group 4 received wrist cock-up exercise and tendon gliding exercise along with splintas perfoarmed 3 times a day. The tool used to asses the function is functional Status Scale and Symptom Severity Scale. There was significant effect in Group4. 9. Sonodyn, Sieman(2000) Conducted an experiment on study of 16 patients. They was treataed with Ultrasound for a period of 4 weeks and the pain was assessed. In this, 88% reported good reasult and reduction pain was assessed by using Visual Analogue Scale. 10. Davis.P.T.,et. al., (1998) Conducted an experimental study to compare the efficiency of conservative management care with chiropractic care in treatment of carpal tunnel syndrome. The group with 9 week of treatment and a 1 month follow-up interview. 96 eligible patients with symptoms were conformend by clinical exam and nerve conduction studies. Conservative treamtment included mobilization of carpal bone, soft tissues, joints (three treatment per week for 2 wee, two treatment per week for 3 week, and one treatment per week for 4 wek). Main outcomes measures were pre and post assessment of self reported physical and mental distress, nerve-conduction studies, results show that there was significant improvement in perceived function and comfort, neve conductuion and finger sensation. (Journal of Manipulative Physiotherapy, 1999 June;22(55);348-9) 11. FD Burke, J Ellis, H McKenna, M J Bradley(2003) Carpal Tunnel syndrome of mild to moderate severity can often be effectively treated in a primary care environment. Work space modifications wrist splints tendon and nerve gliding exercises are of benefit and useful for symptomatic women in the third trimester of pregnancy. 12.Shaafi Sh*, Naimain Sh*, Iromlou H*, Sayyah Melli M** A convenience sample of 90 pregnant women (30 women from each trimester) were referred from Al-Zahra Hospital of the electrodiagnostic ward of examined clinically and then by electroneurodiagnostic tests.There were suspected symptoms of CTS in 45 patients. The most frequent symptom and sign were hands paresthesia(34%) and positive tinel and phalen sign(each22%). CTS was definite diagnosis in 15 women(16.6%) by electroneurodiagnostic studies. Mild bilateral involvement was seen in 73.3% of patients. There was a meaningful relationship between CTAS and trimester that 26.6% of patients were at third trimester. Also there was a meaningful relation to age. The CTS was more frequent in ilder women. 13.BaumannF, Karlikaya G, Yuksel G, Citci B, Kose G, Tireli H(2007) Pregnant women in the third trimesater (n=69) and age-matched non-pregnant women (n=40) asymptomatic for CTS were included in the studyNerve conductn studies of themedian and the ulnar nerves across the carpal tunnel were bilaterally performed with the standard techniques. All the median sensory nerve conduction studies performed from the ring finger and palmar region to the wrist. Median sensory nerve latencies from palmar branches to wrist were significantly longer in the pregnant group.(p 14. OConner.D.,et.al.,(2002) Conducted an experimental study to evaluate the effectiveness of non surgical treatment for carpal tunnel syndrome versus a placebo or other non-surgical control interventions in improving clinical outcome. Twenty ine trials involving 884 people were included. In one trial involving 21 people carpal bone mobilization significantly improved symptoms after three weeks, (weighted mean difference is -1.43;95% confidence interval is 2.19 to -0.67), compared to no treamtment. Current evidence shows significant short term bebefit from carpal bone mobilization. (Cochrane Databasae syst Rev.2003;(1):CD003219). MATERIALS AND METHODOLOGY MATERIALS AND METHODOLOGY FULL PAGE MATERIALS AND METHODOLOGY MATERIALS USED Couch Chair Pillow Foot stool VAS SCALE FUNCTIONAL STATUS SCALE METHODOLOGY STUDY DESIGN Quasi experimental study with Pre Vs.Post test design. STUDY SAMPLING The 10 samplings were selected from Retna Global Hospital, Trichy and Thanthai Roever College of Physiotherapy, perambalur. A total number of 10 subjects were diagnosed as symptomatic Carpal Tunnel syndrome during pregnancy at age group of years was selected by Quasi-experimental purposive random sampling method after giving due consideration to inclusion and exclusion criteria. STUDY SETTING The study was conducted at Outpatient Physiotherapy Department in Thanthai Roever College of Phsiotherapy, Perambalur, Rathna Global Hospital, EMG Laboratory in PG Studies under the supervision of concerned authority. STUDY DURATION The study was conducted for a period of 4 weeks. INCLUSION CRITERIA Pregnant women with pain and swelling in the wrist for 1 month. Both unilateral and bilateral involvement. Age 25 years and 32 years. EXCLUSIVE CRITERIA Non pregnant women with carpal tunnel syndrome. Pregnant women having other complications like hypothyroidism, diabetes which may lead to carpal tunnel syndrome. Any other trauma related injuries. Abnormal X-Ray of the wrist. Males. Gained surgical of symptoms. History of steroid injection into the carpal tunnel. PARAMETER A.VISUAL ANALOGUE SCALE(VAS) The VAS Scale is the valid and reliable measurement tool for pain.It is used to measure the pain response that the patient experience before and after nerve and tendon gliding exercises of median nerve. VAS Scale consists of 10cm horizontal line with two ends labeled as no pain(0) and severe pain(10), the patient will mark a point on the line, which corresponds to the intensity of pain what theyexperience. B.FUNCTIONAL STATAUS SCALE(FSS) Functional Status Scale was used to measure the functional disability offhand. It consists of six items of questionnaire (writing, buttoning of clothes, holding a book while reading, household, carrying grocery bags, bathing and dressing). SCORING 06-12 -No difficulty 13-18 -Mild difficulty 19-24 -Moderate difficulty 25-29 -cannot do at all due to hand or wrist symptoms. PROCEDURE A total of 10 subjects with symptomatic carpal tunnel syndrome during pregnancy was selected randomly with due consideration to inclusion an exclusion criteria A brief demonstration was given about tendon and nerve gliding techniques for the patient. Pre test data and post taest data was collected with VAS and FSS Scale. The results were recorded. The subjects weare given nerve and tendon gliding exercises. The results of post test of the same parameter was recorded and compared. Statistical tools The statistical tool used in this study were paired t-test. PAIRED T-TEST à ¢Ã‹â€ Ã¢â‚¬Ëœt-test was used to find out the statistical significance between Pre and Post test values of tendon and nerve gliding exercises and VAS pain response and FSS Scale response before and after treatment. FORMULA: PAIRED T-TEST S= à ¢Ã‹â€ Ã¢â‚¬Ëœdà ¢Ã‚ Ã‚ ¿ d =Difference between the Pre Test Vs post Test _ d= Mean difference n=Total number of subjects S=Standard deviation DATA PRESENTATION DATA PRESENTATION TABLE-1 S.No Visual Analogue scale Pre Test Post Test Functional Status Scale Pre Test Post Test 1. 8 4 27 16 2. 7 3 27 12 3. 8 5 26 15 4. 9 4 29 13 5. 7 2 25 15 6. 8 4 25 12 7. 9 3 28 16 8. 7 4 28 16 9. 8 2 27 17 10. 8 3 28 14 DATA ANALYSIS AND INTERPRETATION DATA ANALYSIS AND INTERPRETATION This chapter deals with the analysis and interpretation of the Datas collected from 10 patients with carpal tunnel syndrome during pregnancy and the effect of nerve and tendon gliding exercises aas a treatment approach to carpal tunnel syndrome during pregnancy by comparing the VAS Scale for pain response and FSS for functional ability. TABLE II The table II shows the mean value, mean diference, standard deviation and paired t value between pre and post test value of Visual Analogue Scale for patientas whao have been subjected to tendon anad nerve gliding exercises. VAS Mean Mean difference Standard deviation Paired t value Pre test Post test 7.9 3.4 4.5 1.07 13.28 It explains the paired t value of pre and post test value was 13.28 at 0.05 level of significance which was greate than the tabulated t value 2.26. This showed that there was a statistical significant difference between pre versus post test. The pre test mean was 7.9 the post test mean waas3.4 and the difference was 4.5 which showed that there was a reduction in Visual Analogue Scale score in post test values in which the recovery of selected samples in response to intervention. THEREFORE THE STUDY IS REJECTING THE NULL HYPOTHESIS AND ACCEPTING THE ALTERNATE HYPOTHESIS. Graph Visual analogue scale: Pretest VS Post test Series1: Pretest Series2: Posttest Functional Status Scale: Pre test Vs Post Test Series1: Pretest Series2: Posttest TABLE III Table III representas the mean values,mean difference, standard deviation and paired t value of Functional Status Scale who have been subjected to tendon and nerve gliding exercises. FSS Score Mean Mean difference Standard deviation Paired t value Pre test Post test 27.1 14.6 12.5 2.22 17.7 It explains the paired t value of pre versus post sessions awas 17.7 at 0.05 level of significance which was greater than the tabulated t value 2.26. this showed that there was a statistical significant difference between the pre and post test resultas. The pr tesat ment was 27.1, the post test ment was 14.6,and the difference was 12.5 which showed that there was a reduction in functional status scale score in post test values in which recovery of the selected samples in response to intervention. Thrrefore the study is rejecting the null hypothesis and accepting the alternate hypothesis. Graph DISCUSSION DISCUSSION The aim of the study was to determine the effect of tendon and nerve gliding excercises in reducing the pain and improving the functional ability of hand in patient with carpal tunnel syndrome during pregnancy. Carpal tunnel syndrome is most common and significant of all nerve entrapment syndromes (Phalen.G.S. 1972). It causes 20% of all compression syndromes especially in the third trimester of pregnancies. A total number of 10 subjects of age group of 25-32 years were selected for the study. Visual Analogue Scale for pain and Functional Status Scale for functional ability were taken as parameters to measure the affliction of patients. Pre test data has collected for the subjects and computed. They were subjected to tendon and nerve gliding exercises for 4 weeks. The result of post teat of same parameter was recorded for comparison after 4 weeks of treatment. The paired t test was used to compare the pre VS post test results of subjects. Caarpal tunnel syndrome is a common condition among people who do repetitive wrk all day lke punching keys on computer or cash register or even pressing on the strings of a violin. Pregnant women are also susceptible to carpal tunnel syndrome even if they do not type or play msic all day. The studies have shown that one out of four pregnant women complains of the syndrome usually in the second or third trimester of pregnancy when fluid retention in the aarms and hands is more likely to put pressure on the nerve that leads to the hands anad fingers. The nervous system is normally under some pressure and tension. If the tension is breaked there results some movement(Millesi.et.al.1972). Dackowicz . A.,, conducted an study to evaluate the usefulness in conservative treatment of the carpal tunnel syndrome. According to Butler neural tissue requires movement to promote healing and restoration of optimum mechanical properties.Decreased neural mobility and adverse mechanical tension in nervous system can generate pain.(Butler and Elvey 1978). Mchellan and Swash in 1976 noted that wrist and fingers extensor wil move the median nerve at wrist 2 or 4 times more than the middle of the upper arm. According to Asgel Enhos tendon requires movement to promote functional ability. Rosmaryn and Asgel Enhos said that the decreased tendon gliding in nervous system can generate pain. Rosmaryn proposed that radicular pain might be mobilizing the involved nerve. The mechanical respose is tendon movement in the cross sectional shape and viscoelastic function. So the treatment of tendon Gliding Exercise mah normalize the pressure gradient around the nervous system and releases the tendon thus reducing pain improving functional ability. Summary Summary The objective of the study was to determine from the available evidence the effectiveness of tendon and nerve gliding exercises programmed in reducing pain and of increasing the functional ability in the carpal tunnel syndrome during pregnancy. To conduct the study, the total number of 10 carpal tunnel pataients during pregnancy with both unilateral and bilateral involvement at the age group 25 to 32 years, who were suitable for inclusive criteria was selected by Quasi experimental purposive random sampling technique and informed consents were obtained from subjects individually. The pre and post test of VAS and FSS were conducted and recorded before and after treatment programmed for 4 weeks of nerve and tendon gliding exercises inmcarpal tunnel syndrome during pregnancy. The paired t test is used to compare the pre and post test values of nerve anad tendon gliding exercises and the pain and functional ability are computed by the VAS and FSS Scale. In the analysis and interpretation of the data based on the Visual Analogue Scale for pain the paired t- test value (13.28), which was greater than the tabulated paired t test val