Differences Between Chinese And German Employment Systems

Differences Between Chinese And German Employment Systems Employment systems are complex structures of productive and reproductive activities, various payment schemes, and different working time arrangements (Christiansen, Koistinen, Kovalainen, 1999, p 1). They can be shaped by societal structures, national cultures, social welfare systems, educational and vocational training systems (Christiansen, et al., 1999). This argument successfully explains why there are so many different employment systems globally. In addition to the structural and cultural differences, globalisation, technological innovation and workforce aging also have resulted in tremendous changes in the social and economic context (Christiansen, et al., 1999; Tuselmann, 2001; Ying Warner, 2005). This paper discussed how and why the employment systems in Germany and China are different and the influences of globalisation. The German employment system was chosen to be the counterpart not only because Germany is one of the worlds leading economies and a prototype of the Continental Model, but also in consideration of its close international trade relationship with China. The attention was focused on the differences between the aspects of Trade Union role and Vocational Education and Training System (VET). The changes in China was focused on the State-owned Enterprises (SOEs) because it is still the dominant employer in China and the data are relative easily be accessed. The term of human resource management (HRM) was used in broad sense in order to cover more aspects of the current HRM practices. This is because HRM, first derived from Northern America after the Second World War and spread to the world, is getting popular in China but there are great variations in interpretation, understanding and practices (Cook, 2004). Differences between German and Chinese employment systems When we talk about the social models in Europe we may consider that the Europe Model is unique and pervasive. However, the notion of Europe Model is too big to reflect the natural differences between each national system, thus it was re-categorized into several sub-groups, named Nordic Model, Anglo-Saxon Model, Mediterranean Model and Continental Model (Sapir, 2006). Germany, along with France, Austria, Belgium, Luxembourg, was categorised into the Continental Model characterized with collective bargaining between unions and employers associations, close tie between companies and banks, the comprehensive vocational education and training (VET) system, and extensive labour market regulations (Tuselmann, 2001). Employment system in Germany One outstanding characteristic of the German employment system is its dual representation and legalistic structure industrial relations system. Trade unions and work councils are well established with their counterparts of employers association and firms respectively. Legislations and laws provided a framework for different parties (Katz Darbishire, 2000; Schnabel, Zagelmeyer, Kohaut, 2006). In Germany, collective bargaining is mainly carried out at the region or sector level and the agreement is legally binding. The collective bargaining parties have been legally empowered a great sense of autonomy, so it is possible to apply the agreements without the direct intervention of the state. Wages is a good example. It is collectively negotiated and applied at the state or sector level. Therefore, individual company within a bargaining sector do not has considerable differences in terms of the wages despite the organizations size, structure, technology, capital intensity and global exposure (Katz Darbishire, 2000; Schnabel, et al., 2006; Tuselmann, 2001). This leads to a high functional flexibility while a relatively low numerical and financial flexibility (Tuselmann, 2001, p 546-547). Comprehensive VET system is another feature of German employment system which has successfully supplied a large pool of qualified labours. In Germany, VET is supported by the state and regulated by different labour laws. Qualifications are designed on consensus of the employers association, trade union and educationalist. Chambers of commerce is employed to monitor the training progress and ensure that the trainee is not exploited. The close tie between the firms and banks ensures that investment is in long term interests instead of short one so that firms have much more patience to invest into the VET system. At the same time, because the pay is collectively negotiated in the sector level, it reduce the possibility of key technicians be poached so that firms are more willing to invest into VET (Grugulis, 2007; Tuselmann, 2001). Employment system in contemporary China In order to catch up the rest of the world and improve the economic situation, China has adopted a series of political and economic reforms since 1979, which have resulted in great changes in the context of management practices (Zhu, Thomson, Cieri, 2008). The government has less directly intervened into the workforce management at the enterprise level. Instead, a series of laws and regulations have been adopted to handle the employment issues. SOEs have decentralized or privatized and more and more collectively owned enterprises, privately owned firms, self-employed business as well as foreign-related businesses, such as multinational corporations (MNCs), joint ventures (JVs), were setup. The changes of ownership structure and government involvement methodology undoubtedly impacted the employment system at the macro level. The trade union role, pay structure and VET system have gone through radical changes accordingly (Cooke, 2005). In china, the officially recognized trade union is the All China Federation of Trade Union (ACFTU), which was set up in 1920s and supported the Communist Party to fight against Japanese and Kuomintang. Since 1979 its influence has improved largely but differences are apparent due to the difference of ownership structure, enterprises size and location (Cooke, 2005; Rowley, Benson, Warner, 2004; Ying Warner, 2005). All the union members, despite their occupations, sectors and regions, all belong to the same Union ACFTU. The Trade Union Law, adopted in 1995 and amended in 2001, and the Labour Law (1995) provide a legal framework and empowered union to represent, monitor and protect the members legal rights and interests and develop their activities according to the law (Cooke, 2005; Ying Warner, 2005). In terms of the pay distribution, performance-based incentive policies have been initiated but the basic wage is still largely based on the traditional seniority-based egalitarian wage structure (Cook, 2004, p 25) which can not fully reflect the competences and contributions of the workers. As a result some workers are low motivated and some of the key technicians have been poached by private or foreign-related companies by high wages or higher social identification (Cooke, 2005; Ying Warner, 2005). Another characteristic of Chinese employment system is the ineffective VET system and severe skilled shortage although China has the largest labour pool in the world. VET in China is mainly funded by the government and SOEs. But only in recent years VET received some attentions. There are considerable differences between different enterprises ownerships, sectors and regions. Most of the enterprises leaders think VET is not the core business so that very limited fund was allocated to it (Cooke, 2005). These problems make it difficult for VET to train skilled labours for the social development. In short, compare with Germany, the trade union in China has well organized and developed. It has actively and effectively involved into the collective bargaining and disputes settlement especially after the adoption of the Trade Union Law. The pay structure has abandoned the Maos equality norm and some incentive policies have been introduced but failed to reflect the individual competence. At the same time, compare with the German VET systems, the Chinese VET system is less effective and fail to supply enough skilled labours to meet the social needs. Why are they different Employment systems are complex structures which can shaped by several factors, such as societal structures, national cultures, social welfare systems, education and vocational training systems (Christiansen et al., 1999, p 1). This part explores the reasons of the differences between these two systems from the perspectives of political structures and culture differences. Political structures In Germany, the employment relations is famous for its high degree of juridification (Katz Darbishire, 2000; Lansbury, Bamber, Wailes, 2004). Trade unions activities are guided and governed by the series of legislations and laws, such as the Works Constitution Act, the Co-determination Acts, the Collective Bargaining Act and the Social Security Act (Lansbury, et al., 2004). Dual representation system and various unions make it more effective to represent and protect the members legal interests. In contrast, in China, there is only one officially recognized trade union All China Federation of Trade Union (ACFTU). It is mainly guide and regulated by the Trade Union Law (2001) and the Labour Law (1995). National culture Cross-culture management studies and theories have acknowledged the pervasive influence of cultures on choosing HRM practices in the global business context (Aycan, 2005; Leat El-Kot, 2007). Employment systems theories re-emphasized the importance of the cultures in the shaping of a national system. The comparison between these two countries cultures will provide a new perspective to understand why the German and Chinese employment systems are so different. Hofstedes dimension of culture scales is a powerful indicator to recognize the differences between cultures. Chinese ranks higher on power distance, long term orientation and low on individualism. Germany, however, ranks very high on individualism and very low on long term orientation (Arrowsmith, 2009). The differences between individualism and collectivism will largely affect the workers attitude to job satisfaction, security duty and harmony (Warner, 2008). For example, the contribution norm and egalitarianism is very popular in Chinese pay structures. The attempts from the top to increase income differentials according to workers performance and competence have been largely mediated by the operational managers (Cooke, 2005). While the elitism, which regards manual skill as an inferior to formal education, resulted in low attention be paid to VET development. How has the globalisation changed the situation? Globalisation is growing faster than ever before (Briscoe Schuler, 2004). Organisations are more and more exposed to international exchanges and competitions. Managers interact more commonly with multi-cultural background customers, suppliers and employees (Warner, 2008). This creates great opportunities as well as threats to the organisations which are struggling to be successful in the global business. However, the involvement in the globalisation does not guarantee a success. How to integrate the market differences, realize the business scales and transfer the knowledge beyond the physical boundary, but more importantly, how to manage and motivate the multi-culture employees play a crucial role (Friedman, 2007). Hence, both the worldwide organisations, such as European Union (EU), World Trade Organisation (WTO), and countries, like China, Germany, UK, US, have adopted series of changes and reforms. This part aims to assess the globalisations influences on the national employment systems from the institutional perspective. Is it more convergent or divergent? Convergence and divergence debate has existed in the comparative studies for a long time. Convergence theorists believe that the development of the industrialisation, globalisation, decentralizing and transfer of knowledge will lead to a convergent business management practice. However, the divergence theorists insist that the national culture and values will resist to this change and the management practice cannot be duplicated across nation borders (Warner, 2008). The core of the debate is the management practice should be localized or not. In China, globalisation has showed its power to convergent the various practices. Studies found that Chinas active participation into the global business context especially after the joining of WTO has resulted in tremendous changing in its business law, taxation and business management. These changes make the Chinese management practices are closer to the international standards and western management philosophies (Warner, 2008; Ying Warner, 2005). For example, before the reform, the Chinese employment was high centralized lifelong iron bowl system. However, after two decades of massive efforts, the Chinese employment system has primarily established a market-driven, performance-based, decentralized employment system. Trade unions are empowered to monitor and protect the workers legal interests according to the newly amended Trade Union Law. China even tried to duplicate the German VET system in 1980s. Some of the trials failed but these movements made Chinese practices closer to G erman way. Meanwhile, some of the underlying Chinese traditional values are functioning as an resistance force to stop or slow the progress of convergence. For example, performance-based pay structure were introduced to differentiate the income differences according to individuals competences but it was mediated at the operational level due to the underlying egalitarianism (Cooke, 2005). This controversial finding consist with the process of globalisation it is a process rather than an end-state (Hughes ONeill, 2008). With the development of globalisation, the management practices and philosophies come from different countries will keep conflicting, but at the same time, more similarities will be found in the international business arena. Conclusion Different political structures and national cultures resulted in considerable differences between employment systems. Coming from two continents, China and Germany have very little in common before 1970s. However, globalisation put these two countries, as well as the other countries, on the same arena, global business context. This creates opportunities as well as threat to these countries which are struggling to be or keep being prosperous. Therefore, series changes and reforms have been conducted in different sectors and contexts in order to seize the opportunities. Decentralization in Germany has been conducted (Katz Darbishire, 2000). But compare with China the German employment system change is smaller. Since 1979, China has conducted radical changes in its ownership structures, HRM practices, legislation and laws. A market-driven, performance-based and decentralized employment system has been primarily setup. The differences between these two employment systems in terms of trade union role and VET system are still big but some similarities have been successfully identified. At the same time, the underlying long-lasting national cultures and values are functioning to resist some of the changes. The controversial findings between convergence and divergence reflect that the process of learning and conflicting will not finish overnight. It, likes the progress of globalisation, will not be stopped or reversed. Meanwhile, it should be taken into consideration that differences of employment systems may exist between regions, sectors and firms even in a same country (Arrowsmith, 2009). This increases the difficulties of comparative studies across the national boundaries. Much more efforts will be needed to make this issue clearer.

Dream Therapy Essay -- Psychology Essays

Dream Therapy Dreams have been considered and debated since people have existed. Research on dreams began in the 19th and 20th centuries. However, nothing has proven why dreams happen or what they do. Freud suggested that dreams are an expression of subconscious desires, from which all sorts of strange animal impulses come. He believed that he would be able to find out what bothered people by analyzing their dreams. While dreams reveal troubles much older than Freud, he was the first to try and rationalize dream therapy (Dreaming of a better life). According to American Health (April 1997) about three-quarters of people who use dream therapy are women. They speculate this is due to hormonal differences. Other reasons to speculate that women are more inclined to use dream therapy are because they seem more connected to the dreaming world than men, women dream more often than other times during their menstrual cycle (which helps them recall their dreams more clearly at those times) and women tend to dream more during pregnancy (Waking). People who suffer from frequent nightmares also use dream therapy. Dream therapy may help those who suffer from frequent nightmares find underlying signs of other illnesses or perhaps drug reactions (Dream Therapy: Nightmare). Danya C. MacKean, student at Augustana University College, stated in a paper for a psychology paper that dream therapy is used by patients who are treated for post traumatic stress syndrome These patients use dream therapy to make his or herself aware that they are dreaming to lessen the resistance of confrontation with the figures or situation in which they are dreaming (MacKean). Dream therapy can b... ...oing on in my life. I had fun doing this paper and will more than likely start my journal again. SOURCES Colors in Dreams & Their Meanings. From journal: Dreams Obscure. Common Dream Symbols. Infotrac at Concord Library. http://www.dooyoo.com 7 February 2001. Dreaming of a better life. Pearson, Bryn. http://www.dooyoo.com 10 August 2001. Dreams are the language of the soul†¦ Whitehorse. http://www.garynull.com/Documents/spectrum/waking_up_to_dream_therapy.htm Waking Up To Dream Therapy. http://www.iris-publishing.com/sleep/sleep_help/nightmare_reduc.html 12 November 2003. Dream Therapy: Nightmare Reduction Training. http://ma.essortments.com/dreamstherapya_rfrf.htm 12 November 2003. Dream therapy & alternative psychology. http://www.sawka.com/spiritwatch/mackean/htm. April 1997. MacKean, Danya C. Symbols. Infotrac at Concord Library.

In Opposition of Eugenics and Human Embryo Research Essay -- Argumenta

In Opposition of Eugenics and Human Embryo Research There are a variety of views of eugenics and all that it entails. The definition of eugenics is "the science of improving the physical and mental qualities of human beings through control of the factors influencing heredity," ( Funk and Wagnall's, 1984). Others think eugenics is the social control of human genetic evolution, an ideology of racism and genocide, thought to improve society and halt disease while others think only of the Nazi Regime (Saetz, 1985 and McGee, 1997). Eugenics has a long and tumultous past but with the mapping of the human genome and research on human embryos, where will eugenics lead the wolrd in the near future? There are two main practices of eugenics: positive eugenics, increasing the procreation of those with "desireable" traits, including high IQ, physical attractiveness, resistance to disease, etc., and negative eugenics, halting the procreation of those with "undesirable" traits through sterilization, abortion, infanticide, birth control and couseling (Saetz, 1985 and Davis, 1981). Und...

Review of Patient Safety Standards for Hospitals by Joint Commision on Healthcare Essay

The safety goals outlined for hospitals are intended to stimulate greater awareness of the elements of vulnerability or risk associated between patient and worker. Ultimately, patient safety, worker health and safe practice methods can have a positive influence on saving lives, reducing risk and controlling costs. The goals attempt to outline a uniform standard. When adopted by a health care organization, a successful culture of safety that benefits everyone has an opportunity to develop. The following are the Commission’s patient safety goals with respect to hospitals. The first goal is to improve the accuracy of patient identification. Patients are given the wrong medications, taken to the wrong surgical rooms, and specimens get contaminated or mixed up. To address this issue and achieve improved accuracy, implementation of two patient identifiers attempts to reduce these errors. First, the patient should be identified reliably by their name, telephone number or other number that is person specific. The second is to verify that the treatment matches the patient. The verification of the identifiers should be done with two individuals checking the same patient or having one person identify the patient, with a second verification assisted by the addition of a technology item, like a barcode. The second goal is to improve the effectiveness of communication among caregivers. Each clinical aspect of healthcare utilizes a different vocabulary. A patient may be seeing a psychiatrist, a physical therapist and a cardiologist at the same time. While each profession has a foundation of science that is designed help them communicate in a uniform manner, each clinical area will have specific language and understanding that may not translate from one specialty or discipline to another. Critical results of tests and diagnostics that are outside the normal range and indicate a life threatening situation must be communicated. Reports must be delivered and critical results given on a timely basis so the patient can be treated as soon as possible. Third, is the goal to improve the safety of using medication. Medications that are not labeled properly or medications that are similar in name or packaging can obviously lead to a 1 deadly consequence. Suggested ways to achieve this goal is to make sure all medications, and containers are labeled correctly. Some of the specific suggestions to achieve this safety goal are to adopt the use of oral unit-dose products, prefilled syringes, or premixed infusion bags when these products are available. The fourth goal is to reduce the risk of health care-associated infections. Many people are in fear of going to a hospital. They may feel at risk of getting a communicable disease. And while that is a possibility, few are aware that they may experience infections directly associated with the delivery of the medical service or treatment. The simplest and most obvious way to protect the patient from infection is to feverishly adhere to the Centers for Disease Control or World Health Organizations guidelines for hand washing. The late physician and scientist Ignaz Semmelweis would be astonished to see this method universally adopted. Although, with as much science that has since validated his pioneering work, he could be annoyed to see a lack of compliance, considering the volumes of evidence published which supports his early theory. Patients are acquiring hospital based infections at an alarming rate, according to an NBC news story which was based on data from the Agency for Healthcare Research and Quality. And a brief review of the CDC report from 2011 on rates of infections clearly shows a link between number of days in the hospital and acquired infections. The longer a patient is in the setting, the more likely it is that the patient is at risk. The likelihood of risk depends on the kind of treatment the patient receives. Risk assessment tools are essential to understanding which staff, providers, or independent practitioners need to be educated to understand the types of infections and their origins as they relate to their practice area. The families and patients must likewise be educated to understand the risks, complications and microbial hazards that are inherent to the treatment or service they are receiving. Finally, goal fifteen is for the hospital to identify safety risks inherent in its patient population. This goal is a contributing factor to why Patient Safety Coordinators and certifications to become one are becoming more popular. Particularly, the goal speaks to the population that is at risk for suicide. While this goal is stated to apply only to psychiatric hospitals and patients being treated for emotional or behavioral issues, most all hospitals have at least a small population that could fit into this category. While not every hospital has a psychiatric floor, or even a psychiatrist on call, patients that appear or make a statement that they fear harming others or themselves may be detained temporarily at the discretion of the medical staff. The terms and length varies from state to state. Georgia’s law, O. C. G. A. Â § 37-3-41 allows basically for a forty-eight hour detainment period. But, that can be extended indefinitely if the treating physician deems it necessary and appropriate based on their examination.

A comparison between cardiac CT scanning and cardiac digital subtraction angiography (DSA)

Abstract Coronary artery disease affects nearly one tenth of the UK population and remains the leading cause of death in the western world. To investigate and provide interventions for coronary artery disease, imaging of the coronary arteries to enable visualisation of atheromatous plaque is required. This review looked at the techniques of cardiac computed tomography scanning and cardiac digital subtraction angiography, and their contribution to the investigation of coronary artery disease. Comparison of the procedures considered technique, radiation exposure, contrast agent, clinical indications and efficacy in diagnosis of coronary artery stenosis. On comparison of the effectiveness of the techniques, both were shown to have been effective non-invasive procedures that may be used to rule out diagnoses and avoid inappropriate use of invasive angiography. The research shows mixed evidence for cardiac computed tomography angiography as a test of high specificity, however sensitivity and speci ficity of cardiac digital subtraction angiography is high, and therefore suggest that the techniques may be useful in low risk patients. Introduction Coronary artery disease remains the main cause of death in the UK and western world (Hacker, 2013; Liu et al., 2002) and contributes a substantial disease burden, affecting 7% of men and 5% of women in the UK in 1999 (Liu et al., 2002). Coronary artery disease results from the build up of atherosclerotic plaque within the arteries supplying the myocardium. This plaque limits the flow of blood through the arteries, and can cause ischaemia of the heart muscle. If the plaque becomes unstable and ruptures, this may lead to thrombus formation and the complete occlusion of an artery, resulting in a myocardial infarction (McClure et al., 2009). Acute coronary syndrome (ACS) is a sub-classification of coronary artery disease and encompasses unstable angina, non-ST elevation myocardial infarction and ST elevation myocardial infarction. ACS represents a range of conditions that result from thrombus formation in coronary arteries, and if untreated has poor prognosis and high mortality (NICE, 2010). To investigate and provide information for interventions for coronary artery disease and ACS, visualization of the coronary arteries and any lesions caused by atherosclerotic plaque is required. Advances in technology have given rise to several sophisticated perfusion analysis techniques, which provide greater prognostic value than morphological imaging (Hacker, 2013). Perfusion analysis allows the blood flow through the coronary vessels to be observed and any abnormalities in the perfusion can be interpreted as a functional consequence of atherosclerotic changes within the vessels (Hacker, 2013). Currently, UK guidelines (NICE, 2010a) recommend coronary angiogram as first line management for patients presenting with ACS. This enables imaging of the coronary arteries to assess perfusion. It is important to assess the circulation as arteries can be affected from the earliest stages of endothelial dysfunction to high-grade coronary artery stenoses (Hacker et al., 2010; Bugiardini et al. 2004; Kaufmann et al., 2000), and this provides the information necessary for prognosis and intervention. With the advances in technology, there are now various diagnostic tests available to assess coronary artery disease, including coronary angiography and computed tomography (CT) scanning (Gorenoi, Schonermark & Hagen, 2012). This review aims to review the literature on coronary CT scanning and digital subtraction angiography, their clinical applications, techniques and comparative value in coronary artery assessment and diagnosis. Cardiac Digital subtraction angiography Coronary angiography is the conventional diagnostic procedure used in coronary artery disease. It is a minimally invasive technique, whereby a catheter is placed into the radial or femoral artery and is advanced through the arterial system to the coronary arteries. A contrast agent is then injected at the aortic root and allows visualization of the arteries using x-ray in real time at up to 30 frames per second. This allows a view of the extent, location and severity of coronary obstructive lesions such as atherosclerosis and enables prognostic indication (Miller et al., 2008). Coronary angiography also enables catheter placement either side of the lesion to assess pressure changes and determines the degree of flow obstruction (Miller et al., 2008). . Digital subtraction angiography (DSA) again works by introducing a contrast agent into the coronary arteries and taking x-rays in real time, however a pre image is taken by x-ray. This allows for the post images to be subtracted from the original mask image, eliminating bone and soft tissue images, which would otherwise overlie the artery under study (Hasegawa, 1987). Unlike conventional angiography, it is possible to conduct DSA via the venous system, through accessing the superior vena cava via the basillic vein (Myerowitz, 1982). This removes the risks associated with arterial cannulation (Mancini & Higgins, 1985). The procedure can also be performed with a lower dose of contrast agent and be done more quickly therefore eliminating constraints of using too much contrast during a procedure (Myerowitz, 1982). Whilst DSA is the gold standard in arterial imaging of carotid artery stenosis (Herzig et al., 2004), the application of DSA to the coronary arteries is limited due to motion artefacts associated with each heartbeat and respiration (Yamamoto et al., 2009). There are numerous cardiac clinical applications of DSA, it can be used to assess coronary blood flow (Molloi et al., 1996), valvular regurgitation (Booth, Nissen & DeMaria, 1985), cardiac phase (Katritsis et al., 1988), congenital heart shunts (Myerowitz, Swanson, & Turnipseed, 1985), coronary bypass grafts and percutaneous coronary intervention outcomes (Katritsis et al, 1988; Guthaner, Wexler & Bradley, 1985). However, others have suggested that the coronary arteries are not visualized well due to their small size, movement, their position overlying the opacified aorta and left ventricle, and confusion with other structures such as the pulmonary veins (Myerowitz, 1982). Cardiac CT Scanning Development of CT scanning in the 1990s enabled an increase in temporal resolution that was sufficient to view the beating heart, and they now provide a non-invasive technique for diagnostic and prognostic purposes. Cardiac CT scans have clinical applications that go beyond perfusion investigation, and can be used to assess structure and function of the heart (for example in electrophysiology disorders or congenital heart disease) due to its ability to provide anatomical detail (Achenbach & Raggi, 2010). CT scans can be used to assess coronary artery disease with and without injection of contrast agent (Achenbach & Raggi, 2010) by calcium scan or CT angiography. Coronary calcium CT scanning uses the evidence base that coronary artery calcium is a correlate of atherosclerosis (Burke et al., 2003) and is a strong prognostic predictor of the future development of coronary artery disease and cardiac events (Arad et al., 2000; Budoff et al., 2009; Achenbach & Raggi, 2010). Calcium is easily depicted on CT scan due to its high CT attenuation, and is classified according to the Agatson score, which considers the density and area of the calcification (Hoffman, Brady & Muller, 2003). Coronary CT angiography (CTA) allows visualization of the coronary artery lumen to identify any atherosclerosis or stenosis within the vessels. Patients are injected intravenously with a contrast agent and then undergo a CT scan. There are limitations regarding the suitability of patients for coronary CTA due to prerequisites of sinus rhythm, low heart rate and ability to follow breath-holding commands. Additionally, obesity presents a problem for patients that cannot fit into the scanner and affects the accuracy of the procedure. (Achenbach & Raggi, 2010). Comparison of cardiac DSA and cardiac CT scanning The technical differences between cardiac DSA and cardiac CT scanning give rise to differences in the clinical indications for the procedures, their diagnostic efficacy and also different risks or relative benefits to the patients. Due to the nature of the images produced by coronary CTA and DSA, each lends itself to different indications for use. Whilst coronary DSA provides imaging of all aspects of perfusion, CTA used with contrast agent also provides this however has the additional advantage of being able to assess structure and function of the heart. Coronary CTA has been shown to have a high accuracy at detection and exclusion of coronary artery stenoses (Achenbach & Raggi, 2010). In a multicentre trial conducted by Miller et al. (2008), patients underwent coronary calcium scoring and CT angiography prior to conventional invasive coronary angiography. The diagnostic accuracy of coronary CTA at ruling out or detecting coronary stenoses of 50% was shown to have a sensitivity of 85% and a specificity of 90%. This showed that coronary CTA was particularly effective at ruling out non-significant stenoses. Additionally, coronary CTA was shown to be of equal efficacy as conventional coronary angiography at identifying the patients that subsequently went on to have revascularisation via percutaneous intervention. This was shown by an area under the curve (AUC), a measure of accuracy of 0.84 for coronary CTA and 0.82 for coronary angiography. Miller et al.’s (2008) study included a large number of patients at different study sites , and additionally represented a large variety of clinical patient characteristics. The author’s claim that these factors contribute to the strength and validity of the study findings, and suggest that in addition to using patients with clinical indications for anatomical coronary imaging, should be used as evidence that coronary CTA is accurate at identifying disease severity in coronary artery disease. Miller et al. (2008) did however,, find that positive predictive and negative predictive values of coronary CTA were 91% and 83% respectively and therefore suggested that coronary CTA should not be used in place of the more accurate conventional coronary angiography. A low positive predictive value (in relation to the prevalence of disease) was proposed to be due to a tendency to overestimate stenosis degree as well as the presence of artefacts leading to false positive interpretation (Achenbach & Raggi, 2010). Other research providing comparison between coronary CTA and conventional coronary angiogram has highlighted variability in results. A meta-analysis conducted by Gorenoi, Schonermark and Hagen (2012) investigated the diagnostic capabilities of coronary CTA and invasive coronary angiography using intracoronary pressure measurement as the reference standard. The authors found that CT coronary angiography had a greater sensitivity than invasive coronary angiography (80% vs 67%), meaning that coronary CTA was more likely to identify functionally relevant coronary artery stenoses in patients. Despite this,, specificity of coronary CTA was 67%, compared to 75% in invasive coronary angiography, meaning that the technique was less effective at correctly excluding non-diagnoses than invasive coronary angiogram. This research appears to contradict the power of cardiac CTA at excluding diagnoses of coronary artery stenosis as suggested by Miller et al. (2008), he study did combine evidence from over 44 studies to provide their results and therefore had a large statistical power. The authors interpret the results in light of the clinical relevance of cardiac imaging, suggesting that patients with a higher pretest possibility of coronary heart disease will likely require invasive coronary angiography for revascularisation indicating that coronary CTA may be a helpful technique in those patients with an intermediate pre-test probability of coronary heart disease that will therefore not require invasive angiography. Goldberg et al. (1986) investigated the efficacy of DSA in comparison to conventional coronary angiography in 77 patients. They found that the two angiograms agreed within one grade of severity in 84% of single cases and 90% of multiple cases, identifying both patent and lesioned arteries. The results led the authors to conclude that there was no significant difference between the two methods and that DSA could be used in selective coronary angiography to find results comparable to that of conventional angiography. In addition to being a small study into the efficacy of DSA, the study also had several sources of inherent variability that should be considered when interpreting the results. These included differing sizes of digital imaging screen and non-use of calipers, meaning that the interpretation of the images could vary throughout the study. The authors also suggest that whilst showing strong support for the use of DSA in coronary artery disease, the technique may not actually p ermit better prognostic determinations or clinical judgements that are better than conventional angiography, and therefore the further implementation of the techniques may not be founded or necessitated. More recently, there has been further research looking at the effectiveness of DSA as a way of measuring coronary blood flow. Whilst motion artefacts have proven a problem in lots of past research (Marinus, Buis & Benthem, 1990; Hangiandreou, 1990), recent research has developed methods to minimise these. Moilloi and colleaues (1996) showed that using a motion-immune dual-energy digital subtraction angiography, absolute volumetric coronary blood flow could be measured accurately and thus provide an indication of the severity of any arterial stenosis.This may provide further suggestion for clinical implementation of DSA. Although these studies provide evidence for the efficacy of cardiac DSA and CTA, they often make comparisons to conventional angiography. This is useful as a baseline comparison, however it is difficult to make comparisons between the two procedures directly due to less available evidence making direct comparisons. Lupon-Roses et al. (1985) conducted a study investigating both coronary CTA and venous DSA. The study looked at the efficacy of both techniques at diagnosing patency of coronary artery grafts compared to the control conventional angiography. CT was shown to diagnose 93% of the patent grafts and 67% of the occluded grafts whereas DSA correctly diagnosed 98% and 100% of patent and occluded grafts respectively. Interestingly, the DSA picked up the 11 grafts that were misdiagnosed by CTA and the CTA picked up the 2 grafts misdiagnosed by the DSA. This data may suggest that individually, DSA has a better profile for diagnosis of coronary artery occlusion, however if the two procedures are used in combination exclusion of patent arteries and diagnosis of occluded arteries would be effective (Lupon-Roses et al., 1985). Coronary DSA and CTA are both non-invasive procedures (unlike the conventional coronary angiography where a wire is placed in the coronary vasculature). With the only invasive part of the procedure being the injection of the contrast material into a vein. This presents a significant advantage to both procedures over that of conventional angiography, and may even permit investigation on an outpatient basis (Meaney et al., 1980). Similarly, both DSA and coronary CTA are favoured because of their intravenous approach, eliminating the risks of bleeding or arterial injury from an intra-arterial catheterization and being able to be used in those with limited arterial access. However, although the intravenous approach used in cardiac DSA makes it favourable, it does lead to difficulty with visualisation of the coronary arteries due to the overlying iodinated pulmonary and cardiac structures (Mancini & Higgins, 1985). Therefore,, intra-arterial DSA is also sometimes used (Yamamoto et al., 20 09). As with all CT scanning, coronary CTA carries with it a dose of ionizing radiation (Brenner & Hall, 2007). Studies have estimated that for diagnostic CT scanning, patients are on average exposed to 12mSv of radiation during the procedure, the equivalent of 600 x-rays (Hausleiter et al., 2009). Estimates of radiation doses associated with conventional coronary angiography are lower than that of coronary CTA at 7mSv (Einstein et al., 2007). Additionally, DSA technique reduces the radiation dose from that of conventional coronary angiography as the vessels are visualised more clearly (Yamamoto et al., 2008). The dangers of radiation exposure are increased risk of developing cancer, skin injuries and cateracts (Einstein et al., 2007). It is therefore important that the benefits of conducting the procedure greatly outweigh the risk of radiation exposure. CT calcium scanning provides a low radiation dose at around 1mSv (Hunold et al., 2003). Cardiac CT calcium scanning does not require administration of a contrast agent, unlike in coronary CTA and DSA that use iodine based contrast agents. The risks associated with contrast agent include nephrotoxicity and risks of hives, allergic reactions and anaphylaxis (Maddox, 2002). The amount of contrast agent used is partly dependent on the length of the procedure and how clearly the arteries can be visualised. For this reason, both cardiac CTA and DSA use less contrast agent that conventional coronary angiography (Brant-Zawadzki, et al., 1983). CT calcium scanning of the coronary arteries is therefore recommended in those with less likelihood of coronary artery disease (NICE, 2010). Both coronary CTA and DSA require interpretation by trained physicians, and the importance of training and achieving intra-rater reliability should not be underestimated (Pugliese et al., 2009). Conclusion Overall, both coronary CT and DSA have been demonstrated as effective procedures for the imaging of the coronary arteries in CAD (Achenbach & Raggi, 2010; Miller et al., 2008; Moilloi et al., 1996; Goldberg et al., 1986). Whilst cardiac CT scanning does provide a wider range of clinical applications, allowing assessment of perfusion as well as cardiac structure and function (Achenbach & Raggi, 2010), coronary DSA has many applications that allow assessment of coronary blood flow (Molloi et al., 1996; Katritsis et al, 1988; Booth, Nissen & DeMaria, 1985; Guthaner, Wexler & Bradley, 1985; Myerowitz, Swanson, & Turnipseed, 198). Both cardiac DSA and CTA procedures have their advantages. As non-invasive procedures, these techniques pose less risk to patients, and enable the possibility of outpatient investigation, to be used to rule out diagnoses and to avoid inappropriate invasive coronary angiogram (Gorenori et al., 2012). Additionally, intravenous access is preferential to arterial cannulation for the contrast infusion, removing the risks associated with bleeding or intra-arterial injury. Cardiac DSA exposes the patient to a lower dose of radiation that coronary CTA (Hausleiter et al., 2009; Yamamoto et al., 2008; Einstein et al., 2007), which is beneficial at reducing the risk of genetic mutations and cancer. Cardiac CTA and DSA also have their common disadvantages. The use of contrast agent may present side effects for the patient including kidney damage and risk of allergic reactions and anaphylaxis (Maddox, 2002). For this reason, calcium CT scanning can be useful in patients that are not at high likelihood of coronary artery disease (NICE, 2010b). Additionally, both cardiac DSA and CTA are subject to motion artefacts from respiration and heart beats, which can cause difficulties with interpretation (Achenbach & Raggi, 2010; Yamamoto et al., 2009). In the case of cardiac CTA, this excludes a subset of patients that are unable to follow commands and those who have high heart rates. Overall, cardiac CTA and cardiac DSA are effective, non-invasive imaging techniques for assessment of coronary artery disease. Whilst they are not the gold standards in cardiac monitoring, they can provide important diagnostic information without exposing patients to the risks of invasive angiography. Due to this, their use should be weighted against clinical need, the risks of the procedures, and the suitability of the patient. Interpretation of cardiac CTA and DSA imaging should be by trained individuals. 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Living Together Is Not Wrong

Chanut Tipphanawadee 155 100 5877 SECTION 5153 Assignment 2 : ————————————————- There is nothing wrong with people living together before they get married. It seems undeniable that living together of couples and marriage of them are totally different of what they did in past. The amount of divorce rate, abortion rate, abandoned children are unstoppable increase. The reason is people in this era have been changed the concept of marriage and living together. Moreover, the rights of human has affected us. Especially, women in this epoch have more powerful than the past.Therefore, I strongly agree with the statement â€Å"There is nothing wrong with people living together before they get married†. There is more than one reason why living together before get marriage is not wrong and should be accepted by our society. Firstly, the couples that living together before they get married is able to look how life would be like with the person who lives with. For the reason is when two peoples whether men or woman living together the conflicts might be occurred because of the different of each other’s behavior such as spending habits, cleaning ,and time.These are important to the couples getting along in the long terms and they can only be learned by proximity when they live together for a period of time. Furthermore, they have to learn to be more responsible and take care of each other like what marriage couples do. Moreover, we are in the new generation where the society is liberal. So, if they can live together before they get married their marriage and couples’ life are more tend to be perfect marriage . That why there is nothing wrong with living together before marriage.

FINANCIAL ACCOUNTING POLICY AND PRACTICE Essay Example | Topics and Well Written Essays - 1750 words

FINANCIAL ACCOUNTING POLICY AND PRACTICE - Essay Example The economic sector is keen on financial institutions and government; accounting is seen as an economic asset. Theoretically speaking, financial accounting and reporting is objective, neutral and political through the standard setting process is influenced by external factors with different interests. The activities in the economic sector affect directly the accounting practice of corporations. The standard setter regulator in accounting is either a government-controlled institutions or independent agencies. These two bring up the regulated and non-regulated theories (Marchetti, 2012). The unregulated approach states that the market and its mechanism determine the production and regulation according to its needs. The Agency Theory is introduced here, which is the relationship between principals and agents and helps with resolving problems that exist in the agency, these problems arise from inefficiencies and incomplete information. The unregulated approach, also known as free market approach contributes to positive accounting as it requires lower or higher standards to recognize losses or ga ins in contract markets. A regulated market, also known as the controlled market, is where the government controls the forces of supply and demand, which includes who is allowed to enter the market and what prices are charged (Mclaney, 2009 p. 56). According to Mclaney, E. (2009), free market economies have a freedom to innovate which allows the business owners to bring new ideas, new products, and new services. In the unregulated market, the customers make decisions on which products succeed or fail because they decide on which product to use and on what. The primary objective of a free market economy is to make a profit. The companies sacrifice worker safety, when a free market economy gets out of control, the consequences can be damaging. This includes; lost income, unemployment, and homelessness. Many of these failures come from those with short-term