How Does Technology Influence Our Daily Lives Essay

The tÐ µrm „ technologyâ€Å" has been defined by the ancient Greeks as a collective term of human achievements, inventions, creations, knÐ ¾wledge and expertise. Without a doubt, technology dramatically affects our lives in virtually each and every aspect and area. One of the greatest and most heated contemporary debates has been: „Does technology influence our lives in a positive or negative way?â€Å" In my opinion, technology by itself has neither positive nor negative consequences. The only defining factor is how people use technology. Nevertheless, I would rather support the idea that technological inventions serve predominantly good purposes. It is really hard to point out the areas where technological achievements have been the most spectacular. Therefore, the present work will focus on three sectors: nuclear technology, internet and medical applications. Since nuclear power’s earliest discovery as a theoretical principle, and later as practical applica tions, methods, equipment and devices, this exceptional breakthrough has played a great role in our lives. The only large-scale and applicable alternative to fossil fuels for generating electricity is the nuclear power. Despite their numerous flaws, NPPs ( Nuclear Power Plants) are so widespread around the world, that without them huge regions in the globe would be left in darkness and silence. Scientists have put enormous efforts into modernizing and mastering not only the principle of nuclear fusion and fision, but also into the whole equipment and machinery behind. Such problems as nuclear waste disposals, contamination, natural disasters, etc. do not deter people from relying on this reasonably-priced energy source. Moreover, an easily accessible and moderately-priced energy source is of great significance for vast, overpopulated but poor world regions, as it contributes to developing these areas to achieve higher living standards. Even though there are many issues with nuclear power production and waste management, I believe it will remain a desirable source of energy in the future because of its reach and application.I believe that the developments and discoveries in medical sciences, appointed to saving human lives, improvement of quality of life and expansion of the ifespan, are the greatest and most noble achievemen The discovery of X-ray methods gave doctors the opportunity to look inside the human body and know exactly where surgery is needed or see the broken bones. Furthermore, another crucial breakthrough is lazer technology which made bloodless operations possible and dramatically shorten ed the recovery period of patients. The MRI , ultrasound and computer tomography all provide a unique chance to observe and analyze pathogenic tissues, cells, tumors, the fetus growth, and make extremely complex heart and brain surgeries more accessible. The outstanding combination of medical and engineering research gave the world unbelievable access to sub-cell processes, the discovery of the human genome and DNA structure. This has widely opened the doors for fundamental genetic research, powerful pharmaceutical development and generally, the expansion of life expectancy of humans. Here it is a point to mention one extraordinary latest discovery in medicine- nanotechnology, and one special application- Quantum Dots. Combined with the knowledge about the human genome, this high-tech method gives a reliable tool for fighting different types of cancer. First ly, QDs can spot and trace very small tumor formations, even separate tumor cells by marking them in different light from the spectrum. Later, all the tumor cells and tissues emitting fluorescence are traced and consequently, being destroyed with the help of similar dots. Such QDs are charged with miniature laser source inside, encapsulated safely and put into the blood stream. When detecting the tumor cell or tissue, a laser impulse is emitted, and within the tumor cell it is transfered into heat which destroys the tumor without harming the healthy cells.( Wood, 2004). Another fascinating application of nanotechnology is the so called polymeric micelles, which can help the efficient delivery of drugs directly into cells and tissues. These compounds have much greater tissue penetrating power, more controlled drug release and are less harmful. This recent discovery gave doctors a great hope to make fine cure on cell and tissue levels and make treatments much more effective and less i nvasive. Computer invention and development, combined with one of the greatest achievements in the modern technological world – the Internet, have really changed the nature of contemporary communication and ways of doing business.(Passion Computing, 2012) The discovery of computer principles and construction is also connected to the name of a scientist with Bulgarian roots – John Atanassov, who is considered a person with great contribution to this breakthrough. Computer technology gave people the opportunity to make mathematical calculations with immence speed and accuracy never seen before. The following developments such as the ability to solve complex technical, technological and scientific problems; visualizingprocesses and trends in business; transmitting and transfering information to each and in any point of the world, – changed completely the way of thinking and working in our globalised world. The first one is undoubtedly education. This area has benefitted greatly from modern high-tech inventions.First of all,students have the option to search quickly and easily information on the Internet about their academic studies, written assignments and courseworks, numerous projects and multimedia presentations. The variety of options in visualization and graphical applications expanded the usage of visual aids and the ability to interprete, discuss and predict different trends in the processes under study and research. Another great advantage is given to education by the chance to share, exchange and communicate new ideas, discoveries and suggestions with professors and colleagues. (Lewis H. 2009) This way, it became possible to make panel discussions, conference talks, even to take exams and tests during distant learning courses.These developments augmented immensely the boundaries of education and provided opportunities for lifelong learning and continuous training and qualification for professionals of all walks of l ife. The access to virtual libraries, databases of knowledge, archives and other sources of stored information made it possible to attend a university or course in a really distant location, and get your diploma without even being physically at the educational institution. Another area with great benefits from Internet technology is business and banking. The nature and content of modern business deals changed dramatically due to modern methods.(Passion Computing, 2012).Nowadays, making a complex deal and trade, even an export of goods, is possible without moving away from the office. All the necessary documents, contracts, invoices, specifications and licences can be transfered over the Internet, all the changes can be negotiated the same way within a couple of days. Moreover, the shipment documentation can also be transfered online and even opening of the Letter of Credit, money transfer and other payments can be done online by a service bank. What is more, huge projects with many drawings, schemes, charts and graphs can be exchanged over the net, and even great architecture projects can be made by international teams based in several countries.The world of money is also of great use from the Internet. Huge funds may be transfered from one bank to another with just one click of the button. This development saves efforts, time and makes the modern business payments easier than ever before. All these deals are accompanied by the problems with data security, illegal access to database, fraud problems and abuse oj personal data, but the work and efforts never stop to resolve these issues. Last but not least, we have to mention the sphere of manufacturing and production. Internet and computerised methods of processing metals, plastics, cotton and textile, leather, vegetables and fruit, gave the greatest ever advancement in producing all the necessary goods and services for the life of modern humans. We are now able to create complex telescopes, planes, spaceships and equipment to explore the processes in space and Universe, and maybe to find a new planet for humanity to settle and develop in the future. To put it in a nutshell, advanced technology is an integral part of our modern life and will be even more important in our future.

Management Of Transient Ischaemic Attacks Health And Social Care Essay

The NICE guidelines and the National Stroke Strategy ( 2008 ) emphasises the importance of measuring all patients with a suspected TIA within a hebdomad and all high hazard patients within 24 hours. This is to enable originating appropriate direction. This includes life manner steps such as weight decrease, smoking surcease, cutting back on intoxicant etc. in add-on to turn toing hazard factors for shot. Suitable patients are referred for surgical intercession. This systematic reappraisal will look at all these issues and expression at the grounds for medical and surgical intercessions and the timing of the surgery, the type of surgery etc. Around 15,000 people per twelvemonth have a suspected TIA but presently merely 35 % of people are investigated and managed in a timely manner. There is a 20 % hazard of shot within the first 4 hebdomads after shot. Investigating and handling bad patients with TIA within 24 hours could bring forth an 80 % decrease in the figure of people who go on to hold a full shot. The hazard of shot after a TIA is approximately 12 % in the first twelvemonth and so about 7 % per twelvemonth thenceforth. There is a high hazard of shot in the seven yearss after TIA, perchance every bit high as 10 % . The hazard of shot, bosom onslaught or vascular decease is about 10 % a twelvemonth. This is approximately seven times the hazard in the background population. [ From thee Stroke Website ]PurposesThe intent of this reappraisal is to discourse the rapid appraisal and early direction aimed at cut downing ischemic encephalon harm, and in the instance of TIAs, forestalling subsequent shot. This will be achie ved by utilizing the most recent and up-to-date grounds from the literature.IntroductionA transeunt ischemic onslaught ( TIA ) is defined as an acute loss of focal encephalon or monocular map with symptoms enduring less than 24 hours and which is thought to be caused by unequal cerebral or optic blood supply as a consequence of arterial thrombosis, low flow or intercalation associated with arterial, cardiac or hematologic disease. [ Hatano 1976 – Page 1 G.Book ] . More late in 2002, Albers et Als proposed a revised definition for TIA, adding that there is no grounds of acute infarction on encephalon imagination. Infracted tissue is non ever obvious on imagination and so this definition has non yet been widely adopted. Stroke is the 3rd most common cause of mortality in the developed universe and there are a figure of preventable causes. Over the past 30 old ages, the direction of shot has changed at a phenomenal rate. New probes help direct patient choice for specific therapies and may well increase the opportunity of a successful curative result. Specialists have seen a broad scope of therapies introduced for the direction of TIAs and acute ischemic shot. These progresss have led to a theoretical account displacement in intervention, which is apparent in the protective direction of shot victims today.Methods( See ‘Methods ‘ in Appendix 1 ) .Epidemiology of TIAFor us to understand the clinical direction of TIAs and shots, to be after clinical services or to plan randomised controlled tests, and to mensurate the overall impact of interventions, it is of import to understand the epidemiology of TIAs and shots. Each twelvemonth at that place are about one million shots in Europe. [ Sudlow and Warlow – Pg 3 G.Book ] . Approximately 25 % of work forces and 20 % of adult females can anticipate to hold a shot if they live to be 85 old ages old and shot is the 2nd most common cause of decease worldwide. [ Murray and Lopez 1996 – Pg 3 G.Book ] . Mortality information underestimates the true load of shot since in contrast to coronary bosom disease and malignant neoplastic disease, the major load of shot is chronic disablement instead than decease [ Wolfe page 4 g.book ] . Strokes cause 23 % of healthy old ages lost and about 50 % of old ages of life lived with disablement in Europe. Stroke causes many secondary unwellness such as ; dementedness, depression, epilepsy, falls and breaks. In the UK the costs of shot are estimated to be about twice those of coronary bosom disease, accounting for about 6 % of entire NHS outgo. [ Rothwell 2001 – Pg4 G.Book ] . In add-on to shots, TIAs are besides common, and it is estimated that 54,000 TIAs occur yearly in England. Rothwell and Warlow estimate that about 20 % of shots are preceded by a TIA. MRI of patients who have suffered a TIA lasting longer than an hr shows that over 50 % have seeable countries of infarction. Technically they have non suffered a ‘stroke ‘ but a intellectual infarction. This emphasizes that TIA and shot are a continuum. The epidemiology of TIA is a batch more ambitious than that of shots since patients with TIAs are more heterogenous and present to a assortment of different clinical services, if they present to medical attending at all. Furthermore, dependable diagnosing of TIA requires early and adept clinical appraisal, as there is no diagnostic trial for TIA, doing epidemiological surveies really labour intensive and expensive.Aetiology and Clinical PresentationThe causes of TIAs are the same as the causes of shot, with the caution that the huge bulk of TIAs appear to be caused by ischemia instead than haemmorhage. In a TIA it is of import to find the site of the cerebrovascular lesion since this narrows down the likely implicit in aetiology and enables appropriate aiming of probes. The differential diagnosing of TIA differs from that of shot due to the transeunt nature of its symptoms. Hints in the history and on scrutiny can direct the tester to the likely underlying cause, enabling specific intervention to commence and secondary bar. [ Pg 113 G. Book – first parity ] A diagnosing of TIA is supported by a sudden oncoming and definite ‘focal ‘ symptoms, sudden oncoming and definite focal symptoms in the history and grounds of vascular disease on scrutiny [ manus et Al Pg 104 G. book ] . The most common of the symptoms can be seen in Table Ten:SymptomsFrequency ( % )Unilateral failing, weightiness, or awkwardness 50 Unilateral sensory symptoms 35 Dysarthrias 23 Transient Monocular Blindness ( Amaurosis Fugax ) 18 Dysphasia 18 Ataxia 12 Bilateral coincident sightlessness 7 Dizziness 5 Homonymic Hemianopia 5 Diplopia 5 Bilateral Motor Loss 4 Dysphagia 1 Crossed Sensory and Motor Loss 1 The symptoms of a TIA enable classification of onslaught by arterial district affected ; carotid in about 80 % or vertebrobasilar in 20 % . This has of import deductions for farther probe and secondary bar. There are no trials to corroborate a TIA, and the gilded criterion method of diagnosing remains a thorough clinical appraisal every bit shortly as possible after the event by an experient shot doctor, although the coming of new imaging techniques, peculiarly diffusion weighted MRI has allowed the diagnosing to be made or excluded with more certainty in some patients.Probes and Imaging/Diagnosing techniquesThe function of imaging in TIA is to corroborate the diagnosing, confirm the vascular district affected ( where the lesion may be ) , and to place those people who would profit from carotid intercession. [ 1- pg 8 Imaging Guidelines ] . The chief modes for imaging the encephalon parenchyma are CT and MRI. These are progressively being used to measure the intellectual vasculature in TIAs. In TIAs and minor shots neuro-imaging is required to: Exclude stroke mimics Distinguish between haemorrhagic and ischaemic events Determine the Aetiology, eg: carotid stricture with lesions in multiple vascular districts Identify patients at high hazard of early recurrent shot, in order to aim suited intervention. Sensitivity and specificity of different imaging modes varies with the pre-test chance, the nature of the lesion, the hold from event to imagination, whilst expertness in imaging techniques besides varies greatly. Hence when doing determinations about imagination after TIA, the pick of imagination will depend on all these factors, every bit good as patient safety, tolerability and contraindications. For illustration see Table X, for the advantages and disadvantage of CT versus MRI in TIA and minor shot. [ Page 132 – G.Book ] .Imaging ModalityAdvantagesDisadvantagesConnecticutLow Cost and broad handiness Low sensitiveness for little acute ischemic lesions Superior sensing of haemmorhage in early stage Low sensitiveness for mimics, particularly tumors. Radiation exposure IV contrast is nephrotoxic and potentially allergenic.Magnetic resonance imagingSuperior sensitiveness for shot mimics Patient tolerability and contraindications Provides predictive information. Superior sensing of bleeding in the subacute and chronic stage Table – Advantages and Disadvantages of CT and MRI in minor shot and TIA. In cohorts of patients with suspected TIA who were referred straight for scanning by primary attention doctors, prior to expert reappraisal by a shot doctor, rates of alternate diagnosings were high, likely reflecting high rates of misdiagnosis prior to imaging. [ Lemesle et Al 1998 – G.Book Page 132 ]Non-Radiological Probes for TIAFirst-line probes include ; basic blood and urine trials at presentation. Table Ten shows the baseline non-imaging trials for TIAs and shots.ProbeDisorders detectedFull Blood Count Anemia Polycythaemia Leukemia Thrombocythaemia/thrombocytopenia Erythrocyte Sedimentation Rate/ C-Reactive Protein Vasculitis Infective Endocarditis Hyperviscosity Myxoma Electrolytes Hyponatraemia Hypokalaemia Urea Nephritic Damage Plasma Glucose Diabetess Hypoglycemia Plasma Lipids Lipemia Urine Analysis Diabetess Nephritic Disease Vasculitis Second-line probes must be chosen suitably since the likeliness of a relevant consequence depends on the choice of patients and farther probe will incur more cost. [ Page 174 G.Book ] . Cardiac jobs such as AF – echocardiogram may demo atrial thrombus, aneurism of the anterior wall of the left ventricle with mural thrombus, atrial myxoma or left side valve disease. Cardiac monitoring may demo paroxysmal AF. Doppler surveies of the carotid and vertebral arterias may demo contracting. This probe may be followed by Carotid angiography and Carotid endarterectomy if stricture is a least 70 % . It may be argued that full probe for CHD should be initiated, as the most common cause of decease after TIA is MI. Table 1 Secondary probes by the specializer servicesShort-run forecast after TIARecent research has shown that the hazard of shot instantly after TIA is considerable [ Giles and Rothwell 2007, pg 195 G.book ] . However, this poses a challenge to clinical services because it leaves many TIA sick persons at a hazard of a major shot in the short term. Predictive tools have been developed to place patients at high and low hazard in order to inform public instruction, assistance effectual triage to secondary attention and direct secondary preventative intervention. Datas from population-based surveies and tests suggest that 20 % of patients with shots have a preceding TIA. [ Rothwell and Warlow 2005 – Pg 195 G.Book ] . A recent systematic reappraisal identified 18 independent cohorts, all published since 2000, describing shot hazard in 10,126 patients with TIA [ Giles and Rothwell 2007 – Pg 196 G.Book ] . 3.1 % shot hazard at two yearss and 5.2 % shot hazard at seven yearss.ABCD2 score – proof? i? See Document 48395 – Page 9 of 27.A new marking system for two twenty-four hours hazard of shot following TIA, dubed ABCD2. The Hazard factors employed in the ABCD2 marking system for 2 twenty-four hours hazard of post-TIA can be seen in table Ten:Hazard FactorValuessPointsAge a†°? 60 old ages1Blood Pressure lift ( either/or ) Systolic a†°? 140 millimeter Hg Diastolic a†°? 90 millimeter Hg1Clinical Features ( either/or ) Unilateral failing Speech damage without failing21Duration of TIA a†°? 60 min 10-59 min21Diabetess Yes/ No1( Reference = Johnston SC et al – Lancet 2007 369 ( 9558 ) :283-292. )Recognition of Symptoms and delays to directionPressing direction of patients with TIA depends upon the right acknowledgment of symptoms and appropriate action by patients and their fleet triage to specialist attention where probe and intervention are quickly initiated. Public consciousness and behavioral surveies are missing, nevertheless, one survey of cognition among the general populace indicated that 2.3 % of a indiscriminately selected sample of people in the USA have been told by a doctor that they had a TIA, based on self-report in a telephone study conducted in 2003 [ Johnston et al – Pg 239 G.Book ] . However an extra 3.2 % of respondents recalled symptoms consistent with TIA but had non sought medical attending at all and accordingly had non been diagnosed by a physician. Of those with ‘diagnosed ‘ TIA, merely 64 % had seen a physician within 24 hours of the event. Merely 8.2 % right related the definition of TIA, and 8.6 % were able to place a typical symptom. This suggests that frequent public instruction is required non merely on the nature of a TIA but besides what to make in the event of one.Recognition ToolsSeveral tools have been devised to help the right acknowledgment of shot and TIA symptoms. In the pre-hospit al scene, FAST, LAPPS and CPSS have been designed for usage by exigency services to guarantee rapid conveyance of patients to specialist attention. In the exigency puting ROSIER mark has been designed to help exigency doctors in diagnosing. The chief purpose of these tools has been to increase the Numberss of patients showing to hospital within three hours and, therefore, addition eligibility interventions. However due to the increasing accent on rapid direction for minor shot and TIA, their usage in informing public instruction and right diagnosing of minor shot and TIA is likely to go more widespread. The ABCD system was so developed to foretell the early hazard of shot following a TIA, and one of its chief utilizations has been in triage between primary and secondary attention. [ Rothwell et all 2005 – pg 241 G. book ] .Discussion of the Management of TIAs – Critical Reviewing( Use Diagrams and Tables ) Although the acute intervention of major shot, TIA and minor shot have many common elements, there are of import differences. In the acute intervention of TIA, the purpose is secondary bar of a disenabling shot, which might follow in the immediate hours and yearss after the initial event, as opposed to reversal of any neurological shortage caused by the shot itself. To cut down the hold in intervention, improved public instruction and improved triage to secondary attention and coordinated patient direction in specialist units are critical facets of intervention in TIAs. However there is a greater focal point on pressing, effectual secondary bar for TIA and minor shot. Although the construct of TIA arose in the 1950s and interventions for it were proven effectual, it was non until 2007 that the first studies were published on the feasibleness and effectivity of pressing appraisal and intervention of TIA in specialist units [ Rothwell 2007 – Pg 239 G.Book ] .Lifestyle AlterationAll tobacco users, including those with a history of shot or TIA, should be advised to halt, and intercessions such as guidance, nicotine replacing should be used if needed to assist them accomplish this. [ 257-263 ] . Avoiding extra intoxicant is reasonable and everyone including those who have suffered from a TIA or shot, should avoid heavy imbibing. Although a twosome of units of intoxicant per twenty-four hours may protect against future vascular events. [ 274-276 ] Reducing dietetic salt intake reduces BP, peculiarly in the aged with high BP, possibly ensuing in long term decrease in vascular events. It may besides assist those on antihypertensive medicine to halt their intervention without a rise in BP. It is advisable for old TIA or stroke sick persons to cut down consumption of concentrated fat, since it produces moderate decrease in cholesterin degrees, which are associated with little decreases in vascular events. [ 279-281 ] . Corpulent persons should be encouraged to lose weight utilizing dietetic or if necessary pharmacoligcal or surgical intercessions. All patients should have general advice about a healthy diet, low in concentrated fats, with plentifulness of fish, fruit, fiber and veggies. These intercessions have good effects on vascular hazard factors and seem likely to bring forth little decreases in vascular results despite there being no clear grounds that they do. [ 286-289 ]The Medical Management – Secondary PreventionNumerous interventions have been shown to forestall shot in the long term after a TIA, including antiplatelet agents such as acetylsalicylic acid, clopidogrel, and the combination of low-dose acetylsalicylic acid and extended release dipyridamole [ CAPRIE 1996 – pg241 GB ] ; blood force per unit area take downing drugs [ PROGRESS 2001 ] ; statins [ Amarence et Al 2006 ] ; anticoagulation for atrial fibrillation [ European atrial sibrillation test survey group 1993 ] ; and endarterectomy for diagnostic carotid arteria stricture & gt ; or equal to 50 % [ Rothwell 2003-04 ] . If the effects of all these interventions are independent, combined usage of all these intercessions in the appropriate patients would be predicted to cut down hazard of recurrent shot by 80-90 % [ Hackam and Spence 2007 Pg241 GB ] . However tests of intervention in acute shot suggest that the benefits of several of these intercessions are even greater in the acute stage, until late there has merely been few dependable informations on the benefits of ague intervention after TIA. NICE guidelines suggest that appraisal and probe should be completed within one hebdomad of a TIA. [ Wolfe 1999, Johnston 2006, NICE 2008 – pg 242 GB ] . Rapid intervention of TIA can forestall up to 80 % of recurrent shots. [ Rothewell Pg 285 GB ] . There is considerable grounds associating to the effectivity of assorted interventions to cut down the hazards of vascular events after TIA and shot. See Table 1:DrugTestTreatmentAspirinCastAspirin versus placebo within 48 hours of major ischemic shotISTAspirin versus placebo ( and SC heparin versus placebo ) acutely after major ischemic shot.Anti-thrombotic Trialists ‘ CollaborationMeta-analysis of tests analyzing antiplatelet agents in patients at high hazard of occlusive vascular disease. DipyridamoleClairvoyances 2Aspirin and Modified Release Dipyridamole versus placebo in a 2Ãâ€"2 factorial design started within 3 months of TIA or ischemic shot.EspritAspirin versus acetylsalicylic acid plus dipyridamole started within 6 months of TIA or minor shot. ClopidogrelMatchClopidogrel versus acetylsalicylic acid plus clopidogrel within 6 months of ischemic shot or TIA.CharismaAspirin versus acetylsalicylic acid plus clopidogrel in patients with cardiovascular disease or multiple hazard factors ( including ischemic shot )FASTERAspirin versus acetylsalicylic acid plus clopidogrel in the ague stage after TIA or minor ischemic shot. Antihypertensive DrugsAdvancementPerindopril plus or minus Indapamide versus placebo after TIA or ischemic shot in patients with or without high blood pressure. Cholesterol-lowering drugsHorsepowerSimvastatin versus placebo in patients with coronary disease or other occlusive vascular disease including TIA or shot.SPARCLAtorvastatin versus placebo started within 1 to 6 months of TIA or ischemic shot. Table: Major tests and meta-analyses lending to the grounds base for medical intervention in secondary bar after TIA and ischemic shotVariation in intervention worldwide:Unsurprisingly there is considerable international fluctuation in how patients with suspected TIA are treated in the acute stage, possibly due to the historical deficiency of grounds. For case, Gallic and German health care systems provide immediate exigency inmate attention and the average infirmary stay is about seven yearss [ albucher ] , whilst other systems ( such as Canada ) provide non-emergency outpatient clinic appraisal [ Johnston and Smith 1999, Goldstein 2000 – pg 242 ] . For illustration a Canadian survey showed that in more than one tierce of the patients, antithrombotic therapy was non prescribed on discharge. In the UK, the standard agencies of appraisal and direction is a neurovascular outpatient clinic ( â€Å" TIA Clinic † ) [ Intercollegiate working party for Stroke 2004 – Pag e 242 ] .Antiplatelet AgentsSeveral big controlled tests have now compared antithrombotic therapy ( antiplatelet or anticoagulant agents ) versus control in acute ischemic shot these have been big and have provided dependable grounds on safety or efficaciousness. Antiplatelet drugs such as acetylsalicylic acids can be effectual in the secondary bar of ‘serious vascular events ‘ ( Stroke, MI, and Vascular decease ) [ 12 from the IST survey ] . If taken for a few old ages after a myocardial infarction, ischemic shot, or transeunt ischemic onslaught ( TIA ) , antiplatelet therapy typically avoids about 40 serious vascular events per 1000 patients treated. In acute ischemic shot there is significant thrombocyte activation, which can be inhibited by acetylsalicylic acid. [ 2,14,15,16 from IST ] . Aspirin was by far the most widely studied antiplatelet drug in the ATT ( antithrombotics triallists coaction ) reappraisal. Among about 60,000 high hazard patients, excepting those with acute ischemic shot, aspirin entirely reduced the odds of a serious vascular event by one one-fourth. Almost 10,000 of these patients had a anterior TIA or ischemic shot. Aspirin significantly reduced the comparative odds of a serious vascular event by 17 % , matching to an absolute hazard decrease of 30 per 1000 over 3 old ages. Controversy has surrounded the most appropriate dosage of acetylsalicylic acid, clinicians have argued about doses runing from 30 milligrams to 1500 mg. [ 158-160 Big book chapter 16 ] . Theoretical grounds suggest lower doses might in fact be more good than higher doses. After sing all the available grounds from direct and indirect comparings in bad patients, it seems sensible to reason that acetylsalicylic acid at a dosage of 75-150 mg day-to-day is every bit effectual as higher doses and is most appropriate for long-run secondary bar of serious vascular events to maximise benefits and to minimise inauspicious effects. Doses below 75 milligrams day-to-day may be as effectual, but this still remains rather unsure. Patients with TIA or acute shot, should be treated with acetylsalicylic acid every bit shortly as operable after encephalon imagination has excluded bleeding. Sandercock et al 2003 reviewed two really big randomised controlled test ( International Stroke Collaborative Group 1997 ( IST ) and Chinese Acute Stroke Trial Collaborative Group ( CAST ) which together randomised over 40,000 patients. Sandercock clearly established that get downing aspirin therapy within the first 48 hours of acute ischemic shot avoids decease or disablement at six months for about 10 patients per 1000 patients treated. A farther 10 patients per 1,000 treated will retrieve wholly. intracranial and extracranial bleeding are reported with aspirin therapy but this has low rates, and it is offset by the benefit of excess lives saved. In the IST, patients were allocated, in an unfastened factorial design, to intervention policies of: 300 milligrams aspirin daily, Lipo-Hepin, the combination, or to ‘avoid both acetylsalicylic acids and Lipo-Hepin ‘ for 14 yearss. In the CAST, patients were allocated, in a double-blind design, to 1 month of 160mg aspirin day-to-day or fiting placebo [ Get references 156 and 157 from Chapter 12 -Big Book ] . There is no clear consensus about whether acetylsalicylic acid should be given before encephalon imagination. This is applicable in state of affairss where entree to imagination is delayed or where drugs could be administered by ambulance staff. [ IST 1997 ] There is besides no clear grounds that any peculiar dosage of acetylsalicylic acid is more effectual that others. However symptoms of aspirin toxicity are dose-related, so the smallest effectual dosage should be used. Initial dosage of 150-300mg per twenty-four hours is advised for the acute stage, followed by long-run intervention with 75-150mg per twenty-four hours. Patients intolerant to aspirin should be treated with clopidogrel or with dipryidamole, these newer agents are well more dearly-won than acetylsalicylic acids.Alternate Antiplatelet therapies/regimensAspirin acts on merely one of a figure of tracts taking to platelet activation and so thrombosis. Antiplatelet drugs moving through different tracts might hence be more effectual than aspirin if given as options to, or combined with, acetylsalicylic acid. Several recent big tests have provided information about alternate antiplatelet regimens. Clopidogrel V acetylsalicylic acid: A systematic reappraisal of RCTs of a thienopyridine V acetylsalicylic acid in bad patients identified 10 relevant tests in 26,865 patients. Aspirin was compared with clopidogrel in one test of 19,185 patients with ischemic shot and with ticlopidine in the staying nine tests in a sum of 7,633 patients, most of whom had a recent TIA or minor shot. Thienopyridines modestly and significantly reduced the odds of a serious vascular event compared with acetylsalicylic acid. [ 174 from chapter 16 BB ] . No important inauspicious effects were found in footings of bleeding. On the other manus the thienopyridines were associated with lower hazard of GI shed blooding. [ 174 ] . Few tests that have compared clopdogrel and ticlopidine have straight suggested better safety and tolerability with clopidogrel, doing it the theienopyridine of pick on safety evidences [ 183-185 BB ch 16 ] . In drumhead, clopidogrel is every bit effectual as acetylsalicylic acid and slightly perchance more so. The high cost of clopidogrel and the uncertainness of any extra benefit compared to aspirin do it unreasonable to propose that it should replace aspirin as the first pick antiplatelet drug for all patients at high vascular hazard. It is a sensible alternate antiplatelet drug for patients with a history of TIA or minor shot, who are truly allergic to aspirin. There is presently no grounds from RCTs to back up the usage of combination of clopidogrel plus acetylsalicylic acid to forestall vascular events in patients with TIAs. Antiplatelet therapy reduces the hazard of perennial vascular events after TIA. Most test informations concerns aspirin nevertheless, clopidogrel { CAPRIE Steering commission 1996 ) and drawn-out release dipyridamole ( Sivenius 1991 ) have besides been shown to be effectual in their ain mechanisms of action.Combination Antiplatelet therapy:The combination of acetylsalicylic acid and dipyridamole is more effectual than aspirin alone [ Diener et Al 1996, Halkes et al 2006 ) . This combination shows a comparative decrease in the hazard of perennial shot of around 30 % compared with aspirin entirely. On the contrary, the combination of clopidogrel and acetylsalicylic acid was non superior to clopidogrel entirely in secondary bar after shot, TIA or other vascular disease in the MATCH and CHARISMA tests. [ Diener et al 2004, Bhatt et al 2007 ] . However there was no important tendency towards benefit from combination antiplatelet intervention in the MATCH test, there was besides a higher hazard of bleeding after 18 months in the combination therapy, which was non evident until 4 months into the test. Consequently, it is possible that draw a bead oning along with a short class of clopidogrel may be effectual in the ague stage after a TIA and minor shot. Antiplatelet agents: – prevent extension of arterial thrombus, prevent thrombocyte collection in microcirculation, prevent re-embolisation from embolic beginning, cut down release of eicosanoids and other neurotoxic agents. Aspirin: – inhibits COX-1, cut downing dislocation of arachadonic acid to thromboxane A2 and thrombocyte granule release. Clopidogrel and other thienopyridines: – encirclement of thrombocyte membrane ADP receptors, suppressing ADP-dependent thrombocyte activation and granule release. Dipyridamole: – Inhibition of phosphodiesterase, doing lift of intracellular thrombocyte cyclicAMP and a attendant decrease in Ca suppressions ; this thrombocyte activation and granule releases. [ TABLE 24.2 – Page 287 G.B ]Anticoagulation and patients with AF:Immediate therapy with decoagulants such as LMWH, unfractionated Lipo-Hepin, and heparinoids in patients with acute ischemic shot is non associated with net short- or long-run benefit [ IST 2007 – Berge 2007, Wong et Al 2007 – Pg 258 GB. ] . These agents cut down the hazard of DVT and PE, but are associated with important hazard of intracranial bleeding, which is dose dependent. Patients in AF after a presumed TIA benefit from anticoagulation in the long-run to forestall a farther shot. However, the best clip to get down therapy after an ischemic shot is ill-defined as the hazard of bleeding is hard to foretell. [ IST – Donnell 2006 – pg 258 GB ] . Patients in AF who have a TIA should be given anticoagulation therapy if there are no contraindications [ European Atrial Fibrillation Trial Study Group 1993,1995 ] . Recent surveies have shown that Coumadin is every bit safe as acetylsalicylic acid in aged patients with AF [ Rash et Al 2007, Mant et al 2007 ] . Patients with presumed cardioembolic TIA or stroke secondary to other causes should surely have antithrombotic therapy. Besides they may profit from anticoagulation in other cardiac fortunes, but at that place have been no randomised controlled tests in state of affairss other than non-valvular AF. Anticoagulation is non effectual in secondary bar of shot for patients in sinus beat. Warfarin intervention to a mark INR of 3-4.5 was associated with important injury due to a big addition in major hemorrhage complications, particularly intracerebral bleeding, in patients with old TIA – in the Stroke Prevention in Reversible Ischaemia Trial ( SPIRIT ) [ Algra et al 1997 ] The subsequent Warfarin versus Aspirin in the Secondary Prevention of Stroke ( WARSS ) test of aspirin versus Coumadin for patient in fistula beat and without cardioembolic beginning or with more than 50 % CAS ( carotid artery stricture ) showed no extra benefit for Coumadin at a mark INR of 1.4-2.8 [ Redman and Allen 2002 ] . There has been uncertainness as to whether anticoagulation is preferred to antiplatelet intervention for the secondary bar of ischemia relate to intracranial coronary artery disease. A robust randomised dual unsighted test ( WASID – Warfarin-Aspirin Diagnostic Intracranial Disease ) test of Coumadin, to a mark INR of 2-3, versus acetylsalicylic acid to 1300 milligrams per twenty-four hours in patients with 50-99 % stricture of a major intracranial arteria showed no important benefit for Coumadin over aspirin [ Chimowitz et Al 2005 – pg 287 G.B ] . In fact, Coumadin was associated with increased rate of bleeding and other inauspicious events ; as a consequence the survey was stopped early. However patients having Coumadin were in the curative scope for merely 63 % of the clip. Curative INR appeared to be associated with a much reduced incidence of ischemic shot and cardiac events, proposing that anticoagulation may supply increased benefit over acetylsalicylic acid if curative INR can be maintained much more systematically.FASTER: [ Kennedy FASTER et Al 2007 – pg 246 ]The FASTER randomised controlled pilot test, studied the benefit of clopidogrel versus placebo and Zocor versus placebo initiated within 24 hours of symptom onset in patients with TIA or minor shot, all were treated with aspirin [ Kennedy et Al 2007 – pg246 GB ] . The survey was stopped early owing to failure to recruit patients, likely due to the increased usage of lipid-lowering medicines during the survey period.Blood Pressure and Lipid take downi ng agents:There is some robust grounds from randomised tests to demo that blood force per unit area and cholesterin lowering are effectual for secondary bar of shot. The PROGRESS survey of perindopril and Lozal showed that BP decrease with an ACEi and diuretic get downing several hebdomads or months after TIA reduces the hazard of subsequent shot by about a 3rd. There is a positive correlativity between cholesterin and hazard of ischemic shot. Cholesterol take downing with lipid-lowering medicines reduces the hazard of shot in patients with old shot, coronary or peripheral vascular disease or diabetes. The Heart Protection Study 2002 did non demo a decrease in hazard of perennial shot on lipid-lowering medicines [ Collins et Al 2004 – pg 288 ] , perchance because patients were at low hazard of shot return since the incident shots occurred on mean 4.6 old ages before the survey oncoming. However the subsequent SPARCL test of Lipitor in patients who had had a shot or TIA within one to six months before survey entry showed a reduced overall shot hazard [ Amarenco et Al 2006 – page 288 ] . However there was a important parallel addition in hazard of hemorrhagic shot had been found in the HPS in the 3280 patients with old shot or TIA [ Collins et Al 2004 pg 288 ] . Lipid-lowering medicines should non, hence, be used in patients with old intracerebral bleeding unless there is a strong indicant related to the hazard of ischemic events.Cholesterol-lowering drugs:Meta-analyses found that larger decreases in LDL Cholesterol led to larger decreases in hazard of major vascular events and its constituent results, proposing that attachment to a statin regimen bring forthing a 1.5mmol/L decrease in LDL cholesterin would take to a decrease of about one tierce in the comparative hazard of major vascular events. The full benefits of cholesterin take downing with a lipid-lowering medicine emerged over the 2-3 old ages of intervention and continued for each twelvemonth that intervention was continued thenceforth. HPS was the largest of the RCTs in this meta-analysis. It included over 20,000 people. In a subsequent RCT, the SPARCL test, non included in the meta-anlysis, patients with a recent shot ( about all ischemic ) or TIA and no known coronary bosom disease were indiscriminately assigned to either atorvastatin 80 mg day-to-day or placebo for 5 old ages. The difference between HPS and SPARCL in the effects of of shot or TIA could be explained by opportunity, different intervention regimens, enlisting of patients earlier after their event in SPARCL, or a different balance between ischemic and hemorrhagic shot results. Both tests found similar comparative decreases of approximately 20 % in ischemic shot, and a 70 % or more increased relation hazard of hemorrhagic shot. Both tests found comparative decreases with a lipid-lowering medicine of approximately 20 % in major vascular events. [ See 119-120 ref from BB page 811 ] . There is really good grounds for routinely sing the usage of drawn-out lipid-lowering medicine intervention to take down cholesterl degrees in allpateints at high hazard of any type of major vascular event, including those with a anterior ischemic shot or TIA, and irrespective of the baseline cholesterin concentration. Treating 1000 people with a anterior ischemic shot or TIA for 5 old ages with a lipid-lowering medicine will take to the turning away of over 50 major vascular events. The grounds clearly suggests that cholesterin take downing with a lipid-lowering medicine should be considered in everybody with a history of an ischemic cerebrovascualr event. Lipid-lowering medicines are non recommended for those patients whose untreated cholesterin or LDL choleserol degrees are below 3.5 mmol/L in cholesterin and below 2.6 mmol/L in LDL choleseterol. It is besides non recommended to order a lipid-lowering medicine for patients with a history of intra intellectual bleeding ( ICH ) but no ischemic vascular events, since really few of these patients were included in the two chief RCTs. For those patients with a history of ICH who are besides considered to be at peculiar high hazard of future ischemic shot or coronary events, it is likely sensible to order a lipid-lowering medicine [ Page 814 Big Book ] . Evidence besides suggests that it may be good to get down the lipid-lowering medicine therapy in the first few yearss after the TIA. [ 134 Large book page 815 ] . To reason on lipid-lowering medicines ; intervention tends to get down with a lipid-lowering medicine every bit shortly as the diagnoss is made of a TIA with a baseline entire cholesterin of & gt ; 3.5 mmol/L or LDL cholesterin & gt ; 2.6 mmol/L. Both simvastatin 40mg day-to-day and atorvastatin 80mg daily have been shown to be good in these patients.SURGICAL INTERVENTION120,000 people have a TIA or shot every twelvemonth in the UKat least 10,000 might be suited for CEA yet merely 4500 are being performed each twelvemonth. Recently published NICE guidelines suggest that CEA should be done on appropriate patients in 2 hebdomads of presentation. There have been unacceptable holds between symptom and surgery in the UK. Merely a fifth of diagnostic patients have surgery within two hebdomads, which is the recommended NICE guidelines. Diagnostic CEA is pressing and should hold precedence over elected surgery. The recent GALA test shows that the first 1001 UK patients had a average hold between symptoms and surgery of 82 yearss [ 7 from BLUE BMJ Research article )Carotid Endarterectomy – Evidence of its benefitSurgical remotion of the atheromatic plaque from within the carotid arteria – the carotid endarterectomy ( CEA ) . Tests have proven that it is an effectual intervention for the secondary bar of shot in selected patients. CEA is associated with a assortment of possible complications such as shot and decease [ Naylor Ruckley, Bond et al – GB Ch 25 ] . It is apparent that surgery clearly prevents stroke in patients with diagnostic terrible CAS, but at a monetary value: hazard of shot as a effect of surgery, cost of surgery, hazard of other complications of surgery, cost of probes for choosing suited patients. Nowadays there is concern in the UK as to which patients should be offered surgery. [ 374 375 – BB- Ch 16 ] . As a consequence of big RCTs, it is now clear that CEA of late diagnostic terrible CAS about wholly abolishes the high hazard of ischemic shot over a period of 2-3 old ages. [ 369-371,445-447- Ch 16 BB ] . A clear advantage to surgery is shown when the diagnostic stricture exceeds 80 % diameter decrease of the arterial lms utilizing the ECST method ( European Carotid Surgery Trial ) , which is different to 70 % utilizing the NASCET method. In the NASCET test, CEA reduced the comparative hazard of shot by 65 % compared to medical intervention. The hazard of shot in patients with less than 60 % ( ECST ) stricture is so low, the hazard of surgery is non worthwhile for them. For patients with between 60 % and 80 % ( ECST ) stricture there is still some uncertainness as some of these may be at immense hazard of shot who gain from surgery. Whether the benefits of CEA or stenting in patients with symptomless stricture warrant the hazards and cost is still ill-defined, peculiarly in an epoch of improved medical interventions. ACST and ACAS, had absolute decreases in five-year hazard of shot with surgery were similar: 5.3 % and 5.1 % , severally.Carotid Stenting:Carotid stenting is less unpleasant and less invasive than carotid endarterectomy, and is more convenient and quicker. It is carried out under LA. Some little tests have compare stenting with CEA, and suggested that the procedural shot complication rate of stenting was similar to that of CEA and that there are fewer shots in the long-run. They besides showed that stenting might hold a higher hazard of shot and decease than CEA, and a higher rate of restenosis. The SPACE test is the largest survey comparing CEA with carotid stenting.Timing of SurgeryOptimum timing of surgery has been a extremely controversial subject [ 473-474 – ch 16 BB ] . Surgery should be performed every bit shortly as it is moderately safe to make so, given the really high early hazard of shot during the first few yearss and hebdomads after the TIA in patients with diagnostic CAS. [ 16-475 – ch 16 ] . In stable patients there is no difference between early and subsequently surgery. Thus for stable patients with TIA, benefit from endarterectomy is greatest if performed within 1 hebdomad of the event. [ 390 ch 16 ] However in exigency carotid enarterectomy patients with germinating symptoms ( sucha s stoke in development, crescendo TIA ) had a high operative hazard of shot and decease of 19.2 % which was much greater than that for stable patients 9390 – 477 ch 16 ] . Therefore there is still uncertainness about the balance of hazard and benefit of surgery within 24-72 hours of the presenting event. [ 475 478 479 – hc 16 ] . Merely a minority of patients with TIA are possible campaigners for carotid endarterectomy ( CEA ) or stenting, make up one's minding on surgical intercession instead than medical intervention entirely can be hard. In the ECST 30 % of patients with 90-99 % stricture had a shot in three old ages, 70 % did non. Both ECST and NASCET have two values for the stricture and this difference has been down to the manner the two tests underwent at that place angiographic techniques and to what extent the techniques used to mensurate stricture were accurate. ECST i? 70 % NASCET i? 50 % – WHY THE Difference? ? THE BIG AUDIT The DoH stroke scheme recommends that CEA should be carried out within 48 hours of symptoms, when the hazard of shot is highest, in patients with TIA who are neurologically stable. [ 17 BMJ ARTICLE ] . To accomplish this, utilizing FAST will assist public to recognize TIA and early shot [ 17 BMJ article ] . And the ABCD2 mark helps primary and secondary services to place those patients with TIA who are at highest hazard of shot. [ 18 BMJ Art. ] .Future Directions – How Potential Future Research may be designed to get the better of spreads and challengesMentionsAppendix 1:MethodsLiterature Search StrategyA controlled hunt scheme was employed to obtain informations from medical databases such as PubMed, EMBASE, MEDLINE ( Via PubMed ) , Web of Science, Science Direct ( Elsevier ) , and The Cochrane Library. I besides used the University MetaLib system. I used the capable hunt subdivision and selected ‘Health and Medicine ‘ as the chosen subject of research. It helped further my hunt for e-journals and articles. The systematic hunts were performed in September 2010 to place suited surveies and reappraisals that were published from 2000 until the present twenty-four hours ( i.e from the past ten old ages ) . Although some robust randomised controlled surveies were included which were necessarily dated back beyond this day of the month scope. Drawn-out hunts were made via cyberspace web sites and manual searching of diaries. Recently published, well-conducted systematic reappraisals and primary surveies were selected for inclusion in this systematic reappraisal. Interlending and Document Supply was besides used as a service provided by the Lancaster University Library, to recover some diary articles.Key WordssTranseunt Ischaemic Attack, TIA, TIA Management, Treatment, Current therapy, Anti-coagulation, antiplatelet drugs, acetylsalicylic acid, clopidogrel, dipyridamole, combination therapy, cerebrovascular accident, secondary bar.Using MeSH and seeking different Fieldss by using bounds enabled me to polish my consequences from databases. Any articles found within this hunt were so critically appraised ; their relevancy to this systematic reappraisal was besides so decided.Relevant diaries that were non found on the library MetaLib system, were searched for on Google Scholar and the page was taken straight to the database beginning site and so searched within the peculiar database archives. These include: Stroke, The Lancet, New England Journal of Medicine, European Journal of Vascular and Endovascular Surgery, Journal of Vascular surgery, An nals of Vascular surgery.

Chinese literature response 1st Essay Example | Topics and Well Written Essays - 500 words

Chinese literature response 1st - Essay Example This was a central theme to the Yuang and Ming dynasty based on ideas of political expansion and social diversity that was beginning to influence different regions and is portrayed throughout this work. â€Å"Only this place is paramount†¦.At heaven’s edge autumn clouds furl; / bamboo hawsers cable together the floating bridge, / On the water a steel blue dragon reclines. / East and west it breaches into the rune regions / north and south it threads together a hundred streams† (118). While Wang is speaking about the place that Student Zhang is going to, it also shows that this is a central point for unification of east, west, north and south. The politics that relate to this and the influence of the environment at the time influence this specific concept and theme. This one rhetorical passage not only defines the idea of expansion and unification of political territories. This is also seen through the symbol of the characters that reflect this passage, as well as the metaphor of the entire work. The Student Zhang is located in the western wing of the monastery and Oriole, his lover, is in the east wing. Their love is seen by each when they go to different sides of the monastery to visit each other. This is representative of the theme of unification of north and south. The two characters and monastery become symbolic of the division of each side that is brought together through the actions and expressions of both characters. This is able to intertwine with the passage given that shows the meeting point of all sides. Another relationship to this main theme is based on the actions taken throughout the book. The plot line follows the Yuan and Ming dynasties and what was politically occurring during this time. This is specifically represented by Oriole’s mother and the actions she takes after the monastery is invaded, specifically by offering her daughter’s hand in marriage for defeating the opposing side. Putting this conflict into

German Syntax Essay Example | Topics and Well Written Essays - 2000 words

German Syntax - Essay Example 2.0 Word Order2.0 Word Order German is considered an SVO language (Fagan 146), which means that the underlying word order is Subject-Verb-Object in a phrase. 1)    Seine       Mutter      trinkt Whisky.              Ã‚     [subj-his mother]       [verb-drink]   [obj-whisky]           His mother drinks whisky.    (Collins 175)Sentence 1 demonstrates the most common word order in German; it is a declarative sentence and has only one main clause (Weyerts et al. 216). So the verb is in second position in a sentence that is complete and can stand alone; in other words in an independent clause. Weyerts et al. claim that â€Å"it is always a finite verb or auxiliary that appears in second position, and it only appears there in main clauses† (216).Double clause sentences are constructed in a similar way. If two independent or main clauses are joined with a conjunction, the word order remains as SVO in both clauses. Sentence 2 is an example of two independent clauses joined with a conjunction.   2)    Wir                   wollten                     ins       Kino,                        aber          wir                hatten  [subj-we] [verb-wanted] [indir. obj- to cinema] [conj-but] [subj-we] [verb-had]  kein      Geld[direct obj-no money]

Health Report Essay Example | Topics and Well Written Essays - 250 words

Health Report - Essay Example I had an opportunity to interview one of the directors. He narrated their foremost great achievement of implementing the healthy, hunger-free kids Act. The Act remains imperative in improving and reauthorizing child nutrition programs. They were to get rid of unhealthy food and beverage in school, and other social amenities. This legislation provides more than 31 million American children who need greater access to healthy amenities. Despite some challenges, about 90% of schools have reported to meet the set food and beverages standards. NANA has improved nutrition and physical resources at CDC. Funding amplified between $2 in 1998 to $45 million in 2010. This has helped improve their services to the targeted population in the USA. NANA has made great achievements and improved the lives of many, thereby reducing deaths and health related diseases amongst children. I would recommend the government to be part of the greater contribution to create room for better services. The merging organization have helped in ensuring that the preferred healthy living is met in local areas and gives back report to NANA for better servicing. Science-based nutrition guidelines for school foods have also reinforced parents’ efforts to help their children eat healthy, making NANA’s work much easier at times. Story, M., Nanney, M. S., & Schwartz, M. B. (2009). Schools and obesity prevention: creating school environments and policies to promote healthy eating and physical activity. Milbank Quarterly. 87(1): 71–100. doi:

Assessment in Counseling Essay Example | Topics and Well Written Essays - 750 words

Assessment in Counseling - Essay Example Assessment being an integrated assortment of data gathered from both informal and formal interactions with the client by the counselor provides a more holistic insight into the problems of the client (Juhnke, 1995, p. 2). The assessing process is found to begin when the counselor starts to see â€Å"a clear picture of the outcomes a client expects from counselling† (Hiebert, 1996). The assessing process should focus on client learning outcomes as well as client impact outcomes (Hiebert, 1996). It can be seen that client learning outcomes are easy to realize while impact outcomes may remain difficult to attain yet (Hiebert, 1996). This is shown in the below given example: School counsellors can feel confident about teaching children conflict resolution procedures or anger management skills (which are learning outcomes), but they may be less successful in making a child less aggressive (which is an impact outcome), because they cannot have sufficient impact to counteract the eff ects of contextual factors such as family violence and many years of practice using aggression to resolve conflict (Hiebert, 1996). When a counselor tries to bring about both these outcomes through assessment, the assessment techniques are used in harmony with each other so that it becomes â€Å"a continuous process, throughout treatment† (Juhnke, 1995, p.2). ... circumstances and the range of client learning outcomes make it unlikely that appropriate standardized assessments could be developed (Hiebert, 1996). Informal assessment techniques comprise of â€Å"informal, yet systematic, procedures for documenting the evidence that client progress has been made† (Hiebert, 1996). Some informal assessment techniques are, goal attainment scaling, checklists, self-monitoring, thought listing, mind mapping, life line, role play, and photograph safari (Hiebert, 1996; Juhnke, 1995). Here, the process of assessment itself is viewed as part of the change process that happens in the client ((Juhnke, 1995, p.2). The five major uses of assessment according to Wall (n.d) have been â€Å"selection and placement, diagnosis, accountability and evaluation, identifying trends or progress (and) self discovery† (p.69). Wall (n.d) has also listed the advantages of using assessment, namely, objectivity, cost effectiveness and fairness (p.71-72). Two sit uations in which I would use formal assessment While dealing with children with language disabilities, I may use developmental screening method (Gullo, 2005, p.45). Gullo (2005) has described developmental screening tests as â€Å"norm-referenced assessment instruments that allow one to compare an individual child’s score with those of other children of similar chronological age† (p.45). These tests will also enable me to gauge the â€Å"visual-motor and adaptive skills† of these children and design special learning packages for them. I can use another formal assessment method, diagnostic tests, while handling children with dyslexia. The purpose of such a test is that we identify and measure â€Å"the existence of a disability or specific area of academic weakness in a child† (Gullo, 2005, p.46). I will

Health Promotion Assignment Example | Topics and Well Written Essays - 750 words

Health Promotion - Assignment Example Despite the fact that these health complications are preventable, they are still a major challenge in the modern world. By looking at some of the fixed and variable costs likely to be incurred by individuals with these complications, this paper has been able to come up with a rough estimate of the average costs likely to be incurred by individuals. Despite the availability of information both online and locally, diabetes and obesity are still a major threat in the twenty-first century. These are just some of the common lifestyle diseases. Healthcare provides often overcharge treatment services of these diseases especially those in the private sector. By looking at the average cost of treatment in the average society, we can be able to come up with a budget of the average cost of treatment. The budget may seem a bit inclined to the high class of people and disadvantage the middle and low-class people in the society. The main reason why this may be the case is that some of the equipment used to treat these diseases are rather expensive and rare. Additionally, these diseases are associated with the wealthy members of the society. Cost benefit analysis Despite the fact that promotion of health services is not meant to be a business venture, it ought to be conducted in an economically sustainable way. In this case, the total benefits may not be quantifiable in monetary terms. All in all, the promotion process is fruitful since it helps the country save a lot and maintain health standards within its territories. Worthiness of implementing health promotion activity based on the cost-benefit analysis The issue of whether or not to implement promotion activities remains to be a controversial matter. Health providers are torn between whether to conduct health promotion activities or not to (Tones and Tilford 2001). While these activities may be resource

The big brother Essay Example | Topics and Well Written Essays - 1500 words

The big brother - Essay Example We had realized this basic fact even centuries ago. An authority to rule and regularize is a must for the very survival of a society. All the systems which do not own such a surveillance arrangement will get only history of failure. Either other forces win over them or they perish by themselves. Realizing the unavoidable role of an administrative authority, we are pursuing the search for finding good models. Many options are developed, but still difficult to point out a perfect one. Developing new models, facing problems when they are attempted practically, trying for other forms- this set of activities is a continuing process. It is not sure whether we can reach a completely foolproof system. Anyway the necessity of administrative systems makes it relevant to continue with the discussions and studies on this topic. Different administrative systems are having different features. On common points different systems may have contradictory approaches also. There will be people to support both the approaches. So it is difficult to rate administrative systems and differentiate as good or bad. The only thing one can do is to compare and explain merits and demerits of each and all systems. We can name enough administrative forms like democracy, imperialism and autocracy. But when we start discussing about one particular system it is quite sure to think about other systems also. Of course, in such thoughts and discussions some terms also will be so common. Big Brother is one among the very important and popular term in these sorts of studies. For so long the term is in use among students of administrative systems. The term Big Brother was used first by George Orwell in his novel Nineteen Eighty-Four. (books.google.co.in/bookshl=en&id=yxv1LK5gyV4C&dq=big+brother&printsec=frontcover&source=web&ots=ol68A61VMb&sig=yu_lbdDeMTS6kHyAZDugrC6KE6M&sa=X&oi=book_result&resnum=3&ct=result#PPA1,M1). Big Brother is being presented as the all powerful dictator of Oceania state. Oceania is a totalitarian state where the ruling party is all important and superior to all other power centers and individuals of the state. It is observed that everybody is under the surveillance of Big Brother all the time. Even a phrase "Big Brother is watching you" developed as an after effect. It is not clear from the novel whether Big Brother was a real man or not. But the Party presents Big Brother as a real leader and one important one among the founder leaders of it. He is considered to be the leader of revolution also. O'Brien, a character in the novel Nineteen Eighty-Four explains the cause which led to the development of Big Brother concept. According to O'Brien the aim of the Party is to gain power. It is not planning to create a heaven on earth. But need power only. The Party after capturing power is bothered only of remaining power, says O'Brien. To capture power they are thinking of bringing changes in the mindset of people. Make them stay off from enjoyments in life and Party believes that through this society also will undergo a change which will be favorable to the Party. If it is possible to bring this change in the society, the Party leaders hope that they capture power. Such a society will not have any good qualities like mercy or love. It will be a society with no space for art, literature or even science. Absence of such areas will give birth to such a situation in which people won't be having much topics other than party to think of.

Public Goods Essay Example for Free

Public Goods Essay We are very much familiar with this line â€Å"I believe the children are our future, teach them well and let them lead the way†. Children are considered the hope of every nation for they will soon become our leaders. We all want our children to get everything they deserve to get, receive fair treatment and have high quality education because this will help them contribute to the welfare of the society, they are a good investment. But not all parents have the capacity to provide even the most basic needs of their children. Sometimes we wish children were just valued as a public good. A public good is a term used by economists to refer to a product (i. e. , a good or service) of which anyone can consume as much as desired without reducing the amount available for others. ( Public Goods: A Brief Introduction). Myra Stober suggested in her article that children must be raised and guided collectively so the nation as a whole will benefit from them not just their parents. If that happens, equality among children can be accomplished and the nation will prosper a lot from them. However, if this will be implemented it can lead to market failure where uncoordinated markets driven by parties working in their own self interest are unable to provide these goods in desired quantities. (Wikipedia) Considering children as a public good is only an alternative and should not be considered the best solution because is not the best remedy to proper child care. Meeting their needs cannot be done in a snap because it takes a lot of consideration to do so. Works Cited The Linux Information Project (LINFO) â€Å"Public Goods: A Brief Introduction† Web . 16 Feb 2006. 29 July 2010 http://www. linfo. org/public_good. html Public Good. Wikipedia. org. 29 July 2010. http://en. wikipedia. org/wiki/Public_good

Relationship influence relationships Essay Example for Free

Relationship influence relationships Essay Physical attraction is based on peoples appearances. Often a caring, kind, and affectionate person will go unrecognized among others. Mostly such people find their partners due to physical proximity, ones actual physical nearness to others, in terms of housing, work, school, and so forth. On the other hand, an attractive person usually would have far more attention from others. Mills had an experiment which showed that most important determinant of desire to continue relationship was physical attractiveness. (1982) However, in Todays Magazine, the article read : according to a new study, [men are] willing to overlook a womans body shape and weight if shes friendly and likeable. But, consider that the article, if you read it, doesnt present other important information, such the percentage of people who are in the category, and to what extreme were those studies true: its likely that men can overlook minor unattractive traits, but it doesnt totally disprove the study mentioned above. Even though the point if this study may have changed slightly, it is not a secret that attractive people seem to be more of everything, since with beauty, person seems happy, healthy, successful, interesting, even if it isnt necessarily so, which is called the halo effect. Another kind of attraction is romantic attraction. It is love that is associated with high levels of interpersonal attraction, heightened arousal, mutual absorption (with regard to romantic love, the nearly exclusive attention lovers give one another.), and sexual desire. Romantic attraction has a like scale and a love scale, that Zick Rubin brought up to measure the attitude towards friends and love partners. In result, love usually included passion and commitment, whereas liking lacked those things. Estimated by these scales, type of attraction can be described by the chosen attitude towards each other, as to what the two people think of each other, and whether they are intimate or not, and so on. Just as there are different reasons for forming our personalities, there are different causes which bring people together. The reason some people choose to date who they date is partially due to homogamy -the attraction of people who are alike and heterogamy the attraction of opposites. A person may seek to find someone with similar qualities or with the opposite ones to balance out. To some degrees, love may be just a mere excitement. This love (which is also something like secret love) is determined by different situations, such parents disapproval, or when fleeing the country with someone. Just as in secret love, those events may lead to feel even stronger attraction. But even if such situations can be an attribute to the relationship, it can also bring conflict. Those relationships can be affected by uncertainty of whether there is any kind of attraction between the two people. (As Kenrick wrote, it is sometimes hard to tell the difference among sex, love, and infatuation (1989). There are also two problems: excitement that adds to attraction and boredom that decreases it; the influenced behavior may not be the cause of attraction. (Homans 1961) Similarly, I am sure there have been times when youve known or heard of someone who, for example, embraced everyone he or she was friends with. His or her behavior doesnt necessarily mean deep attraction, but it may just be a way in culture, personal way of showing friendship, or a habit, or may be the fact that he or she misses his/her girlfriend/boyfriend. Any of those reasons may be the factor, why due to body language, a woman may take such action for affection, or, from another point, a man can misunderstand womans warning signals. References Homans, G.C. (1961) Social Behaviour: Its Elementary Forms, New York, Harcourt, Brace and World. Kenrick, D.T. and Trost, M.R. (1989) ‘A reproductive exchange model of heterosexual relationships’ in Hendrick, C. (ed) Close Relationships (Review of Personality and Social Psychology 10) Newbury Park, CA, Sage. Miell, D. Croghan, R. (1996) ‘Examining the wider context of social relationships’ in Dallos, R. Miell, D. (eds) Social Interaction and Personal Relationships, Milton Keynes, Open University. Mills, J. and Clark, M.S. (1982). ‘Communal and exchange relationships’ in Wheeler, L (ed.) Review of Personality and Social Psychology (Vol 3), Beverley Hills, CA, Sage

Competition in the banking industry

Competition in the banking industry The banking system of a country plays a vital role in social welfare of the people in the country and of people of the world in general. It offers services to enterprises and consumers to undertake their business activities and to easily perform their day-to-day transactions. It is necessary to ensure an efficient functioning of the banking system; otherwise, a dull and bogus banking system brings about an ultimate threat of potential for financial instability. That is the reason why the competition in financial sector is of much importance. The importance is for many reasons; i.e. it relates to the efficiency, quality and innovation of the production of financial services. Most importantly, it helps in taking careful decisions in policy making for banks (Claessens and Laevens, 2003). In recent years, a lot of research work has been carried out, investigating the nature of competition in the banking industry along with the degree of competition, factors affecting the competition and the effects of competition on other market factors on micro level as well as on macro economic level. An explanation for the vast amount of studies on this topic is that competition can not be measured directly due to the lack of detailed information on prices and costs of the various banking products (Bikker et al., 2007). This topic has also gained popularity among bankers, economists and policy makers because of globalisation, liberalization of financial markets and banking harmonization all over the world, especially in the European Union. Since early 90s, there are a lot of regulatory changes observed in the banking industry in order to achieve the establishment of a single, competitive market in the financial sector of Europe. It was initially triggered with the implementation of the Second Banking Coordination Directive defining conditions for Single Banking License. As a consequence, entry barriers have been removed substantially for the new entrants increasing competition, coupled with a significant consolidation process. The intuition behind this was Market Contestability; a market is contestable if there are no barriers to entry, exit is absolutely costless and the prices are highly elastic to demands for industry output. The key idea is that a firm may be compelled to be more competitive and efficient by the prospect of new entrants (Allen and Engert, 2007). Furthermore, costless exit means that if a firm enters into a new market and then decides to withdraw, it is required to recover sunk entry costs. These features insure that even if a market has a small number of active firms, it is still effectively contestable and competitive (Nathan A. and Neave E., 1989). Moreover, the pro-competitive deregulation process has increased the level of competition (Cetorelli, 2004), particularly in non-traditional and non-interest bearing areas of banking activity (Goddard et al. 2001). Trivieri F. (2005) documents that in the course of the 1990s, the Italian banking system underwent profound changes at normative and institutional levels, which led among other things to a significant relaxation of the entry barriers, to the liberalisation of bank branching, to the redefinition of ownership structure and to a large number of mergers and acquisitions. The effects of these transformations and, in particular, of those linked to the process of consolidation have been studied by many authors (see, among others: Resti, 1997; Angelini and Cetorelli, 2000; Messori, 2001; Sapienza, 2002; Focarelli et al., 2002; Focarelli and Panetta, 2003). According to European Central Bank 1999, 29 percent banks had been merged or shrunk between 1985 and 1997. In Italian banking industry, the Second Banking Directive was implemented in 1993, followed by a 20 percent reduction in the number of banks as a result of consolidation. It is observed that competition has been increased in recent years in European banking markets which is also generally true for Italy. Angelini and Cetorelli (2000) cite that a rise in the competition is easily found in European banking markets during recent years. Danthine, Giavazzi, Vives and von Thadden (1999) report a somewhat generalized decrease in banks net interest margins across Europe during the 1990s. Consistent with the European evidence, a declining trend in bank margins is also observed across different markets in Italy. This paper focuses only on the banking industry of Italy and analyzes the evaluation of competitive conditions, nature and the degree of competition in the Italian banking industry using firm-level balance sheet data. In this paper, we explore more thoroughly the competitive nature and degree of competition in the Italian banking industry by adopting a methodology developed in empirical industrial organization and used extensively in banking. Further more, we will compare our results with previous results to find out that whether the degree of competition has been increased or it has been as same as it was in the past. The setup of the remainder of this paper is as follows. Section 2 contains some important information about structure and features of a competitive banking industry which helps in understanding the competition more thoroughly. Next Section 3 introduces the original Panzar-Rosse model along with the previous studies in the field. Section 4 gives a brief explanation of the general Panzar and Rosse model. This section also shows the interpretation of the H-statistic along with the description of the testing hypothesis. Following Section 5 deals with the empirical model used in this study including long-run equilibrium test. This section also contains the banks data used for the empirical illustration for our theoretical findings. Finally in the last Section 6 empirical results and conclusion is discussed. OPTIMAL COMPETITIVE STRUCTURE OF THE BANKING SYSTEM According to Northcott C. (2004), competition improves efficiency and growth in the banking sector but market power or concentration is necessary for stability in the industry. Moreover, competitive environment promotes productive and allocative efficiency leading towards economies of scale while market power improves credit availability, stability, quality of banks loan portfolios, screening of loans and monitoring them. As a result, market power should not be eliminated, but rather used to facilitate an environment that promotes competitive behaviour. FEATURES OF A COMPETITIVE BANKING INDUSTRY Concentration weakens competition by fostering collusive behaviour among firms. Increased market concentration was found to be associated with higher prices and greater than normal profits (Bain, 1951). Smirlock (1985) and Evanoff and Fortier (1988) argue that higher profits in concentrated markets could be the result of greater productive efficiency. Berger (1995) finds some evidence that the efficiency hypothesis holds in US banking. In Europe, on the other hand, structural factors appeared to be more important and the SCP hypothesis seemed to hold (Goddard et al., 2001). If a well-developed financial system is provided then contestability improves with new entrants. Contestability is not necessarily related to concentration or the number of banks. Concentration and competition can exist together because of the presence of asymmetric information and branches and the effect and use of new technologies. (Northcott C, 2004) LITERATURE REVIEW AND THEORETICAL ISSUES: According to Bikker and Haaf (2000), initially the economic literature on the issue of competition in the industrial sector can be divided into two main categories; structural approach and non-structural approach. Structural approach can be further divided into two main paradigms. First type of structural approach is Structure-Conduct-Performance (SCP) paradigm, which tells us that the degree of competition is determined by the structural characteristics of the market, such as, number of firms, size of the firms, etc. The SCP was developed in the early 1950s by Mason (1939) and Bain (1951). Bain (1951) constructs the market power hypothesis that collusive behaviour is initiated by high concentration which results in large profits for firms. Later, Stigler (1964) and Demsetz propose efficiency hypothesis in contrast of marker power hypothesis stating that the efficiency of bigger firms may be the reason for high concentration instead of collusive behaviour of firms, while during 1980s, Baumol, Panzar and Willig (1983) build contestability hypothesis. Their hypothesis states that if entry and exit barriers are relaxed then competition may be prevailed (Mkrtchyan A. 2005). Second approach is Efficient-Structure-Hypothesis (ESH), which states that greater concentration in the industry not only increases the level of efficiency in the sector but also increases the degree of competition in that sector. Non-structural approach is based on describing the nature of competition in the context of the studies of New Economic Industrial Organization (NIEO). It suggests non-structural models to analyse the competition in markets which do not rely on the markets structure. Particularly, Klein (1971), Baumol, Panzar, and Willig [1982] provide a theory that shows that market competitiveness can be inferred irrespective of the structure of the market. NIEO studies include Iwata Model (1974), Brasnahan Model (1982), Rosse and Panzar (1977), Panzar and Rosse (1982), Panzar and Rosse Model (1987), etc. Non-structural method or firms input-output cost studies have gained more popularity than the structural approach among academics, researchers, analysts and policy makers. Particularly Panzar and Rosse model (1987) is the most widely used and is very popular model for competition. Duncan (2003) mentions that the Panzar and Rosse (P-R) model provides a comprehensive and simple method to calculate the competition. It does not require intensive data as compared to other models and has been firmly related to theoretical side. The information required for this model is easily available as it calculates the sum of the factor prices elasticities estimated from a reduced form of revenue function. The Rosse-Panzar test has been developed to examine competitive conditions in the light of the contestability theory (Rosse and Panzar, 1977; 1982; 1987). This approach measures the degree of competition by analyzing how each banks revenues react to changes in input prices. It has primarily emerged to test market conditions that encompass all spectrums of competitiveness away from the restrictions brought about by the structural concepts. Basically, it depends on the relationship between gross revenues of the firm and the change in its input prices by using a statistic which is called the H-statistics that measures the sum of elasticities of total revenue with respect to each input price. As this approach includes the revenue equation so for banks, mainly the revenues are interest revenue. In this approach, h-statistics is used to measure the degree of competition. The H-statistics will tell us the responsiveness of revenues to the changes in input prices. If h-statistics is less t han or equal to zero then there will be monopoly, if it is between zero and one then there will be monopolistic competition and if it is equal to one then there will be perfect competition (Greenberg J. and Simbanegavi W.). This approach is preferred when testing the data of different individual banks. Moreover, P-R approach yields similar results without any ambiguity as it has clearly defined hypotheses with specific interpretations. PREVIOUS GENERAL STUDIES ABOUT BANK COMPETITION: Rearrange the literature review according to the claessens and neave. A great number of papers have been written on investigating competition in the banking industry using Panzar and Rosse model (1987). But the motivations for analyzing the nature of the competition are vastly varied like contribution of institutional and structural factors, growth, regions, stability, financing, efficiency, contestability, consolidation, cross-border capital flows, risks etc. The summary of the previous works and their findings can be seen in the Appendix Table 1. Panzar J. and Rosse J. (1987) develop test for Monopoly and use linear regression model to estimate the H-statistic for the newspaper industry, reporting that it is vague to conclude that the newspaper firms earn oligopoly profits. Looking at the cross-country studies carried out in the EU banking markets, one of the earliest analysis is undertaken by Molyneux et al. (1994) who test the Panzar-Rosse statistics on a sample of banks in France, Germany, Italy, Spain and the UK for the period 1986-89. Results indicate monopolistic competition in all countries except Italy where the monopoly hypothesis can not be rejected. Shaffer and Disalvo (1994) use this test to analyze the data of a duopoly banking market in south central Pennsylvania to exercise the procedure for concentration and competitive conduct. Waleed Murjan and Cristina Ruza (2002) examine the Arab Middle Eastern banking markets with this test concluding that the banking sector is more competitive in non-oil-producing countries than the banking industry in oil-producing countries. Gelos and Roldos (2002) apply this method on 8 different countries of Latin America and Europe, finding that market contestability prevents the competitive pressure from declining which can happen because of the consolidation while Claessens and Laeven (2003) process the data of 50 countries obtaining the same results. Bikker and Haaf (2002) assess the banking industry in 17 European countries and six countries that are outside of Europe comparing competitive conditions and market structure. Goddard, J. and Wilson, J. (2006) report misspecification bias in the revenue equation for the banking sectors of 19 developed and developing countries. They suggested a dynamic revenue equation for unbiased estimation rather than fixed effects estimation which is severely biased towards zero. Gilbert (1984) and Berger (1995) test the data for 8,235 banks in 23 developed nations producing the results that a higher degree of market power has less risk exposure. Yuan Y. (2005) assesses the competition in Chinese Banking sector and comes up with the results that China already has had perfectly competitive condition before new foreign entrants and it still has the same situation. Duncan D. (2003) presents the empirical assessment of the market structure of the Jamaican banking sector and competitive trends in the market finding monopolistic behaviour. Al-Muharrami S. et al. (2006) take GCC Arab countries into observation and suggest that Kuwait, Saudi Arabia and the UAE operate under perfect competition; and Bahrain and Qatar operate under conditions of monopolistic competition. Nathan A. and Neave E. (1989) exercise the test on Canadian financial industry and reject the hypothesis of monopoly power in Canadas financial system. PREVIOUS STUDIES ABOUT COMPETITION IN ITALIAN BANKING INDUSTRY: A great number of studies on competition in financial sector of EU countries have been reported which also include Italy in general. But there are also some research-papers which are produced specifically for Italy. Some of them are: Cetorelli N. and Angelini P. (2000) study the case of the Italian banking industry and cite that competitive conditions have improved substantially after 1992, and it is believed that the introduction of the Single Banking License in 1993 also helps fostering the competitive behaviour in Italian banking industry. DellAriccia G. and Bonaccorsi E. (2003) investigate the relationship between bank competition and firm creation. They document that the effects of competition in the banking sector on the creation of firms in the non-financial sector are less favourable to the emergence of new firms in industries where information asymmetries are greater. Coccorese P. (2002) rejects the theory that competition can be easily reduced by the collusive behaviour of the firms, and comes up with the conclusion that strong concentration does not necessarily prevent competition among firms. Trivieri F. (2005) compares the banks involved in the cross-ownership and banks that are not involved. He finds that Italian banks involved in cross-ownership are less competitive than the banks which are not involved in cross-ownership, hence proving cross-ownership decreases competition. GENERALIZED PANZAR AND ROSSE (1987) APPROACH: P-R model assumptions: Firstly, there are some assumptions and conditions in which Panzar and Rosse model works. The model supposes that banks operate in long run equilibrium. Although Goddard Wilson (2006), documents that this condition is not needed any more if a correctly specified dynamic revenue equation is adopted which permits virtually unbiased estimation of the H-statistic. This eliminates the need for a market equilibrium assumption, but incorporates instantaneous adjustments as a special case. So in this paper long run equilibrium postulate holds. Another assumption is that the market participants affect the performance of the banks by their actions. Another postulate is that the price elasticity of demand is greater than unity. Moreover, the model posits that there is a homogenous cost structure. Furthermore, profits are maximised to obtain the equilibrium number of banks and the equilibrium output. In long rum equilibrium, it is known that banks maximise their profits when, marginal revenue eq uals to marginal cost (Bikker and Haaf, 2000). Trivieri F. (2005) also adds that the banks are treated as single product firms which mainly provide intermediation services. EXPLANATION OF PR MODEL: Claessens and Laeven (2003) cite that the Panzar and Rosse model studies the impact of changes in factor input prices reflected in equilibrium revenues by a specific bank. Bikker and Haaf (2000) write that Panzar and Rosse model gives simple models for oligopolistic, competitive and monopolistic markets. This test works on the reduced form revenue equation and uses H-statistics. This H-statistics can tell us not only the nature of competition but also gives information about the degree of the competition. H-statistics if measures between 0 and 1, it is monopolistic competition, 0 is considered as monopoly and 1 as perfect competition. Here, a general banking market model is used, which determines equilibrium output and the equilibrium number of banks by maximising profits. The model is also able to allow for bank-specific variables in the equation. According to Bikker and Haaf (2000), in the long run equilibrium, it is known that banks maximise their profits at the break-even point. The break-even point is where marginal revenue equals marginal cost. So, the bank i maximises its profits, where marginal revenue equals marginal cost: (1) Ri refers to revenues and Ci to costs of bank i (the prime denoting marginal), xi is the output of bank i, n is the number of banks, wi is a vector of m factor input prices of bank i, zi is a vector of exogenous variables that shift the banks revenue function, ti is a vector of exogenous variables that shift the banks cost function. Secondly, it means that in equilibrium at the market level, the zero profit constraint holds (Bikker and Haaf, 2000): (2) Variables marked with an asterisk (*) represent equilibrium values. Panzar and Rosse define a measure of competition H as the sum of the elasticities of the reduced-form revenues with respect to factor prices (Bikker and Haaf, 2000): (3) According to Khan, M. (2009), it measures the percentage change in (equilibrium) revenue due to a one percent change in all input factor prices (change in cost). From duality theory, it is known that one percent increase in factor prices will lead to one percent upward shift in cost function. The impact of this shift in cost function on the (equilibrium) revenue of the banks is directly related to the degree of competition in the banking sector. Bikker and Haaf (2000) further explain that Panzar and Rosse prove that under monopoly or under perfectly collusive oligopoly, an increase in input prices will increase marginal costs, reduce equilibrium output and subsequently reduce revenues; hence H will be zero or negative. An increase in input prices raises both marginal and average costs by an equal proportion as the cost is homogeneous of degree one in input prices without altering the optimal output of any individual firm. Exit of some firms increases the demand faced by each of the remaining firms, thereby leading to an increase in prices and total revenues by as same amount as the rise in costs, resulting perfect competition where H-statistic is positive but not greater than unity. In this case marginal and average cost will be increased by the rise in input prices (Nathan A. and Neave H., 1989). INTERPRETATION OF H-STATISTICS: Panzar and Rosse prove that, under monopolistic competition, H is between zero and unity. H is a decreasing function of the perceived demand elasticity, so H increases with the competitiveness of the banking industry. As a result, this H-statistic can serve as a continuous interpretation of the competitiveness. Although this is not mentioned by Panzar and Rosse (1987) but with some assumptions this continuous interpretation is correct. So, the testable hypotheses are: The banking industry is characterised by monopoly for H=0, monopolistic competition for 0 HYPOTHESIS TESTING; Khan, M. (2009) mentions: Two-sided Perfect Competition Test: Maintaining the long run equilibrium postulate, if banks are operating under perfect competition, a one percent change in cost will lead to a one percent change in revenues. Output will not be changed if the demand function is perfectly elastic under perfect competition, output price and cost both will increase by the same extent. This implies that under perfect competition, H-statistic will be equal to one. Statistically, we will test the following hypothesis. H0 : H = 1 Perfect competition prevails in the banking sector. H1 : H à ¢Ã¢â‚¬ °Ã‚   1 There is no perfect competition in the banking sector. Two-sided Monopolistic Competition Test: If banks are operating in monopolistically competitive environment, one percent increase in cost will lead to less than one percent increase in revenue as the bank faces fairly inelastic demand function. Statistically, we will test the following hypothesis. H0 : 0 H1 : H à ¢Ã¢â‚¬ °Ã‚ ¤ 0 or H à ¢Ã¢â‚¬ °Ã‚ ¥ 1 Banks are not operating in a monopolistic competition environment. One-sided Monopoly Test: Standard theory of market structure suggests that the sum of factor input price elasticities should be less than zero if the underlying market structure is monopoly. Statistically, we will test the following hypothesis. H0 : H à ¢Ã¢â‚¬ °Ã‚ ¤ 0 Banks are operating in a monopoly condition. H1 : H > 0 Banks are not operating in a monopoly condition. (Khan M., 2009) EMPIRICAL FRAMEWORK AND METHODOLOGY: The test is robust with any definition of market whether it is within the national boundaries or it is the global international banking industry because there is no need to specify a geographic market. Before testing, it is commonly necessary to obtain a reduced form of revenue equation which consists of revenue as a dependent variable, factor input prices as independent variables and some controlled or firms specific factors. The basic equation is: Total interest revenue = total cost + controlled variables + error term The panel data is used in the paper which is the data collected over multiple time periods. It is the combination of cross-sectional and time series dimensions. Hence, it can be derived as: Ci = a + Byi + Ei (4) Ct = a + Byt + Et (5) Where, C is the dependent variable, a is constant term, B is the coefficient of the independent term, y is the independent variable and E is the error term. Combining both the equations (4) and (5), the final basic equation can be given as: Cit = a + Byit + Eit (6) But Panzar and Rosse define the H as the sum of the elasticities of the reduced-form revenues with respect to factor prices, so the econometric model of the Panzar and Rosse statistic may be represented by the following equation: (7) For i = 1,..I; t = 1,T; Where, R is a measure of gross revenue. W is a vector of factor prices (the H statistic is given by the sum of the estimated coefficients of the variables in this vector); S is a vector of scale variables; X is a vector of exogenous and bank-specific variables that may shift the cost and revenue schedule, ÃŽÂ µ indicates the error term; I is the total number of banks; T is the number of periods observed (Trivieri, 2005). To calculate the sum of elasiticities, it is necessary to estimate the log linear model instead of estimating a simple linear model that is the reason for taking the log of all the variables in equation (7). The sign of the variables of different costs and bank specific variables are positive showing a direct relationship to revenues (Trivieri, 2005). In this pooled regression, extra intercepts or dummies for time are used, but dummies for individuals are not included because of the application of within-group-estimators. Because with-in-group estimator takes first difference and removes the individuals dummies variables by itself. Thus being a fixed effects model, it measures differences in intercepts for each group and the differences are calculated by a separate dummy variable for each group (Trivieri, 2005). The use of fixed effects panel regression with time dummies allows calculating the relevant parameters of the empirical model. Furthermore, unobserved heterogeneity is controlled by the fixed effects too avoiding omitted variable problems (Trivieri, 2005). In this paper, the intermediation approach developed by Sealey and Lindley (1977), is followed which tells that deposits, labour and capital are inputs for the banks. The empirical model applied in this paper is as: LGIRTA = B1LLABCOST + B2LCAPCOST + B3LFUNDCOST + B4LLTA + B5LBMIX (8) Where, LGIRTA = Log of Gross Interest Revenues over Total Assets LLABCOST = Log of Labour factor price LCAPCOST = Log of Capital Cost LFUNDCOST = Log of Funding Cost LLTA = Log of Loans to Total Assets LBMIX = Log of Loans to Banks and Clients over Total Loans This paper addresses the banking industry of Italy. The data includes 480 banks approximately, of all sizes in Italy. The data contains two different samples. First sample consists of the data from 1995 to 1997, total 3 years, and the second sample contains data from 1997 to 2000, total 3 years. We make a comparison and inference between the results obtained by these two samples through our empirical model and find out the competitive behaviour of Italian financial market. LONG RUN EQUILIBRIUM TEST: An important underlying condition of the H-statistic for competition is the long run equilibrium. Panzar and Rosse (1987) cite that this postulate is crucial for the cases of perfect competition and monopolistic competition. Though, it is not a fundamental assumption in the case of monopoly because when H is less than or equal to zero then it is a long run assumption for monopoly (Trivieri, 2005). Long run equilibrium test for the observations can be done with the prerequisite that: competitive markets equalise the return rates across firms, so that in equilibrium these rates should not be correlated with input prices (Trivieri, 2005). In our empirical model as in Shaffer (1982), this test can be carried out by re-estimating the equation with the proxy for the return on assets, ROA, as dependent variable in the calculation of H. In this context, H = 0 implies that the data are in long run equilibrium (Trivieri, 2005). The intuition behind this theory is that, return on assets, ROA, should not be related to input prices. De Bandt and Davis (1999), define the equilibrium condition as the state in which changes in banking sector are considered as gradual, long run equilibrium for the observations does not mean that competitive conditions remain the same and do not change through out the period of observations (Trivieri, 2005). Although it is inappropriate to use Rosse-Panzar test which is based on a static equilibrium framework, but in the real financial market, the equilibrium adjustments are less than instantaneous, resulting disequilibrium on some points in time or frequently, or always. Moreover, when it is known that the adjustments towards equilibrium are partial and not instantaneous then using fixed effects estimation for the static revenue equation will result in biased H-statistics toward zero (Goddard J. and Wilson J., 2006). For the long run equilibrium, we estimate the following equation: LROA = B1LLABCOST + B2LCAPCOST + B3LFUNDCOST + B4LLTA + B5LBMIX (9) DATA AND SAMPLE DESCRIPTION: The empirical part of this paper uses an unbalanced panel data set on which the Panzar and Rosse methodology has been applied containing a range of Italian banking firms. The data and the samples used for the estimation of H indicator are provided by Dr. Leone Leonida, Queen Mary, University of London. The data used in this paper are annual and refer to the period 1995-1997 (3 years) for the first sample. The first sample for the econometric analysis is made up of an unbalanced panel data of 480 financial institutions of all sizes, for a total of 1401 observations. The number of parameters is 487. The longest time series is 3 years long and the shortest time series is only 2 years long with 2 time dummies. The second sample covers the period of 1998-2000 (3 years) having 1330 number of observation from 474 banks of all sized. The number of parameters is 481. The longest time series is 3 years long and the shortest time series is 2 years long depicting unbalanced panel data with 2 time dummies. In the Appendix, Table 3 provides a summary of the definition of relevant dependent variable, independent variables, bank specific factors variables and control variables. LGIRTA is the log of gross interest revenue over total assets, which is used as dependent variable, also used by De Bandt and Davis (2000), and Trivieri F. (2005). Trivieri (2005) points out that according to Vesala (1995) and De Bandt and Davis (2000) it is the most appropriate choice because it then represents a price equation and not the revenue equation. Moreover, our equation will be consistent with the conceptual structure used by the application of Panzar and Rosses statistic to the banking sector. The choice for taking only the interest part of the total revenue of banks is consistent with underlying notion of the P-R model that financial intermediation is the core business of most banks. However, Shaffer (1982) and Nathan and Neaves (1989) have included total revenue instead of only interest revenue because of the fact that banks have increased their non-interest activities and services which have started generating income other than interest. But s