The Role of the Registered Nurses in the Emergency Room Essay

The Role of the Registered Nurses in the Emergency Room - Essay Example The changes in RN roles especially in the ER are a result of increased public and political demands to set up higher benchmarks in the medical field (Gardner et al., 2007). Subsequently, emergency departments are focused to undertake initiatives to successfully meet government lay-down key performance standards and benchmarks that determine the performance of the healthcare units. Role of Registered Nurses In different parts of the world today the ER nurses have adapted their responsibility to incorporate tasks that were formerly undertaken by medical staff. For instance, suturing wounds, plastering fractures, and recording of electrocardiograms, X-raying of patients with potential fractures, and cannulation of patients are important tasks that ER nurses undertake (Neades, 1997). In recent years the educational qualification of an Emergency Nurse Practitioner in addition to sound nursing practice based on all aspects of nursing is an essential criterion. However, in general the requi rement is formal post-basic education in holistic assessment, physical diagnosis, prescription of treatment and promotion of health. The Emergency Nurse Practitioner is a key member of the healthcare team directly available to members of the public (Neades, 1997). Hence in several health care set ups it is expected that the nurses must be an independent practitioner who is able to assess, diagnose, treat and discharge patients without reference to a doctor. Since this job comes with high responsibility, there are several guidelines provided by the government as well as the health care set up. Additionally, the nurses must be able to make independent referrals to other healthcare professionals (Neades, 1997). A variety of roles such as identification and management of minor injuries, preliminary scans, pain management, recommendation to other health professionals, and health promotion activities are the role of registered nurses. According to the Royal College of Nursing the role of registered nurses in ER include, several investigative tests (such as X-rays), preceding to the patient being seen by the specialist (Neades, 1997). It is a well known fact that the role of nurses is not restricted to the health care units but is also extended into the society. For instance, the health promotion aspects are also highlighted, signifying how their knowledge and skills can be further utilised to care for vulnerable groups in cases of emergencies. In order to reduce the over-crowding in the emergency rooms to some extend, the Nurse Practitioner may undertake advanced roles such as the assessment and treatment of injuries, as well as developing a health promotion and accident prevention role within the community (Neades, 1997). It is believed that the ER nurses may have a positive role in primary care delivery and reduce the work load of the doctors. Diverse needs and the function of NPs will vary between institutions and around the world.

Biblical Writings Essay Example | Topics and Well Written Essays - 1250 words

Biblical Writings - Essay Example "Torah" is a Hebrew term meaning 'teaching' or 'instruction', which is used to refer to the Five Books of Moses, otherwise known as Pentateuch, which include Genesis, Exodus, Leviticus, Numbers and Deuteronomy. However, the term is also used to refer to the entire Jewish bible and to the entire Jewish law and teachings, in its broadest sense. The Talmud may be realized as one of the central texts of conventional Judaism which incorporates the rabbinic teachings concerning Jewish law, ethics, customs and history, and it has two components: Mishnah and Gemara. The Hebrew term Mishnah (or Mishna), which means 'repetition', can be comprehended as the earliest written redaction of the Jewish oral traditions and it can refer to the entire tradition of the Oral Torah. The second component of the Talmud, known as the Gemara, is a collection of rabbinical commentaries and studies of the Mishnah. The terms such as Hebrew Bible, Jewish scripture, Old Testament, and First Testament are closely c onnected, because all these refer to the same scripture in different traditions. Thus, the Hebrew Bible refers to the books of the Jewish Bible (also known as Tanakh), which is known as the Old Testament in Christian Biblical canon. Similarly, First Testament is another term used for the familiar term Old Testament, referring to the first section of the Christian Biblical canon. Therefore, Tanakh, Torah, Mishnah, Gemara, Talmud, Hebrew Bible, Jewish scripture, Old Testament, and First Testament are important terms used to refer to the various Scriptures, books, traditions etc in the Jewish and Christian religion. A profound source criticism of the Bible refers to significant designations such as J (Jahwist), E (Elohist), P (Priestly), D (Deutoronomist), and Q (Quelle) and these terms denotes the major sources of the Old Testament and the New Testament. One of the major developments in source criticism of the Bible has been the "documentary hypothesis", according to which the first five books of the Old Testament ((known as the Pentateuch) were comprised of four major sources such as J (Jahwist), E (Elohist), P (Priestly), and D (Deutoronomist). The Jahwist (J), one of the four major sources of the Torah, is the oldest source according to the "documentary hypothesis" and it refers to God as Yahweh. The second source of the Torah, known as the Elohist (E), refers to God as Elohim and presents God as less anthropomorphic to Yahweh of the earlier Jahwist source. The most recent of the four chief sources of the Torah is the Priestly Source (P) emphasizes the laws of Moses and priestly duties. The fourth source of the Torah, i.e. the Deuteronomist (D), considers the texts of Scripture as products of human intellect. Therefore, the Jahwist, the Elohist, the Priestly, and the Deutoronomist are the four major sources of the Torah, according to the "documentary hypothesis". It is also important to recognize these four sources were in the long run combined into the Pentateuch to organize the first five books of the Old Testament. Source criticism of the New Testament introduces one to the term Q (Quelle), which refers to an earlier, lost source of the Gospels. Significantly, the German word 'Quelle' means 'source' and this lost textual source was central to the origin of the Gospels, especially the Gospel of Matthew and the Gospel of Luke. Part

Toyota Case Essay Example for Free

Toyota Case Essay 1) For a long time there has been an alignment of Toyota vision with both Japanese culture and national and international stakeholders. This alignment can be seen in our opinion according two different perspectives: from the innovation activity and from the social responsibility (attention for environment). Referring to the innovation of the product process, Toyota has always been one of the leader in creating high-level cars both from mechanical and electronic aspect as it is typical of Japanese economy. The Japanese business is traditionally known at a global level for its profitable performance concerning the management of electronic and mechanical activities. From this point of view there was a perfect alignment between internal and the external vision. In relation to social responsibilty, the Japanese culture shows a great concern on energy conservation and environment, that is the reason why Toyota has traditionally supported these aspects in the car production process. In 1998, Toyota received an important award for the production of Prius ( the world’s first passenger vehicle in mass production powered by a third power train system). The introduction of Prius in the market, allowed the company to make a clear statement on its commitment of environmental protection. During the following years, the company gained many awards and leader position in environmental technology field. Recently, in relation to these two perspectives of analysis, a misalignment can be verified for the following three reasons: 1) Toyota has focused too much on cost control and economies of scale, leaving out esthetic and design aspects, creating too much standardized cars ( a same kind of product all over the world). In this case we found the first gap because of the different expectations of the worldwide stakeholders in comparison with Japanese and Toyota culture , particularly talking about European customers who care about design much more than the others. 2) The strong attention on cost control and economies of scale policy , has created a lot of technical troubles that forced the company to recall a huge amount of cars from the market. As consequence the company lost a lot in term of reliability. Here we faced a gap between vision and image (In the vision they really support the safety part but the collective image is far from that). Considering the worldwide market and international stakeholders, we think that there has been a misalignment on American customers who are interested in technical aspects more than esthetics. The final point of the misalignment has been caused by the exaggerated focus on energetic conservation, so the company produced no high performing cars in order to satisfy international customer’s requirement. For instance, in 2009, Toyota had so poor performance in F1 that the company decided to withdraw from F1 with immediately effect. In order to address this GAP, we believe that Toyota should: first of all, adapt his products to international market, giving special consideration to esthetics and design. be more focused on customer’s requests, that consist in high performing and environmentally friendly cars at the same time. Moreover, since the break problem that obliged Toyota to recall a big amount of cars from the market. 2) We would change the communication strategy into the following two directions: a) A traditional way, based on incentive messages focused on energy conservation connected to the concept of safety and brightness cars, in order to retrieve the loss of company credibility. A lot of marketing activities can be organized such as: o planning amateur competitions that involve young people with their own cars at an international level; o planning events or competition characterized by the participation of sport champions (like F1 drivers) o arrange Visitor Centers, based in the regional headquarter country, in order to give customers the chance to drive cars and to understand the topic of energy conservation o promote â€Å"green days† o partnership with environmental friendly organization (like WWF) b) An innovative way, using guerrilla or tribal marketing techniques. In several ways such as: o Use social networks for empowering the costumers to decide on specific aspects as internal design, colors, extra services, [†¦] of their cars offer. Doing this thing, they will be available to focus on the costumer and not only on the product as they always did. o During holydays such as Easter or Christmas, make people drive specific cars by organizing spectacular race trucks, enriched by music and light effects. The event should be introduced by well-known personalities, as signers, actors, sportsmen. o Promote musical or sport-events for young people, such as concerts, championships and matches. o Create partnerships with tour-operators to promote specific cars during adventures trips, like safari. o Transform their headquarter in a tourist attraction, thanks to the partnership with local and international tour operator that promote day trip in the company. o using cars during appealing movies for young people (like Mini in ‘’The Italian Job’’) o Use amusement park as a stage for car shows, parades and games. 3) Most of the crisis response strategies applied in the report by Toyota, belong to reducing offensiveness category. Even if the company seems to be aware of its responsibility, it never used mortification quotations. In our opinion, the document we`ve analyzed, is characterized by the following strategies: MINIMIZATION: CORRECTIVE ACTION: GOOD INTENTIONS: 4) We can affirm Toyota acted in a good way in minimizing in order to not damage the company image more. Moreover they could have improved corrective actions and provide their customers with facilities, like substitutive-cars during the fixing period of the damaged ones. Even if they did well in minimizing the event, they could have shown more mortification, not only for the damage itself, but also for the waste of time and the other troubles related to it. They could also have adopted a denial strategy (shifting the blame) by giving responsibility to the specific divisions in charge of the production of defected components; consequently they could have renewed the responsible divisions or made an outsourcing agreement for that. Regarding the good intentions, they could have provided more detailed information about their future control and safety standards. Another good strategy, could have been ‘’attack the accusers’’, trying to focus on the main competitors that were taking advantage from their crisis. Finally, according to what we read in the case study, we`d have expected a more customer oriented behavior. ITALY According to Italy Toyota starter two different recall campaigns: the first one recalls 260. 000 cars with accelerator pedal problems and the second one 2500 Ibrid car with brake problem. In order to fix the first problem the company sent letters to the 26000 clients involved in this problem; the letters contained all the information regarding how to get the appointment with the car retailer in order to fix the problem (fixing time about 30 minutes). The second recall concerned the Prius models which had some ABS problems on 2500cars; they used the same technique and the time to fix took about 40 minutes. Toyota provided an assistance number(gratis): 800 869 682 available 24h/7d, useful to know if the car is involved in the problem and to know technical details. The A. D. of Toyota Motor Italy, Massimo Gargano, stated â€Å" Toyota as a world leader for sales volume and quality reputation has to accept to be criticize facing this problem. We have to underline that the company decide to recall all the car just to satisfy our costumers expectations and make them sure about the safety of the product†, he also underline that â€Å"regarding the accelerator pedal problem we chose to recall 1. 800. 000 cars even if only 26 really faced this problem† . CONTACTS: Edoardo Caccin Valentina Cruciani Carminia Lucariello Lucrezia Zambelli Marco Zavatta [emailprotected] com [emailprotected] com [emailprotected] it lucr3zia. [emailprotected] com dott. [emailprotected] com.

Ethical Behaviour Within The Work Place Philosophy Essay

Ethical Behaviour Within The Work Place Philosophy Essay Yes I believe that the use of ethical behavior will pay off in the long run. I believe that the ethical behavior at work place is highly influenced by the leaders at workplace. We human beings are social animals and as a part of one of our basic instincts we like to copy people we admire and respect. So if the leader is transparent, truthful, self-sacrificing and shows the highest standards of ethical and moral conduct his followers eventually develop respect and admiration. If the leader believes that ethical standards and ethical commitment builds customer trust and winning with integrity is the key mantra to business success then his/ her employees will do as well. This is what will attract and keep the best employees in the company. The main proposition for the ethical behavior is that ethical behavior is concerned with should and should not, and implies that there is required by law or which are commercially a responsibility of, and depends on the leadership in an organization, that the argument has significant implications for corporate governance. There are well known difficulties in defining the term leadership and in specifying what is meant by ethics in the context of business behavior, difficulties which have been rehearsed recently in the Journal of business Ethics.   While business ethics have always been important from a social and moral point of view, they also become a pragmatic requirement in the corporate Olympics. The doing- more- with less strategies place in even greater premiums on trust than did the adversarial protection, business practices of the traditional corporation. Some of the key characteristics of ethical behavior are: try to satisfy all constituencies, dedicated to high and broad purpose and also committed to learning in order to remain current and responsive to change which also tries to be the best at whatever they do. For example I would like to cite a story from my past experience in life. The principal of our school (ARMY SCHOOL) use to receive monthly salary through a cheque from the director general of the school committee. But once the principal received 2 cheques of the same amount for the same month. Being an ethical human being and a man of principles and values he returned the extra cheque back to the director gen eral. Now many of his colleagues said that he should have en cashed the money from the extra cheque and should not have returned it. However the principal replied that it would have been unethical if he would have used it for personal use. A few years later the director general of the school committee had to appoint a secretary for funds department and was looking for a suitable candidate. So all of his colleagues and other principals applied for the vacant position. Out of all the principals of army schools throughout northern India he chose our principal. All his colleagues were amazed as they were more qualified that he was and had much more experience. However when the director general of the school committee asked replied that there wasnt a better person than him suited for this job. Just because the principal was ethical and had high moral conduct, maybe he wasnt rewarded at that time but if we look at it, in the long run he outlasted all of his colleagues and was rewarded a m uch higher position than all of them. The same can be applied to the business as well. If one wants the business to survive and flourish successful one should have an ethical concern towards the customer, employees, shareholders and community. The customer always wants the quality of the product to be legit and want to be treated fairly while purchasing the product. Expecting the returns from the investments keeping the same standard of the growth within the business and maintaining the standard quality of the ethical behavior for the well beings of entire society. We learn from mistakes and we should be passionate about what we believe and I believe not matter what but we always learn from good ethical environment at workplace. Another advantage of ethical code is protection of company assets. A good example of high ethical standards in a company is when its employees protect the companys asset and not misuse them. Manager or the supervisor should take an active role in bringing awareness to all the individuals at the workplace of the responsibilities and expectations of the organization. Also he must set the standards at workplace for ethical code of conduct. He should make clear to the employees what is right and what is wrong. On the other hand the employees should actively be aware and should have knowledge of the ethical code of conduct. Management must demonstrate through consistent examples their personal alignment with ethical principles and values, their expectations that employees will do what is right and fair, their encouragement and support of open communication and candor within the organization. Responsibility is another element which is combining to the moral ethical value. The sense of responsibility also comes from within. If one feels proud of the company he /she is working and is satisfied from the work condition, then the urge to work ethically for that company comes from w ithin. One feels like taking the initiative to perform task. You dont make excuses or hide your face when a task is assigned to you instead you make sure that the task is performed in the right way and feel like taking up the whole responsibility for the task. This is what we call as winning with integrity. And when an employee reaches this stage their actions become unrestricted and they perform far better than what is expected out of them. Being ethical is essential when it comes to problem solving and improving processes. In a work place it is always required to establish baseline measures and increase the efficiency. Also one should never be afraid of admitting mistakes. If you cover up your unethical behavior then, firstly its can affect our image and secondly it prevents us from growing as leaders in the long run. For example once a teacher gave an assessment to 2 students which was due in weeks time. Once of the student was hard working and honest and the other one was totall y opposite but very clever at copying assessments. So the 1st student worked day and night to make the assessment however the 2nd student copied it from him and submitted it to the teacher before he could. After the assessment the 1st student got a zero and the 2nd one got 85%. When the teacher asked by the teacher for reason by the first student said the assessment was copied from the other student. But the hard working student didnt give up because deep inside he knew that he was ethically correct and hadnt cheated. At the end of the year when it came to the final exam the teacher gave a similar case study assessment. But the only difference was that it was to be finished in 3 hrs under his supervision. Now the 2nd student who used to slack of and never did any assessment by himself was dumbstruck and it was like the tip of his pen had almost frozen. He didnt know what to write and how to conduct the assessment. However the 1st student who always prepared his assessments honestly just knew what to write and how to write. He completed the assessment and cleared the semester with good grades however the copy cat failed the exam and had to re-sit the exam. The moral of the story is again that if you believe what youve done is right and complies with your ethical standards then it will always pay you off in the long run. So in all to sum it up the higher the ethical climate the higher the profit of an organization. If one has to be ethical at work then he/she should ask the following 4 basic questions from him/herself which are being practiced at Rotary international: Is it the truth? Is it fair to all concerned? Will it build good will and better relationships? Will it be beneficial to all concerned? If you can answer these four questions accurately then you are in a position to act ethical at your workplace. Also being ethical means solving common problems at workplace which are generally: Quality Safety Property Human relationships It is the duty of the leaders to understand them and make judgments. Finally it is our elders or leaders who pass ethics to us in many ways and if we learn from their experiences we will get to know that being ethical will pay you in the long run. Answer 2) Ethical leadership is about all knowing your core moral values and having the ability and courage to live them in every aspect of your life for the betterment and upliftment of the common. I would like to throw light on the fact that ethical leaders are also human beings but the only difference between an ethical leader and a regular human being is the moral courage. Life is not perfect and we are not perfect. Everyone has his/her own moral sense. We have the ability to make choices (right or wrong), important to us, as we travel the path of life. Choices which we choose are basically based upon the personal set of values we have quoted as rules or principles for how we will carry out and live our life. Also the fact remains that all the choices are not necessarily ethical. But most of us know when such a situation occurs. But standardizing our actions through moral conduct is the right thing to do. Before we discuss our main topic of discussion i.e. impact of ethical leaders on the society I would like to say that: Whatever type of ethical standards we have accustomed for ourselves will always be with us 24 by 7. There are no other different moral conducts or ethical principles for business. We carry them with our personality. Leaders co-exist everywhere. Leaders are everywhere in every field. They are present in a family, community, workplace, school and represent the interests of the common good. Besides that they safeguard rights of their followers. Some nations who are pioneers in certain fields and dominating the worlds economy call themselves as leader but when it comes to sense of moral conduct they are not ethical. Today, developments are taking place at a very rate but the standard of human life span is shrinking. The hunger for money and power has watered down the difference between right and wrong. We have designed a cob-web around us. Everyone wants to climb the ladder and reach to the very top even if it means pulling someone down and stepping on their head to do so. The harmful effects are noticeable in the environment around us, by chaos and increase in fraud, offence, contamination and social disturbance. Today the common masses have lost their trust in their leaders and blame them for their misery. For example in India, the population no longer believe that their political leaders are trustworthy. Most of the voters rate them low on ethical conduct and honesty. More than 50% of the subjects surveyed by JAGO (JAGO is a Hindi word meaning awaken or get up) India team on a campaign said that administration is literally making their lives worse. Unethical behaviour and corruption has amalgamated with moral values so much that our new generation can hardly distinguish the two. We learn it at the basic level for e.g. at school, home and sports. So we can says that it is very much involved at every point in business among employees and employers both. People prefer the alleyway (shortcut) instead of the highway. To be equipped with ethically competency in todays dynamic world we need to develop certain specific personal and social skills with a keen understanding of how to make well established flourishing economy while taking care of the world on which the life of the common mass depends as well. As an Indian and as a fellow human being I would like to say this on behalf of the mass population. If for once our politicians and leaders: think for the betterment of the mass population and not their self centred interests. Exhibit legitimacy and veracity in their conduct Then they should not be scared of any hatred for their ethical practices.   In some situations when leaders may feel extremely stressed that they have to decide between personal Benefits or Ethics. If siding with the ethics will only earn you reputation, then that should be the only option.   Leaders need to be unbiased towards their followers and should favour what is appropriate. This will spread of a lot of operation in the organization, even if it means creating some opponents, too. When no one is supporting the leader. They should act bold and adhere to the cause. If our leaders just even implement few of the above mentioned points I believe this world would be a much merrier place to live in. Ethical leaders need to be for the people, by the people and should be conscious of how their decisions impact others. The leaders should have the sense of serving the people from within and should come with benign interests for the mass population. This way they can motivate their follower and show them what self sacrifice means. This implementation involves participation of both the parties towards common goals. Ethical leadership is very important in communicating in a business culture as well. While making a decision the leader should make such choice or decision which is good both for the people and the business as well. The leaders should have lucid ethical conduct of doing business and make these principles known to others in their circle clearly. They should convey their message through all channels on all the possible grounds (personal, professional and legal). This not only helps in gaining respect and admiration from the employees but also gives a peace of mind for oneself knowing that one have done right. Dealing otherwise will generate mistrust at both personal and professional level. Ethical leaders should be truthful, see-through and trustworthy. For this very reason the world knows Mahatma Gandhi. There are many people who want to restore ethical values in the society. But, having a larger section infected with the virus, it becoming difficult to stay ethical and lucid in this dynamic world. If ethical leadership needs to be reformed it needs to introduced at the top level first The leaders would need to demonstrate an example of ethical behaviour before their followers expect it from their leaders.

The Yellow Wallpaper -- essays research papers

The Yellow Wallpaper   Ã‚  Ã‚  Ã‚  Ã‚  In the short story 'The Yellow Wallpaper'; by Charlotte Perkins Gilman, the narrator and her husband move to a colonial mansion for three months in order to help the narrator get better. She moves upstairs in this horrid room with yellow wallpaper. Throughout the story she studies the wallpaper because she isn't allowed out of the room that much because her husband, John, a physician, says that it is best that she stays inside. As she learns more about the wallpaper she realizes that she sees a woman inside it and she spends a lot of time plotting how to free the woman. She locks her room and tears off most of the wallpaper and frees the woman. At the end John comes into the room, sees what she has done and faints. Everyone deals with their personal obstacles differently and 'The Yellow Wallpaper'; is a perfect example because there are many different obstacles throughout the story. The narrator and John both handle them differently and a result of which, is an essential change by both of them.   Ã‚  Ã‚  Ã‚  Ã‚  First of all, John handles everything to an extent but he doesn't solve the problem at hand. He tends to run away from it. For example, when the narrator asks, 'why the house had stood so long untenanted,'; he just laughs at her and doesn't even investigate about it, which proves that he just let it go and does nothing about it. And that is what he does throughout the whole story. Also he 'scoffs openly at any talk.'; This means that he doesn't talk about his problems and he would prefer to keep things bottled up then to express how he is really feeling. He is also always 'going into town for more serious cases.'; This is another way in which John deals with his problems, he runs away from them. He also avoids the actual subject by calling his wife a cute name like, 'bless her little heart,'; and, 'my blessed little goose.'; These quotes just make it so he doesn't have to answer the question and then he has relinquished himself from the situation. Another thing th at he does to handle obstacles is he lies. When the narrator says that she doesn't feel any better, and this happens often, then he just says, 'you are getting better, you are eating more and you have more color today.'; So john handles his obstacles in an inefficient and ineffective matter.   Ã‚  Ã‚  Ã‚  Ã‚  The... ...hing normally, but she is restricted to a limited amount of socialization. This gives her time to analyze her obstacle and overcome it quicker than John does.   Ã‚  Ã‚  Ã‚  Ã‚  Both the narrator and John undergo an essential change. The narrator begins the story as a woman who is somewhat mentally distraught. Throughout the story you can see her become different through her thoughts and actions. By the end of the story she has become clinically insane and is in desperate need for help. John on the other hand does not come to the realization that at the beginning of the story, the narrator has some issues that have to be dealt with and he just ignores them for the most part. Finally at the end of the story he comes to the realization that in fact, his wife is nuts.   Ã‚  Ã‚  Ã‚  Ã‚  In conclusion, everyone experiences obstacles in their life, and all have a different approach in which they attack the obstacle. Some are more effective than others are. The narrator was much more effective than John was because she had time to analyze the problem and then do something about it. Where as John would pretty much just leave it be and hope it eventually went away.

Japanese Yen :: Essays Papers

Japanese Yen The Japanese Yen When Richard Nixon suspended the convertibility of US dollars to gold in 1972, the fixed rate between the dollar and the yen was exchanged for a floating rate. The international value of the yen rose sharply and is today one of the most attractive currencies on the market as it directs the world's second largest economy. The yen is controlled by a central bank known as the Bank of Japan or BOJ. This central bank is under the supervision of the Minister of Finance. Over the past decade, the yen has fluctuated greatly. From early 1990 through mid 1995, the yen doubled in value from 160/$ down to 80/$. From 1995-1998, the yen lost value and was back up in the 140's/$. The trend in the past year has been a steady increase in value for the yen. Over the past six months, the yen has fluctuated. From April through mid-July, the yen floated between 124/$ and 118/$. Since then it has increased in value falling to the area of 105/$. On Friday September 24, the closing rate on the yen was 104.24/$. Over this next week, the yen rose to a close of 105.0000/$. This means that the yen lost a little value in comparison to the dollar. This slight fall is not representative of what is going on with the yen however. Over the past few months, investors have put money into Japanese stocks. The government is putting pressure on the BOJ to increase the yen supply in order to stave off inflation and curb long-term interest rates. This pressure came after a G-7 meeting in which the members suggested that Japan do something to weaken the yen. Prices and wages are falling and output is below Japanese productive potential. Despite these factors, the BOJ is hesitant about responding because it is concerned that expanding the yen supply will cause inflation. Last week, Japanese companies were becoming more optimistic about economic growth. The BOJ didn't take in cash from money markets on Sept. 30, leaving in twice the normal sur plus, so traders felt that the BOJ would follow the idea of expanding the yen supply. The BOJ is conducting a survey on Monday Oct. 4 to see how optimistic business sentiment is as the economy tries to rebound. The yen could rise this next week to its highest level since that 1995 value of 80/$.

Eggshell Membrane Reduces Joint Pain Essay

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Design Carmelo Galati, SeeSaw Creative Communications, cgalati@seesawcreative. ca Published Precision nutrition inc. , precisionnutrition. com aBSTRaCT Can Eggshell Membrane Reduce Joint Pain? BaCkGRound While many conventional treatments have been used to remedy chronic joint pain, interest continues to grow in the area of alternative, natural treatments. Eggshell membrane (EM) supplementation is a novel treatment for joint health, and has recently been shown to rapidly and continually improve joint pain in patients with osteoarthritis and joint and connective tissue disorders. The current study aimed to observe the effects of one particular eggshell membrane product (fast joint care+; FJC+) supplementation on chronic joint pain in physically active adults. METhodS Sixty adults (40. 2  ± 10. 2 y; 78. 6  ± 10. 2 kg) experiencing chronic joint pain supplemented daily with either 500mg FJC+ or placebo, over the course of 4 weeks. Participants also completed a weekly exercise protocol designed to challenge their irritated joint. Participants then rated their joint pain immediately, and one day after, this exercise challenge. RESulTS Participants in the FJC+ group reported significantly less joint pain post-exercise following FJC+ supplementation (-16. 13  ± 3. 60) when compared to those in the placebo group (–4. 30  ± 2. 84; p=0. 00171). In addition, during the 4 week study, both groups experienced decreases in next day joint pain (p=0. 0015), although there were no significant differences between the two groups (p>0. 05). ConCluSionS In the current study, daily FJC+ supplementation appeared to decrease post-exercise joint pain vs. placebo, although this effect did not persist 24 hours post-exercise. Because eggshell membrane research is in its infancy, further research may be needed to clarify its utility in managing joint pain. 1 Precision Nutrition | www. precisionnutrition. com BaCkGRound Why Study Eggshell Membrane? n the united States, over 20% of adults have reported doctor-diagnosed joint and connective tissue (JCT) disorders; this number has been projected to increase by 40% over the next 25 years [1, 2]. numerous forms of intervention have been used as treatments to improve joint pain. Conventionally, nonsteroidal antiinflammatory drugs (nSaids) and analgesics have been used to address joint pain associa ted with JCT disorders; however, their long term use has been associated with diverse and severe side effects including cardiac and gastrointestinal complications [3, 4]. Alternative therapies used to treat joint pain include dietary supplements; the most popular of these supplements being glucosamine, chondroitin and methylsulfonylmethane (MSM). While many turn to these complementary treatments to avoid the side effects associated with NSAIDs and analgesics, there is little evidence to support their effectiveness, and the evidence that does exist is equivocal [5]. Several large-scale human clinical trials [6], including the National Institutes of Health-sponsored Glucosamine/Chondroitin Arthritis Intervention Trial, as well as a few additional meta-analyses and reviews [5, 7] have reported limited effectiveness of glucosamine and chondroitin supplementation in reducing joint pain. However, other groups have noted long-term improvements in joint pain from glucosamine supplementation alone [8], and further enhanced effectiveness of combined glucosamine sulfate and chondroitin sulfate, rather than the separate use of either supplement [5, 9]. The question of their effectiveness in JCT populations is subject to ongoing debate. There has been growing interest in eggshell membrane (EM) supplementation as a treatment for joint pain, as it does not present the side effects of conventional treatments (NSAIDs). Eggshells and their membranes have been extensively analyzed 2 Eggshell Membrane Reduces Joint Pain for their components: the separate layers of the eggshell have been analyzed and found to contain several types of collagen (types X, I, V) [10-12]. Additionally, EM has been found to have notably high concentrations of a number of amino acids [13], collagenlike proteins [14-16], enzymes [17-19] and glycosminoglycans (GAGs). Glycosaminoglycans are of high interest, as they play key roles in connective tissue [20]. Glucosamine, hyaluronic acid and chondritin sulfate are important GAGs in EM (21, 22). With the high protein and enzyme content, and naturally occurring GAGs in EM, scientists and nutritional supplement companies have speculated that it could present a viable alternative to traditional joint disorder and osteoarthritis treatments. Additionally, while the aforementioned elements of EM have been detected, it should be noted that membrane components have not yet been wholly characterized; there are likely a number of compounds that have yet to be identified in the membrane. Some of these yet undetected elements may contribute to benefits or improvements seen in joint health. To date, very few studies have investigated the effects of EM supplementation on joint pain and range of motion. In rats, 4 weeks of EM treatment led to significant reductions in many proinflammatory cytokines (measured in plasma), notably including TNF-? nd IL-1 [23]. Two recent clinical reports [24, 25] investigated the timing and effectiveness of EM supplementation in JCT and osteoarthritis patients experiencing severe pain and limited range of motion. These patients received daily 500mg doses of oral EM for four to eight weeks. Rapid (seven to ten days) and continuous effects were seen in terms of reduced pain and stiffness, as well as im proved flexibility. In both investigations, there were no reports of adverse effects with supplementation. In the present study, we set out to observe the effects of EM (fast joint care+; FJC+) supplementation on joint pain within a physically active adult population experiencing chronic joint pain in one of four joints (ankle, knee, shoulder or elbow). As many adults use exercise to manage joint and connective tissue disorders, this population would likely see great benefit from adjunct therapies designed to reduce pain and increase range of motion. 3 Precision Nutrition | www. precisionnutrition. com METhodS What We Did. And How We Did It. Prior to commencing the study, all participants gave their informed consent. A total of 60 adults between the ages of 18 and 70 (45 men and 15 women; 40. 2  ± 10. 2 y; 78. 6  ± 10. 2 kg; see Table 1) agreed to participate. Each reported chronic pain in one of the following joints: elbow, shoulder, ankle or knee. Participants were recruited online through a popular health and fitness community and data were collected through self reports in a distance-based capacity. Participants were also prescreened to exclude those who had used any additional medications (methotrexate or immunosuppressants), NSAIDs, analgesics, or joint supplements (MSM, glucosamine or chondroitin) two weeks prior to the start of the study. Those with egg allergies, or who were pregnant or breastfeeding, were also excluded. Participants were asked to refrain from use of pain medications throughout the study period. TaBlE 1. dEMoGRaPhiCS of BoTh SuPPlEMEnT and PlaCEBo GRouPS GRouP MalES fEMalES aGE (yRS) WEiGhT (kG) knEE loCaTion of Join Pain ShouldER ElBoW anklE Supplement Placebo 23 22 7 8 41. 0 +/- 10. 0 39. 4 +/- 10. 5 78. 6 +/- 10. 4 78. 6 +/- 10. 1 12 13 10 10 6 5 2 2 Sex, age, weight, and reported joint pain area are shown for each group. In order to participate, individuals had to be exercising regularly, at least three times per week. They were screened for their regular physical activity (reported 4. 8  ± 1. 1 exercise sessions/wk), and asked to ensure that both their exercise and nutritional regimens remained unchanged over the course of the study. After matching for age, sex, and affected joint, participants (n=60) were randomly assigned to receive either the EM supplement (fast joint care+; FJC+), or a placebo supplement for 4 weeks. These groups did not differ significantly in terms of age or weight, contained similar numbers of men and women, and contained similar numbers of individuals with shoulder, elbow, knee, and ankle pain (see Table 1). All supplements were provided to subjects in identically marked containers, and all capsules (placebo and FJC+) were identical in appearance (color, flavor, size). All participants were instructed to take their â€Å"supplement† once per day, at the same time of day (i. e. first thing in the morning, with breakfast). 4 Eggshell Membrane Reduces Joint Pain Each capsule of the FJC+ supplement contained 500mg of Gallus gallus (chicken) eggshell membrane extract (a commercial preparation sold as fast joint care+ by Genuine Health, Toronto, Ontario); additional non-medical ingredients included rice flour, magnesium stearate, gelatin, and water. The color and flavor matched placebo capsules contained only rice flour, magnesium stearate, gelatin, and water. The individual components of FJC+ were not quantified in the supplement as the product is intended to be used as a complete eggshell membrane extract, without additional ingredients (ie. additional glucosamine, chondroitin, etc. . In addition to their normal exercise program, participants were asked to complete an additional exercise challenge once per week. This exercise challenge was to be completed on the same day of each week (Monday) and at the same time of day (in the morning, after supplementation and breakfast). The exercise challenge for those with chronic shoulder or elbow pain consisted of pushups. For those with chronic knee or ankle pain, the exercise challenge consisted of jump squats. Each of these sessions involved performing 10 sets of 5 repetitions of the given movement, with 2 minutes of rest between sets. Immediately after each exercise challenge session, participants rated their specific joint pain on a Visual Analog Scale (VAS) at two time points: within 10 minutes of completing the challenge and 24 hours following the challenge. Compliance to the exercise programming and supplementation schedule was self-reported and logged by participants; those logs were provided to researchers weekly via email. Subjects were also asked to report any side effects during the trial. Joint pain was assessed using a 100mm visual analog scale (VAS), and participants submitted this information via electronic form. A self-assessment was performed at the two time points (post-exercise, and next day after exercise) for each of the 4 weeks. Each subject was asked to â€Å"click on the line below to indicate how severe the pain is on the affected joint with 0 being no pain and 100 being pain as bad as it can be†. Responses were submitted electronically on a weekly basis, after each pair of assessments. VAS scores were then measured in millimeters from the left hand end of the scale to the point marked by the subject. Data were collected across the 4 weeks of supplementation, and analyzed using a two-way ANOVA with repeated measures (i. . MANOVA). In cases of significant interactions (p? 0. 05) post-hoc analysis was performed using Student’s t-test for comparison between groups, and paired t-test for comparison within groups (JMP, SAS Institute Inc. , Cary, NC). The VAS ratings were reported on a scale of 0 to 100, with 0 indicating no pain, and 100 representing greatest pain. Where ap propriate, change scores were examined after adjusting absolute scores and then comparing between groups with a one-way analysis. All values are reported as mean  ± SEM, and statistical significance was set at p? 0. 5. To summarize the protocol in brief: During week 1 of the investigation, subjects took their first 500mg dose of FJC+ with breakfast on Monday. After breakfast they immediately performed their first exercise challenge and then rated their joint pain using the VAS described above. In addition, they rated their joint pain on Tuesday, 24h later. During each subsequent week, subjects repeated the same protocol, providing 4 weeks’ worth of joint pain data, with week 1 serving as a baseline. 5 Precision Nutrition | www. precisionnutrition. com RESulTS So What Happened? Following 4 weeks of supplementation, participants in the FJC+ group had a significantly greater decrease in post-exercise joint pain compared to participants in the placebo group (-16. 13  ± 3. 60 in the FJC+ group and –4. 30  ± 2. 84 in the placebo group; p=0. 0171; see Figure 1). Figure 2 illustrates changes in joint pain between groups across the 4 weeks of supplementation: main effects were found for both time (p=0. 0003) and the interaction between group and time (p=0. 0354). 0 Change in Joint Pain Index (VAS) -5 Placebo FJC+ -10 -15 -20 * -25 Figure 1. Mean change in joint pain (measured with VAS) following 4 weeks of supplementation. Participants in the FJC+ group experienced significantly larger decreases in post-exercise joint pain compared to participants in placebo group (p=0. 0171). Note: absolute scores were adjusted into change scores, which were then compared between groups using a one-way analysis. 6 Eggshell Membrane Reduces Joint Pain 50 Joint Pain Index (VAS) 40 30 20 10 0 1 2 Weeks 3 4 FJC+ Placebo * Figure 2. Post-exercise joint pain (measured with VAS) across 4 weeks of supplementation. There was a main effect for time (p=0. 0003), and an interaction between time and group (p=0. 354), indicating greater joint pain decreases in the FJC+ group (-43. 4%) than the placebo group (-30. 6%). Post-hoc analysis showed between group differences from week 1 to week 4 (p=0. 0171). Note: higher VAS values indicate more pain. In accordance with Figure 1, post-exercise joint pain in the FJC+ group decreased by 43. 4% while the placebo group experienced a 30. 6% decrease in pain over the 4 week period. Post-hoc analysis shows a mean difference between groups when comparing overall change in pain from week 1 to week 4 (p=0. 0171). Next day reports of joint pain also decreased over time (p=0. 015; see Figure 3) with next day joint pain decreasing by 46. 7% in the FJC+ group (from 35. 34  ± 4. 33 during week 1 to 18. 82  ± 4. 38 during week 4) and by 40. 9% in the placebo group (from 26. 38  ± 4. 58 during week 1 to 15. 59  ± 4. 01 during week 4). There were no significant differences between the groups’ joint pain scores across the 4 weeks of supplementation (p=0. 1971 for group and time interaction). 7 Precision Nutrition | www. precisionnutrition. com 50 Joint Pain Index (VAS) 40 30 20 10 0 1 2 Weeks 3 4 FJC+ Placebo Figure 3. Next day joint pain (m easured with VAS) across 4 weeks of supplementation. A main effect was seen for time (p=0. 0015). However, there were no significant differences between groups across the 4 weeks (p>0. 05), indicating similar joint pain decreases in both the FJC+ group (-46. 7%) and the placebo group (-40. 9%). Note: higher VAS values indicate more pain. Participants in both placebo and FJC+ supplementation groups did not report any side effects during the study. 8 Eggshell Membrane Reduces Joint Pain diSCuSSion Some Clarifications About Our Work The results of this investigation suggest that four weeks of supplementation with 500mg fJC+ daily improves post-exercise joint pain vs. upplementation with placebo, specifically in physically active adults experiencing pain in the ankles, knees, shoulders, and elbows. Other investigations using EM supplementation have observed similar reductions in joint pain, specifically in populations with osteoarthritis and JCT disorders. In one randomized, double-blind, placebo-controlled study, daily oral administrat ion of either 500mg placebo or 500mg EM was given to patients with knee osteoarthritis [24]. After 10 days, rapid improvements in both joint pain and stiffness were seen in the EM group. Improvements in pain and stiffness were sustained (and enhanced) following 60 days of administration. A similar study with JCT patients [25] also observed both rapid (7 days) and sustained (30 days) improvements in pain and flexibility following daily administration of 500mg EM. There were no adverse events reported in either study, and the treatments appeared to be well tolerated by the patients. These statistically and clinically significant outcomes suggest that EM supplementation may be a natural and effective alternative therapy for both clinical populations with limited activity levels as well as physically active populations. Many of the various components present in EM have been thoroughly analyzed. Eggshells consist of a number of layers: an inner and outer membrane, a mammillary layer (connecting the eggshell and outer membrane), an outer palisade layer, and an outer cuticle covering the eggshell [10]. The inner and outer shell membranes are the first layers of extracellular matrix covering the egg itself [11]; the outer membrane is predominantly made of type I collagen, whereas the inner membrane consists mainly of type V collagen [12]. In addition, type X collagen has been reported to occur in both of these membrane structures [10]. EM amino acid profiles have also shown high concentrations of arginine, glutamic acid, histidine, cystine and proline [13]. Additionally, a number of collagen-like proteins (including hydroxyproline, hydroxylysine, desmosine, and isodesmosine) are primary structural components of the membranes. 9 Precision Nutrition | www. precisionnutrition. com Other components have been quantified in EM including: lysyl oxidase (reported to play a role in the development and repair of connective tissue), ovotransferrin, and lysozyme [17-19]. However, the presence of glycosaminoglycans in EM is of particular interest. Glycosaminoglycans (GAGs), such as glucosamine, are composed of repeating hexosamine disasccharides and act as major components of connective tissue [20]. Clearly, there are a number of individual components present in the EM that have known physiological roles in joint and connective tissue; however, EM is novel in that it is a natural extract that provides a combined source of these compounds. The absolute quantity of each component in the EM is not known, and those quantities may likely vary with each extraction in the supplement production process. Additionally, it is plausible that a number of yet unisolated elements, proteins, and enzymes exist in EM, which may also contribute to improved joint and connective tissue health. Therefore, the observed benefits associated with EM supplementation may not be directly attributable to any one specific component of the supplement (ie. lucosamine, chondroitin, etc. ); it may be more appropriate to assume that the combined effects of the known—and unknown—components of EM contribute to the observed improvements in joint health. A number of individual components in EM are known to have important roles in maintaining connective tissue in vivo, though the physiological mechanisms by which those components improve overall joint health through supplementation (flexibility, connective tissue repair and maintenance) have no t been measured in humans. One experiment, however, investigated the effects of EM supplementation on systemic pro- and anti-inflammatory markers in rats [23]. In this study, rats were given oral doses of EM for 7 days. Significant decreases were observed in plasma levels of numerous inflammatory antigens following supplementation; thus, it is possible that the anti-inflammatory effects of oral EM supplements may contribute to the improvements in joint pain ratings seen in human trials. More research is warranted to investigate these effects. Interestingly, the most pronounced effects of FJC+ supplementation in this study were present in post-exercise ratings of joint pain. This may be due to the proposed anti-inflammatory benefits associated with EM. If the exercise challenge used in this investigation led to acute joint inflammation, it stands to reason that the most pronounced impact of EM would be to reduce the pain associated with this postexercise increase in inflammation.