Case of Cladophialophora caroinii Chromoblastomycosis

Case of Cladophialophora caroinii Chromoblastomycosis A Rare Case of Cladophialophora caroinii Chromoblastomycosis in a Skin Graft Recipient Roy PK, Dudhat VL, Prasanna S Introduction: Chromoblastomycosis, also called chromomycosis is a subcutaneous chronic mycosis caused by dematiaceous (black) fungi.1 The most frequently isolated organisms are Fonsecaea pedrosoi, Phialophora. verrucosa, Cladosporium carrioni, and less frequently, Rhinocladiella aquaspersa.2 It Progresses slowly and involves exposed body parts. It is characterised by crusted and raised lesions. The fungi present as sclerotic bodies in the lesions, which is a pathognomic feature of this disease. It is distributed worldwide. However it is most commonly seen in tropical and subtropical regions.1 C. caroinii has been reported only sporadically in India in a few case reports.3,4,5,6,7 We present a rare case of chromoblastomycosis by C. caroinii. Case Description: A 40 year old male patient, presented to the surgery OPD with cutaneous ulcer over right knee after a fall injury, not associated with fever or pain. The patient was admitted in a tertiary care centre, I.V antibiotics and daily dressing had been done. The swabs from the base of the ulcer had been sent for bacterial culture and sensitivity, shown no growth. After a few days of treatment ulcer was healing with good margins and base. Patient was discharged with oral antibiotics and anti-inflammatory agents. After one month patient came back for review to OPD with hypopigmented patch over the right knee. The patient was referred to plastic surgery department and skin grafting was done. The graft was taken from the right back. The patient was administered with I.V steroids, antibiotics and oral anti-inflammatory agents. The patient was discharged with oral steroids with tapering dose and antibiotics. After two weeks period, patient developed soft non-raised fluctuating swelling post skin grafting over the same region (right knee). Differential diagnosis of cutaneous tuberculosis and aspergilloma was made. The FNAC was carried out from the swelling, from which frank pus was aspirated. The pus sample was forwarded for bacterial culture, fungal and mycobacterial culture. The bacterial cultures, both aerobically and anaerobically showed no growth. The sample was negative for acid fast bacilli by Ziehl Neelsen staining. However, KOH mount and Gomori’s methenamine silver (GMS) stain showed septate hyaline hyphae. The GMS stain revealed few grey black round structures measuring around 6-10 Â µm, suggestive of Medlar or sclerotic or copper penny bodies. The culture of the pus sample, on Lowenstein-Jensen medium showed no growth after eight weeks of incubation. However, culture on Sabouraud dextrose agar with chloramphenicol revealed slow growing fungus, which was first observed on the tenth day and gradually matured over next three weeks. The growth was initially grey-green which slowly turned to olive-green with cottony folded out texture and with a jet black reverse after three weeks of incubation at 25Â °C. The lacto phenol cotton blue (LPCB) preparation, from the culture showed septate hyaline hyphae with acropetal long chains of conidia suggestive of Chladophialophora species. The fungus showed growth at 37Â °C, but not at 42-45Â °C and urease negative. Based on these findings the fungus was identified as Chladophialophora carrionii. The patient was diagnosed to have subcutaneous mycosis (chromoblastomycosis) with the presence of sclerotic bodies and the causative organism was identified as Chladophialophora carrionii. The patient was started on oral Itraconazole and he showed good improvement in the condition. Discussion: As first described by Medlar in 1915, the term chromoblastomycosis is used for cases in which sclerotic bodies are present in tissue. Sclerotic bodies, also known as Medlar bodies, are globe-shaped, cigar-colored, thick-walled structures that are 4-12 Â µm in diameter.8 The best name to define the disease was recommended as chromoblastomycosis by the International Society for Human and Animal Mycology (ISHAM).9 The term chromoblastomycosis (chromo – coloured, blasto – budding, mycosis – fungal) was coined by Terra et al in 1922 to define a polymorphic fungal disease located on lower limbs, consisting of nodular or verrucous plaques which could probably ulcerate and develop into hyperkeratosis and acanthosis of the affected epithelial tissues.10 This condition is often misdiagnosed as it is clinically indistinguishable from tuberculosis verrucosa cutis, squamous cell carcinoma, palmo-plantar psoriasis, and sporotrichosis.11,12,13 In this case also, a differential diagnosis of cutaneous tuberculosis was kept in mind. The typical histopathological findings of cutaneous chromoblastomycosis are marked epitheliomatous hyperplasia, microabscesses, chronic granulomatous infiltrates with multinucleate giant cells, epithelioid cells, histiocytes and lymphocytes and presence of copper penny bodies.14 in this case we found septate hyphae and sclerotic bodies on GMS stain of FNAC sample. Certain non-pathogenic or contaminant fungi such as Paecilomyces spp and Penicillium spp. may be sometimes confused with Cladophialophora carrionii. Although both these fungi produce long chains of elliptical conidia, the conidia arise from structures such as metula and phialides, which are not seen in C. carrionii. Both these fungi are rapid growers, unlike C. carrionii, which grows very slowly. Moreover, these non-pathogenic fungi usually form greenish white or greenish brown colonies with no pigment on the reverse, in contrast to the jet black reverse of C. carrioni i, which helps in correct identification of this fungi.15 However, C. carrionii should be differentiated from other similar dematiaceous fungi such as Cladophialophora bantiana and Fonsecaea pedrosoi. C. bantiana has the ability to grow at 42-43Â °C, which can be used to differentiate it from C.carrionii. Unlike Cladophialophora spp., Fonsecaea spp. produce short chains of five or less conidia. Moreover, in Fonsecaea spp. At least two of the three types of anamorphic conidiation (rhinocladiella, phialophora, cladosporium) will be seen.15 Slide culture technique will be useful for proper identification of the above-mentioned features.15 Surgery was considered the treatment of choice for chromoblastomycosis before the advent of triazole antifungal agents.16 However, currently with the availability of potent antifungal agents, chemotherapy has become the first-line of treatment with itraconazole and terbinafine being the drugs of choice, while surgery is used only for limited or small lesions.17 As there have been only few and sporadic case reports of chromoblastomycosis caused by C. caroinii from India, this case reports finds its importance.3,4,5,6,7 References: Kalabhavi AS. Chromoblastomycosis – Review article. International Journal of Current Research 2013: 5(7);1691-5 Silva JP, de Souza W, Rozental S. Chromoblastomycosis: a retrospective study of 325 cases on Amazonic Region (Brazil). Mycopathologia 1998-1999;143:171-5. Pradeepkumar NS, Joseph NM. Chromoblastomycosis caused by Cladophialophora carrionii in a child from India. J Infect Dev Ctries 2011; 5(7):556-560. APTE G, GEDAM JR, POOJARY S, GURU N, PAI VV. Chromoblastomycosis in a case of borderline lepromatous leprosy with recurrent Type II lepra reaction. Lepr Rev (2011) 82, 310–5 Shanthala GB, Rudresh SM, Nagarathnamma T. Chromoblastomycosis: A Case Report. Journal of Clinical and Diagnostic Research 2011:5(4); 865-6 Mandal RK, Banerjee S, Kumar P, Chakrabarti I. Non-healing verrucous plaque over upper limb for 1 year in a tea garden worker. Dermatology Online Journal 19 (3): 12 Kindo AJ, Ramalakshmi S, Giri S, Abraham G. A Fatal Case of Prostatic Abscess in a Post-Renal Transplant Recipient Caused by Cladophialophora carrionii. Saudi J Kidney Dis Transpl 2013;24(1):76-9 Medlar EM. A cutaneous infection caused by a new fungus Phialophora verrucosa with a study of the fungus. J Med Res. 1915; 32:507-22. Odds FC, Arai T, Disalvo AF, et al. Nomenclature of fungal diseases: a report and recommendations from a Sub-Committee of the International Society for Human and Animal Mycology (ISHAM). J Med Vet Mycol. 1992; 30(1):1-10. Terra F, Torres M, Fonseca Filho O. Novo tipo de dermatite verrucosa; micose por Acrotheca com associado de leishmaniose. Brasil Medico. 1922; 36:363-8. Pradhan SV, Talwar OP, Ghosh A, Swami RM, Shiva Raj KC, Gupta S. Chromoblastomycosis in Nepal: a study of 13 cases. Indian J Dermatol Venereol Leprol 2007: 73; 176-8 Mohanty L, Mohanty P, Padhi T, Samantray S. Verrucous growth on leg. Indian J Dermatol Venereol Leprol2006: 72; 399-400. Nair PS, Sarojini PA. Chromoblastomycosis resembling sporotrichosis. Indian J Dermatol Venereol Leprol 1993: 59; 125-6. Nirmala V, Chacko CJ, Job CK. Tuberculoid leprosy and tuberculosis skin: a comparative histopathological study. Lepr India 1977: 49; 65-9 Fisher F, Cook NB. Fundamentals of Diagnostic Mycology. Philadelphia: W.B.Saunders Company 1998; 372 Sayal SK, Prasad GK, Jawed KZ, Sanghi S, Satyanarayana S. Chromoblastomycosis. Indian J Dermatol Venereol Leprol 2002:68; 233-4. Gupta AK, Taborda PR, Sanzovo AD. Alternate week and combination itraconazole and terbinafine therapy for chromoblastomycosis caused by Fonsecaea pedrosoi in Brazil. Med Mycol 2002:40; 529-534

Enternal and Parenteral Nutrition in the Critical Care Setting Essay

Enteral and Parenteral Nutrition in the Critical Care Setting Management of patient nutrition has long been a topic of controversy. Questing of timing, route of administration and composition of feeding solution constituents are several variables that share a lack of consensus.   Ã‚  Ã‚  Ã‚  Ã‚  There is a 50% rate of malnutrition cited in hospitalized patients.   Ã‚  Ã‚  Ã‚  Ã‚  Many states associated with critical care admissions have altered metabolic rates. Some examples of increased catabolism are multiple injury trauma, sepsis, organ failure (CHF, ARF, RF), and ventilator dependent status. It is important to assess for a history of such hyper- or altered metabolic states like Diabetes Melitus, Alcoholism, Renal Failure, and COPD.   Ã‚  Ã‚  Ã‚  Ã‚  Over feeding is associated with: immunosuppression, hyperglycemia, liver dysfunction and refeeding syndrome. Enteral  Ã‚  Ã‚  Ã‚  Ã‚  No associated immune suppression, no associated infection complications, easier to maintain electrolyte balance. Parenteral  Ã‚  Ã‚  Ã‚  Ã‚  Immune suppression (the converse is also true- malnutrition also causes immune suppression), fatty liver, potential for pneumothorax, line infections, loss of gut barrier, hyperosmolality, refeeding syndrome Feeding tubes – great option, if the gut works, use it. Prealbumin (2-3 day t1/2) Transferrin (8-10 day t1/2) Albumin (14-20 day t1/2) Nitrogen balance studies can aid in the clinica...

If I Could Tell You Essay Essay

TimeTime, said to be eternal, possess neither a beginning nor an end. Yet however there is a fixation on being able to measure it in years, months, days, hours, minutes and seconds. Trying to save time with new technology, manage time with multi-tasking activities. All in the hopes of giving meanings to the past, present and future. The past is able to been seen but not changed, today is in the present yet still unpredictable, and tomorrow is not guaranteed. If I Could Tell You by W. H. Auden is a villanelle much like others using rhyme, repetition, and meter, that revolve around the main idea of the continuity time and its unforeseeable nature. The rhyming of the alternating ending lines, â€Å"Time will say nothing but I told you so† (1) and â€Å"If I could tell you I would let you know† (3) keep the rhyme scheme which stays on the central themes. â€Å"Time will say nothing but i told you so† shows that time keeps going, because this is a statement. Although the things of the future are unforeseeable, it is guaranteed that in the end the only one who will know what will happen is Time. â€Å"If I could tell you I would let you know† show how unforeseeable Time is. Auden knows that he can not see into the future, which is why he says â€Å"If I could†¦ †. These two phrases depict the speakers understanding of the continuity of time even though he shows to have a desire to know ahead of time what to do before certain events. The villanelle itself has a rhythm as a whole through periodical thinking. The beginning shows how Time does not wait for anything or anyone, â€Å"nothing but I told you so†. He later goes on to question Time in the second stanza and if we should fight back, which is why he says â€Å"weep when clowns put on their show† and â€Å"stumble when musicians play† which are juxtapositions since these actions are not likely given the circumstances. The third stanza shows the shift as he begins to understand that Time is necessary and things have to happen for a reason, â€Å"the winds must come from somewhere†. In the fourth stanza his train of thought is nearing a conclusion as he begins to wonder if not only do things have to happen, but are they meant to happen for the greater good, â€Å"Perhaps the roses really want to grow†. The ending shows Audens maturity throughout the villanelle and ends with â€Å"If I could tell you I would let you know † stating that Time is out of his hands, but it is acceptable and if there was anyway he could help, he would. Throughout the villanelle, time is personified and introduced to the reader as an unreliable character, through. Auden blames Time for unwanted changes in life, and he repeats the line because he observes that all changes, even those that are unintentional, come with Time. The repetition of Time at the end of the stanza rather than the beginning or end display how eternal time is. The first part of each stanza question Time, but all ends with â€Å"Time will say nothing but I told you so†, explaining that whatever Auden thinks or observes, will all be part of the past in the future. Much like poetry as a whole, used to express emotion and speechless opinions, the villanelle is almost perfect fitting for the theme of time. A villanelles structure alone portrays almost a near exhibition of time. Through the first five stanzas, a villanelle is predictable with tercets although the last stanza is a quatrain. This depiction could be metaphorical that time can be planned although in the end, everything may not come to together as hoped. The meter only emphasises this metaphor more by breaking the alternating line in each of the tercets before at the end. Audens desire to be able to match time is emphasized by the repetition of two phrases by the structure of the poem, which in itself helps portray the author’s idea about times continuity and its unforeseeable nature.

Building technology notes

In a building frame, a structural element that is shorter than usual, as a Cogged Joint stud above a door opening or below a window sill is called 2. A carpentry Joint by two uneven timbers, each of which is notched at Bull-nosed step the place where they cross 3. A step usually lowest in a flight, having one or both ends rounded to a Gravity wall Quoin semi-circle and projecting beyond the face of the stair string's 4. A massive concrete wall that resists overturning by virtue of its own weight 5. In masonry, a hard stone or brick used to reinforce an external cornerScarf Joint Baluster off wall 6. A type of half lapped Joint used to resist tension 7. One of a number of short vertical member often circular in section, Fenestration Fig. A-I mom Inflection point used to support a stair handrail 8. The arrangement and design of window in a building 9. What concrete block that is used in making a corner of an anchor wall 10. Lateral ties used for mom main bars for column is 1 1 . Refer to the portion of a beam where bending moment changes from Rowlock Scab positive to negative 12. A brick laid on its edge so that its end is visible 13.A short flat piece of lumber which is bolted, nailed or screwed to Cross bridging butting pieces in order to splice them together 14. Diagonal bracing in pairs between adjacent floor Joist to prevent the Web Brad Pyramid roof joist from twisting 15. A bar used to hold the reinforcement on a beam 16. A small finishing nail is called 17. A roof wherein the four sides are sloping towards the center Stirrup Pile terminating at a point 18. A metal sheet used to connect girder and floor Joist at the same level 19. A slender structural unit introduced onto the ground to transmit load Soldier Pigment o underground strata 20.Brick set on end with the narrow side showing is called 21 . Finely divided solid particles added to the vehicle to contribute color CACM Carriage Channel CM Fig 8-2 Miter box and durability to the paint 22. End lapping o f corrugated G. L. Roofing sheets 23. Inclined structural member that supports the steps of a stair 24. Structural steel shape having unsymmetrical balance 25. Hooked end off mom stirrups 26. Which among the concrete block is the header block 27. A device used as a guide of the hand saw in cutting object to form a Plastic hose with water 1 Com 40 bad. T. Fig.C-3 Bosses Load bearing wall Effective length Volume Stirrups Cement Gypsum board Fade Skylight Soft wood Fire brick Plaster ground miter Joint 28. The best and accurate tool for guiding the work in establishing a horizontal level 29. Minimum thickness of suspended R. C. Slab 30. Total board foot of 10 PC's. 31 . Which among the brick work is a common Flemish bond 32. Clearer is a product of 33. Wall that support weight from above as well as their own dead weight 34. The distance between inflection point in the column when it breaks 35. The amount of space measured in cubic units. 6. A bended rod to resist shear and diagonal str esses in a concrete 37. The most important component to determine the strength of concrete 38. Another term for plaster board 39. The face or front of a building 40. An opening in the roof for admitting light 41 . Wood coming from trees with needle leaves, rather than broad leaves 42. A kind of brick used for high temperature 43. A nailed strip incorporated in rough concrete wall to be plastered to act as guide and support for finish trim around opening and near the base Span Rip-rap Striking tool Fig. D-2 Striping of the wall 44.The distance between two structural supports 5. Stone placed on a slope to prevent erosion 46. Hammer is a 47. Which among the finger Joint is the hidden dove tail 48. The process of removing concrete forms from the cured concrete Purling 49. A structural member spanning front truss to truss or supporting Anchor bolts rafters 50. Steel bent inserted in masonry construction for scouring wood or Lintel plates to concrete construction 51 . A horizontal piece o f wood, stone, steel or concrete across the top of door or window opening to bear the weight of the walls above the Chord Sleeper Stud opening 52.The placing of glass in windows and doors 53. A rejected building material because of its below standard grade 54. A Joint produced by lapping two pieces of materials 55. Lumber that still contains moisture or sap 56. The internal angle formed by the two roof slopes of a roof 57. A vertical board attached on the ends of the rafters. It is part of the cornice 58. A large heavy nail is referred to as 59. What is the scientific name of wood 60. A wall that holds back on earth embankment 61 . The term used to indicate top and lower principal member off roof or bridge truss 62.Strips of hardwood usually 2†³xx† laid over a concrete slab floor 63. A vertical tutorial member which acts as a supporting element in a Tyrone finish wall or partition 64. Rough plaster finish obtained by flinging plaster on a wall with a hand Adiabatic curing operated machine 65. The curing of concrete or mortar without the gain or loss of heat Vinyl tile Creep Riser Plough during the curing period 66. A floor tile composed principally of polyvinyl chloride 67. The permanent deformation of a materials under a sustained load 68. The vertical face of a stair 69.A groove extended along the edge or face of the wood member Glazing cull Lap Joint Green lumber Valley Fascia Spike Xylem Retaining wall Post-tensioning Ashlars brick Perforated tape Control Joint Hopper Parquet Wrought iron Lag screw Lead Goslings Admixture Gallivanted Seismic stile Baseboard Mortar Balalaikas Barbarian Contusion Saturday Rooster Sloshes Platelets Skittishly Abattoir Gillian Lastingly Tubs De banana Cesspool Pie De Gallo Bandier being cut parallel to grain 70. The stressing of unbounded tendons after concrete has cured 71 . A brick whose face has been hacked to resemble roughly hacked stone 72.A type of tape used in finishing Joints between gypsum board 73. Employ ed to reduce restraint by accommodating movement of masonry walls 4. A window sash which opens inward and is hinged at the bottom 75. Inlaid wood flooring usually set in simple geometric pattern 76. Anchor bolts and strap are molded out of 77. Common hardware fastener for truss braces 78. Sealer type of washer for 6. 1. Roofing sheets 79. Trade name for anti-termite surface application on wood 80. Retards or accelerators concrete setting 81 . Coated with zinc 82. Technical term for earthquake 83.Vertical frame of paneled door 84. Fascia between floor and wall 85. Cement, sand, and water 86. Filipino term for framework 87. Filipino term for bottom chord 88. Filipino term for collar 89. Filipino term for plastered course 90. Filipino term for purling 91 . Filipino term for wainscoting tiles 92. Filipino term for wrought iron strap 93. Filipino term for ceiling Joist 94. Filipino term for door fillet 95. Filipino term for girder 96. Filipino term for masonry fill 97. Filipino term for downspout 98. Filipino term for cabinet hinge 99. Filipino term for brace 100.Filipino term for temper (metal work) Horizontal distance from the face of a lock or latch to the center of the knob or lock yielder A principal member of a truss Rough plaster finish obtained by flinging plaster on a wall with a hand operating machine A roofing tile which has the shape of â€Å"S† laid on its side A commercially pure iron of fibrous nature, valued for its corrosion resistance and ductility COLD JOINT A Joint formed when a concrete surface hardens before the next batch of concrete FOUNDATION WALL is placed against it Has high compressive strength but low tensile strength Horizontal surfaces on which the stone units lie on course That part of the foundation for a building which forms the permanent retaining wall Building technology notes In a building frame, a structural element that is shorter than usual, as a Cogged Joint stud above a door opening or below a window sill is called 2. A carpentry Joint by two uneven timbers, each of which is notched at Bull-nosed step the place where they cross 3. A step usually lowest in a flight, having one or both ends rounded to a Gravity wall Quoin semi-circle and projecting beyond the face of the stair string's 4. A massive concrete wall that resists overturning by virtue of its own weight 5. In masonry, a hard stone or brick used to reinforce an external cornerScarf Joint Baluster off wall 6. A type of half lapped Joint used to resist tension 7. One of a number of short vertical member often circular in section, Fenestration Fig. A-I mom Inflection point used to support a stair handrail 8. The arrangement and design of window in a building 9. What concrete block that is used in making a corner of an anchor wall 10. Lateral ties used for mom main bars for column is 1 1 . Refer to the portion of a beam where bending moment changes from Rowlock Scab positive to negative 12. A brick laid on its edge so that its end is visible 13.A short flat piece of lumber which is bolted, nailed or screwed to Cross bridging butting pieces in order to splice them together 14. Diagonal bracing in pairs between adjacent floor Joist to prevent the Web Brad Pyramid roof joist from twisting 15. A bar used to hold the reinforcement on a beam 16. A small finishing nail is called 17. A roof wherein the four sides are sloping towards the center Stirrup Pile terminating at a point 18. A metal sheet used to connect girder and floor Joist at the same level 19. A slender structural unit introduced onto the ground to transmit load Soldier Pigment o underground strata 20.Brick set on end with the narrow side showing is called 21 . Finely divided solid particles added to the vehicle to contribute color CACM Carriage Channel CM Fig 8-2 Miter box and durability to the paint 22. End lapping o f corrugated G. L. Roofing sheets 23. Inclined structural member that supports the steps of a stair 24. Structural steel shape having unsymmetrical balance 25. Hooked end off mom stirrups 26. Which among the concrete block is the header block 27. A device used as a guide of the hand saw in cutting object to form a Plastic hose with water 1 Com 40 bad. T. Fig.C-3 Bosses Load bearing wall Effective length Volume Stirrups Cement Gypsum board Fade Skylight Soft wood Fire brick Plaster ground miter Joint 28. The best and accurate tool for guiding the work in establishing a horizontal level 29. Minimum thickness of suspended R. C. Slab 30. Total board foot of 10 PC's. 31 . Which among the brick work is a common Flemish bond 32. Clearer is a product of 33. Wall that support weight from above as well as their own dead weight 34. The distance between inflection point in the column when it breaks 35. The amount of space measured in cubic units. 6. A bended rod to resist shear and diagonal str esses in a concrete 37. The most important component to determine the strength of concrete 38. Another term for plaster board 39. The face or front of a building 40. An opening in the roof for admitting light 41 . Wood coming from trees with needle leaves, rather than broad leaves 42. A kind of brick used for high temperature 43. A nailed strip incorporated in rough concrete wall to be plastered to act as guide and support for finish trim around opening and near the base Span Rip-rap Striking tool Fig. D-2 Striping of the wall 44.The distance between two structural supports 5. Stone placed on a slope to prevent erosion 46. Hammer is a 47. Which among the finger Joint is the hidden dove tail 48. The process of removing concrete forms from the cured concrete Purling 49. A structural member spanning front truss to truss or supporting Anchor bolts rafters 50. Steel bent inserted in masonry construction for scouring wood or Lintel plates to concrete construction 51 . A horizontal piece o f wood, stone, steel or concrete across the top of door or window opening to bear the weight of the walls above the Chord Sleeper Stud opening 52.The placing of glass in windows and doors 53. A rejected building material because of its below standard grade 54. A Joint produced by lapping two pieces of materials 55. Lumber that still contains moisture or sap 56. The internal angle formed by the two roof slopes of a roof 57. A vertical board attached on the ends of the rafters. It is part of the cornice 58. A large heavy nail is referred to as 59. What is the scientific name of wood 60. A wall that holds back on earth embankment 61 . The term used to indicate top and lower principal member off roof or bridge truss 62.Strips of hardwood usually 2†³xx† laid over a concrete slab floor 63. A vertical tutorial member which acts as a supporting element in a Tyrone finish wall or partition 64. Rough plaster finish obtained by flinging plaster on a wall with a hand Adiabatic curing operated machine 65. The curing of concrete or mortar without the gain or loss of heat Vinyl tile Creep Riser Plough during the curing period 66. A floor tile composed principally of polyvinyl chloride 67. The permanent deformation of a materials under a sustained load 68. The vertical face of a stair 69.A groove extended along the edge or face of the wood member Glazing cull Lap Joint Green lumber Valley Fascia Spike Xylem Retaining wall Post-tensioning Ashlars brick Perforated tape Control Joint Hopper Parquet Wrought iron Lag screw Lead Goslings Admixture Gallivanted Seismic stile Baseboard Mortar Balalaikas Barbarian Contusion Saturday Rooster Sloshes Platelets Skittishly Abattoir Gillian Lastingly Tubs De banana Cesspool Pie De Gallo Bandier being cut parallel to grain 70. The stressing of unbounded tendons after concrete has cured 71 . A brick whose face has been hacked to resemble roughly hacked stone 72.A type of tape used in finishing Joints between gypsum board 73. Employ ed to reduce restraint by accommodating movement of masonry walls 4. A window sash which opens inward and is hinged at the bottom 75. Inlaid wood flooring usually set in simple geometric pattern 76. Anchor bolts and strap are molded out of 77. Common hardware fastener for truss braces 78. Sealer type of washer for 6. 1. Roofing sheets 79. Trade name for anti-termite surface application on wood 80. Retards or accelerators concrete setting 81 . Coated with zinc 82. Technical term for earthquake 83.Vertical frame of paneled door 84. Fascia between floor and wall 85. Cement, sand, and water 86. Filipino term for framework 87. Filipino term for bottom chord 88. Filipino term for collar 89. Filipino term for plastered course 90. Filipino term for purling 91 . Filipino term for wainscoting tiles 92. Filipino term for wrought iron strap 93. Filipino term for ceiling Joist 94. Filipino term for door fillet 95. Filipino term for girder 96. Filipino term for masonry fill 97. Filipino term for downspout 98. Filipino term for cabinet hinge 99. Filipino term for brace 100.Filipino term for temper (metal work) Horizontal distance from the face of a lock or latch to the center of the knob or lock yielder A principal member of a truss Rough plaster finish obtained by flinging plaster on a wall with a hand operating machine A roofing tile which has the shape of â€Å"S† laid on its side A commercially pure iron of fibrous nature, valued for its corrosion resistance and ductility COLD JOINT A Joint formed when a concrete surface hardens before the next batch of concrete FOUNDATION WALL is placed against it Has high compressive strength but low tensile strength Horizontal surfaces on which the stone units lie on course That part of the foundation for a building which forms the permanent retaining wall

Group decision making essay Essay

Introduction. Managers in today’s business environment are faced with numerous often-unplanned events that require decision-making. In the past it was more common for a manager to decide the course of action individually or within formal groups. Important decisions in the business circle are now deemed too risky or important to be made entirely by one person. A manager must seek the right advice from several different sources. Today it is often common for many managers to seek involvement from lower level employees in the decision making process whenever it can be done. However it is not always possible just to ask a colleague what they should do. Most decisions will require a process of a greater degree of subordinate participation; these decisions can be made through a variety of different ways such as committees, task groups, departmental participation and so forth. It is said that making decisions in a group allows for every angle to be looked at and every possible idea to be created with every decision from a group offering the best solution this method of decision making. However like many techniques it has its positives and negatives.It can be time consuming and may not offer an answer to the problem that satisfies everyone. This essay hopes to discuss both the advantages and disadvantages of group decision-making using several theories and some real life case studies. We will see how participation in decision-making affects companies decisions; we will look at several helpful models i.e. vroom-jago model and all referencing it to real life situations and quotes from famous persons in the field Circumstances Of Group decision. Managers as part of their job are faced with many decisions in which they have to undertake, it is up to the managers themselves to decide in what kind of way they want to make the decision and solve the problem. However groups can offer an essential feature in decision making for an organisation. As Coghlan points out: â€Å"Membership of teams and groups shape perception and participation in organisational change.. Groups and teams play a key role in the process of planned organisational change. The change process typically involves teams in the organisational’s hierarchy responding to the change agenda and adapting to it in terms of its tasks and processes† (Coghlan) Coghlan statement clearly leads us to believe that groups are critical in making important direction changing decisions for the company. Evidence supports this statement and we will look at this a little later as we discuss the advantage and disadvantages. First we will look at how managers come about making the decision to use group participation. A manager may decide to use group decisions in several circumstances and the contingency model by Vroom and Yetton as well as the Vroom and Jago decision model can prove useful in helping management decide when to encourage group participation. In he contingency model by Vroom and Yetton there are five key management styles as described by Vroom that a manager can undertake to make decisions. This is shown in appendix 1. We can see from this that the amount of participation that a manager involves in a decision varies greatly. It would not be logical for managers to always  involve group decision-making on smaller problems such as whether to refund a customer (if it was something worth 10) this would be a waste of time and resources for the company and could easy be dealt with on the stop with a programmed decision by the staff. Group decisions as described by Coghlan can be very useful for important or company changing problems or opportunities. It would not be wise to let one person decide whether to invest 4 billions pounds to merge with another company. This is a case when it would be wise for the company to go for the style as vroom described as decision style â€Å"GII† i.e. where you share a problem with your subordinates as a group and implement any solution that has the entire support of the group. The Vroom and Jago decision model goes onto produce a decision tree for choosing a appropriate decision-making method.This decision tree allows the manger to move along the branches by answering the questions at each point. This leads to one of the five decision making styles as described in the Vroom Yetton model. However it has to be said that this model as well as models in general are neither right nor wrong they must be seen as guidelines or as a reference. However the Vroom-Yetton, Jago model must be seen as a useful tool in the aid of decision-making although it is not perfect. Looking at appendix 2 we can see that the model looks a little complex however once you reach the starting point QR we can see that the model is simply a set of high, low yes, no answers that guide you to an eventual decision style. This model has been criticized as being not perfect. However it is not possible for me to say these critics are not right or wrong only this model is neither. However support is growing for this model as more examples of its uses come to light. Advantages, Disadvantages To Group Participation. In today’s empowered work places managers involve all workers in decision making as a rule rather than choice. However companies must understand that  participative decision-making does has its disadvantages as well as it obvious advantages. It is seen that in business two heads are better than one. This can be true in some circumstances as it offers an advantage in terms of offering a boarder perspective to establish the problem and sort out its causes and effects. It also enables the company to have more ability and facts at its disposal therefore allowing for greater scope to sort out any potentially tricky problem. Group discussion leads to the evaluation and correction of possible decisions, plus group discussion also helps to back up and support a decision that an individual may not wish to take on his or her own due to the risk involved. And finally group discussion allows for more satisfaction from the workers, as they feel involved with the project and decision that their work place is taking. Group decisions however can tend to be time consuming, everyone must be consulted on the problem and then they must all find the time to jointly diagnose the problem and decide a solution. Groups may also have the problem of not using the best solution for the problem, although the group discussion allows for more ideas some members may not agree on the best solution and therefore a comprise solution will have to be used to gain group wide acceptance. A boarder instant of this would be the risky shift phenomenon, this suggests that instead of groups taking fewer risks and making safer decisions the reverse is often the case. There is a tendency for groups to make more risky decisions than an individual may take. Another point is that people inclined to make risks are more influential within the group than say the more conservative members, therefore good ideas could be lost. Group think is another problem that must be considered within a group. Group  think tells us that pressures on individual members to conform and reach consensus mean that minority or unpopular ideas maybe suppressed. Members who oppose the group are stereotyped as being weak, stupid, and argumentative. As People may not wish to question any ideas of the group, bad ideas may filter through. One other big problem to group think as see we see in the example of Napster is that it can lead to a inherent morality of the group which in turn can lead to members to be convinced of the logical correctness of what it is doing and to ignore ethical or moral consequences of decisions ( more harsher examples of groupthink would be Pearl harbour, Vietnam, Mullins99) The final problem is people do not feel the same sense of responsibility for group decisions or their outcomes. â€Å"A decision which is everyone’s is the responsibility of no one†(Mullins,98) An example of disadvantages of group decision-making and group think can be seen by www.napster.com. Even when it was clear that their practice of providing free mp3’s of the latest musical material was wrong they decided as a group in the face of the courts to continue their practice. This was because their group norms supported them doing so and that they were the most sought after website on the Internet. However group members of Napster had to compromise all their values so as to keep dissent and as there was no clear reasonability everyone agreed to this illegal practice. If some members would have voiced their concerns and beliefs earlier in the process and put an end to the practice before the courts took over they could have save themselves much time and money. However lets go back to advantages of group decision-making and look at the techniques used to promote it and stimulate creativity. Management have realized that encouraging employee participation in solving problems can be extremely advantageous toward the company. Frontline workers are constantly in touch with the needs, wants and concerns of the companies customers, it allows them fuller insight into how to possibly solve problems  that concern the company’s consumer base. When I first worked at Matalan they operated a system by where you could post any ideas you had on how to improve the operation of the store and its service to the customers. If you idea was put into practice you would receive a financial reward. This system received many replies and allowed for many improvements to be implemented around many Matalan stores. There are many different ways in which can pursue employee participation. The most common and well-known participation tool would be brainstorming. Brainstorming is a decision-making technique in which group members present spontaneous ideas and suggestions for solving the problem concerned. It allows any ideas regardless of how impractical they may seem. This in turn hopefully promotes freer and more creative thinking. Brain storming works on involving everyone, and encouraging communication, listening, and information sharing in the hope that it maximises ideas/possible solutions to problems and also minimises the risk of overlooking any points of the problem under question. An advancement of the brainstorming technique is the Delphi technique this is based on anonymous inputs from individual members of the group and then management assess the responses until a consensus is reached. This can be time consuming but overcomes the limitations of brainstorming and the systems of group think. Now Lets take for example many common marketing departments; it is now commonplace for them to have basketball hoops, televisions, computers games, and other stimuli within the room. Management hope this will promote a relaxed environment within the group in the hope that it will allow for more creative thinking and brainstorming within the marketing group Other techniques used for group decision making include signing a devils advocate. The devils advocate challenges the assumptions and assertions made by the group to prevent any premature consensus. (Daft,00) This it hopes  forces the team who created the idea to solve the problem to examine and explain any risks that maybe associated with it. Another similar approach would be multiple advocacy. Multiple advocacy, involves several advocates and allows for the presentation of several different points of view on the idea in question. It allows minority and unpopular opinions, decisions are therefore based on solid augment and the understanding of all the pro’s and con’s. Conclusion. As we can see there are circumstances where group decisions are more necessary than others and it is up to the managers to decide which situations would be best to involve group decision. Although the decision of when to involve group decisions is entirely up to the manager there are models available such as vroom to help give guidance should they need it. Group participation offers a variety of different advantages for solving problems and tasks. It allows for the group as a whole to participate toward solving the task and allows for more creative thinking than would be given by an individual. Groups cover all angles of a problem and enable any ideas to be looked at in detail before being implemented. However like all good things it has its disadvantages. Group participation includes such problems as groupthink and risky-shift phenomenon. These tell us that support can be given to ideas just to enable group harmony or because individuals don’t wont to gain a reputation. It also includes the point that people inclined to take risks are more influential within the group. Whatever the disadvantages and advantages of group participation and performance, groups will always form part of the pattern of work organisation. It is merely a matter of judgement for the manager as to when, and how best, to use groups in the execution of work.

IT601-0903B-07 Information Technology in Business Management - Phase 1 Essay - 1

IT601-0903B-07 Information Technology in Business Management - Phase 1 Discussion Board 2 - Essay Example Also the other functions of the company like the Human resources and pays department can also be outsourced and this will help the company improve and concentrate in the online sales to improve the online business. Yes, it would be very beneficial for FYC to outsource near its distribution centre for the starting phase. This will be helpful as the company needs to maintain communication with the customers which will allow the company to understand the needs of the customers as well as for the customers to get to know the company better as well. The company will however be able to gain complete cost benefits only by outsourcing offshore (Brown & Wilson, 2005). The possibility of this however is only once the company is able to restructure the organisational tree and the company is able to coordinate the functions with the assistance of the local call centres. However the company can also benefit from the local outsourcing and this is mainly only possible if the company details it internal restructuring and also develops its online business and increases while other processes are outsourced, like mentioned earlier. FYC will also gain as it will gain newer customer from the online portal and will mostly be from high class and best companies using the state of the art

Medical microbiology Assignment Example | Topics and Well Written Essays - 2000 words

Medical microbiology - Assignment Example (ii) The most commonly used stain for the gastric biopsy for the detection of H. pylori is the modified giemsa stain. Sections of the biopsy in a patient with gastritis would show epithelial damage and a generalized decrease in the thickness of the mucus layer. Eroded areas of the stomach lining would also show the presence of white blood cells such as lymphocytes and neutrophils. A haematoxylin and eosin stain of a person with chronic gastritis would show polymorphonuclear leucocytes intruding into the lining of the mucus gland. Helicobacter pylori resides deep into the lining of the stomach wall, and as the polymorphonuclear cell cannot easily reach the site of infection, they release superoxide radicals which damages the stomach lining. A methylene blue stain of the section would stain the H. pylori bacteria blue and would present as small curve shaped, spiral bacteria in the mucus lining. (iii) 13C urea breath test is a very accurate, non-invasive, simple test that can produce results within 20 minutes. Helicobacter pylori produces urease enzyme which forms the basis of 13C urea breath test. The patient is given a non-radioactive 13C urea to drink, which is broken down into ammonia and bicarbonate by the urease enzyme in Helicobacter pylori. Bicarbonate ions dissociate into Carbon dioxide and water in the acidic environment of the stomach. The 13C isotope containing carbondioxide is absorbed into the blood stream and taken to the lungs to be expired. Readings are taken of the expired air and the results are sent to the lab for Mass correlation spectrometry to be performed and levels of 13CO2 are determined, which are synonymous with the presence of Helicobacter pylori. (iv) A triple regimen therapy is advised to the patient, which consists of a proton pump inhibitor (e.g. omeprazole) and two antibiotics (e.g. amoxicillin,