Injury Underlying Obstetrical Brachial Plexus Palsy (OBPP)

Injury Underlying Obstetrical Brachial Plexus Palsy (OBPP) Mechanism of Injury Underlying Obstetrical Brachial Plexus Palsy Introduction Obstetrical Brachial Plexus Palsy (OBPP) is defined as a flaccid paresis of an upper extremity due to traumatic stretching of the brachial plexus occurring at birth, where the passive range of motion is greater than the active (Evans-Jones et al. 2003: F185–F189). Obstetrical brachial plexus palsy results from injury to the cervical roots C5-C8 and thoracic root T1 (Pollack et al. 2000: 236–246). The occurrence of Obstetrical brachial plexus injuries are reported in the medical literature at a rate of 0.38 to 2.6 per thousand live births (S. M. Shenaq et al. 2005). To understand the mechanism of injury causing OBPP it is necessary to have a fundamental anatomical knowledge about brachial plexus. Five spinal nerve roots C5, C6, C7, C8 and T1 combine to form brachial plexus. These five nerve roots combine into 3 trunks above the clavicle, the upper trunk at the C5-C6 level, the middle at C7 and the lower trunk at C8-T1. The cords end in 5 main peripheral nerves: the musculocutaneous, radial, axillary, median and ulnar nerves. The entire shoulder and the arm is supplied by the brachial plexus that helps in upper extremity function (Laurent et al. 1993: 197–203). There is a lot of controvery regarding the underlying mechanism of obstetrics brachial plexus injury that is a cause of recent litigious debate (Andersen et al. 2006: 93). OBPP is caused by excessive traction to the brachial plexus during delivery, as in majority of the cases upper shoulder gets blocked by the mother’s pubic symphysis (shoulder dystocia). With the traction to the child’s head, the angle between the neck and the shoulder is forcefully widened, overstretching the ipsilateral brachial plexus. The extent of injury can vary from neurapraxia or axonotmesis to neurotmesis and avulsion of rootlets from the spinal cord (Pondaag et al. 2004: 138–144). Some studies determine that in certain cases, brachial plexus injuries occur secondary to shoulder dystocia that is associated with high intrauterine forces, not traction injuries (S. M. Shenaq et al. 2005). Though the main theories have been that of compression (either direct or indirect caused by instrument s, fingers or between the bony structures) or traction (Sever 1916: 541) some authors proposed that infection or ischaemia is the cause, whilst others proposed postural in vitro causes, this view was strengthened by the apparent coincidence of other congenital malformations (S. P. Kay 1998: 43–50). The biomechanics of the size of the maternal pelvic and the foetal shoulder size and their position during the delivery determine the extent of injury to the brachial plexus (Zafeiriou Psychogiou 2008: 235–242). Also intrauterine factors, such as abnormal intrauterine pressures arising from uterine anomalies causes obstetrical brachial plexus palsy at the time of pregnancy (Gherman et al. 1999: 1303–1307). Some authors have (ACKER et al. 1988: 389–392) also discussed the possible reasons as to why relatively few OBPP happens during vaginal deliveries without shoulder dystocia; their analysis shifted the focus of OBPP’s cause, away from those forces appl ied by the clinicians towards the endogenous maternal propulsive forces. Both maternal expulsive forces and uterine contractions together form the natural forces. obstetrical brachial plexus palsy may happen in case of caesarean section (Jennett et al. 1992: 1673–1677) or operative vaginal delivery (Alexander et al. 2006: 885–890) also due to forceful traction and manipulation by the obstetrician. The risk factors for brachial plexus palsies may be divided into four categories: neonatal (: Birth weight > 4000 gm,Macrosomia, Breech foetal position, Apgar score: (a) 1 min, (b) 5 min), maternal (Age, Body mass index, Gestational diabetes, Multiparity, Maternal pelvic anatomy), labor-related factors (Duration of second stage of labor, Labor management: (a) induction of labor; (b) oxytocin augment; (c) epidural analgesia, Shoulder dystocia , Mode of delivery: (a) vaginal; (b) vacuum or forceps) and Associated Injuries (Clavicular fracture) (Zafeiriou Psychogiou 2008: 235–242). Brachial plexus injury can be classified according to severity : avulsion, rupture, neuroma, and neurapraxia (S. M. Shenaq et al. 1998: 527–536). anatomical location: upper, intermediate, lower, and total plexus palsy (Sandmire DeMott 2000: 941–942). Upper plexus palsy involves C5, C6, and sometimes C7. Also called Erb’s palsy, it is the most common type of brachial plexus injury (Gilbert Abbott 1995). It presents with an adducted arm, which is internally rotated at the shoulder. The wrist is flexed, and the fingers are extended, resulting in the characteristic ‘waiter’s tip’ posture. Intermediate plexus palsy, involving C7 and sometimes C8 and T1, has been proposed by a few researchers (Zafeiriou Psychogiou 2008: 235–242). Lower plexus palsy involves C8 and T1. Also called Klumpke paralysis, it is very rare and accounts for Total plexus palsy involves C5-C8 and sometimes T1 (J. K. Terzis et al. 1986: 773) and is the second most common type of injury (Laurent et al. 1993: 197–203). It is the most devastating plexus injury: the infant is left with a clawed hand and a flaccid and insensate arm. There is a strong positive correlation between assisted deliveries and total brachial plexus palsy, which indicates that a more severe injury has occurred to the plexus (Michelow et al. 1994: 675–680). Narakas classified obstetrical brachial plexus lesions into four, based on the examination 2- 3 weeks after birth: Group I: C5-6; paralysis of shoulder and biceps. Group II: C5-7; paralysis of shoulder, biceps and forearm extensors. Group Ill: C5-T1, complete paralysis of limb. Group IV: C5-T1; as above with Homers syndrome (S. P. Kay 1998: 43–50). The majority of the patient (70%-95%) recovered completely within 3 to 4 months. Rest 5% patients were requiring conservative or surgical treatment according to extent and severity of injury. Physiotherapy and splinting are conservative treatment and nerve reconstruction, grafting, neurolysis, tendon transplantation procedures are in the surgical treatment. Many classifications and scoring systems for assessing function and predicting outcomes for children with obstetric brachial plexus palsy have been proposed. The most common and clinically useful measures used are mention below. British Medical Research Council Scale A number of methods have been used to describe or quantify motor function in children with OBPP.The British Medical Research Council (M R C ) system of manual muscle testing is the most recognized scale for the evaluation of strength for patients with peripheral nerve injuries. This test employs the use of limb segment positioning without and against gravity and the use of manual resistance to grade muscle strength on a 6-point scale (O = no contraction, 5 = normal power). The MRC scale as a measure of strength for infants with OBPP has been reported by a number of authors. This scale falls within the body functions and structures domain of ICF (Ho et al. 2012). Gilbert and Tassin Scale Gilbert and Tassin have suggested a modified MRC scale for the evaluation of children with OBPP to account for the difficulties encountered in examining infants with manual resistance. The MO-M3 scale has been used as an outcome measure in some studies. This scale is limited in the ability to distinguish improvements in motor recovery however, as it has only one grade to classify partial movement. This scale falls within the body functions and structures domain of ICF (Ho et al. 2012). Mallet Scale Mallet has described a method of evaluating children with OBPP based on the ability to perform functional positioning of the affected limb. With this classification, patients are asked to actively perform five different shoulder movements: abduction, external rotation, placing the hand behind the neck, placing the hand as high as possible on the spine, and placing the hand to the mouth. Each shoulder movement is subsequently graded on a scale of I (no movement) to V (normal motion that is symmetric with that on the contralateral, unaffected side). Although utilized as an outcome measure by a number of authors. This system can only be used with a cooperative, older child. This scale is not suitable for use with infants. It has an excellent intra-observer reliability of kappa= 0.76 and an inter-observer reliability of kappa = 0.78 in this patients. This scale falls within the body functions and structures domain of ICF (Ho et al. 2012). The Active Movement Scale The Active Movement Scale is an eight-grade ordinal scale that was co-developed by the candidate and the head of the Brachial Plexus Clinic at The Hospital for Sick Children (HSC) for the specific purpose of evaluating infants (newborn to one year of age) with obstetrical brachial plexus palsy. This tool is used to quantify upper extremity strength by observing spontaneous, active movement both without and against gravity. Each movement is scored on a scale of 0 to 7. The fifteen movements include shoulder flexion, shoulder abduction, shoulder adduction, shoulder internal rotation, shoulder external rotation, elbow flexion, elbow extension, forearm pronation, forearm supination, wrist flexion, wrist extension, digital flexion, digital extension, thumb flexion, and thumb extension. The use of this scale for clinical and scientific evaluation has been reported in a number of publications. It has an excellent intra-observer reliability of kappa= 0.85 and an inter-observer reliability of kappa = 0.66 in this patients. It has established good psychometric properties in this population. This scale falls within the body functions and structures domain of ICF (Ho et al. 2012). Gilbert and Raimondi scale Elbow flexion was graded by the system of Gilbert and Raimondi which ranges from 0 (paralysis) to 5 (complete active flexion and extension). Function of the hand was graded from 0 (paralysis) to 5 in which there is complete active flexion and extension of the wrist and fingers, strong intrinsic muscle function and active pronation and supination in excess of 90Â °, as described by Raimondi (Birch et al. 2005: 1089–1095). This scale falls within the body functions and structures domain of ICF (Ho et al. 2012). Toronto Test Score: Michelow et al. proposed the Toronto Test Score to quantify upper-extremity function and to predict recovery in infants with brachial plexus birth palsy9. With this scoring system, patients are prompted to actively flex the elbow and extend the elbow, wrist, fingers, and thumb. Each of these five movements is then graded on a scale of 0 (no motion) to 2 (normal full motion), and the sum of the values determines the aggregate, or total, Toronto Test Score (maximum, 10 points). The Toronto Test Score was designed to predict outcome in patients with brachial plexus birth palsy. It has an excellent intra-observer reliability of kappa= 0.73 and an inter-observer reliability of kappa = 0.51 in this patients. This scale falls within the body functions and structures domain of ICF (Ho et al. 2012). Literature Review: Julia K. Terzis and Kokkalis (2008) conducted a retrospective study to see the effect of primary and secondary shoulder reconstruction in obstetric brachial plexus palsy. 96children with OBPP were recruited in the study. 30 cases underwent primary reconstruction alone, 37 underwent both primary and secondary procedures, and 31 late cases underwent only palliative surgery. From this population, 23 cases were diagnosed with classic Erb’s palsy, 22 cases with Erb’s palsy and C7 involvement and 53 cases with global palsy (C5-T1). British Medical Research Council grading system and modified Mallet scale were used as outcome measures. The mean follow-up period was 6.7 years. Significant improvement was seen in the entire population according to modified Mallet scale and mean score improved from 8.8 points (range, 6-19 points) preoperatively to 20.9 points (range, 13-24 points) postoperatively (p They used large population. The inclusion criteria was not proper. They used long follow up period. There can be selection bias present. Nehme et al. (2002) conducted a retrospective study to see the prediction of outcome in upper root injuries in OBPP. 30 children with unilateral upper obstetrical brachial plexus injuries were recruited in this study. The age of this group was between 1 week and 2 months. The mean follow-up was 14 years. Each child was examined every month in the first year and every 3 months in the second year. Mallet scale was used to assess the functional recovery and classification of Tassin was used to assess the muscle power. Result showed that three patients had achieved a ‘‘good recovery’’, at 3 months and 12 patients had made a ‘‘good recovery’’ at 9 months with conventional physical therapy. The best predictor of outcome was elbow flexion at 9 months with 13% error, and not 3 months with 36% error rate for brachial plexus reconstruction. A ‘‘good result’’ at final assessment was predicted by the recovery of M2 elb ow flexion at 3 months (Student t-test: P Bisinella and Birch (2003) conducted a prospective study with 74 children with OBPP to see the incident of recovery. The mean age of children was 3.2 months and follow up period was two years. Mallet scale and Gilbert scale used for shoulder function, Gilbert and Raimondi scale used for elbow function and Raimondi’s system used for measuring hand function. Patients underwent to conventional or surgical intervention according to severity. Result showed that very good recovery in 39 cases, useful arm with residual deficit in 29 cases, some function in 4 cases and very poor result in 2 cases. Mallet scale is not appropriate for this age of children. They used large population. Methodology was not good. Grossman et al. (2004) conducted a prospective study to assess the shoulder function following late neurolysis and bypass grafting for upper brachial plexus birth injury. 11 children in age from 9 to21 months were recruited in the study. Modified Gilbert system used for measuring shoulder function. All patients were followed for 2 or more years. In spite of some limitation, modified Gilbert system is accepted as a reliable outcome measure following surgery. Significant improvement was seen in all patients. Sample size was too small. Methodology was not explained properly. Inclusion criteria was not mention properly. Birch et al. (2005) conducted a prospective study to see the improvement after repair of obstetric brachial plexus palsy. 100 children were recruited in the study. Operation was advised when poor clinical recovery was matched by unfavourable neurophysiological predictions. The mean duration of follow-up was 85 months. Gilbert’s system and mallet system was used to assess shoulder and Gilbert and Raimondi system used to assess elbow. Result showed that good improvement was obtained in 33% of repairs of C5, in 55% of C6, in 24% of C7 and in 57% of operations on C8 and T1. Discussion: The debate whether and when to operate on OBPP is still active because it is difficult to predict the natural history for recovery of nerve lesions, because this depends on the severity of the injury (stretch, rupture, avulsion) and on the levels of injury (partial or total plexus lesion). The challenge now lay in deciding which children would recover spontaneously, and which would need direct nerve surgery to aid their progress. Some author proposed three indications for surgery; complete palsy with flail arm and Horners syndrome; complete C5 C6 palsy without muscle contraction by 3 months and with a negative EMG (often, they say, corresponding to a complete root avulsion); and C5 C6 palsy with no recovery in biceps at 3 months (biceps alone is chosen because examination of deltoid to the exclusion of pectoralis major is difficult at this age). Zancolli and Zancollf suggested that for each level of involvement of the plexus there was a different key muscle to consider as an indicato r for direct nerve surgery. For the upper plexus the key muscle was biceps and deltoid, whilst for the middle plexus it was triceps and for the lower plexus, the finger flexors and thumb extensors. In general the decision about surgery in their recommendations is delayed until between 6 or 8 months when absence of clinical or electrophysiological signs of recovery in key muscles, or the cessation of recovery at a value of M2 or less on the British Muscle Movement Scale indicated the likelihood of poor spontaneous recovery and an indication for direct nerve surgery. According to literature review, Julia K. Terzis and Kokkalis (2008) proposed that early plexus reconstruction (

HR Management Roles

The Human Resources Department an important system to any organization and is a key component in the healthcare industry. It is the HR department that is built on skills, performance, and knowledge of the organization and is responsible for hiring and training the new employee’s healthcare services. â€Å"Human resources, when pertaining to health care, can be defined as the different kinds of clinical and non-clinical staff responsible for public and individual health intervention† (WHO, 2000). The roles and functions of the Human Resources Department (HR) management in the health care industry is to work closely with all staff to ensure each employee recognizes the needs and standards of the organization. Management is about planning, performance and team work. Planning is a vital in any organization and in healthcare it is pertinent for proper flow and function of the organization. â€Å"High- performance organization show a greater commitment and skill development† (Gomez-Mejia, 2010). This is the prime element in HR management roles the organization has opening positions, new programs for employees and creating a plan is essential for success. As a representative of management HR a plan to promote employees who show exceptional ability to lead. Management must look at these employees who show skill and focus on how to move them into positions that need their talent. Hiring new personnel for an organization includes providing extensive training for employee development. A program from management would include building proficiency requirements, develop mental skills of potential new employees. The functional roles of the HR department is to provide assistance to all managers who execute responsibilities of the health care organization. The department monitors daily functions of the healthcare organization to ensure the organization is running smoothly. It is their duty to oversee the organization success in practice. The HR department responsibility is to confirm that each employee has the proper skills and training required for the position. This guarantees that the organization is operated effectively day-to-day. The methods used in the HR department creates a team effort atmosphere for the organization. This set clear goals, standards and success in a healthcare organization this gives each employee something to accomplish. The HR department’s role in the healthcare industry is very important, and the functions of the department’s plans, skills, and programs help achieve the organizations goal success in the healthcare industry. Management is the center of the organizations achievements. Proper management in HR is crucial in delivering quality health care. Management in HR is needed to develop new programs and policies. Effective management keeps the healthcare industry in a position to provide quality care to patients.

Case Study on D.I.a Baggage Handling System Essay

According to the initial plan, the project was to span from 1989 to 1993 and cost $1.7 billion. The opening of the airport was delayed four times due to problems with the baggage handling system. Overall 16 long months and a final cost of $4.5 billion. Several factors contributed to this fiasco, ranging from deficient scheduling, simple and untested technology, complexity of the systems and requirements that changed throughout the project itself. Let us take a look back at why Denver International Airport would take on such a project. The vision was to implement the largest automated baggage handling system the world had seen and allows Denver International Airport to be hailed as the air transportation hub, the largest in the United States with a capacity to handle more than 50 million passengers annually. The airport was to replace the Stapleton International Airport, a facility that had experienced serious congestion issues. Of course in order to handle that kind of capacity part of this plan involved implementing an automated baggage handling system, this was the critical piece of the plan. This report discusses the difficulties encountered as a direct result of a poor project plan, communication and implementation. Analyses have been done by many groups regarding this debacle and the failures itself are examples that are used to show the improper project management that was used. First, let us briefly discuss what tried to be accomplished. The Denver International Airport wanted to introduce a baggage system that when operational would rely on a network of computers (approx. 300) to route the bags and then approximately 4000 auto-cars to drive the luggage on a 21-mile track, completely autonomous. There were to be laser scanners used to read bar codes on luggage with tags and that would route them to the correct terminal or location. Sounds simple enough however BAE was the company that would try to bring this all to reality and would be one of the largest airports built in the United States since 1974. United Airlines was one of the main drivers and reasons for the push for a high-speed automated baggage system (http://www5.in.tum.de/~huckle/schloh_DIA.pdf). This was all requested and scoped early in the planning phase. Now prior to deciding how to proceed the officials had thought each airline would develop its own systems, but this failed to occur so the Airport looked into purchasing a system to handle all terminals baggage. The scope of such a project would not find traditional methods as those were too investigated. A man named Frank Kwapniewski, would be the site project manager â€Å"lucky† enough to call this project his â€Å"baby†. BAE had more than twenty some programmers working undistracted for two years to write software to handle all the automated needs of luggage, the engineers, which took just as long in their initial efforts of development. The initial design’s failures were inconsistency, so BAE sought to reduce such confusion and mishap, and wanted to understand the complex nature, however even a more scrutinous view would have foreshadowed the mishap of making such a large system functionally. Richard de Neufville stated in an excerpt from his book that the theoretical studies, models and reports regarding the automated baggage system at Denver were avoidable and should never be repeated (Neufville). BAE’s design flaws of complexity and the effects thereafter were a result of improper project planning and scope. The complexity of what it would take to operate and control automated machinery was never addressed or fully tested prior to implementation. Even after work ended when it was turned on and expected to work as intended, Denver officials were surprised at how poor it performed even enough to turn off the system. Let us take a moment to look at how complex this system truly was and how BAE design and planning failed to gain a glimpse of what it would take to operate such a daunting task. An empty cart is called and needs to go from one track to another, albeit simple sounding, this type of activity would have had to take place over a thousand times a minute under normal operating conditions. Since there were differences or variances in demand for empty carts throughout the airport, empty ones must continually switch direction, change tracks or completely change to another loop in the circuit. This is a logistics nightmare as one can imagine on such scale, so many variables to account for and they must do it error free. This was not using modern technology but even still it would have had to been almost instant decision making on again an error free basis. Typical systems with around 10k function points are cancelled approximately 65 percent of the time (capers Jones). In Denver, though the system’s workload hindered the network terribly to around 4000 tele-cars or auto-cars. These 1994 computers were tracking so many cars that several times a minute they mis-t racked just simply due to timing limitations. The planning of such a system was again originally contracted by United in 1991 to build, however after several years into it, BAE was concerned that the city of Denver still had not contracted for a baggage system. Sadly, the baggage system was nothing more than an afterthought of the design of the airport, AFTER construction began, let me make sure you understand that AFTER construction had begun and only then did the details surrounding the baggage handling system start to begin. This of course caused major problems due to limitations of resources that were not allocated properly which would contain the baggage system’s tracks and other components. The system then was made to fit in the underground tunnels and space available, not designed. These auto-carts had sharp turns now to make which again was not part of any plan. The schedule that BAE or timetable rather that they had set for the grand opening was not remotely realistic and as all good projects should do, have taken into consideration any potential issues along the way. BAE officials were even quoted as stating â€Å"We knew that was not long enough and we said so. It is a job that ought to take twice as long† (Why Technology Projects Fail). They knew but accepted the timetable of 4 years when they knew it should take 7 to 8 years for such a task. Denver Aviation Director James C DeLong even stated they just misjudged the timeline completely. The project as most will when unrealistic deadlines are given will continue to fall behind more and more, which then calls for more rapid work, longer hours which can lead, as the case here, to human error since the training and testing period were almost non-existent to meet the make-believe deadline. One of the other common misnomers in this project was the frequency and number of changes to its requirements, not a refining of them, but completely adding new functionality along the way. When the company BAE, took on the task, unrealistic as this sounds they took it on with anticipating no changes at all. As soon as work began though, Denver officials began changing plans and timetables without consulting either the airlines or BAE. Sadly, when changes were made to one piece of the system, the ramifications they made to other pieces was not clearly understood or the system as a whole. Again to reduce costs and save time, it was decided to remove an entire loop of track, from one of the concourses, this saved them 20 million, keep that figure in mind as later the system as a whole would cost them much more in the months after being deployed. Other such changes were made to save money, such as relocation of stations and addition of middle sub floor for baggage platforms that they referred to as the mezzanine baggage platform. Another airline also demanded the request for large baggage link. As the project matured, prior to implementation its scope size and complexity, along with design changed which increased the systems difficulties on a technical level that would continually deter progress. BAE then later chooses to decentralize all of the tracking and sorting computers, all these changes to scope should have led to review of alternate or contingency planning or delayed launch dates. However due to the shortened development and testing timetable, on the fly changes which should have required major pushback from core team members were â€Å"duct-taped† as I like to refer to it. One of the directors of engineering for the DIA, stated that BAE should have paid more attention to the programming issues early enough in the design phase. Lack of system testing, what I have I continuously stated all semester long about system testing and end-user testing, as a project manager most would agree, more than 75% of all IS projects are hampered by quality issue and 1 percent which are completed on time. I see reasons behind such statistics is not enough testing. I would advise any IT PMP to read ePMbook which is an online e-book regarding scope and project control, as was the case here a project that started out to be huge, got even bigger and eventually spiraled out of control. The ePM Book will has an excellent section that the BAE, airline and Denver City officials should have read prior to beginning step 2 of the project. They should have implemented any change coming through a request known now as a Change Request form. These forms are used to control the project’s scope and allow for the Project Lead, along with the core team, which requests can and will be made part of the original project and which can be sla ted as next phase or next step after implementation. It almost sounds as if this project never had a Change Control Process (CCP) whatsoever, if it did whoever was in charge of such did a horrible job, this CCP should exist throughout a project. It allows for requests to acknowledged in a timely fashion within a phase, and most important to determine impact in the planning for the next phase. This as stated on the site can be easier than de-railing the entire project due to shortening length of next step phases in the project path due to scope creep. Airlines kept changing the requirements, which resulted in numerous issues. One of the major reasons the whole thing went awry stems from BAE, the company that designed the system had previously implemented a similar system in Germany. The IT infrastructure was inadequate and design was not meant for such a large scale as that at the DIA. Well sadly it was not just a lesson for the DIA, BAE and Denver, but the taxpayers also ended up with a $1 million PER DAY cost, totaling $500 million by the end of the whole ordeal. Remember that 22 million they saved, good thing huh. Now let us think about how more time spent in analysis and design phase, let alone a Change control process, saved Colorado taxpayers millions of dollars. Since every project has a set of deliverables, assigned budget and expected closure time, there are agreed upon requirements and tasks to complete prior to the closure of a project. These constitute a project’s scope. The PMBoK clearly speaks to creeping scope and defines it adding features and functionality without addressing the effects on TIME, COST, and RESOURCES or without customer approval (PMBOK Version 4). References A guide to the project management body of knowledge (PMBOK ® Guide) (4th ed.).(2008). Newtown Square, Pa.: Project Management Institute. Brooks, F.P. (1995). The mythical man month: Essays on software engineering. (Anniversary Ed.). Boston: Addison Wesley Longman, Inc. JOHNSON, K. (2005, August 27). Denver Airport Saw the Future. It Didn’t Work. – New York Times. The New York Times – Breaking News, World News & Multimedia. From http://www.nytimes.com/2005/08/27/national/27denver.html?pagewanted=al lchloh_DIA.pdf Neufville, R., & Odoni, A. R. (2003). Airport systems: planning design, and management. New York: McGraw-Hill. New Denver Airport: Impact of the Delayed Baggage System — GAO/RCED-95-35BR. (n.d.). RITA | National Transportation Library. Retrieved December 6, 2012, from http://ntl.bts.gov/DOCS/rc9535br.html Scope & Change Control. (n.d.). Project Management and Program Management – The FREE ePMbook by Simon Wallace. Retrieved December 2, 2012, from http://www.epmbook.com/scope.htm Wiegers, K. (2003). Software Requirements (Second ed.). Redmond: Microsoft Press. Why Technology Projects Fail. (n.d.). Calleam Consulting – LLC. Retrieved December 1, 2012, from http://www5.in.tum.de/~huckle/DIABaggage.pdf

Was Public Health Better in the Roman Era or the Middle Ages

In my opinion, the Romans had superior public health, as they had much better sanitation and plumbing systems, which were in the Middle Ages available solely in monasteries, rather than entire towns. This was due to the fact that the Romans infrastructure and methods of treatment were more developed than Medieval ones, as well as the fact that the Roman government were far more involved in the health of their citizens than later rulers, who found war and developing trade far more important, and viewed civilians health as their own responsibility. The Roman towns were also much better planned and built than those in the Middle Ages, which often placed wells and sources of drinking and bathing water in close proximity to cesspits and†¦show more content†¦However, the Roman Empire was also poorly equipped to deal with plagues, such as the one which occurred in AD 80, and claimed hundreds of lives. However, public health in the Middle Ages did have some benefits: the towns often employed people such as gong farmers and muck rakers to survey and clean the streets to prevent disease, and remove sewage, although it was not possible to employ enough to maintain the cleanliness. The Romans had a similar system which worked to much greater advantage. Medieval towns also developed regulations and fines for littering and dirtying the streets, although these could not be easily enforced. As well as this, the rich were happy to pay the fines and continue to deposit refuse in the streets. Moreover, near the end of the Dark Ages, butchers were banned from working in the inner city, which prevented pollution and assisted in keeping the streets clean. In conclusion, I believe that public health was much better under Roman rule, although the Medieval government did endeavour to improve the situation (albeit without much success.) This is further evidenced by the average lifeShow MoreRelatedProgressives And The Progressive Era1253 Words   |  6 PagesThe progressive Era was times in History were local state and federal government took a leap forward in power and activism. In addition, the progressive era, was a time of development of new reforms and changes for America. Progressivism handles a wide range of problems and struggle for America. Such problems were created by unstructed industrialization, urbanization and immigration. As well as, the unfavorable distribution of power and wealth. Progressives believed strongly that problems such asRead MoreDifferent Philosophies And New Discoveries Have Created A Foundation That All Nurses Work1339 Words   |  6 Pageshave one thing in common, taking care of ones in need. History goes back to the classical era where Egyptians were known to have remedies that would cure sickness with the use of lizard’s blood, swine’s ear, putrid meat and fat, milk of lactating women, and excreta of donkeys and lions (Masters, 2014). In this time, experiencing illness was a punishment for some act of sin (masters, 2014). The Greek Era, brought treatment of sickness rather than viewing sickness as a punishment of a sin (MasterRead MoreEssay about Life and Death in The Middle Ages1456 Words   |  6 Pagesliving conditions. In past centuries the average lifespan was shorten due to economic situations such as famine, starvation, infections disease, and even death. In medieval time food and feasting were great past times. The extent to which the people of this time period could enjoy the variety of food we enjoy today, as well as many other aspects of medieval life depended on a person wealth and station in life (Nimocks). The eating schedule was similar involving three meals. The schedule consistedRead MoreThe Roman Law2088 Words   |  9 PagesLastly the last political piece to mention would be the Roman Law. This covers Rome s judicial system over the course of the empire. With this system, philosophy and the study of law became most prevalent. In today s world this system is no longer used however pieces linger on in judicial systems now. At Law school, you need to learn Roman Law in order to better understand judicial legal systems currently. Roman Law, like most Roman concepts are continually borrowed and altered throughout historyRead MoreThe English Renaissance : The Golden Age1861 Words   |  8 Pages Mrs. Robinson English 4 June 5 , 2015 The English Renaissance The English Renaissance, often known as the â€Å"Golden Age†, reflected the rebuild and change of the era prior to it. It was a cultural and artistic movement beginning in the late 15th century and lasted until the 17th century. The English Renaissance was a powerful, inspiring and known as the greatest era of British history being held for the success of literary, cultural and scientific inventions that signaled expanded new ideasRead MoreAncient Greece s Influence On The Life Of The Greek Peoples1898 Words   |  8 Pagestheir medical knowledge. Ancient Greece was steeped in mythology, such that, no matter what went on in the world around them, it was explained as having something to do with one god or the other. Unless it concerned medicine. The physicians of that time looked toward a natural reason why an illness would happen to someone, instead of saying a god caused it to happen. Around the time of the sixth century B.C., people would visit an asciepeion, which was an ancient Greece healing temple, ran byRead MoreHistory of Punishment2331 Words   |  10 PagesHistory of Corrections †¢ Codified punishment for offenders was developed in the early ages of human history. †¢ One of the earliest known written codes that specified different types of offenses and punishments was the Code of Hammurabi in 1750 B.C. The Code of Hammurabi was divided into sections to cover different types of offenses and contained descriptions of the punishments to be imposed to offenders. †¢ The Draconian Code was developed in classical Greece in the seventh century BRead MoreTaking a Look at Pharmacists2543 Words   |  10 Pages Pharmacy is an essential part of modern day health care. Pharmacists today are well trained, highly skilled and easily accessible to the public. However, pharmacy was not always as convenient and advanced as it currently is today. Since the times of prehistoric man, pharmacy has evolved greatly over the years and has become a safer, more efficient and more important part of society. There are still many opinions about pharmacy’s origin because many theories are based on logic and analogies ratherRead MoreThe Historical Development Of Nursing1978 Words   |  8 Pagesby the healing traditions of religion and magic as well as something guided by instinct and affection, would continue to linger at the time of the Middle Ages. In the Roman Empire, the Hellenic Medicine arising independently of other health culture on the basis of the Christian religion arises. Christianity had its influences in the early nursing as was the feeling helps the patient and thus the creation of institutions dedicated to this as a religious duty, equal treatment should be no differencesRead MoreAdvancements in the Roman Empire Compared to that of the Han Dynasty2165 Words   |  9 Pagesin an ocean; however, most of them are forgotten to this day because of their insignificant impact. The Roman and Chinese Empires were established like any other civilization, but rose to power th rough proper governing of the people. They later became so successful that they emulated one another in different fields of culture. The Han Dynasty was one of many dynasties in ancient China and it was able to change the outlook on society because of its radical and novel ideology based on Confucianism.