Discuss the reality of using problem solving and solution generating Essay

Discuss the reality of using problem solving and solution generating tools in a real consultancy case - Essay Example The third step is the evaluation and the selection of the best alternative, based on how much the option will solve the issue without causing negative results; that all parties accept the option taken; that the alternative is practical, and that the option is fit for the constraints of the problem. The fourth steps are implementing and follow up on the solution, which is done through campaigning for the acceptance of the option among involved parties and involving their efforts. This tool is more effective as compared to others like random idea generation, provocative idea formulation, challenge idea formulation and concept fan formulation and disproving. This paper is a discussion of the reality of problem solving and solution generating tools, through a real case of consultancy (Old 1995). The consultancy case used for this study is that of Veema Enterprises, whose management and stakeholders were interested in capturing an outside perspective – in the area of identifying the opportunities available to the venture, for improvement in the area of management. The venture sought to diagnose areas of improvement, define fresh perspectives – while remaining appropriate to regulated service, as well as place focus on managerial practices and areas of proficiency, which can be controlled for long-term success. This can be supported by the theory of constraints, developed by Goldratt Eliyahu in 1984, covering a set of insights and holistic processes – all founded on systems approach to mange and simplify the complexity of the enterprise, by focusing on the logical and physical limiting areas. For the enterprise, these constraint areas include leadership inefficiencies, strategic planning deficiencies, decreasing quality and the lack of innovation. This pr ocess can also be explained using Kurt Lewin’s theory of 1951, which explains behavior as the product of a dynamic balance of opposing forces. The theorist talks

Down East Spud Busters National Distribution Program Research Paper

Down East Spud Busters National Distribution Program - Research Paper Example Because the company wants to improve its sales and capture a large market, the sales associate will be expected to work hard towards convincing most business entities that can buy the products. The sales associates can have their operating centers in each region and should receive feedback from the clients concerning the products of sales services. The HR policies and procedures should be changed to incorporate the new strategy of distributing the products. The company expects to sell in several regions using sales associates. Policies should include restrictions on product storage, handling, and management of center stores. Procedures should guide the sales associate on how they will manage the regional centers and distribution of the products. The company should develop a portfolio indicating the skills experience and qualities needed in a sales associate to help it achieve its goals. This will guide its recruitment (Bateman & Snell, 2013). Industries that could use this model are; the agricultural industry, the automotive industry, and Food and beverage industry among others. An ice cream producer could use this model and get so many customers. The same applies to a baker. Some foodstuff however, cannot be distributed in this manner, the model can still be implemented is stores are constructed in specific regions like most coffee shops have done. Another example is the retail industry.

Classical Music Criticism and Judgment Essay Example for Free

Classical Music Criticism and Judgment Essay Classical music is one kind of the art music from various style of music. On Oxford Dictionary give the meaning of classical music as serious music following long-established principles rather than a folk, jazz, or popular tradition, and even give more specifically meaning by the period of music(since the music has 6 periods; middle age, renaissance, baroque, classic, romantic and contemporary) that classical music is the music written in the European tradition during a period lasting approximately from 1750 to 1830, when forms such as the symphony, concerto, and sonata were standardized. How do we judge the classical music, and what is the musical value of classical music? I think this is the hard thing to critics about the good or bad of the things that we call it as one kind of art. We could analyze music by their elements such as the musical form, the harmony, the rhythm, orchestration, register of that piece etc. But also the problems is everyone has different taste and also some have the same taste too such as one composer love the way dominant chord run to sub median chord and then resolve to dominant again then end with tonic chord but another one like the way to begin the phrase with sub median then dominant for two bars to extend the dominant longer (could call it as dominant prolongation) until tonic in the last bar. The question is what is the best chord progression of those two ideas? , and how do we judge what is the best chord progression? And interesting question is how do we judge that one piece copy from any other pieces? Another example is if we judge one of the phrases in symphony no. 9 by Beethoven â€Å"Ode to Joy† as the best phrase that compound with many good melodies, best chord progression and orchestration and great idea to add choir to that movement but there is also a question that who judge that this phrase is the best. How do they judge? , and what is the material that they use to judge this kind of classical music to make it the best of Beethoven’s pieces? The Best music in all kind of area not only includes by best music by creativity composers but also has to have best performers that can perform the best performances too. In classical music the performers have to do analyze and interpretation the music that they will perform, have to know the period of that music so they could play as the style of each period, have to practice in the right way to gain more techniques to their muscles to control their musical instrument, have to perform as natural as possible like they are speaking, eating or walking. The best performers have to bring all emotions and energy from the music that is just a music note on the paper to touch their audiences’ heart. The problems are what is the best performance? , and how do we judge the performance? As a classical guitarist I used to compete in one competition. All juries have to fill in the form for all competitors there topics are Technique, Dynamics, Balancing, Precision and Rhythm, Style and Expression, and Stage Performance. Maybe those topics could judge the best performance but the problem I could see was one song that I performed called Marley’s Ghost by Andrew York the main part of first section was the melody on the bass line. One of jury wrote on the Balancing blog that I played too loud but another on said I played too soft so I got the question that who is correct? This could show that it is hard to judge the best performance. It is depend on what do you like? What is your feeling? What are the things that you used to experiences. At last the way we critic and judge classical music could be judge from both quality of pieces and the quality of performance. The performers should know the aesthetic of composers who composed the songs that they will perform so they can perform in the way right way from performers’ interpretation. And definitely the listeners will judge it by their experience and feeling.

Nursing A Patient Receiving Ostomy Surgery Nursing Essay

Nursing A Patient Receiving Ostomy Surgery Nursing Essay Various gastrointestinal and genitourinary etiologies may need the creation of urinary or fecal diversion. These may include inflammatory bowel disease, diverticular disease, intestinal obstruction, colon-rectal cancer, gynecological cancers and gastrointestinal trauma (Beitz, 2004). Indications for coming up with the urinary stoma include; neurogenic bladder, bladder cancer, refractory radiation cystitis and interstitial cystitis. The cause of the disease will determine if the condition will be a temporary or permanent one (Thomas and McGinnis 2004). Among various types of surgically created ostomies, colostomy involves the opening made on the large intestine to allow for the passage of stool. The location of colostomy can be in sigmoid, transverse or ascending position. In this case, surgical resection will ultimately determine the stool output consistency. Ileostomy is a surgical construction from the small intestine and it is located high in the gastrointestinal route hence the stool output is comparatively of high quantity and liquid consistency (Gordon and Vasilevsky, 2004). Ileal conduit or urostomy is made using a short portion of the ileum to assist in urine elimination. Ureters are connected to conduit to allow urine to flow out of the body into ostomy pouch through the stoma (McGinnis and Tomaselli, 2004). Whether the ostomy is temporary or permanent, nurses must posses the knowledge to give the patient and the family the necessary information to improve recovery and enable a positive experience when obtaining informati on about ostomy care. Patient education. Any patient who is scheduled for an ostomy surgery can experience a number of feelings like fear, anxiety, depression and loss of body image especially if the cause of the surgery is a diagnosis related to cancer. Pre operative teachings assist the patient by receiving these feelings and contribute to quick recovery of the patient (Oshea, 2001). A very important ingredient in the teaching procedure before the operation is the Wound Ostomy and Continence Nurse (WOCN). Counseling before the operation allows for the assessment of the patients knowledge about the disease, support systems, level of education, employment, physical activity involvement, financial concerns and hobbies. Assessment of any physical shortcomings is also necessary because poor manual dexterity, poor vision and loss of hearing may affect the patients ability to undertake ostomy self care. Patients spiritual and cultural beliefs should be also assessed because certain particular rituals concerning ostomy care may n eed to be taken in. Employing all these factors can assist the patient to recover successfully and feel confident in managing the condition (Oshea, 2001). WOCN reviews the cause of the disease, stoma characteristics, surgical procedure, peristomal skin care, dietary considerations and a variety of ostomy appliances. If appropriate teaching proceedings may enable the patient to have an insight of the ostomy pouching system. Use of teaching booklets and illustrations helps to improve the education. Another component of preoperative teaching is the stoma site marking. This is recommended for all who are set to undergo a permanent or temporary stoma (Goldberg and Carmel, 2004). A poorly located stoma on the patients abdomen can lead to peristomal skin complications, stool and urine leakage, stoma, emotional and physical stress for the patient. During stoma site marking, there is abdomen assessment with the patient in sitting standing and lying positions. Also the abdomen can be assessed for the skin folds, bony, creases, scars and prominences. Patients belt and line should be avoided from the stoma site and not affect any prosthetic devices. The stoma site should also be put in an area that the patient can visualize and access. Ideal stoma site is situated in the anal muscle that extends to symphysis from the xyphoid process (Goldberg and Carmel, 2004). Nursing education. In stoma assessment the patient must enter the operating room with the pouching system on stoma. Immediately after the operation the, a transparent pouch is recommended to enable the nurse to have a view of stoma characteristics and stool and urine presence (Goldberg and Carmel, 2004). Initially after the operation period, the stoma can appear edematous, red, shiny and moist. In general terms, the stoma is red to pink in color according to tissue that was used in construction. Brown to dark color may show stoma ischemia and the consultations must be made with the physician. The shape of the stoma ranges from round to oval. It changes its shape and size in a period of six to eight weeks after the surgery. Since the stoma decreases in size with time, the nurse must use a skin barrier that has been cut to fit to the stoma (Goldberg and Carmel, 2004). For the first six to eight weeks after the surgery, measurements of the stoma should be taken each time the barrier of the skin is changed. Measuring guides are provided to measure round stomas, oval stomas will need the length and width measurements of the stoma (Colwell, 2004). Lack of sphincter by the stoma to regulate the passage of urine or stool, then the opening should be placed near the center of the stoma to aid the flow of urine and stool (McCann, 2002). The stoma may not or may protrude out of the skin surface. Stomal protrusion vary from a flush stoma at the skin level to a moderate one which is about 1-3 cm in length (Erwin-Toth and Doughty, 2002). Actually, stoma protrusion should be at least 0.8 inches above the skin level (Colwell, 2004). Protruding stoma helps urine and stool to flow into the pouch directly. A flush stoma is not suitable because it can cause difficulties when skin barrier attaches to it and leakage of stool below the skin barrier leading to peristomal skin irritations. The stoma output is determined by the location of ostomy. The output resulting form the ascending colon produces a semi liquid consistency whereas the one from the transverse colon produces a semi-liquid to pasty consistency and the one located in a sigmoid or descending colon will be more of a solid stool (McCann, 2002). An Ileostomy stool output is constant and watery with a lot of digestive salt and digestive enzymes. At the initial postoperative stages, the stool may be greenish and thick. The stool output from Ileostomy range from 800-1,700 cc in one day (Colwell 2004). When the patient comes back to the regular diet, there is development of the stool consistency from the ileum and a reduced out put in a daily basis ranging from 500-800cc/day. With time the small intestines recovers and with a decrease in stool output (McCann, 2002). Urine is immediately produced after the surgery by the Ileal conduit stomas. It is usually normal for the urine to be blood-tinged after the operation. Also the small intestines produce mucous which may be seen in urine (Colwell, 2003). Peristomal skin care involves the protection of the peristomal from coming into contact with the urine and stool to stop the occurrence of peristomal skin complications. Skin barrier needs to be properly measured to suit the stoma. If the skin barrier opening is too large, urine or stool will cause irritation on the peristomal skin area. The opening should not be more than 2cm larger than the size of the stoma. Cleanliness of the peristomal skin can be done by gently using warm water then dry it. Moisturizing soaps must be avoided because they affect negatively the skin barrier attachment. Male patients need to be taught trimmed peristomal using electric razor, scissors and other safety devices in an outward manner from the stoma (McCann, 2002). When choosing the pouching system of the patient, the information that was gathered before the operation is heavily relied upon. Other factors to be considered include location of the stoma, its size and shape plus the anatomical location. Pouching system should give anticipated wear time and protect the underlying skin from stool and urine (Colwell, 2003). Most of the pouching systems are designed in a way that the weight is light, easy to maintain and odor-proof (Colwell, Carmel and Goldberg, 2001). One of the most important components of the pouching systems is the skin barrier because it protects the peristomal skin from stool and urine (Colwell, 2004). Skin barriers can be found in either cut-to fit or pre-cut product. The pre-cut models are meant for the round stomas. Barrier opening should fit stoma size to limit the probability of the urine and stool coming into contact with the peristomal skin. The cut-to fit models can be used in oval stomas or the ones which are irregular in shape. The cut-to fit barriers are the commonly recommended in initial postoperative stage because the size of the stoma will reduce for not less than six to eight weeks from the day the surgery was performed. A large skin barrier may cause peristomal skin problems resulting from the exposure to stool or urine (Colwell, 2004). Skin barrier wear time is necessary; the barriers are either classified as extended or standard. The difference between the two lies in their interaction with the moisture and the degree of affinity to the skin. The two barriers absorb the moisture. However, the extended model absorbs moisture slowly as compared to the standard model. This delays the erosion of the skin barrier (Colwell, 2003). Skin barriers have flat or convex shapes. At the back of a f lat barrier is one level surface while the convex one has an outward protrusion. Skin barriers are made with in-built convexity which is created by putting the ring into the barrier. The intention of the curve is to place pressure in a downward position to the peristomal skin to enable the stoma to protrude in an outward position (Colwell, 2003). Different convexity depths are referred to as deep, moderate and shallow. Generally convexity is used in stomas which are flat and retracted to minimize urine and stool leakage below the pouch. Also the convexity can be used in abdomens with skin folds or soft abdomens in peristomal skin (Colwell, 2004). Various ostomy pouching systems are available. It is therefore necessary to elaborate to the patient that the systems used in hospital after surgery may not be necessarily the system he or she will continue using after recovering from the operation. The following must be considered while selecting the ostomy pouching system; the ostoma size and shape, effluent type, presence or absence of abdominal folds and contours and the type of the ostomy. The patients manual and visual dexterity must be considered as well including day to day activities (Colwell, 2004). Pouches sealed to the barrier are categorized as a single piece, and systems that are connected to the skin barrier are seen as a double piece. A two piece pouch gives the patient the capacity to change or remove it without altering the skin barriers. Again it is easier to position the skin barrier at the middle of the stoma. One mechanism for making sure that a two piece pouch is closed is will ultimately depend on the ability of the patient to snap the pouch and the wafer together. Application of the pouch to the wafer will require the patient to be instructed so that he or she can listen to an audible click to make sure that the pouch is safe to the skin barrier.

Essay --

The term ‘market failure’ refers to the quantity of products required by consumers not being equal to the quantity supplied by the suppliers; this could mean that the quantity of products demanded are too high and there is a lack of supplies or that quantity of products demanded are too low and there is a surplus in supplies. The Government in this case plays a significant role in order to control the fluctuation of quantity demanded and supplied in many ways in relation to public goods, merit goods, externalities and imperfect competition. Public goods are provided by the Government, for example street lights. They are non-excludability goods because it cannot be provided to only those who pay for it through taxes so those who have no paid for this can still benefit from this good. If public goods like the street light were left for us to pay individually (like a private good that can only be used if paid for) there would be less public goods available. The Governments role in this department is to make sure a suitable level of public goods is provided. The government intervenes in this by taxing workers, organisations and consumers which result in public revenue. Public revenue can then be used on public goods to ensure enough of it is provided. Another example of a public good is public parks and the fire department that the government provide. Merit goods are different compared to Public goods; they are goods that the government need to interfere in as it would be under-consumed if they did not. They are provided both by public and private sectors. Education and the National Health Service (NHS) are Merit goods. If education was left for us to fully pay for it, then there would be less educated people due to the lack of fina... ... in supplies meets the demand. The increase in supplies was encouraged by offering high wages and salaries to farmers so this overall improved their income. This policy still present today works as agricultural workers being financed mainly through the CAP’s single farm payment which is given yearly to aid the farmer’s work. It now also includes care for environmental pollution, animal welfare and biodiversity. Farmers now being paid through the Single Payment Scheme have set rules they must achieve in order to receive the payment. Farmers gaining the payment have the option to produce any goods on their land however they must also keep their land in good condition and maintain this condition. If the farmer fails to do so, the payment they regularly gain will be lower. In relation to their condition of their land, animal welfare and the environment must be valued.

Comparing Karl Marx and John Stuart Mill Essay example -- Karl Marx vs

Karl Marx was born and educated in Prussia, where he fell under the influence of Ludwig Feuerbach and other radical Hegelians. Although he shared Hegel's belief in dialectical structure and historical inevitability, Marx held that the foundations of reality lay in the material base of economics rather than in the abstract thought of idealistic philosophy. He earned a doctorate at Jena in 1841, writing on the materialism and atheism of Greek atomists, then moved to Kà ¶ln, where he founded and edited a radical newspaper, Rheinische Zeitung. Although he also attempted to earn a living as a journalist in Paris and Brussels, Marx's participation in unpopular political movements made it difficult to support his growing family. He finally settled in London in 1849, where he lived in poverty while studying and developing his economic and political theories. Above all else, Marx believed that philosophy ought to be employed in practice to change the world. Although it at first had little impact on the varied revolutionary movements of the mid-19th century Europe, the Communist Manifesto was to become one of the most widely read and discussed documents of the 20th century. Marx sought to differentiate his brand of socialism from others by insisting that it was scientifically based in the objective study of history, which he saw as being a continuous process of change and transformation. Just as feudalism had naturally evolved into mercantilism and then capitalism, so capitalism would inevitably give way to its logical successor, socialism as the necessary result of class struggle. Marx's insistence that tough-minded realism should replace the utopian idealism of earlier socialists had profound consequences: it enabled revolutionaries like Lenin to be put it into action, but it also tended to encourage its followers to accept ruthless means to justify what they believed were historically necessary ends. Radical politics were being much m ore widely discussed than the small number of radicals justified; but Marx uses this fact to his advantage by proclaiming that any ideology so feared must be important and worth explaining clearly. In the notes, "Marx" is used as shorthand for both Marx and Engels. The Manifesto was originally issued in several languages, including an English version. According to Mark, the modern age is a dangerous age, an age in which we might ... ...or the few is solely due to its non-existence in the hands of those nine-tenths. You reproach us, therefore, with intending to do away with a form of property, the necessary condition for whose existence is the non-existence of any property for the immense majority of society. In one word, you reproach us with intending to do away with your property. Precisely so; that is just what we intend. From the moment when labour can no longer be converted into capital, money, or rent, into a social power capable of being monopolised, i.e., from the moment when individual property can no longer be transformed into bourgeois property, into capital, from that moment, you say individuality vanishes. You must, therefore, confess that by "individual" you mean no other person than the bourgeois, than the middle-class owner of property. This person must, indeed, be swept out of the way, and made impossible. Works Cited Marx, K. and Engels, F. Manifesto of the Communist Party, in The Portable Karl Marx, edited by E. Kamenka, New York: Penguin Books 1983. Mill, John Stuart.  On Liberty. Indianapolis: Hackett, 1978. Mill, John Stuart.  Utilitarianism.  Indianapolis: Hackett, 2001

Bacillus Cereus

B cereus has been discovered since 1955 as a cause of food poisoning (Luna etal 2007). 52 cases of food borne diseases connected with B cereus were reported in the interval between 1972 and 1986 and only two cases were reported in 2003 which represent about 2 % of the actual cases due to underreporting and many of the case go undiagnosed(Benenson 1990) . According to the south Carolina department of Health and Environmental control and CDC,close to 25% of state public health laboratory do not carry out B cereus testing routinely (Kramer& Gilbert 1989).The Centre for Disease Control estimates that 97% of all cases of food poisoning come from improper food handling; 79% of cases result from food prepared in commercial or institutional establishments and 21% of cases result from food prepared at home (Terranova & Blaker 1978). The most common etiologies are as follows: (1) leaving prepared food at temperatures that allow bacterial growth, (2) inadequate cooking or reheating, (3) cross-c ontamination, and (4) infection in food handlers (Blaker 1978).Cross-contamination may occur when raw contaminated food comes in contact with other foods, especially cooked foods, through direct contact or indirect contact on food preparation surfaces. Bacteria cause approximately 75% of the outbreaks of food poisoning and for 80% of the cases with a known cause in the United States (Blaker 1978). As many as 1 in 10 Americans has diarrhea due to food-borne infection each year. The 2 syndromes associated with B cereus food poisoning include short incubation or emetic syndrome with I.C=1-6 hours and the long incubation or Diarrhea syndrome with I. C=6-24 hours (Kramer 1989). Fried rice is the leading cause of emetic syndrome in the US (Bean 1990; Terronova 1978). Heat stable emetic toxin (ETE) is responsible for the short incubation period syndrome while the heat labile enterotoxin is responsible for the long incubation syndrome (Bean etal 1990) Syndrome Types of Bacillus Cereus food poisoning Bacillus cereus food poisoning has two varieties namely the emetic syndrome as well as the diarrhea syndrome types. B.cereus has some toxins responsible for its pathology and such toxins produces diseases that tally more with intoxication than absolute food poisoning. The emetic type can usually be confused with staphylococcal food poisoning due to its short incubation period (Luna etal 2007). However staph aureus being an important cause of food poisoning produces infection following growth in protein and carbohydrate foods. The enterotoxins of S aureus are super antigens and are heat stable making them resistant to the action of gut enzymes .As small as 25 microgram of enterotoxin B can produce diarrhea and nausea (Luna etal 2007). The emetic effect of this toxin is believed to be as a result of central nervous effect following the action of the toxins on the gut neural receptors (Ficker etal 2007). Some strains of staph aureus produce enterotoxins during their developme nt in meat, dairy foods and other food products and characteristically, this food usually has been recently prepared but has not been properly refrigerated. Almost 6 distinct types of staph enterotoxins exist.Following the swallowing of the preformed toxin, it is taken in by the gut mucosa and subsequently stimulates neural receptors and this stimulus is transferred to the vomiting centre in the brain and this projectile form of vomiting usually occur after few hours and it is less frequently associated with diarrhea and staph food poisoning is regarded as the commonest form. The food poisoning due to staphylococcus are usually associated with a smaller incubation period when compared with B cereus (from 1 to 8 hours).It is also associated with a very violent, copious nausea, diarrhea and vomiting all occurring in the absence of fever(Benenson 1990). It should be noted that with the emetic type where the incubation period is 2-8 hours, the prominent symptom is vomiting whereas in th e diarrhea type with incubation period of 8-16 hours the prominent symptom is diarhoea. Other species of bacillus are infrequently associated with human pathologies and difficulty arises in differentiating superficial contamination with B cereus from the authentic disease caused by this same organism .About 5 species of the Bacillus are aetiologic agents in insects and they include: B larvae, B lentimorbus,B sphericus,B papillae and B thurigiences and some of them have been taken advantage of by their use as insecticides(Fricker etal 2007) . Incorporation of the gene from B thuringiesis into some commercial plants has been recently achieved and this subsequently has generated a lot of controversies among the activists on environmental issues about the safety of these genetically fashioned food and plants products (Guerrant and Bobac 1991).Food types associated with food poisoning While the emetic type is associated with foods like fried rice and in fact the leading cause in the US ( Black low &Greeberg 1991), the diarrhea syndrome is associated with the likes of sauces and meat. The short incubation type is linked with fried rice that is cooked and kept warm for many hours and is also often associated with Chinese foods. A previous outbreak has revealed macaroni and also cheese from milk being the source of the bacterium.Incubation Period of the two syndromes of B. cereus that causes Food poisoning In the emetic type the diarrhea usually last for about 24 hours and it usually start 1-5 hours after the ingestion of the food substance like rice and it may also follow the ingestion of pasta foods. Food poisoning of the long incubation period i. e. 10 to 24 hours is the diarrhea type and this type may be confused with clostridia food poisoning. Mechanism of action ETE-forms small molecules, channels and holes in membranes.HBL-stimulates intestinal fluid secretion by various mechanisms including activation of adenylate cyclase and pore formation. Toxin of B-cereus i nclude emetic toxin (ETE), Nhe and EntK. Only 2 of the 3 enterotoxins participate in the causation of food poisoning and they consist of 3 different protein substitute acting together. HBL is a haemolysin while Nhe is not . EntK is a single component protein and not associated with food poisoning (Terranova&Blaker 1978). The 3 enterotoxins of B cereus have cytotoxic effect and they act on cell membranes forming holes and channels in them.People at risk of developing food poisoning The high risk population for food poisoning includes the older adults and this is due to the fact that as you get older, your immune system may not respond as quickly and as effectively to infectious organisms as when you were younger (Blacklow & Greeberg 1999). The Similar explanation goes for Infants and young children because of the immaturity of their gastrointestinal tract and also their immune systems haven’t been so fully developed.People with chronic diseases are also at risk of food poisoni ng because having a chronic condition, such as diabetes or AIDS, or receiving chemotherapy or radiation therapy for cancer reduces your immune response. Clinical features The clinical symptoms produced by the emetic type include abdominal pain, vomiting, nausea and self limiting type of diarrhea. The clinical symptoms of the diarrhea or long term incubation syndrome include fever and vomiting in rare cases but most prominent symptoms are profuse diarrhea and abdominal pain.The intestinal toxin is usually preformed but it can be produced inside the intestinal tract (Kramer &Gilbert 1989). To make a meaningful diagnosis of this organism, one will require that a load of about 105 of the organism is present in the feaces and just the presence of the organism not up to this maximum concentration is not enough to diagnose. Also importantly, B cereus is an important aetiologic agent of eye diseases such as panopthalmitis, endopthalmitis and infection of the cornea too .This organism during a traumatic event is usually inoculated into the eye and it usually does this via the foreign body introduced into the eye. Both local and system problems have been reported associated with B cereus and it’s been associated with medical foreign devices such as braces, prosthetic valves, and some invasive procedures like passage of urinary catheter, nasogastric tube and chest tubes. Some of the associated systemic problems caused by the organism include meningitis and encephalitis, pneumonia, osteomylitis, as well as endocarditis.The use of intravenous drugs also predisposes to infections by B cereus (Bean &Griffith 1990). The organism lives inside the soil and it is a common finding that it contaminates foods like rice (Jones and Blicslayer 2002). The toxins production usually occur when large amount of rice is prepared and then allowed to cool down which subsequently lead to the growth of the spores and the vegetative form now synthesize the toxins and all these occur in th e log phase growth period or during the process of sporulation.Clostridium is the third leading cause of bacteria food borne epidemics following salmonella and staphylococcus aurues The enterotoxin it produces causes a self resolving gastroenteritis and it does this by binding to the brush border membrane receptor and therefore binding to abdominal wall mucosa, interrupting the exchange of ion and the resultant effect is the loss of ions and low molecular weight metabolic products (Benenson 1990). The time of onset of the clinical manifestation is usually between 8 and 16 hours i.e. earlier than that of B cerues and it follows the ingestion of the organism itself. Although it is also associated with abdominal pain and diarrhea but less commonly with systemic problems. Another species of the clostridium family is clostridium difficile is usually associated with over 25% of antibiotic associated diarrhea and 95% cases of psedomembraneous enterocolitis and the organism produces two ent erotoxins (exotoxin A&B). Some of the precipitant antibiotics include clindamicin and ampicillin.However the diarrhea of B cereus infection does not follow antibiotics use. The clinical picture of C difficile diarrhea includes nausea, vomiting, abdominal pain as well as greenish voluminously large amount of diarrhea (Blacklow and Greeberg 1991). Protoscopy will show pseudo membranes and microabscesses with an erythematous mucosa and the diagnosis is confirmed by demonstrating toxins in the stool and the current treatment of choice includes oral metronidazole (Fricker etal 2007). Other aetiologic agents of food poisoningOther bacteria organism toxins that have been implicated to cause food poisoning include those of Vibro cholera, Yersina enterolitica, and Aeromonas species. However the exact role of the organism and their toxins in pathogenesis is not well delineated except for V cholerae. C perfirigens is another aetiologic agent responsible for food poisoning (Jones&Blikslaker 200 2). Case Study 1 Father, mother and 2 children with respective ages 34, 28, 6 and 4 presented in a hospital because of passage of watery stool and fever all of 6-12 hours duration.There was history of eating green salad beans, ground meat and tortillas prepared by someone else in an encampment because they are migrant farm worker family. It was also found out later that another 7 month old child in the family had not taken the food and was found to be well. The children started having abdominal discomfort, diarhoa and fever 24 hours later and the symptoms have been continuous since the previous 12 hours and both affected children have been having bloody stool.The parents also started having similar symptoms 5 and 7 hours ealier excluding visible bloody stool. There was history that some other persons in the encampment had similar symptoms in the past 2 weeks and that the camp’s hygienic state is poor. Both children are warm to touch on examination as well as the parents and h ave increased heartbeat and the children also appeared to lack fluid . A mount of their stool revealed white cells that fight infections and the faeces of the children were blood stained. Comments and explanationGenerally speaking, vomiting, nausea, fever abdominal pain and diarrhea are the major key symptoms of infection of the gastrointestinal tract and the main symptom will depend on the cause whether it is a toxin or invasive or a combination of the two (Guerrant &Bobak 1991). Usually, nausea and vomiting are often related with preformed toxins in food. For instance, B cereus and staph aureus can generate enterotoxins in food and this usually happen few hours after the ingestion of the food substance (Guerrant &Bobak 1991).The likes of enterotoxins of enterotoxigenic E coli and Vibrio Cholera usually affect the superior aspect of the bowel to cause watery and massive diarhoea. As in the above scenario, invasive bacteria penetrate the colonic mucosal and cause abdominal pain with blood and mucous associated with fever and dehydration and this constellation of symptoms are regarded to as dysentery and the implicated aetiologic are for dysentery are:Entamoeba histolytica,Clostridium difficile ,enteroinvasive E. coli,salmonella ,campylobacter jejuni.The above children were admitted in the hospital and treated and parents were also treated as outpatients with fluids and drugs and this is followed by public health sanitary measures in the camp. In conclusion, food poisonings are very common most especially in the developing parts of the world with high morbidity and mortality most especially among infants and children (Kramer &Gilbert 1989). Therefore of value are public health preventive measures by the provision of good water supply as well as sanitary and hygienic water and food supply.(Guerrant RL, Bobak DA: Bacterial and protozoa gastroenteritis. N Engl J Med 1991; 325:32). Case study 2 A reported incidence of acute gastrointestinal infection occurred in Ju ly 21, 1993 among the members of staff as well as the pupils of a co-owned child day care school after a catered lunch. This lunch was served for eating to 82 pupils of the day care centre to children between the age of 6 and less and the children are 82 in number along with 9 staff members. Past dietary history was gotten from 80 individuals and 67 were said to participate in the lunch.An individual at the day care made a case definition of vomiting. Among those served and who ate at the lunch, 21 %( 14) became sick and 13 did not. The symptoms observed ranged from diarrheal in 14 %,pain in 30% case and nausea in 71% case. 12 out of the 14 instances occurred among the children from ages 2. 5-5 and 2 other members of staff. Stastical analysis reveals that the median incubation period was 2 hours(the range is 1. 5-3. 5 hours). The resolution of symptoms took place over median interval of 4 hours following the onset(range 1. 5-22 hours).Among the dishes served in the local restaurant, only chicken fried rice was linked with notable illness and the problem occurred among 14(29%) out of the 48 individuals who ate the chicken fried rice in comparison to none of the 16 individuals who did not eat. The implicated rice was prepared the night preceding the incidence on July 20 under room temperature before it was refrigerated. The report also confirms that the rice was heated in oil with the slices of the cooked chicken on the morning of the lunch, then handed over to the daycare centers at around 10:30 am without refrigeration and served at noon without rewarming it.As a subsequence to the outbreak the advice by the health personnel to the restaurant officials and daycare staff was to stop the custom of cooling of rice or any other food at room temperature henceforth and that food should be kept at appropriate temperature of 5 degree or above 60 degree and that the temperature should be confirmed by a thermometer. Analysis of the case study 2 This short incubation syn drome variety of the disease which featured in this outbreak is overseen by highly stable toxin that can withstand enzymatic effect as well as extremes of temperature and PH.The diarrhea syndromic type is mediated on the other hand by an acid and heat labile intestinal toxin affected by the effect of the proteolytic enzymes like pepsin, trypsin etc. To make a diagnosis of Food poisoning, it is essential to isolate more than 10 5organisms per gramme from the epidemiologically implicated food substance . The self resolving as well as the lack of severity in most cases account for the reason B cereus is underreported(qtd in Todar 2004). Moreover recent research reveals that close to 20 % public health laboratory do not have the facility for the routine test for B cereus.In the United States, the leading cause of the emetic syndrome type or the â€Å"Short incubation syndrome† type of B. cereus is fried rice. As discussed before that B cereus more often than not is found in uncoo ked rice where the heat resistant spores also withstand and survive cooking. The survival of the vegetative form is a possibility after cooked rice is placed in an incubator as it generates heat stable toxin substance which can withstand heating(Kramer &Gilbert 1989). In this described scenario, the vegetative form must have proliferated at the food joint and also at the day care centre while the rice was being kept at room temperature.The problem is the unawareness of the restaurant food workers that certain danger is associated with cooked rice potentially. It’s imperative from the report the need to properly inform food handlers about fundamental rules and customs for hygienic healthy and safe food management and handling (Benenson 1990). Web Review of Todar's Online Textbook of Bacteriology. â€Å"The Good, the Bad, and the Deadly†. (SCIENCE Magazine- June 4, 2004 – Vol 304: p. 1421). 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