Prevention Of Pressure Ulcer

Prevention Of Pressure Ulcer Pressure ulcers, or bed sores, or have been affecting humans for ages, and addressing the overall prevention of pressure ulcers is now a prominent national healthcare issue. Despite of all the advances in medicine, surgery, nursing care, pressure ulcers still remains a major cause of mortality. Pressure sore is a common problem among old people and those who are immobilise or limited activity like post-operative and other bedridden patients. (Bergstorm, 2005) Many studies state that elderly are prone for pressure ulcer throughout the world and its becoming a crucial issue (Nakagami et al., 2007). Pressure ulcer can be defined as a type of injury that affects areas of the skin or underlying tissue of the body due to application of too much pressure on it. (Grey et al 2006) It develops as a result of tissue necrosis of the skin over the bony prominence, due to the obstruction of the blood vessels flow caused by the application continual pressure on it. (Lyder, 2003) The total expenditure for the prevention of pressure ulcer is substantially less when compared to its treatment (Lapsley H M and Vogels R, 1996). It can cause severe infirmity and high health-care expenditure. The estimated annual expense for the prevention and treatment of pressure ulcers has been expected nearly  £1.4 to  £2.1 billion in the United Kingdom and is measured as a massive economic problem (Bennet et al., 2004). After cancer and cardio vascular disease, pressure ulcers are the third most money consuming disease (Schoonhoven et al., 2002) According to European Pressure Ulcer Advisory Panel (EPUAP) the occurrence rates of pressure ulcers are ranging from 8-23%. In acute care hospitals in the western countries the reported prevalence has wide-ranging between 9-22%. Improving the standard of pressure ulcer care could in ¬Ã¢â‚¬Å¡uence the estimated annual expenditure and quality of life (Tannen A et al., 2004). According to Whittington et al (2000) the prevalence of 15% of pressure ulcers are recorded on admission, whereas for the 60% of the individuals there was no specific information about the presence or absence of the pressure ulcers. In another study, it is clear that 12.8% have already had the infirmity on their admission. According to Rycroft-Malone, (2000) pressure ulcers can develop at any area of the body, but commonly occurs over bony prominences. ( Murdoch, 2002; Jones, 2001) The areas can supposed to develop pressure sores are sacrum, heels, elbows and back of the head. The appearance of pressure sore is very fast and hence the early assessment and steps to prevent is very necessary (George and Malkenson, 2008). Pressure intensity and duration are the two main factors for the pressure ulcer formation because of pressure. Pressure intensity is the volume of external pressure applied on internal tissues whereas duration is the amount of external force is sustained by internal tissues (Cullum et al., 2000) According to NICE guidelines (2003) the risk factors influencing to develop pressure ulcer in an individual includes intrinsic risk factors and extrinsic risk factors. The intrinsic risk factors such as reduced mobility or immobility, sensory impairment, acute illness, level of consciousness, extremes of age, vascular disease, severe chronic or terminal illness, previous history of pressure damage, malnutrition and dehydration. And extrinsic risk factors are pressure, shear, and friction. Shear is defined as the applied force that can cause an opposite, parallel sliding motion in the planes of an object. The amount of pressure exerted has got a direct affect on Shear. (Pieper B, 2007, Nix DP, 2007). Friction is defined as a superficial, mechanical force directed against the epidermis, resulting in increased susceptibility to ulceration (Pieper B., 2007). Pressure ulcers are classified according to different stages as defined by the National Pressure Ulcer Advisory Panel (NPUAP). Originally there were only four stages, but in February 2007 these stages were revised and two more categories such as deep tissue injury and unstageable were added to it. Stage I -Redness of a localized area, usually over a bony prominence. Darkly pigmented skin may not have visible blanching; as its colour may differ from the surrounding area. Stage II loss of partial thickness dermis showing as a shallow open ulcer with a red or pink wound bed, without any slough. It may also present as or open or ruptured serum filled blisters. Stage III The layer of subcutaneous fat may be seen but bone, muscle or tendons are not exposed. Slough may be present but does not cover the depth of tissue loss. Stage IV exposure of bone, tendon or muscle. Slough or may be present on some parts of the wound bed. Unstageable Loss of the thickness of the skin in which in which the base of the ulcer is covered by slough (yellow, tan, gray, green or brown) in the wound bed. Deep tissue Injury Purple or maroon localized area of discolored skin or blood-filled blister due to damage of underlying soft tissue due to pressure. The area may be preceded by tissue that is firm, painful, and mushy compared to adjacent tissue. (NPUAP 2007) To prevent the formation of pressure sores nurses are adopting a variety of measures such as risk assessment and risk assessment tools, changing the position of the bedridden patients regularly, inspecting the pressure area regularly and while doing personal care, applying ointments or creams over the pressure areas, providing comfortable mattresses such as air bed, water mattress for the bedridden and immobilise patients, placing pillows under the places prone to form pressure ulcer for the vulnerable peoples, maximise nutritional status, etc. However the efficiency of all these methods is in discussion and argument. This essay report will collate all the various available literatures regarding the prevention of pressure ulcer and suggest the better and good practice to prevent the formation of pressure sore among the high risk people. The standard of nursing care is very important for the prevention and management of pressure ulcers. The caring of patients, who are at risk with pressure ulcer, is the main challenge for nurses (Sinclair et al., 2004). According to Lewis M et al 2003 the first step nurses should make out is the risk assessment of patients and it is better to identify the patient at risk in the early stages, so we can prevent the pressure sores. It consists of level of mobility, nutritional status, level of consciousness and neurological status, incontinence, sensory impairment, complete patient history, and physical and psychosocial examination assessing mental status and cognitive ability. To support caregivers there are assessment scales to identify the patients at risk. According to Walker D K et al 2010 skin care and moisture are essential to prevent pressure sore. Maintaining skin integrity is important for the patient`s at risk. Moreover excessive of moisture and dryness can breakdown the skin`s resistance. Wherever moisture is present,it is important to clean the portion thoroughly. Patients identified at risk should be bathed once a day. PH balanced cleanser is used to protect the skin from moisture and dryness,it is a natural protection mechanism of a skin. When cleansing the skin daily or in the presence of moisture, it is necessary not to use extreme force or friction. Eventhough moisture cannot be controlled, use skin barriers to protect skin from moisture. Dry skin also needs to be prevented by using a pH-balanced moisturizer. The studies conducted by saleh et al,(2008) and Lindergren et al., (2002) evidenced that use of risk assessment scale is successful in predicting the formation of pressure sore(Decubitus Ulcer).The studies substantiated the role of risk assessment scales and their usefulness in the prevention and management of pressure sores. According to Lindergren et al., 2002 states the reliability of risk evaluation scale in the prediction of pressure sore formation. However, the revision conducted by saleh et al. (2008), argues about the reduction in the occurrence of clinical acquired pressure scores through the regular application of risk assessment scales. Their learning also states that judgement of clinical assessment is also same valuable as associate with the detection of pressure sore through risk assessment scale. In addition, Defloor and Grypdonck, (2004) also stated that assessment tools have a vital role for the prevention of pressure sore. There are many limitations for the risk assessment tools which may lead to provide wrong positive results. The reliability, specificity and feeling of the scale are influenced by the preventive method applications. Nurses are using a variety of risk assessment tools based on practical experience they acquired. The risk assessment tools are assessed by means of numerical scores. The variables like level of continence,medications and nutritional status will give an average score for the risk patients(Whitening, N. L., 2009). Braden scale is the universally used risk assessment scale which includes the variables like sensory perception, activity, mobility, moisture and the nutritional status. The risk assessment scale works in such a way that as soon as the patient admitted in the hospital two step evaluation is carried out within the first six hours. The t wo steps include the skin assessment and the risk assessment to identify the possibility of formation of pressure sore (O Neil, 2004). Frequent evaluation and assessment should be done in every consequent evaluation at every 12 hours on patients who are at high risk .In the same way patients who are at low risk also needs to be evaluate frequently to observe or to identify any new risk factors and providing suitable preventive measures (O Neil, 2004). The most commonly used tool assessing the pressure sore in U.K is the Waterlow pressure ulcer risk assessment tool. And it is user friendly and recommended by the nurses in U.K. Pancorbo-hidalgo et al. (2006), suggests that the Waterlow pressure ulcer risk assessment tool has well pressure sore guessing ability and sensitivity which may result to get wrong positive results. With the waterlow pressure ulcer risk assessment tool among the seven assessment studies conducted by pancorbo-hidalgo, P.L. et al. (2006) they got only few findings with corrects values. Bergstorm et al. (2001) agrees that risk assessment is done by scales like Braden scale or the Norton scale in the hospitals which is more reliable. However there is no universally accepted risk assessment tool to be adopted to prevent pressure sore. Besides this, the utilization of the risk assessment tools has their own limits in clinical systems. Alternatively, Saleh et al. (2008) argues that medical judgement is successful as risk assessment tools to determine the suitable to be delivered. Nevertheless, Pancorbo-Hidalgo et al, (2006) Braden and Norton scales were noticed to be well again at risk calculation than the scientific judgements. On the other hand, according to NICE guidelines (2003) risk assessment tools can only be used as an aide-mà ©moire and should not replace clinical judgment. Normal supply of oxygen and nutrients are essential for the tissues, to maintain health. (Gottrup 2004). When patients sitting or lying, the pressure form particular part of the body results in the decrease of oxygen causes pressure sore (Defloor 2005). The study conducted by Kaitani et al., 2010, Vanderwee et al., 2007 and Pearson et al., 2010 reveals the importance of changing the position for the bed ridden or immobilize patient in preventing pressure sore occurrence. Their studies evidenced the effectiveness of repositioning in regular intervals among the vulnerable patients. Repositioning is considered as an effective control method against pressure sores (decubitus ulcer). According to Vanderwee et al., (2007) the effectiveness of force of pressure greater in sideway position. He also suggested that supine position is the comfortable position to reduce the effect of pressure on the bony prominence. The experiment conducted by Vanderwee et al. (2007 reveals that more regular rep ositioning does not actually decrease the occurrence of pressure sore. But he recognizes that turning of patients is an effectual preventive method. The incidence of pressure ulcer is more in patients who are lying down in side way position. The risk has been reduced when the patients are lying down in supine position. On the other hand the study conducted by Peterson et al. (2010) argues that the effectiveness of repositioning is less or not reliable even though it is done by any experienced nurse. And he found that after maintaining an appropriate pressure below 33 mm of Hg reduce the incidence of pressure ulcer. He states that by doing this there is still chance of occurring pressure sore in the risk areas. While turning the patient they are not unloading the all areas prone to pressure effect with the skin. Even though the standard methods for preventing pressure sores are maintained the skin breakdown happening as the risk areas are not relieved from pressure. The study conducted by Kaitani et al. (2010) evidenced that patients suffering from pressure sore have done only a fewer change of positioning and turning. In their studies they states that they didnt noticed any patients with pressure sore who has been changed their position frequently in a regular intervals. From the findings of Hobbs (2004) also reveals that there is no decline of incidence in pressure sore in the hospital due to the routine repositioning on older people. Similarly Peterson et al 2010 found that still the incidence of pressure ulcer are increasing in the clinical settings where standard turning of patients has already been done. In EPUAP guidelines (2009), suggests that repositioning is an effective method which will decrease the extent and occurrence of pressure over susceptible points like sacrum, heels, elbows and back of the head bony prominences. However, there was no research study conducted by any researchers to calculate the time gap needed to turn the patient that means there is no evidence of turning intervals from any previous studies or researches. It is very important to inspect the support surface while doing repositioning. Patient must be repositioned in regularity after inspecting the tissue viability, mobilising level, medical condition and evaluation of skin integrity. It is also subjected by the supportive surface So repositioning can reduce the incidence of pressure sore to an extent. In hospitals and health care homes it is suggested that repositioning to be done in every 4 hours and by the use of air mattress the incidence of the occurrence of pressure sore can be prevented. Many of the patients feels very discomfort while turning frequently, to avoid frequent turning pressure reducing support surfaces can be used to relieve pressure. Importantly pressure relieving support surface devices has vital role in the prevention of pressure. According to Cullum et al., 2001 it is divided into two, low tech devices and high tech devices. Low tech devices are comforting support surface to dispense the body weight over an area whereas high devices are alternating support surface where inflatable cells consecutively inflate and deflate. According to Lewis M, et al (2003) if the patients having a moderate to high possibility of developing pressure sore, dynamic support surfaces include a large cell alternating pressure mattress, a low air loss or air fluidized bed, or other pressure redistributing systems can be recommended. In a study conducted by Nixon et al (2006)found that in operating tables, specialized foam mattress overlays are effective to reduce the incidence of postoperative pressure sores while in other settings, specialized foam and overlays were the only surfaces that were constantly better to standard hospital mattresses in reducing incidence of pressure ulcers. To decrease the contact between bony prominences and support surfaces, pillows and foams are used. In addition to that for reducing the friction and shearing damage, lifting devices such as slide sheets, slings or sleeves can be used to move the patients. On the other hand, it is unclear about the evidence for the advantages of higher-specification constant low-pressure and alternating-pressure support surfaces for preventing pressure sores. However, there is clinical evidence of a difference in risk of developing pressure ulcers when using high-specification foam mattresses, compared to standard hospital mattresses. (NICE 2005) Decisions for pressure relieving device should determine at risk assessment. It must include level of risk, comfort, patient`s preferences, general health and timing of the surgery. . The studies conducted by Holm et al. (2007) and Ferguson et al. (2000) evidenced the significance of nutrition in pressure ulcer prevention. This study suggests that older people are mostly affected due to pressure ulcer. This is because of their less skin integrity and low nutritional status. The nutritional status of the elderly people is usually related with the level of intake of food and fluids along with various nursing intervention methods (Holm et al., 2007). Management of pressure sore and its treatment closely related with the clients nutritional status. The people with less nutritional status have a high risk of occurrence of pressure ulcer. The nutritional status of the patient has to be assessed by the nurse initially. Adequate quantity of proteins, calories, minerals, vitamins and fluids are necessary to maintain the skin integrity and wound healing promotion (Ferguson et al., 2000). The advancement and management of pressure sore highly influenced by their nutritional status. For doing an successful preventive measures it is essential to carried out with proper nutritional evaluation techniques and planning (Ferguson et al., 2000).pressure sore and nutritional status are closely related to each other and are directly proportional to each other.patients who are with less nutritional status or malnourished are likely to be more prone to develop pressure sore (Thomas, 1997).To reduce the incidence both dieticians and nurses should work jointly. To assess the nutritional status of the patient and the level of malnourishment and proper planning and interventions to be done to improve the status if inadequate (Ferguson et al., 2000).According to EPUAP (2009) recommendation every health care system should do screening and evaluation tests of the nutritional level of the vulnerable people who are at risk of pressure sore. Pressure sore in majority cases are preventable and controllable. A targeted control measure is far better than pointing on treating previously recognized pressure sores. Preventive measures to deceits (pressure) sore saves time and money. By doing an effective preventive techniques can also minimise the loss of energy and reduction in the work load over the health care delivery personnels and staffs mainly nurses. Bergstrom N., Braden B., Kemp M., Champagne M. Ruby E.(1998) Predicting Pressure ulcer risk. A multisite study of the predictive validity of the Braden scale. Nursing Research. 47(5), p.261-26 Bergstrom N, Braden B. A prospective study of pressure sore risk among institutionalized elderly. J Am Geriatric S Bennett G, Dealey C, Posnett J. The cost of pressure ulcers in the UK. Age Ageing 2004; 33:230-5 Cullum N, Nelson EA, Nixon J (2000) Pressure sores. Clinical Evidence: 979-98 Defloor, T. and Grypdonck, M. F. (2004) Validation of pressure ulcer risk assessment scales: a critique. Journal of Advanced Nursing. 48(6), p. 613-621. Defloor T, De Bacquer D, Grypdonck MH. The effect of various combinations of turning and pressure reducing devices on the incidence of pressure ulcers. International Journal of Nursing Studies 2005; 42(1):37-46. European Pressure Ulcer Advisory Panel and National Pressure Ulcer Advisory Panel (2009) pressure Ulcer Prevention Quick Reference Guide. NPtJAP, Washington DC. Ferguson, M., Cook, A., Rimmasch, H., Bender, S. and Voss, A. (2000) Pressure ulcer management: the importance of nutrition. MEDSURG Nursing, 9(4). Gottrup F.( 2004) Oxygen in wound healing and infection. World Journal of Surgery;28(3):312-5. Gray,J.E.Enoch,S.Harding,K.G.(2006) ABC of wound healing.Pressure ulcers.British medical journal.332.p.472-476 Holm, B., Mesh, L., and Ove, H. (2007). Importance of nutrition for elderly persons with pressure ulcers or a vulnerability of pressure ulcers: a systematic review. Australian Journal of Advanced Nursing, 25(1), p. 77-84. Jones I, Tweed C, Marron M (2001) Pressure area care in infants and children: Nimbus Paediatric System. Br J Nurs 10 (12): 789-95. Kaitani, T., Tokunaga, K., Matsui, N. and Sanada, H. (2010). Risk factors related to the development of pressure ulcers in the critical care settings. Journal of Clinical Nursing, 19, 414-421. Lewis,M., Pearson,A., Ward,C. (2003) Pressure ulcer prevention and treatment: Transforming research findings into consensus based clinical guidelines. International Journal of Nursing Practice, 9, p.92-102. Lindgren, M., Unosson, M. and Krantz, A. M. (2002) A risk assessment scale for the prediction of pressure sore development: reliability and validity. Journal of Advanced Nursing. 38, p.190-199. Lyder, C., Yu C, Stevenson, D., Mangat, R., Empleo- Frazier, O., Emerling, J. and McKay J. Validating the Braden Scale for the prediction of pressure ulcer risk in blacks and Latino/Hispanic elders: a pilot study (1998). Ostomy Wound Manage. 44(3A) p.42S-49S. Murdoch V (2002) Pressure care in the paediatric care unit. Nursing standard 17(6): 71-6 National Institute for Clinical Excellence. (2003) Pressure ulcer prevention. Clinical guideline 7. Nix DP. Support surfaces. In: Bryant R, Nix D, eds. Acute Chronic Wounds: Current Management Concepts. 3rd ed. St Louis MO: Mosby; 2007:235-248. Nixon, J., Nelson, E.A., Cranny, G., Iglesias, C.P., Hawkins,K., Cullum, N.A., Philips, A., Splisbury, K.,Dorgerson,D.J., Mason, S.,2006b. Pressure relieving support surfaces: a randomised evaluation. Health Technology Assessment 10(22) Nakagami G., Sakai K., Matsui N., Sanada H., Kitagawa A., Tadaka E. and Sugama J. (2008) Validation and determination of the sensing area of the KINOTEX sensor to develop a new mattress with an interface pressure-sensing system. BioScience National Pressure Ulce Advisory Panel (NPUAP) (2007, February). Pressure ulcer definition and stages. Retrieved 4/13/2007, from http://www.npuap.org Pancorbo-Hidalgo, P. L., Garcia-Fernandez, F. P., Lopez-Medina, I. M. and Alvarez- Nieto, C. (2006) Risk assessment scales for pressure ulcer prevention: a systematic review. Journal of Advanced Nursing. 54, p. 94-110. Peterson, J. M., Schwab, W., Oostrom, V. H. J., Gravenstein, N.and Caruso, J. L. (2010). Effect of turning on skin-bed interface in healthy adults. Journal of advanced Nursing, 66(7), p. 1556-1564. Pieper B. Mechanical forces: pressure, shear, and friction. In: Bryant R, Nix D, eds. Acute Chronic Wounds: Current Management Concepts. 3rd ed. St Louis, MO: Mosby; 2007:205-234. Rycroft-Malone J and McInnes E (2000) Pressure ulcer risk assessment and prevention-technical report London, Royal College of Nursing Saleh, M., Anthony, D. and Parboteeah, S. (2009). The impact of pressure ulcer risk assessment on patient outcomes among hospitalised patients. Journal of Clinical Nursing. 18, p. 1923-1929 Schoonhoven, L., Haalboom, J, R, E., Bousema, M, T., Algra, A., Grobbee, D, E., Grypdonck, M, H., Buskens, E. (2002) Prospective cohort study of routine use of risk assessment scales for prediction of pressure ulcers. BMJ, 325, p.1-5. Sinclair, L., Berwiczonek, H. and Thurston, N. (2004) Evaluation of an evidence based education program for pressure ulcer prevention. Journal of Wound, Ostomy, and Continence Nursing. 31(1), p. 43-50. Tannen A, Dassen T, Bours G, Halfens RJG. A comparison of pressure ulcers prevalence: concerted data collection in the Netherlands and Germany. Int J Nurs Stud 2004;41:607-12 Thomas, D. R. The role of nutrition in prevention and healing of pressure ulcers. (1997). Clinical Geriatric Medicine. 13, p. 497-511. Vanderwee, K., Grypdonck, M. and Defloor, T. (2007) Non-blanchable erythema as an indicator for the need for pressure ulcer prevention: a randomized-controlled trial Journal of Clinical Nursing .16, p.325-335. Walker D K, Sell S V, Kindred C. (2010) Pressure Ulcer Prevention Utilizing Unlicensed Assistive Personnel Crit Care Nurs Vol. 33, No. 4, pp. 348-355 Whitening, N.L. (2009) Skin assessment of patients at risk of pressure ulcers. Nursing Standard. 24(10), p.40-44. Whittington, K., Patrick, M., Roberts, J, L. (2000) A national study of pressure ulcer prevalence and incidence in acute care hospitals. Journal of Wound, Ostomy and Continence, 27, p. 209-215.

Welsh Poetry Comparison and Analysis Essay examples -- Owen Sheers Dyl

Welsh Poetry Comparison and Analysis This essay will consider two poems, both written by Welsh authors. The first poem to be discussed will be Dylan Thomas' Do Not Go Gentle into That Good Night. Following this, the emphasis will progress to Owen Sheers' poem, When You Died, where ongoing comparisons between the two poems will be made. The content of this essay will discuss the themes and ideas present in both poems, and the devices and techniques used to illustrate them. One of the distinct similarities between the two is that both are themed heavily on the topic of death. Bearing this in mind, the atmosphere, mood and tone of each poem will be discussed with both comparisons and differences made. In addition, the different sets of structures used will be analysed and the effects resulting from the employment of these structures. Dylan Thomas' poem is in the form of a villanelle. This can be inferred from the rigid structure of nineteen lines and the rhyming scheme, which utilises only two rhymes throughout the entirety of the poem. The strict rhyming scheme gives the poem a strong rhythm and a determined, inflexible pace, and as a result, the poem exudes a sense of insuperability in the face of death. The repetitiveness of the rhyming lends an imploring tone to the poem and as such represents Thomas' genuine intent - to advocate (to his father) the subjugation of death, as confirmed by the theme of the poem. Throughout the poem, "night" is used as a metaphor for death. This comparison is apt to the extent that both are regarded with fear and apprehension, feelings also associated with darkness, which is also used, as a metaphor for death. The "night", however, is referred to as being a "good nig... ...ivid recollections of the past he possesses, which perhaps provide him with an opportunity to escape from the traumas of reality. The significance of the egg could possibly a subtle portent of hope after death, even new life. The positive note that the poem ends on consolidates this idea. This concept ties in with the one used in Thomas' poem where, as mentioned earlier, he refers to death as being "good", thus indicating the benevolence of death, a release from suffering. Hence the moral of Sheers' poem, although relatively elusive and ambiguous in comparison with the moral of Thomas' poem, is that there is hope after death. The moral of Do Not Go Gentle into That Good Night, is much more apparent, the theme displayed in the title (metaphorically) and throughout. Thomas' poem therefore urges us to fight against death, a message pertinent to everyone.

International Business: Doing business in another country Essay

1.0 INTRODUCTION This report will investigate the viability of â€Å"Aussie Boardies† expanding its business overseas. The potential country chosen is India. This country will be analysed with its business protocol, communication and cultural differences. The report will also investigate the strengths and weaknesses of setting up business in India and make comparisons to Australian business ethics. An informed recommendation will be made based upon evidence within the report in relation to establishing an overseas branch. 2.0 GENERAL FACTS 2.1 CLIMATE India’s climate and weather are varied depending on the relevant region; the three main regions are the Northern Plains, Central India and the Southern region. The Northern Plains have cities like New Delhi that experience extreme ranges of temperature and are very prone to monsoons during the monsoon season (June to September). Central India consists of hot and dry weather but temperature drops at night. It is the most monsoon prone in all of India during the monsoon season. The southern region of India has generally high humidity throughout the year and relatively low rainfall. The southern region of India’s climate is the most similar to the Gold Coast as they are both tropical and generally high temperatures throughout the year (see Appendix 2). 2.2 GEOGRAPHIC LOCATION India occupies most of the Indian subcontinent in Southern Asia. Its western border consists of only Pakistan and the eastern border is Bangladesh (see Appendix 1). The town of Chennai located on India’s south eastern coast would be the optimal place to set up â€Å"Aussie Boardies†. Chennai’s beaches are similar to the Gold Coast, and are the main tourist attraction. Thus, the demand for swimwear would be higher in that area. Therefore, this will be the optimal area in India to set up a branch of â€Å"Aussie Boardies†. The  distance from Australia to India is evident in appendix 6, as it is 7822.21km apart from Australia. 2.3 LIFESTYLE India is one of the most diverse countries, with an incredibly large mixture of races and hundreds of different languages spoken. Many aspects of the western lifestyle have been embraced in India in modern day. Foods are liked by the different areas of India but vegetables, pulses and rice are very much liked by all Indians. The people who live near the oceans diet consist mainly of fish as they are mostly fisherman. The Indian clothing is still traditional at its core, with many women wearing the Sari (Appendix 3). However, swimwear is the same as contemporary western styles, making â€Å"Aussie Boardies† have more relevance in the Indian society. 2.4 RELIGION As Appendix 4 shows, the main religion of India is Hinduism, with Islam as a minority. 2.5 FLAG The flag of India sports 3 coloured lines being, Saffron (top), white (middle) and India green (bottom). In the centre is the design of Ashoka Shakra in navy blue. 3.0 ECONOMIC/POLITICAL DETAILS 3.1 DEMOCRACY, MONARCHY, DICTATORSHIP India’s constitution describes the nation as a â€Å"sovereign socialist secular democratic republic†. (see Appendix 5) Politics of India take place within a constitution. India is a federal parliamentary democratic republic in which the President of India is head of state and the Prime Minister of India is the head of government. The political structure of India is similar to  Australia, as they are both democracies and operate within a constitutional framework. 3.2 POLITICAL ISSUES The social issues of India include a lack of homogeneity which naturally sees certain social groups being discriminated against base upon religion, race etc. Economic issues like unemployment, poverty and economic development are also a concern in India. (The Economic Times, 2014) Unemployment effectively hurts the country as it reduces productivity, therefore reducing the GDP. Also, with less people in gainful employment, the nation’s economy won’t be as active through less expenditure. This will effectively reduce the cash supply within the economy and strengthen the value of the currency, as it will deflate. A strengthening of the Indian currency will be very beneficial towards domestic business, as the currency is valuable, making a branch in â€Å"Aussie Boardies† a good investment by acquiring Indian assets. 3,3 GROSS DOMESTIC PRODUCT India is the world’s tenth largest economy and the second most populous. The most important and the fastest growing sector of Indian economy are services. Trade, hotels, transport and communication; financing, insurance, real estate and business services and community, social and personal services account for more than 60 percent of GDP. GDP (Gross domestic product) is an economic indicator that is measured by the final output of goods and services produced by a country within a certain period of time. It is typically used as the main economic indicator when reviewing a countries economic status. (Investorwords.com, 2014) The GDP value of India represents 2.97% of the world economy. India’s GDP is currently $1841.7 billion, which has seen a steady growth since 2010. (See appendix 8) The GDP growth rate of India expanded by 0.6% at the end of the 2013 quarter, as shown by appendix 9. This steady increase of GDP will increase the confidence of businesses, as the rising rate of GDP guarantees a stable economy. It would be recommended to set up a branch of â€Å"Aussie Bardies† in India at this time as the growth rate of GDP is seeing no fluctuations, indicating a healthy  economy. 3.4 WORKPLACE ISSUES Unemployment is measured by the amount of people who are out of work and are actively seeking employment. (Pettinger, 2010) The rate of unemployment is a key economic indicator to the health of an economy. India’s current unemployment rate is 3.8%, as appendix 10 shows; unemployment has seen a rapid decline in the past 3 years, from 9.4% to 3.8%. This low unemployment also encompasses children, as child labour is a big issue in India. The main cause of this compulsory child labour is no education and a high amount of poverty. (ilo.org, 2014) A 2011 UNICEF report showed that in India, 28 million children under the age of 14 were engaged in child labour. (Digitaljournal.com, 2014) This can potentially be beneficial to branching â€Å"Aussie Boardies† to India as it can assist in hiring child employees as they don’t require an adult’s income, and need the work, making it a mutually benign arrangement. 4.0 TRAVEL INFORMATION 4.1 TIME DIFFERENCE As appendix 11 shows, India is 3 hours 15 minutes behind Australia. If you were to set up an international conference, it would have to be ahead to ensure it is between the working times in India. 4.2 CURRENCY The Indian rupee (INR) is the official currency of India. As appendix 12 shows, 1 Australian dollar can purchase 55.16 Indian rupees. As India’s inflation has seen a steady trend of decreasing, this will increase the purchasing power and value of the Indian currency, thus making it a good investment to set up an the Australian â€Å"Aussie Boardies† branch in India. (See appendix 7) 4.3 LANGUAGE As appendix 13 shows, there are many different languages spoken in India. The official language spoken is Hindi along with English and French as minorities. If the Australian business was to set up a branch in India, a translator would probably not be needed as some of the population would know English. This would make communication with the local customers a lot more efficient within the established branch of â€Å"Aussie Boardies†. 5.0 CULTURE AND CUSTOM 5.1 COMMUNICATION STYLES As India is part of Asia, their communication styles are very similar to that of Asians. Likewise with many Asians, Indians consider it extremely troublesome to say â€Å"no† – feeling that to do so might be hostile and lead to harmful towards future relationships. Accordingly, when confronted with difference, Indians are likely to express dubiousness and lack of commitment. (Worldbusinessculture.com, 2014) This is a polar opposite to how Australians communicate, being western in their communication style. Australians are confronting and to the point, they will express how they feel and aren’t afraid of declining. Australia has alot of slang that other cultures would not understand and should be weary not to use it to avoid miscommunication. In India, a nonverbal form of greeting is to bow slightly with palms together. Australia’s form of nonverbal communication is shaking hands as per usual with western culture. 5.2 SOCIAL BEHAVIOUR Indians want to work with those they know. Numerous organizations are family run and may utilize numerous family members, since it is accepted that you can trust family over all others. Indeed in multi-national organizations, it is normal for one relative to be contracted and, assuming that it works out, recommend that cousins, siblings, or different relatives discover occupation there, as well. (Rw-3.com, 2007) This is less prominent in Australia as they  value friendship or â€Å"mateship† rather than families when doing business. The value of modesty is emphasised in India, as boasting about ones achievements is considered rude. This is similar in Australia, as pretentiousness is loathed and authenticity is appreciated. 5.3 ETIQUIETTE In India, business meetings are more casual when it comes to scheduling and dont need much lead time. Scheduling is recommended to be carried out through telephone or letter. It is good to set up a meeting between October and March to avoid the heat and monsoon seasons. (Kwintessential.co.uk, 2014) Also be considerate of the numerous religious holidays in India. When entering a meeting room, it is conventional to greet the most senior member first. In Australia, the hierarchy is based on the position rather than the age. When doing business in India, business cards should be exchanged at the first meeting. It is a good idea to have it translated in Hindi as well as English on one side as an indication of respect rather than linguistic need. (Intercultures.ca, 2014)When giving your business card to someone you should present it with your right hand and have it face up with the text facing the recipient so they can read it as you hand it to them. Likewise, it is convention to receive it with your right as the left hand is considered unclean in India. Also, putting the business card in your back pocket is considered rude, as you should put it in your wallet to signify prosperity. Australia is indifferent to how someone receives the business card as it is more of the contents of the card that matters. 5.4 STATUS, RANK AND POWER India is a male dominated society, making the status of women in business fairly low. Foreign women don thave issues being accepted in India, but Indian women are usually discriminated against. Although it might be hard for a woman in India to be in a higher position, it still occurs and they are treated with the same respect as a male in that position. Australia has gender equality and doesn’t discriminate, as women have the exact same opportunity as men within business. In India, senior members of the business  are usually revered and are in higher positions. This is contrary to Australia as age is respected, but not to that magnitude; with experience and status valued more. 5.5 DECISION MAKING Business negotiating in India is non-confrontational and it is uncommon for fellow peers to disagree. Decisions are usually made by the person with the highest authority and rarely any discourse occurs in challenging the decision. (Indiahorizonz.com,2014) The process of decision making is slow paced and it is honourable to show patience. Losing your temper out of impatience is looked down upon, making you unworthy of respect and trust. With Australia preferring to sign legal documents and contracts in the knowledge that there is equity in the law for justice should an agreement be broken. Indians wouldn’t appear over legalistic in agreements as they do not trust the legal system. Generally speaking, one’s word is sufficient to reach an agreement and is considered a reflection of their integrity. When decisions are made or negotiations are successful, they are often celebrated with a meal. 5.6 GRATUITIES Indians believe that gift giving signifies an easing transition into the next life. (Kwintessential.co.uk, 2014) It is recommended to not give expensive or cash gifts, as they can be considered a bribe in a business context but are suitable for family and close friends on special occasions. Gift-giving in Australia is generally not part of the business culture, as minor gifts would only be given at business parties of wine or chocolates. Be mindful in India to not have gifts that are meat or made of leather, as most Indians are Hindu or vegetarian, making a cows skin extremely offensive for them to look at. Gifts should be wrapped using primary colours as any black/white wrapping is considered unlucky. 6.0 RECOMMENDATIOBN Based on the impact of various distinctive elements it can be confidently stated that establishing a branch of Aussie Boardies in India has some risks, but is outweighed by the significant amount of benefits. The climate in the southern part of India’s climate has many similarities to the Gold Coast in which Aussie Boardies is located as it has high temperatures and is generally tropical. The optimal area of India to set up business would be the town of Chennai. Located on India’s south eastern coast, Chennai’s beaches are similar to the Gold Coast, and are the main tourist attraction. Thus, the demand for swimwear would be higher in that area. India is seeing a transition into a first world country with increased development as India is very stable with a booming rise in GDP and a fairly low unemployment, thus setting up a business at this time would be encouraged. The Indian currency is also seeing a strengthening through deflation; this is good for an Australian business as the exchange rates are very high with Australian currency which could see potential profits with an investment of Indian assets. Child labour is a prominent issue in India; however, this labour is not forced and is a result of high poverty and low education. This can potentially be beneficial to branching â€Å"Aussie Boardies† to India as it can assist in hiring child employees as they don’t require an adult’s income, and need the work, making it a mutually benign arrangement. As one of the official language used in business is English in India, this lowers a communication barrier with most of the population speaking English. The social and business etiquettes of Australia and India are diverse but Indians are usually accepting of the cultural differences and are open minded about them. Although, many of the core business protocols are similar and the re isn’t any radical changes. 7.0 CONCLUSION Considering the analysis of the viability of expanding the business â€Å"Aussie Boardies† overseas, there are many positive factors. Based on the evidence of the stable economic outlook of India, business protocols, communication and cultural differences, expanding business overseas is highly recommended.

Definition of Stack in Programming

A stack is an array or list structure of function calls and parameters used in modern computer programming and CPU architecture. Similar to a stack of plates at a buffet restaurant or cafeteria, elements in a stack are added or removed from the top of the stack, in a â€Å"last in first, first out† or LIFO order. The process of adding data to a stack is referred to as a â€Å"push,† while retrieving data from a stack is called a â€Å"pop.† This occurs at the top of the stack. A stack pointer indicates the extent of the stack, adjusting as elements are pushed or popped to a stack. When a function is called, the  address  of the next instruction is pushed onto the stack. When the function exits, the address is popped off the stack and execution continues at that address. Actions on the Stack There are other actions that can be performed on a stack depending on the programming environment. Peek: Allows the inspection of the topmost element on a stack without actually removing the element.Swap: Also referred to as â€Å"exchange,† the positions of the two top elements of the stack are swapped, the first element becoming the second and the second becoming the top.Duplicate: The topmost element is popped from the stack and then pushed back onto the stack twice, creating a duplicate of the original element.Rotate: Also referred to as â€Å"roll,† specifies the number of elements in a stack which are rotated in their order. For example, rotating the top four elements of a stack would move the topmost element into the fourth position while the next three elements move up one position. The stack is also known as Last In First Out (LIFO). Examples: In C and C, variables declared locally (or auto) are stored on the stack.