Essay writing methods
A Thesis Statement For An Argumentative Essay For Topics
Friday, August 28, 2020
Nature of Industrial Buying: Industrial Marketing
URDANETA CITY UNIVERSITY COLLEGE OF ACCOUNTANCY AND BUSINESS ADMINISTRATION San Vicente West, Urdaneta City 2428 Pangasinan, Philippines Telefax No. (075) 568-7612 Website: www. ucu. edu. com BY: IAN JOSEPH ROBISO MARC TON ALEXIS PEREZ MARITA LABIANO KENT NOEL JAVIER ILENE GONZALES BEVERLY ROSARIO RICHARD SUMERA LOVELY SORIA BSBA-III Major in MARKETING MANAGEMENT SUBMITTED TO: MR. LADI GEORGE L. GASCON INSTRUCTOR Nature of Industrial Buying: Industrial Marketing Buy Phase in Industrial Buying * Buying is an authoritative dynamic procedure There are 8 Phases in Buying Decision Process * In Industrial market the purchasing dynamic procedure perceptible successive stages, understanding these stage assists creating with appropriating selling system The Buying Decision of association is impact by ecological elements, hierarchical variables, relational components and individual elements: * Personal â⬠e. g. Age, Education, Income, Personality, Risk Attitude, Culture * Inter-Personal â⠬ e. g. Intrigue, Authority, Status, Empathy, Persuasiveness * Organization â⬠e. g.Objective, Policies, Procedures, Organization Systems and Structure * Environment â⬠e. g. Level of Demand, Economic Viewpoint, Technology Change, Political Development, Social Responsibility 8 Phases in Industrial Buying * Identify the issue â⬠modern advertisers recognize issues in purchasing association and propose how issue is? * General need Description â⬠when the issue is perceived next is to determine the issue. For specialized items, the specialized. * Product Specification â⬠built up an exact articulation of the item or administration, choosing right providers suggest. Providers Research â⬠search of expected providers from vertical center points, practical centers, direct additional connect to significant providers ,exchange * Analyze Suppliers Proposal â⬠when the certified providers chose, the purchasing association gets the solicitation for recommendations. * Supp liers Selection â⬠Evaluation of proposition of contending providers and select providers * Selection of Order And Routine â⬠putting orders w/chose providers, recurrence of the request position, levels of stock follows. Execution Review â⬠execution criticism of the providers happen and post buy assessment Organizational Purchase Situation * New Task â⬠a Situation that the organization is purchasing the thing just because. The purchasing association will regularly have had little involvement in the item or administration. The hazard included is more, choices may take longer time and top administration is included. * Modified Re-Buy â⬠This circumstance happens when the association isn't happy with the exhibition of the current suppliers.Search data about elective wellspring of flexibly. The change I provider is probably going to incorporate a few delegates, including mid level administration and evaluative measures are investigated. * Straight Re-Buy â⬠Buying it ems or administrations consistently and buys that are made before. Rehash orders with the provider. The reordering procedure might be totally computerized or done routinely by administrative staff. Buys are frequently dealt with under an agreement and cost or reliably the predominant evaluative measures. Members in the Business Buying ProcessParticipants in the authoritative purchasing process play asâ many as seven unique jobs, to be specific those ofâ initiator,â influencer, approver, client, decider, purchaser andâ gatekeeper * Initiators â⬠Recognize an issue or a need. The Initiator can be any person in purchasing firm. * Influencers â⬠Individuals impact the purchasing choice. Specialized individuals, for example, quality control engineers, structure engineers have significant effect on buy choice. * Deciders â⬠The real purchasing choices are made by the deciders. They are at least one people engaged with the purchasing decision.Senior administrators may become d eciders. * Buyers â⬠Buyers get citations from providers, assess, arrange, process buy, orders, advance conveys and execute buy strategies. * Users â⬠Usersâ alsoâ play aâ roleâ ofâ initiators Individuals who use items or administrations Define determinations ofâ needed items * Approvers â⬠Approverâ endorse and consent to the purchaseâ andâ also play aâ role ofâ deciders * Gatekeeper â⬠Gatekeepers control the stream ofâ information in regards to items and administrations and control the purchasing place Assistants orâ junior personâ ofâ purchase managersKey Members of Buying Center * Top Management Executives * Managing Director, Presidents, Vice President orà General supervisors * Approve buy, choose rules and buy strategy * Technical People * Technical individuals are designâ engineers, creation, quality control,à R&à Dà managers * Specify items, specialized assessment, criticism on item provided, haggle with providers * Purchase/Material Depa rtment Senior administrators, junior levels,â purchaser officials or associates * Coordinate with specialized individuals, topâ management, accounts too the providers or sellers * Accounts/Finance for concluding theâ financial endorsements, mode ofâ paymentâ andâ insuranceâ of bankâ guarantees * Marketing * Are the influencers in the purchasing procedure Summary * The modern showcasing need to comprehend the buying targets and buying exercises of the mechanical purchasers. The modern purchasers are affected by both buying goal of the firm and individual targets. The modern purchasers are affected by numerous components, the main considerations like ecological variables, hierarchical elements, relational elements and individual elements. * There are 3 normal sorts of purchasing circumstances including new errand, altered re-purchase and straight re-purchase. * There are 8 periods of purchasing dynamic procedure incorporate Initiator, Influencer, Approver, User, Decider, Buyer and Gatekeeper. The mechanical markets ought to distinguish the key individuals from purchasing focus in each purchasing choice.
Saturday, August 22, 2020
Entrepreneurship Solves Low-income Housing in Chicago Essay
Business Solves Low-salary Housing in Chicago - Essay Example This savagery didn't stop as they proceeded for long, whereby it guaranteed the live of a seven-year old kid in the year 1992. The kid was brought down by a wanderer projectile as he was en route to class. Be that as it may, the most forceful assault that was knowledgeable about the region occurred in the year 1997, when a nine-year old young lady was pitilessly assaulted, stifled, assaulted and afterward harmed, which left he in a place that she was unable to have the option to talk or walk. The then city hall leader of Chicago, Jane Byrne, in the year 1981 chose to move into the complex and remain there for approximately not many months in order to learn and see with her own eyes the earnestness of the issues of the lodging venture (Venkatesh, et al 37). Abrogating the undertaking to destroy the issue The course of action to wreck the Cabrini-Green task was a piece of a broad program. The Chicago Housing Authority, in the year 2000, made a declaration on a course of action to cut d own ass the open lodging ventures that were in the city as a component of the Hope VI, which is a national task planned for canceling lodging ventures the country over because of their clear disappointment in taking care of the issue of modest and reasonable lodging in the city and nation all in all (Venkatesh, et al 41). Despite the awful states of the Cabrini-Green, the individuals who lived there ganged facing the plans of redevelopment that had been offered by the organizers of the city. By and by, the network was fearful of the way that the new blended pay lodging undertaking would constrain out the long-term occupants of Cabrini-Green. Be that as it may, a few people chose to remain in their units vowing never to abandon, rather than moving to what to what they saw as similar states of living additionally expelled from the focal point of the city. Though their plans were effective in postponing of the destruction of various structures, the obstruction didn't last more. At pres ent, the region whereby the celebrated Cabrini-Green remained at one time has been changed and what is at present there is a blended salary neighborhood, which is just a couple of moments from one of the most created or well-off territories of Chicago known as the Gold Coast (Brian and Beauty 20). Greater part of the previous inhabitants have eventually been supplanted. Altogether, they comprise of around twenty thousand lofts, about portion of the subsidized lodging units that are under the administration of Chicago Housing Authority. The dull pads are vigorously gathered in the weakened regions just past the thriving focal business region, and stand up to a few workers that are Loop-bound regular. Their messed up lifts, trash, wrongdoing, flights of stairs that are pee recolored and wrongdoing simply show the quite a long while of abandonment and disregard, and ridicule the fantasies that built up them. As at first considered by the reformers, we locate that open lodging program s hould be a spot whereby the individuals of low-salary class lived until they were in a place of managing something better. The thought was foundation of not too bad and incorporated homes; yet rather, Chicagoââ¬â¢s open lodging is described by shared sadness, poor states of living, destitution, isolation and criminal acts (Brian and Beauty 24). This is a lot of basic in the tasks of tall structures. They were at one time imagined as perfect for the lodging of
Friday, August 21, 2020
Africa During Colonialism
Africa obviously, would be colonized by the numerous Europeans. Be that as it may, a great deal of African gatherings/colonization would begin as well. They would begin and more established ones would be extended. The slave exchange had diminished because of British weights thus Africa began exchanging a greater amount of different things with the remainder of the world. This equivalent thing was going on in Asia and the Middle East as well. In South Africa, the Zulu realm would be framed, and in Western Africa, an Islamic caliphate, Sotto Caliphate would be shaped. A considerable lot of these human advancements were being shaped by a lot of African people groups around the continent.At first, In Southern Africa, there were the Unsung individuals, Just ranchers and steers herders that existed for an exceptionally prolonged stretch of time. Before long, in any case, a dry season would strike, harming their horticulture. This caused the finish of the Unsung individuals. A military virt uoso and pioneer, Shake Zulu would take control and make another development, the Zulu individuals, who, contrasted with every single other clan In Southern Africa, was the most impressive and considerable, in light of its severe military bores and practice and they even utilized bull shroud shields. The Zulu warriors extended their realm, by assaulting numerous different clans andInvading them, taking their steers, kids and ladies. Portions of the Zulu, they split off creation their own military groups and they also did likewise as the Zulu. Before long, this made such huge numbers of new realms going up right to Lake Victoria. As this expanded, so did the quantity of evacuees and scared, discouraged individuals from these To stop the Zulu clan's development and force, two realms shaped, Swaziland toward the north and Lesotho toward the east, which was comprised of numerous displaced people who went to those mountains there. Both Lesotho and Swaziland exist today.Shake effectively made a national character and a country in only 10 years of rule. He took all the youngsters in the country and split them into deferent gatherings, called regiments, in light old enough. These individuals of the regiment lived with one another and they all observed Shake. And so forth. They praised his standard and they were all intensely restrained. Bovine crowds were a proportion of riches in this realm. Then, in the Western Savannah of Africa, there was a major strict battle. Islam was pervasive over yonder. In any case, that was uniquely In the urban communities and exchange zones, ND not in the country areas.The provincial regions despite everything followed customary traditions. From the start, Islam permitted individuals to blend their more seasoned convictions in with Islam. Presently be that as it may, Psalmists began precluding this thought from claiming permitting them to have their traditions and needed them to follow unadulterated Islam. They made a ââ¬Å"holy warâ⠬ , called Jihad, which made Assaults take over numerous rustic and other new grounds where they upheld Islamic laws and spread the religion. These Islamic counters previously occurred in the Hausa states to northern Nigeria. A pioneer in the Hausa states, Susann Dan Food, called a great deal of the rulers there, unbelievers of religion or Islam and drove individuals from god.He drove a Jihad on the King of Gobi, toppling him. A great deal o f Muslims Joined to accumulate to spread Islam and spread it all around Hausa. This Islam would meet up to make a caliph under the capital city of Sotto, called the Sotto Caliphate. The Sotto Caliphate turned into an inside for showing Islam and change. It included numerous new focuses, rapidly, to show Curtain and Islamic subjects to young men. Numerous individuals were pulled in to it on account of the Sotto library, which was really enormous. Muslims ere permitted individuals to follow their own religion however needed to pay an extraordinar y tax.They were not permitted to do their innate moves and ceremonies and any who contradicted the spread of the Jihad were slaughtered, slaved or changed over. The Sotto caliphate sent off huge amounts of slaves for the Trans-Atlantic slave exchange, for the most part ladies and youngsters. Slaves fundamentally cultivated, thus this permitted ladies to really leave the home this time. Sotto sent a great deal of slaves, however it likewise had a ton of slaves in itself as well. Actually, it had a bigger number of slaves than some other American regularly. Napoleon would come and battle in Egypt. This would toward the end in Egypt as an incredible triumph for the Europeans and an extraordinary misfortune for the Egyptians.After Napoleon left Egypt from his misfortunes, Muhammad All took rule. Muhammad All took rule of Egypt. He modernized and industrialized Egypt, causing it to follow a great deal of the Western styles. He expanded exchange of Egypt. He carried a great deal of traini ng to Egyptians, and permitting them to supplant the old privileged. He supplanted all the European specialists and merchants of items with Egyptians. In any case, one awful thing was, that he made a weight on the workers to give military and work administration. The military and Egypt was making its own materials, paper, weapons, military uniforms.Seeing this western development, numerous gatherings in Egypt, of Islam blended in with this Western Culture. For instance, European specialized manuals were meant Arabic. Little was the grandson of Muhammad All. He was more enthused about westernizes than All. Be that as it may, his endeavors, at long last, would Just make a lot of Egyptian obligation to French and British banks. From the start, in his initial 10 years of rule, it was all acceptable with a great deal of riches on account of expanded exchange, more fares, new water system chronicles, railways 800 miles, postal assistance and Cairo.However, after the American Civil War, se nds out went down again and obligation would be one reason for French and British fractional control of Egypt. Ethiopia was Christian for 1 500 years. They also were attempting to modernize themselves. Ethiopians Emperor, Terrors II of Ethiopia was the person who originally began Westernizes and requested a great deal of weapon buys from Europe and furthermore supported some neighborhood maturating. Once, they even made gun that could fire a half ton shell with the assistance of Protestant missionaries.However, they attempted to get some more weapons by holding British authorities prisoner and requesting for weapons, however the British would wind up really attacking Ethiopia. Dread would end it all to forestall catch. At that point the British would pull back, and afterward King Haynes would take the position of authority. Lord Haynes assumed control over a great deal of the lost place where there is Ethiopia, with the exception of one significant land part, Shoo Kingdom, administe red by King Moonlike. The starting occasions of Rupee's scramble for Africa were when France took over Algeria. Algeria initially was a significant provider of olive oil and grain to France.They even gave them grain to Napoleon to assume control over Egypt. Presently, France despite everything owed them for this and a few debates occurred. The new French government needed to show patriotism with a simple abroad triumph. Be that as it may, the battle for Algeria would continue for a long time, much after French government would be ousted once more. Awful al-Qatar was an Algerian sacred man who drove them against France however he would bite the dust, debilitating and almost finishing their multi year battle. Be that as it may, struggle in the mountains would occur for a long time. Pioneers would then come in and execute off 140,000 individuals.
Tuesday, May 26, 2020
What the In-Crowd Wont Tell You About Topics for Analysis Essay
What the In-Crowd Won't Tell You About Topics for Analysis Essay If you like you may look online and find one that you like. You can easily discover a good deal of topics on the world wide web at no cost. Despite the fact that it's unmistakably a complicated topic to write on, it does not follow that you can't gain from some of our basic research paper writing tips online. Consider offering some practical suggestions on how best to take notes or the way to participate in the material. The article by Sarah Kliff was written with the goal of showing how folks spend an excessive amount of time online. The very best thing about us is that each time you can buy original essay papers for sale. If you are searching for top essay writing companies, try out the mentioned above. There are several essay writing services that think they're the very best, and therefore don't be cheated and check the legitimate list of the very best. There are several kinds of essays, it is not difficult to drop an eye on all your writing assignments. Citations and extracts from several sources have to be formatted properly. Finding the rhetorical analysis essay topics list isn't a huge deal online. Rhetorical essay writing may be the true rocket science if not utilizing the expert support. To begin with, make certain you're conscious of what the rhetorical analysis essay is. Moral argumentative essay topics are a few of the simplest to get carried away with. The rhetorical analysis essay topics are easily available on the internet. Our talented writers can deal with just about any sort of writing assignment, along with Math and Physics difficulties and a lot more. Compare the literary devices utilized by Shakespeare and the contemporary authors. The Pain of Topics for Analysis Essay Custom made writers have a fantastic practice and experience too. Advertising and the media are now nearly inseparable from society for a whole. The cost of an essay is dependent upon the total amount of effort the writer has to exert. It is essential that your writing is acceptable for the degree of reader your process is targeted at. If you supply the writer with thorough instructions, you won't will need to talk about anything with them. The language means you use when seeking to convince that you're right. Actually, you can count on us if you require an essay, or some other sort of academic paper whenever you're feeling the load of having too much work. Keep the reader in mind There are various approaches to deal with distinctive folks. Some students utilize the very first idea that arrives in their head and work on it, but the outcome isn't profitable. Politics, bureaucracy and company fatal triangle. Who Else Wants to Learn About Topics for Analysis Essay? There are specific proven and totally written essays that you can buy by paying the given amount. If you don't understand how to begin your essay or where to search for supporting data, we'll be pleased to help you. To maximize your chances of producing a great doctoral dissertation proposal you should comprehend the fundamental concepts of a dissertation paper. 30 rhetorical analysis essay topics list will arrive at the rescue if do not have any time for brainstorming topics all on your own. Once the writer is appointed, they begin working on your essay in line with the requirements you have specified in your purchase. Whatever you require in order to receive a personalized dissertation are available here. It is likely to make your essay really intriguing. This sort of essay has the goal of describing a definite process by means of a set of steps or stags.
Friday, May 15, 2020
Wednesday, May 6, 2020
The War Of The Cold War - 1244 Words
Boos echoed throughout the streets of Harlem, New York in great waves of disapproval. Hippies holding up signs supporting peace, and posters opposing the Vietnam War, otherwise known as the Cold War, greeted the tired and injured soldiers. The familiarity of their hometown created a sense of peace and warmth, despite the angry cries of protest from the enraged nonconformists. As loved ones embraced their fighters, chants of outrage broke out from the hippies, and the soldiers, relieved to be home, wondered why they were being jeered at. In their eyes, they were fighting for what was right, just like the hippies and everybody else in the world. Many of the soldiers thought back to the times when they fought for their lives and surrendered themselves to the harsh world of mother nature, a profuse amount of them wondering, ââ¬Å"Was this all worth it?â⬠The Cold War. A war that killed more than three million people and injured numerous others between November 1, 1955, and April 30 , 1975. It was a time where blood and gore surrounded the lives of countless innocent people and plagued jungles with the shouts of men in uniform, firing AK-47ââ¬â¢s aimlessly. One of those men shooting a rifle at the targeted enemy was Colonel James Leroy Riverstead, one of the sole colonels still standing in the U.S Army and a soldier fighting to return safely to his family. ââ¬Å"Alright men! Move out!â⬠commanded Colonel James L. Riverstead. ââ¬Å"Sir, yes sir!â⬠Stepping over logs and ducking under low hangingShow MoreRelatedThe War Of The Cold War1644 Words à |à 7 PagesThe Cold War was a state of political and military tension stemming from World War II fought primarily between the United States and the Soviet Union. Although the start and end dates of the Cold War are frequently disputed over, it is generally accepted that the conflict started at the conclusion of the Second World War and stemmed from the social climate and lingering tensions in Europe an d the increasing power struggles between the Soviet Union and the United States. Along with economic separationRead MoreThe War Of The Cold War Essay1525 Words à |à 7 PagesOne major war ended and another to begin. The Cold war lasted about 45 years. There were no direct military campaigns between the United States and Soviet Union. However, billions of dollars and millions of lives were lost. The United States emerged as the greatest power from World War 2. (Give Me Liberty 896) The country boasted about having the most powerful navy and air force. The United states accounted for about half of the worldââ¬â¢s manufacturing capacity, which it alone created the atomic bombRead MoreThe War Of The Cold War886 Words à |à 4 Pagesin an infamous battle against ideologies: The Cold War. Even though war took place during this time, both powers were not involved in battle directly, hence the name cold war. The war mainly consisted of assumed and implied threats of nuclear attacks an d political control over states in Europe. Even before 1945, the beginning of the Cold War, tension brewed between the U.S and the U.S.S.R. Both sides had differing views on Europe s state after the war. For instance, programs like the Marshall PlanRead MoreThe War Of The Cold War757 Words à |à 4 PagesAs tensions continued to augment profoundly throughout the latter half of the Cold War period, they brought forth a movement from a previous bipolar conflicting course, to one of a more multipolar nature. These tensions were now not only restricted to the Soviet Union and United states, but amongst multiple other nations of the globe. It became a general consensus that a notion of ââ¬Ëpeaceââ¬â¢ was sought globally, hence, the emergence of dà ©tente. The nature of this idea in the short term conveyed itselfRead MoreThe War Of The Cold War961 Words à |à 4 Pages1945, beginning year of the Cold War. The development of cold war just started after the end of world War ||. Th e cold war was the result of conflict between two powerful country Soviet Union and United State. The war was regarding to the lead the world after the World War ||. The Soviet Union wanted to emerge its power to the world and so do the United States too. The research paper mainly focused on various reasons of opposition of two great power of the world Soviets and United States of AmericaRead MoreThe War Of The Cold War1737 Words à |à 7 Pages Cold War The Cold War, which is often dated from 1945 to 1989, was a constant state of political and military tension between powers in the West, dominated by the United States with NATO among its allies, and powers in the East, dominated by the Soviet Union along with the Warsaw Pact. The development of Nuclear Weapons and long range shooting missiles by the United States gave a lot of fear and caused mass destruction. The Cold War came about after World War II when America used their atomic bombsRead MoreThe War Of The Cold War1123 Words à |à 5 PagesThe Cold War consist of tensions between the Soviets and the U.S. vying for dominance, and expansion throughout the world. Their complete different ideologies and vision of the postwar prevented them from working together. Stalin wants to punish Germany and make them pay outrageous sum of money for reparation. However, Truman has a different plan than Stalin. Truman believes that industrialization and democracy in Germany and throughout th e world would ensure postwar stability. Stalin also wantedRead MoreThe War Of The Cold War942 Words à |à 4 PagesFeelings Do Matter At the close of World War Two in 1945, the United States entered another kind of war, the Cold War, which did not involve two adversaries in open battle fields using bullets against the Soviet Union. Throughout the Cold War, incidents fueled feelings of anxiety, mistrust and pride. Often pride is defined as ââ¬Å"a feeling that you are more important or better than other peopleâ⬠(Pride). Mistrust on the other hand is the ââ¬Å"feeling that someone is not honest and cannot be trustedâ⬠,Read MoreThe War Of The Cold War1636 Words à |à 7 PagesThe U.S. learned greatly after having been declared the victor of the Cold War. Retired four-star U.S. Army general Colin Powell said, ââ¬Å"The long bitter years of the Cold War are over. America and her allies have won; totally, decisively, and overwhelminglyâ⬠(Reed 343). The Cold War started after World War II in 1947 and ended in 1991. The U.S. underwent a political war with the Soviet Union in hopes of advancing more rapidly in certain fields, such as nuclear weapons and space crafts. Avoiding nuclearRead MoreThe War Of The Cold War Essay1075 Words à |à 5 PagesDuring World War II, the United States, Britain, and Russia all worked together to take down Hitler. Although after the war, the coordi nation between the U.S. and Russia became extremely tense which inevitably lead to the Cold War. The U.S. was worried that Russia would spread communism after World War II. Russia was concerned with the U.S. arms increase and intervention in international affairs. The distrust between the two nations resulted in the Cold war which lasted until 1991. In 1946, Winston
Tuesday, May 5, 2020
Academy of Nutrition and Dietetics â⬠Free Samples to Students
Question: Discuss about the Academy of Nutrition and Dietetics. Answer: Introduction: Patients in critical conditions are at higher risk of malnutrition, occurring in almost 40% of all patient cases. The patient's body, in response to stress, suffers metabolic changes that are the cause of the increase in protein catabolism. The ultimate outcome for such patients is a significant loss of body mass and subsequent higher risks of health complications. Such complications might be an infectious disease of increase in wound dehiscence. In either case, the outcomes are unfavourable. The strategy under such condition is to provide nutritional support for achieving optimal body functioning. Prevention of malnutrition and the related complications is the chief aim. The aim is to provide appropriate doses of micro and macro nutrients for meeting the body needs, avoid complications and reduce nitrogen deficits (McClave et al. 2016). Enteral nutrition is defined as the provision of a supply of nutrients through the gastrointestinal tract of the patient under conditions when the p atient is not able to ingest, chew or swallow food but is able to digest and absorb the same. Early enteral nutrition is the process of enteral nutrition commenced within 24-48 hours after admission of the patient to the critical care unit (Yu et al. 2014). The advantages presented by early nutritional support are continually being reported in a vast pool of literature. According to Boelens et a. (2014), intensive care unit patients presented with malnutrition during their hospital stay as well as those who are not supposed to be on the full oral diet within three days are to receive specialised enteral nutritional support. Malnutrition has been linked with morbidity, mortality and increased hospital stay length. Evidence points out that patients admitted to the critical care unit and having the gut in the functional state must be given nutrition through the enteral route. The rationale is that administration of nutrition through other routes of feeding is associated with increased chances of compilations due to infections. In case of early enteral nutritional support, the feeding is to commence on the very first day after admission to the care unit for facilitation of diet tolerance and reduction of risk of intestinal barrier dysfuncti on. The desirable outcomes are mechanical ventilation and reduced hospital stay length (Sun et al. 2013). As per the authors, favourable impacts of early enteral nutrition include prevention of mucosal atrophy, better substrate utilization, preservation of immunocompetence and preservation of the integrity of gut flora. Early enteral feeding has also been linked to the amelioration of oxidative stress after a patient has undergone surgery. The decrease in postoperative mortality in patients is also a benefit of such nutritional support. In modern times, healthcare professionals are focusing on feeding patients as soon as possible through such measures in order to sustain stable patient conditions. As highlighted by Blaser et al. (2017) early enteral nutrition is imperative is a crucial element of the management plan for patients who are in critical condition. Nutrition is important as it supplies antioxidants, vital cell substrates, minerals and vitamins that optimize recovery from heath complications in a speedy process. Specialized immune-enhancing nutritional formulations are into use at the present time that has been reported to decrease inflammation, and augment cell-mediated immunity. Early enteral nutrition is elementary for a decrease of organ failure, and in comparison to delayed enteral nutrition early enteral nutrition improves wound healing, nitrogen balance and immunity. Augmenting the cellular antioxidant systems is the mechanism of increasing the hypermetabolic response to tissue injury and preserving the intestinal mucosal integrity. The decrease in bacterial translocation and increase in mucosal permeability are the other possible mechanisms (Yang et al. 2014) . Shankar et al. (2015) reported that early enteral feeding protects the liver injury if there is endotoxemia or haemorrhage, and kidney damage if there is rhabdomyolysis. They further demonstrated that immediate enteral nutrition improves protein synthesis. In the present patient case study, 55-year-old Helen had been shifter from thee emergency department to the intensive care unit after suffering a high-speed motor vehicle injury at 22:30. The patient had suffered several high rib fractures and major lung contusion/ haemothorax. In addition, she had a fractured left humerus, left femur and a collapsed pelvis. While in the ICU, she was commenced on maintenance fluid and saline. Vital signs were observed for the next two days whose reports indicated that the patient was haemodynamically stable. Enteral nutrition was after that commenced for the patient. In this case, the patient was not given early enteral feeding since the definition for the same indicates that the feeding is to be given one the very first day of admission to the clinical setting. The observed feeding pattern was late enteral feeding as it was commenced after 48 hours of patient admission to the unit. Bakiner et al. (2013) have pointed out that late enteral feeding in case of patients who have suffered tissue and organ injury are linked to intestinal inflammation and other adverse outcomes. Under certain conditions, clinicians have the decision making process pertaining to enteral feeding in favour of late enteral nutrition. Delay in advancing enteral nutrition has been criticised widely. Compelling evidence indicates that there are certain drawbacks associated with such practices. Studies have shown that prolonged period of lack of adequate nutritional support delays mucosal atrophy, mucosal nutrition, and causes dysregulation of secretion of trophic hormones. Late enteral nutrition in case of patients suffering trauma augments the chances of mortality. Further, lack of early enteral feeding might lead to sepsis and increased chances of a systematic inflammatory response. Enteral nutrition is to be started soon after the injury to achieve haemodynamic stability and ensure that re suscitation is complete (Jeejeebhoy 2016). Post surgery, for fixing the pelvis and pinning the femur, the condition of the patient deteriorated considerably. The patient suffered circulatory and ventilation problems, demanding more detailed monitoring. She required blood products due to coagulation disorders, as well as inotrope support for peripheral oedema. While the albumin was 26 g/L, the blood glucose was 8.5 mmol/L. The normal range of albumin in adults is 35-55 g/L, while that of blood glucose is 3.95.5 mmol/L (Pocock, Richards and Richards 2013). The laboratory results indicated higher levels of creatinine and urea at 120 umol/L and 12 mmol/L respectively. The reference range for the same is 50-110 umol/L and 1.5-7 mmol/L respectively (Shier, Butler and Lewis 2015). The results indicated kidney damage and increased protein catabolism due to stress and major illness. Normal levels of Haemoglobin in adult females is 120-156 g/L while in the present case it was found to be low at 98 g/L. Further, the patient reported lac tic acidosis since the value of lactate was 2.6 mmol/L. The common causes of lactic acidosis are ischemia, respiratory failure, renal dysfunction and sepsis. On the sixth day, and after a percutaneous tracheometry, there was a rise in the patients body temperature with an increased count of WBC. This suggested that the patient had incurred an infection for which antibiotics had to be administered. An early enteral nutrition would have increased the immunity level of the patient and would have prevented infection through bacterial translocation. Laboratory reports indicated renal and liver function impairment. Further, a loose stool indicated complications in the digestive tract. On the tenth day, the patient suffered a circulatory collapse after complaining of nausea, vomiting and abdominal discomfort. Upon discharge, she was found to have lost body fat and reported of weakness. As opined by White, Guenter and Jensen (2017) late enteral nutrition often is unable to cope with the immediate nutritional requirements of a patient in case of severe trauma and injury. For preventing secondary infection, it is pivotal to deliver nutritional supp ort the moment possible. An early enteral nutrition would have better supported the patient in achieving optimal health outcomes. References Bakiner, O., Bozkirli, E., Giray, S., Arlier, Z., Kozanoglu, I., Sezgin, N., Sariturk, C. and Ertorer, E., 2013. Impact of early versus late enteral nutrition on cell mediated immunity and its relationship with glucagon like peptide-1 in intensive care unit patients: a prospective study.Critical Care,17(3), p.R123. Blaser, A.R., Starkopf, J., Alhazzani, W., Berger, M.M., Casaer, M.P., Deane, A.M., Fruhwald, S., Hiesmayr, M., Ichai, C., Jakob, S.M. and Loudet, C.I., 2017. Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines.Intensive Care Medicine,43(3), pp.380-398. Boelens, P.G., Heesakkers, F.F., Luyer, M.D., van Barneveld, K.W., de Hingh, I.H., Nieuwenhuijzen, G.A., Roos, A.N. and Rutten, H.J., 2014. Reduction of postoperative ileus by early enteral nutrition in patients undergoing major rectal surgery: prospective, randomized, controlled trial.Annals of surgery,259(4), pp.649-655. Jeejeebhoy, K.N., 2016. Nutrition Needs Should Be Modified to Consider Nutrition Status and Acuity of Illness Lessons From the INTACT Trial.Journal of Parenteral and Enteral Nutrition,40(1), pp.10-11. McClave, S.A., Taylor, B.E., Martindale, R.G., Warren, M.M., Johnson, D.R., Braunschweig, C., McCarthy, M.S., Davanos, E., Rice, T.W., Cresci, G.A. and Gervasio, J.M., 2016. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (ASPEN).Journal of Parenteral and Enteral Nutrition,40(2), pp.159-211. Pocock, G., Richards, C.D. and Richards, D., 2013.Human physiology. Oxford university press. Shankar, B., Daphnee, D.K., Ramakrishnan, N. and Venkataraman, R., 2015. Feasibility, safety, and outcome of very early enteral nutrition in critically ill patients: Results of an observational study.Journal of critical care,30(3), pp.473-475. Shier, D., Butler, J. and Lewis, R., 2015.Hole's essentials of human anatomy physiology. McGraw-Hill Education. Sun, J.K., Mu, X.W., Li, W.Q., Tong, Z.H., Li, J. and Zheng, S.Y., 2013. Effects of early enteral nutrition on immune function of severe acute pancreatitis patients.World journal of gastroenterology: WJG,19(6), p.917. White, J., Guenter, P. and Jensen, G., 2017. Consensus statement: Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition: characteristics recommended for the identification and documentation of adult malnutrition (undernutrition)(vol 36, pg 275, 2012).Journal of parenteral and enteral nutrition,41(3), pp.520-520. Yang, S., Wu, X., Yu, W. and Li, J., 2014. Early enteral nutrition in critically ill patients with hemodynamic instability: an evidence-based review and practical advice.Nutrition in Clinical Practice,29(1), pp.90-96. Yu, J.H., Cha, W., Wang, H.J., Liu, X.L., Chen, X.F., Yin, Q.H., Ye, G.S., Wang, J., Fang, Y. and Fu, S.N., 2014. The Effect of Tpf Enteral Nutrition on Nutritional Status and Prognosis in Elderly Stroke Patients.Journal of the American Geriatrics Society,62, pp.S360-S361.
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