Variations of Tracheal Cartilages

Variations of Tracheal Cartilages The trachea, located in the superior mediastinum, is the proximal part of the tracheobronchial tree (Anne M Gilory 2012). It is approximately 5 inches long and 1 inch in diameter; courses inferiorly anterior to esophagus and posterior to aortic arch (John T Hansen et al. 2005). The trachea extends from the lower border of the cricoid cartilage opposite C6 vertebra up to the upper border of T5 vertebra where it ends by dividing into right and left principal bronchi supplying the right and left lungs respectively (S Nandi,2005). It is a passageway for air between the lungs and the external environment (Anne M Gilory 2012). Anatomical variations occur throughout the human body, and it refers to a structure that is contrasting to the ‘common. There are many variation found in trachea but some common variation are width and dimension of trachea between men and women, variation in size of complete tracheal ring and variation in diameter of the trachea. The aim of this report is to di scuss anatomical variation of trachea and its clinical impact on human. Complete tracheal rings are a rare congenital deformity, which occurs in the hyaline cartilage rings of the trachea and results in a narrowing of the tracheal opening. A normal tracheal ring consists of the cartilage in a â€Å"C† shape and a softer posterior membrane made of muscle to complete the ring, in a complete tracheal ring however, the cartilage is what makes up the entire ring thereby forming a narrower â€Å"O† shape. Complete tracheal ring sufferers can present various symptoms including noisy breathing, recurring pneumonias, wheezing, retractions, wet sounding biphasic noise, cyanosis, apnoea, and chest congestion (Kay 2014). Proper diagnosis and characterisation of complete tracheal rings requires patients to undergo a microlaryngoscopy as well as a bronchoscopy, these tests allow physicians to understand the degree and length of the narrowing of the trachea. Treatment of complete tracheal rings can be determined after diagnosis and is dependent on the con dition of the patient and the severity of the narrowing of the trachea. In over 80 per cent of complete tracheal ring cases, surgery in the form of tracheal resection or slide tracheoplasty is required (Sahoo, Karnak, Gildea and Mehta. 2007). Milder forms of complete tracheal rings can be monitored through regular doctor visits and may not require any surgical intervention at all. The width and dimensions of the trachea are the most common variations found in males and females. A recent study (Jay et al. 1996, pp. 861-864) presented research data, which showed that the width of the trachea is wider in males than females. The study among 38 men and 32 women aged between (13-82 years) showed that average tracheal width for men was 20.9mm  ± 0.32 (SD) mm and 16.9 mm  ± 0.25 (SD) mm for women (Jay et al. 1996, pp 861-864). This study also stated that there was no statistically significant relationship between tracheal size and age, weight and height but there is a significant difference in gender and can only be seen until late adolescence (Ringgold Charles 1986, pp 251). The tracheal width for men was significantly wider than women by (P value The trachea is a vital part of the respiratory system and a normal adult trachea is 120mm long and 25mm in diameter (Saladin 2007). Variations in the diameter of the trachea can cause respiratory problems but also problems during procedures such as transplantation, stenting, intubation and endoscopic (Randestand,Lindholm Fabian 2000). It has been found that the size of the cricoid ring can range from 11mm-24mm depending on the sex of the person (Montner, Miller Calboun 1984). Although height, weight and age affect the rate of flow through the trachea, these factors have no correlation to the diameter of the trachea. As mentioned above, the rate of flow through the trachea is affected by the diameter as it has the smallest cross sectional area with the greatest resistance influencing the peak expiratory flow rate (PEFR) (Montner, Miller Calboun 1984). Through the experiments done by Montner, Miller Calboun (1984) it was found that variation in diameter to the 3rd tracheal ring cau sed the largest variation to the PEFR. The trachea is often used to assist in the operation however; there are not many surgeries that reduce the size of the trachea, as there always will be slight variances between different people. The variation of tracheal and tracheal cartilage is extremely important to understand because it may help the clinicians to understand the etiology of various pulmonary diseases (Nepal med Coll J 2010). It is essential to understand variation in length, width and diameter of trachea by clinicians during transplantation of larynx because helps surgeons to deal with resection and reconstruction of the tracheobronchial tree (Randestad et al 2000). The accurate an anatomical knowledge of variation in size, shape and position of tracheal structure is important when incubation, stenting, endoscopy and transplantation are to be performed (Randestad et al 2000). It also helps medical students to study pulmonary physiology, anesthesiology and while carryout endotracheal intubation and bronchoscopy procedures with skill and perfection (Nepal med Coll J 2010). Therefore in conclusion, like many other structures within the human body tracheal cartilages have anatomical variations. Investigating the variations it was found, there were common and asymptomatic differences of the tracheal rings like the rings sizes and the differences between men and women’s trachea rings. In addition there were more complex variations like complete tracheal rings that, while not necessarily fatal, it still required proper diagnosis to understand the degree of variation. REFERENCES Acosta AC, Albanese CT, Farmer DL, Sydorak R, Danzer E, Harrison MR, Tracheal stenosis: the long and short of it. J Pediatr Surg. 2000;35:1612-1616 Backer CL, Mavroudis C. Pediatric Cardiac Surgery. 3rd edition. St Louis, Mosby Year book; 2003 Chunder R, Nadi S, Guha R, Satyanarayana N (2010), A Morphometric study of human trachea and principle bronchi in different age group in both sex and its implications. Nepal med coll J 2010. PubMed-NCBI 2014, Accessed at 8 April. Elliot M, Roebuck D, Noctor C, et al. The management of congenital tracheal stenosis. Int J Pediatr Otorhinolaryngol. 2003; 67; 183-192 Kay, DJ 2014, ‘Congenital Malformations of the Trachea’, Drugs, Diseases and Procedures, vol. 12, p.p 43-47 Kay DJ, Goldsmith AJ. Congenital malformations, trachea. www.emedicine.com/ent/topic325.htm :2006 Martini, F.H, Ober, W.C, Nath, J.L, Bartholomew, E.F, Garrison, R.N, Weich, K 2011, Visual anatomy physiology, San Francisco, CA. Montner, P, Miller, A, Calboun, F 1984, ‘Tracheal diameter as a predictor of pulmonary function’, vol. 162, no. 1, pp.115-121, viewed 4th April 2014, Springer, http://link.springer.com/article/10.1007%2FBF02715637#page-1> NT Griscom and ME Wohl (1986). Dimensions of the growing trachea related to age and gender, p.p 233-337), American Journal of Roentgenology. Randestad, Ã…, Lindholm, C.-E., Fabian, P 2000, Dimensions of the Cricoid Cartilage and the Trachea, The Laryngoscope, vol. 110, no. 11, pp. 1957-1961, viewed 4th April 2014, doi:10.1097/00005537-200011000-00036 Sahoo, DH, Karnak, D, Gildea, TR, Mehta, AC 2007, ‘Complete Tracheal Ring’ Pulmonary Diseases and Critical Care Medicine, vol. 77, p.p 96 Saladin, KS 2007, Anatomy of physiology: the unity of form and function, 4th edn, McGraw-Hill Companies Inc., New York, America.

Evergreen: Customer and Process Essay

1.1Evergreen’s desired outcomes are to improve customer satisfaction by delivering its orders on time, reduce inventories, reduce employee overtime expense and determine if the shop floor manager should be replaced. The company needs to improve its demand planning responsiveness to better serve customer needs. By improving its process and capabilities as they relate to orders, the desired results will be realized. 1.2Evergreen should try to improve its order entry system by eliminating/reducing constraints to so that the end accomplishment is a faster delivery time to the customer. 1.3We know that the order entry system is working poorly because the cycle time exceeds the customer timeline, but there may be additional problems causing the late orders since the shop is only operating at 80 percent capacity. Additionally, we are not given any information about the delivery system that would move the product from the shop floor to the customer. However, we can reasonable assume there is a problem with the order system, since it can take anywhere from 17 business hours (2 days) to 42 business hours (5.25 days) (assume 8-hour work day) for order to clear the shop floor. Since the three sale clerks are only encouraged to implement a 5-day out due date for the order, this immediately creates a constraint since it is possible for the order cycle to exceed 5 days. Not to mention that the sales clerks may even promise the products sooner. The multiple-steps in the process are creating undue constraints. Additionally, the high amount of erroneous orders (up to 65 percent) is also a large constraint on the process. 1.4The long cycle time is creating a bottleneck in getting the products to the customer on time. Additionally, the process is a made-to-order system, as opposed to made-to-stock, so the product is not created until the order is received. The variance in the way the company receives the orders is also creating problems, since the two processes are treated equally. When the traveling salesperson contacts the company with an order, the order may be up to two days old already, yet it is handled in the same fashion as when a customer calls in an order. The process is riddled with wait time and defects – two of the â€Å"Seven Deadly Sins.† Many of the orders languish in certain parts of the company and are filled out erroneously within a non-digitized system. Process measures are crucial to the processes success, and this system is only using a casual set of metrics to evaluate the effectiveness of its operations process for filling orders. The time it takes for the order to move from one process to the next should be definite – not an estimate, which describes Evergreen’s current process. Additionally, there are no metrics in place for process improvement. The order process is a serial/sequential. The company could improve by paralleling the order after it clears the Sales Account Manager by sending the order to accounting and to the shop simultaneously. A manager should improve the overall process by combining smaller processes, eliminating waste and rethinking the sequence. 2.The customers want their orders to be delivered on time. The existing customers pose a problem for Evergreen because their business spikes around certain holiday, thus increasing orders during certain times of the year. Evergreen needs to have another process in place for peak times versus the normal business schedule. The peak process could include such contingencies as having additional clerks on staff, mandating the traveling salespeople to visit customers within a standardized time frame before each peak season to gather data and pre-order product and running the shop at 100 percent capacity.

Viewpoints of the Great Carajas Project

The main two types of people involved in the Great Carajas Project are the CVRD ( A company which owned mines) and the Garimperos. Garimperos are the illegal miners or free lance miners. They mine for gold and are forbidden to mine in the Carajas area. The Garimperos come from all over Brazil and usually mine for Gold. They are annoyed with the government because they feel that they have the right to mine in the area as well. If a Garimpero is caught mining where they shouldn't be, security guards will hunt them down and confiscate their gold. In Serra Pelada 80,000 Garimperos invaded a Gold mine and took it over. They were extracting around $200 million annually but although they were making good money, they are damaging the environment and working in a very unsafe manor. They are using mercury to separate the gold and this mercury was then getting into rivers and contaminating/poisoning them and various food chains. They also burn the mercury which gave off toxic gas and the safety in the mining pits was appalling; there were regular rock falls and some miners are killed. In January 1986, Riot police were ordered into the mines to force the Garimperos out. A miner was killed by accident when a policeman intended to shoot a bullet in the air but shot too soon and killed the miner. Soon after, the mine was shut down but the company re-opened it and increased safety levels by using bulldozers. The CVRD were confident that they would make lots of money and they were very strict about the area; check posts were set up to ensure that only people involved with the mines/CVRD were allowed to enter and all cars were searched, only allowing people to enter who had a permit. The government were in control of the project and showed interest because of the investment being made. The project had an annual income of $700 million. The company are licensed to run the project, unlike the Garimperos. The companies are looked upon as being sufficient but inhumane and the Garimperos are seen as trying to fend for themselves but obliviously harming the environment and putting their own lives in danger. Local tribes who live in the forest called Amerindians are moved out of their settlements so that the CVRD can expand the mining areas. The CVRD destroy their living area and when the Amerindians next settle they are still weary of having to move again. In My opinion I think that both Garimperos and the CVRD should be allowed to mine there. They should compromise as to who gets what land so that everyone is happy. I think that if this did happen the Government would have to do some serious thinking into safety regulations and the damaging of the environment.

Should Homelessness Be Criminalized - 1747 Words

Should Homelessness Be Criminalized One of the most discussed topics around the world is homelessness. Each and everyday more and more people become homeless. People around the world have tried numerous times to resolve this dilemma. This situation is growing and it s starting to spiral out of control. One solution that s getting popular the more we let this situation grow is that criminalizing the homeless is good. People cannot criminalize the homeless. Homeless people should not be criminalized because they have nowhere to go, they have it hard enough, and putting them in jail will solve nothing. The fact that there’s laws out there for being homeless is just pitiful and low. Every human has rights and just because he or she is homeless does not mean you can take away their rights. Homeless people should not be criminalized because they have nowhere to go. Yes there are homeless shelters but not all homeless shelters are open for them to stay in. Read into things about homeless shelters and go there. There not as amazing as there cut out to be. Some homeless people say they would rather go back to the streets than to stay at homeless shelters. If one were to look in some of these homeless shelters today they would think the same. Some of them are just disgusting and downright horrible. Why do people expect someone to actually sleep in a place where it is not sanitary. 8325771 2 If one were too look into it some homeless shelters do not let people spend theShow MoreRelatedEssay on Should Homelessness Be Criminalized?1007 Words   |  5 Pagesas a counter. I am passionate about the social issue of homelessness, mainly because I was part of this population a decade ago. Applied Survey Research defines homelessness in part as, â€Å"An individual who lacks a fixed, regular, and adequate nighttime residence†¦Ã¢â‚¬  The sad fact is that there are not enough resources to adequately shelter America’s most vulnerable citizens. 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