Pharmacology; Clinical review assignment: Renal failure Essay

Renal failure is an increasing concern in Australia, with over 54 people dying every day from kidney related disease. The incidence of this pathology has been shown to be growing, with the number of people on dialysis rising by 4% from 2010 to 2011 (National Kidney Foundation, 2013). It is estimated that approximately 1.7 million Australians over the age of 25 show signs of renal failure, either chronic or acute. Indigenous Australians are also four times more likely to die from renal failure than non-indigenous Australians (Australian Bureau of Statistics, 2006). Signs of renal failure often show themselves in the form of reduced kidney function, proteinuria (protein in the urine) or haematuria (blood in the urine). Renal failure is a condition involving the failure of the kidneys, or more precisely the nephrons within the kidneys. The nephron is the functional unit of the kidney, with approximately 1.5 million working to filter blood of wastes and reabsorb water and electrolytes necessary to maintain homeostasis (U.S. Patent No. 5,092,886A, 1992). Renal failure occurs when the kidneys fail to filter blood adequately, it is often undetected until late stage failure has occurred. There are two main forms of renal failure; acute kidney disease and chronic kidney disease, both with underlying pathologies (U.S. National Library of Medicine, 2013). Treatment for renal failure involves either dialysis; filtering of the blood to remove metabolic wastes, or a kidney transplant, which is not a cure and requires permanent care and maintenance post-surgery. As of December 2012, 1080 people are waiting for a kidney transplant in Australia (Better Health Channel, 2013). It is important for paramedics to recognise and understand the underlying pathology behind renal failure as the condition results in a wide range of secondary effects & has many different presentations, with some as simple as headaches and â€Å"stomach pain†; pain in the kidney region, and more serious presentations such as metabolic acidosis (National Kidney Foundation, 2013). Pathophysiology: All 1.5 million nephrons in the kidney are working constantly to filter  blood. The kidneys receive approximately 25% of cardiac output via the afferent arteriole, into the bowman’s capsule which surrounds the glomerulus. The glomerulus is often described as a colander, as it is semi-permeable, only allowing certain things to pass through it. The kidneys main functions are to filter the blood, but they also have many other functions, such as regulating acid/base and fluid/electrolyte balances, reabsorbing water and electrolytes and excreting urine. â€Å"In addition, the kidneys excrete metabolic waste products, including urea, creatinine, and uric acid, as well as foreign chemicals† (DeRossi & Cohen, 2008). The kidneys also serve an endocrinological function, â€Å"secreting rennin, the active form of vitamin D, and erythropoietin. These hormones are important in maintaining blood pressure, calcium metabolism, and the synthesis of erythrocytes, respectively.† (DeRossi & Cohen, 2008). The progression of renal failure is often undetected, with renal function able to continue until 50% of the nephrons per kidney are destroyed. After nephrons are destroyed they never regenerate (Tilgner, n.d.). Compensatory buffer mechanisms exist in the body to counterbalance the effects of renal disease. As the kidneys are responsible for water and electrolyte balance, shifts in solute concentrations due to nephron destruction can be seen. Isosthenuria, which is excretion of urine that has not been concentrated by the kidneys and therefore has the same osmolality/gravity as plasma, is the first clinical sign of impaired renal function. Water along with sodium is flushed from the body resulting in dehydration & an electrolyte imbalance (DeRossi & Cohen, 2008). â€Å"In a healthy body, the acid-base balance is maintained via buffers, breathing, and the amounts of acid or alkaline wastes in the urine; this is because the daily load of endogenous acid is excreted into the urine with buffering compunds such as phosphates.† (DeRossi & Cohen, 2008). When the kidneys functions are impaired, a backlog of hydrogen (H+) ion occurs and the nephrons ability to excrete acid becomes inadequate. This results in ketoacidosis, a condition in which the body’s pH falls dangerously below it’s normal homeostatic range, commonly detected by the ‘fruity’ scent of a patients breath which occurs due to acetone; â€Å"a direct byproduct of the spontaneous decomposition of acetoacetic acid† (DiTomasso, Golden & Morris, 2010). Diagnostic tools; The main ways of diagnosing renal failure include serum chemistry/blood tests, urinalysis and creatinine clearance tests. Serum chemistry is the analysis of blood, when diagnosing renal failure, changes in â€Å"Sodium, chloride, blood urea nitrogen (BUN), glucose, creatinine, carbon dioxide, potassium, phosphate, and calcium levels provide a useful tool to evaluate the degree of renal impairment and disease progression.† (DeRossi & Cohen, 2008). The most important of these are creatinine and blood urea nitrogen, both of which are byproducts of protein metabolism which in healthy people is excreted in urine after filtration. In patients with renal failure the levels of createnine and BUN increase to toxic levels, indicating significant functional loss of the kidneys (â€Å"Creatinine Levels and BUN,† 2012). Urinalysis involves examining a patients urine sample, detecting protein, blood, determining osmolality and microscopic examination (Klatt & Georgia, 2013). The main indications of renal failure that urinalysis detects are hematuria and protienuria. Hematuria is defined as â€Å"†¦the presence of red blood cells in the urine. It can be characterised as either â€Å"gross† (visible to the naked eye) or â€Å"microscopic† (visible only under the microscope)† (â€Å"Blood in the urine (Hematuria)†, 2013). Hematuria is commonly benign in younger age groups, with cases of patients less than 40 years old almost always benign. In older age groups hematuria is seen as more serious, prompting medical investigation into the pathology to rule out other causes, such as infection or cancer, as many different types of cancers (bladder, kidney, prostate, urethral) also present with hematuria (American Urological Association, 2005). Proteinuria is another indication of renal failure, occurring when urine samples contain an elevated level of protein, or albumin, which is the main protein in the blood (National Institute of Health, 2010). Proteins are large molecules and should not pass through golmerular filtration. â€Å"The upper limit of normal urinary protein is 150 mg per day; patients who excrete > 3g of protein per day carry a diagnosis of nephrotic syndromeâ€Å" (DeRossi & Cohen, 2008). A creatinine clearance test is another diagnostic tool used to determine renal failure, focusing on the glomerular filtration rate to determine the level of functioning renal nephrons. Creatinine is a metabolic by-product of creatine, which remains at a constant value in the urine. It is caused by breakdown of muscle tissue, and is 100% filtered by the glomerulus. No reabsorption of creatinine should  occur in normal functioning tubules within the nephron (National Institute of Health, 2010). This diagnostic test is done via collecting a urine and blood sample within 24 hours. â€Å"In chronic renal failure and in some forms of acute disease, the GFR is decreased below the normal range of 100 to 150 mL/min. Advancing age also diminishes the GFR, by approximately 1 mL/min every year after age 30 years.† (DeRossi & Cohen, 2008). Acute vs. Chronic; Renal failure classification is broken down into two different parts; onset and location. Renal failure can be acute; occurring within a timeframe of days to weeks, or chronic; renal failure that develops slowly over years. The location of the failure is the second criteria, determining the type of destruction within the nephron (pre-renal, renal, intrinsic or post-renal) (The Renal Association, 2012). Determining the type of renal failure is important as acute renal failure is mostly curable, whereas chronic renal failure is progressive and irreversible, often leading to death. Acute renal failure is characterised by the rapid loss of kidney function, occurring over a few days to weeks, causing azotemia, a condition where a build-up of nitrogenous wastes products occurs, causing metabolic acidosis (DeRossi & Cohen, 2008). It can be broken down into sections based on where the failure is occurring within the nephron. Pre-renal failure occurs due to a reduction in blood flow/renal perfusion to the kidneys, causing loss of function. The kidney remains undamaged in this condition, with the problem being based solely on blood flow. It is the most common type of acute renal failure and can occur as a secondary illness from â€Å"almost any disease, condition or medicine that causes a decrease in the normal amount of blood and fluid in the body† (WebMD, 2013). Post-renal failure is less common, and is caused by an obstruction of the flow of urine â€Å"from the kidneys at any level of the urinary tract and that subsequently decreases the GFR† (WebMD, 2013). It is most commonly caused by prostatic enlargement or cervical cancer, usually found in older males. Intrinsic renal failure is the final type of acute renal failure, occurring from direct damage/trauma to the kidneys. The most common types of intrinsic renal failure are â€Å"acute tubular necrosis (ATN), acute glomerulonephritis (AGN) and acute interstitial nephritis (AIN)† (WebMD, 2013). Causes of the decreased blood-flow/obstruction include;  surgery, cardiovascular disease, direct trauma/impact to the kidneys, severe burns, severe muscle injury or severe physical exertion (WebMD, 2013). Chronic renal failure focuses around nephron destruction. Renal conditions such as glomerulonephritis affects the filtration rate of the glomerulus, while polycystic kidney disease involves the failure of the renal tubules. Nephrosclerosis interferes with blood perfusion, but the most common diagnosis of chronic renal failure is â€Å"diabetes mellitus, followed by hypertension, glomerulonephritis and others† (DeRossi & Cohen, 2008). Although causes vary, each condition shares the common trend of irreversible nephron destruction. Application to paramedic practice: Paramedics must be considerate of all patients with renal impairments. Prophylactic measures are often taken in renal patients, managing â€Å"diet, fluid, electrolytes and calcium-phosphate balance†, as well as dietary modifications to counterbalance the common difficulties renal patients have with hypertension, oedema and weight gain (DeRossi & Cohen, 2008). Emergency care workers should be weary to maintain a blood pressure lower than 130/85mmHg. Bleeding disorders and anaemia are common conditions patients with renal failure will suffer from. Haemorrhaging and bruising are common. â€Å"The antidiuretic hormone vasopressin has been shown to be effective int he short term management of bleeding in patients with renal failure† (DeRossi & Cohen, 2008). Renal patients on dialysis should not have their intravenous injection site compromised by any medication an ALS paramedic may administer. Blood flow through the arm must not be blocked or obstructed, and as these patients are immunocompromised, efforts to avoid sources of infection must be made (DeRossi & Cohen, 2008). Pharmacotherapeutics is a serious concern for anyone treating a renal patient, as most drugs are excreted by kidney, â€Å"and renal function affects drug bioavailability, the volume of drug distribution, drug metabolism and the rate of drug elimination.† (DeRossi & Cohen, 2008). Drug dosage schedules must be altered according to the amount of residual renal function. Drugs that would normally be safe for most patients may be toxic in patients with renal failure. â€Å"The plasma half-lives of medications that are normally eliminated in the urine are often prolonged in renal failure and are effectively reduced by dialysis. Even drugs that are metabolized by the liver can lead  to increased toxicity because the diseased kidneys fail to excrete them effectively. Theoretically, a 50% decrease in creatinine clearance corresponds to a twofold increase in the elimination half-life of any medication excreted fully by the kidneys.† (DeRossi & Cohen, 2008) Knowledge on the pharmacology on all ALS paramedic drugs must be known as certain drugs are nephrotoxic and should not be administered. The early recognition of signs of renal failure is important as mortality rates from acute renal failure (the most common type of renal failure) are high, remaining constant over the past 40 years at approximately 40-70% (Fry & Farrington, 2006). References: National Kidney Foundation. (2013). Facts on CKD in Australia. Retrieved from http://www.kidney.org.au/Kidneydisease/FastFactsonCKD/tabid/589/Default.aspx Australian Bureau of Statistics. (2008). National Aboriginal and Torres Strait Islander Health Survery Retrieved from http://www.abs.gov.au/ausstats/abs@.nsf/mf/4715.0/ Dobos-Hardy, M. (1992). U.S Patent No. 5,092,886A. Boston, Massachusetts. Patent Buddy. U.S. National Library of Medicine. (2013). Kidney Failure. Retrieved from: http://www.nlm.nih.gov/medlineplus/kidneyfailure.html Better Health Channel. (2013). Kidney Failure. Retrieved from: http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Kidney_failure. National Kidney Foundation. (2013). What are the risk factors for kidney disease? Retrieved from http://www.kidney.org.au/KidneyDisease/RiskFactorsandSymptoms/tabid/819/Default.aspx DeRossi, S. & Cohen, D. (2008). Renal disease. Burket’s oral medicine, 11(2), 407- 427. Tilgner, S. (n.d.). Urinary – Kidney support. Journal for the Clinical Practitioner, 10(3), 1-13. DiTomasso, A., Golden, A. & Morri s, J. (2010). Handbook of Cognitive-Behavioural Approaches in Primary Care. New York, NY: Springer Publishing Company. DOI: 10.1037/O.0027784 Creatinine Levels and BUN. (2012). Retrieved from http://www.kidneyfailureweb.com/creatinine/ Blood in the urine (Hematuria). 2013. Retrieved from: http://www.urologyhealth.org/urology/index.cfm?article=113 Klatt, E., Georgia, S. (2013). Urinalysis. Retrieved from: http://library.med.utah.edu/WebPath/TUTORIAL/URINE/URINE.html WebMD. (2013). Prerenal Acute Renal Failure. Retrieved from: http://www.webmd.com/a-to-z-guides/prerenal-acute-renal-failure American Urological Association. (2005) Hematuria. Retrieved from www.urologyhealth.org/content/moreinfo/hematuria.pdf National Institute of Health. (2010). Proteinuria. Retrieved from http://kidney.niddk.nih.gov/kudiseases/pubs/proteinuria/ National Institute of Health. (2010). Creatinine Clearance. Retrieved from http://www.nlm.nih.gov/medlineplus/ency/article/003611.htm The Renal Association. (2012). Acute Kidney Injury. Retrieved from https:// www.clinicalkey.com/topics/nephrology/acute-kidney-injury.html Fry, A., Farrington, K. (2006). Management of acute renal failure. Postgraduate Medical Journal, 82(964), 106-116.

Political Systems in U.K and U.S Essay

What are the similarities and differences between the political systems in U. K and U. S? When the U. S. Constitution was being drafted, its writers had the British Parliamentary system to base on. The British system was the system they were used to and had learnt since childhood. However, because the monarchy was one of the main things that the former colonists had rebelled against, any form of monarchy and most forms of concentrated power were avoided. The most fundamental difference between the political system in the U. K and the U. S is the constitution. The United States has a written constitution which is very difficult to change. The UK does not have a single document called the constitution but instead its constitutional provisions are scattered over various Acts of Parliament, any of which can be changed by a simple majority in the Parliament. Similarities Both the U. S. and British political systems have a head of state, a court system and an upper and lower house. The U. S political system has a constitution which lays out the rules for government and the rights of the people, however, the U. K has documents with constitutional provisions which lay out the same rules. Both systems are democratic in nature, as governments are put in place and removed from power by the will of the people and both have systems of checks and balances to limit the power of any one branch. Head of State In the U. S. political system, the president is the official head of state. The president is elected under the electoral college system. In the U. K. , although the prime minister usually has the spotlight on political matters and is the official head of government, the queen or king is the official head of state. The queen officially signs off on acts of parliament and, just as the U. S. president delivers the State of the Union Address every year, the queen reads the â€Å"Speech from the Throne,† which is written by the prime minister. In U. K, the monarch is more of a ceremonial figurehead and it is unusual for any member of the royal family to directly interfere with the political process. The Upper House The United States has a Senate as the upper house of the legislative branch and the U. K. has the House of Lords. Under the U. S. ystem, each state, regardless of size, has two senators. Originally, senators were appointed by the governor of the state they represented but they are now elected to serve six-year terms. The House of Lords is very different. Members of the House of Lords are not elected. The 792 members of the House of Lords are members by inheritance, appointment or their rank in the Church of England; they are not elected and cannot be removed byvote. This part of t he political system in the U. K is not democratic. Otherwise the House of Lords serve the same purpose as the U. S. Senate. They discuss, debate and vote on legislation passed by the lower house of the legislative branch. The Lower House The U. S. House of Representatives and the British House of Commons have a great deal in common. Each house is made up of representatives elected by the people. In both systems control of the lower house goes to the party that has the most seats. Under the U. K. system, the leader of the party with the most seats becomes the Prime Minister and the official head of the government. Under the U. S. system this person would be the Speaker of the House. One other key difference is elections. Under the parliamentary system, the prime minister can go to the crown at any point and ask to dissolve Parliament. If this is done an election is called. An election can also be called if the prime minister loses â€Å"the confidence of the house. † This means that the prime minister lost a vote in Parliament on a matter of confidence. Matters of confidence are usually over budgetary matters. If the prime minister loses a vote of confidence, the end result is an election Other political differences. The American general electionlasts almost two years, starting with the declaration of candidates for the primaries. The British general election lasts around four weeks. In the United States, no Cabinet member is allowed to be a member of the Congress because of the strict theory of the separation of the powers. In Britain, every Government Minister must be a member of one of the two Houses of Parliament and, if he or she is not already in the Parliament, he or she is made a peer. The constitutional system in the UK involves a lot of custom and practice, and much more flexibility than the US system. For example, the timing of US presidential elections is fixed. In the UK, it is essentially the Prime Minister’s choice as to when elections are to be held, up to the 5 year limit. The resignation of a president in the US would have to lead either to an election or to his vice president taking up the office. In the UK, the resignation of a prime minister will lead to the party choosing a new leader, but there is no technically requiring this, the Queen is technically free to choose whoever she wishes.

The Great Depression and Hebert Hoover - 559 Words

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Comparison of Mr. Wickhams and Elizabeths Attitude...

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Logistics Management Important features of Qube Logistics

Question: Describethe important features of Qube, and identify logistics management strategies to resolve the issues. Answer: Introduction Qube Logisticsis a diversified infrastructure and logistics company inAustralia. It was reformed in 2010; when the KFM, an investment trust Diversified Infrastructure and Logistics Fund got hold of Kaplan Equity and developed into a standardized operating company, re-branded as Qube Logistics. Qube acquired absolute control and mainstream ownership of PO in April 2011. Qube Holdings Limited operates services covering rail and road transport, distribution and warehousing, container parks and other related services; intermodal logistics hubs together with international freight forwarding and rail terminals. These services are combined as tailored or an integrated solution to meet individual customer needs. Over the past few years, Qube has extensively expanded and developed its logistics group to become the biggest service provider of logistics in Australia. The motive of the assignment is to highlight the different problems or issues related to the logistics in the area of NSW and the way to improve the following issues is recommended. The involvement of the government is very much important in these matters and the areas where the government will intervene are also focused upon (www.qube.com.au 2016). Important features of Qube Logistics Services Qube Logistics became the only Australian Company by formulating the idea of involving like port services into single operating group and to offer all land and international logistics services in-house to maintain control over the whole process. Qube in Australia is the only largest provider of amalgamated wharf cartage and port logistics services. The cut-edge technology drives the Qubes national infrastructure and network all over Australia. They try to deliver the best in international and landside logistics results in Australia. Facilities Qube is serving export and import oceanic container provision includes within Brisbane, Melbourne, Sydney, Adelaide and Perth. All the companys Logistics assets are established to maximize the efficiencies of the customers. The Qube Logistics have an all-multi-user terminals that are tactfully located and are used for interstate, port shuttles, and regional services of rail. This enables a seamless network to depot, container park facilities and warehousing as well as all export and import movements. By operating uninterruptedly 24/7 in its largest ports, it can offer its clients supreme synergies. This widespread network of its owned facilities enables it to provide a premium, countrywide services meeting any sort of challenges (www.qube.com.au 2016). Technology This company provides 24/7 real-time status and tracking with the help of state-of-the-art technology. The technology they offer includes: Geo-fence GPS-based technology Warehouse and Transport visibility system Global trace and track system All the landside business operations of Qube Logistics are operated by single Nation-wide system and technology, which is updated and tracked by all time online tracking system. All its trucks are equipped with GPS systems and the PODs are sent automatically after electronic acceptance. All the freights are tracked in real time without drivers activation with messages intimating the status of the vehicles sent automatically based on Geo-fences. Any client can track and enjoy Business-to-Business (B2B) interfaces on their technology operating systems by updating real-time data. Global 24/7 Tracking System Qubes Global Tracking secure tracing and tracking tool convey complete consignment visibility. It lets the client review their report and order progress on completed orders. Client can access their shipment details, reports and documents; they can also download their own key incident data. The Gateway of Qube lets its clients see all of their data so they always know about all the details and status of their cargos. Qube can tailor reporting system and KPIs to clients business operations; also have more than 200 main events that produce customized email alerts. Social Responsibility Community The Qube Logistics is dedicated to working with domestic communities and contributing its financial assistance and services to other local causes. Every year, the company identifies charities and communities it wishes to take care of. Few of them are identified as Beyond Blue, Wilderness Society, Royal Children Hospital QLD, Royal Children Hospital VIC, Rotary Club, Lions club. The Company supported the Victorian bushfire tragedy and ongoing recovery. Environment Qube Logistics is faithful to a sustainable environment across all external operations and within the company. They provide a secure working environment for its employees and any other person they meet. Companys policy ensures its customers and employees are attentive of their enduring responsibilities to their workplace and the surroundings. Safety Safety is a core value of Qube Logistics. Their safety operating methods and practices are business leading and are intended to eliminate all injuries and accidents. Qube Logistics inspiring safety record is the consequence of senior supervision ensuring all contractors, visitors and employees are acceptably skilled, briefed and trained on safety. Operations in New South Wales Qube Logistics in New South Wales (NSW) operates from four sites as follows: Port Botany Filght Terminal Port Botany Intermodal Terminal Macarthur Intermodal Terminal Yennora Intermodal Terminal Two sites are operative within Port Botany named Port Botany Empty Park and Port Botany Freight Terminal. Macarthur Intermodal Terminal is established within the increasing southwestern urban region supporting both Regional and Port activities. Forth site, Yennora Intermodal Terminal, is situated in the Western suburbs enabling rail access direct from Port Botany wharf workstation to Yennora Intermodal Terminal. Total cargo space capacity for all the above listed facilities collectively is in excess of eight thousand FCL containers and nine thousand Empty containers. Main issues of Logistics Network in NSW New South Wales is land bordered by South Australia, Victoria and Queensland and has a long coastal area bordered by Murray river. Geographically this area is diverse and this company is facing a serious issue in providing the logistics services in this area, due to the diversity in the geographical area. The management of the company in a recent survey has confessed that the logistics system in this particular area needs to be changed. The main logistics issues faced by the company in the area are the large number of service providers in the area and non-specific targeting of the market (Luo 2013). There are a growing number of frictions among the regional government and the interstate government regarding providing the services. Moreover, there is a acute lack of dedicated corridors along the geographical areas. Geographical diversity and intense competition in the limited geographical areas makes it difficult for the company to operate the business successfully and make profits. Moreover, there is a lack of the dedicated corridors, like public transport, freight and others. This creates confusion and the chances of fatal accidents are higher in this region (Novellani 2014). It becomes difficult for the company to lay new rail tracks and at the same time, there is a crisis in the expansion of the business due to the intense competition in the market. All these create logistics problems in the New South Wales division and the company is facing problems in the above-mentioned areas. The company even if launches expansion plans in the particular area, they will not be able to successfully implement the plan due to congestion in the market. Moreover, the road networks in the South Wales are really bad and the conditions is getting worse by each passing day. The toll taxes in the particular area increases the costs of the operations and the company is finding it difficult to operate within the tight cost framework. It is affecting the profitability of the concern and is a major area of concern to the company (Grobelny and Michalski 2016). There are many remote areas in the given area, and at the same time the number of petrol pumps and gas stations is very few, and this creates problem in the operations. Moreover, mining sites often comes in the area of operations and these two factors creates a sort of nexus among them thus hampering the operations of the company (Ning 2013). It is indeed difficult to operate for the company with such difficulties and at the same time make profits within the tight framework. The problems related to infrastructure needs long term planning, huge investments and a focus on the public policies. Planning forms, the basis of any changes and the planning has to be made with consultation of different other governing bodies as well as different other sectors. Other sectors also make the use of the logistics and it is important for the company to consider the impact of the changes that will affect the other relevant sectors. Without proper research, the company cannot implement the changes. The benefit must accrue to the company as well as to the different other sectors, so that the company improves the operations (Grobelny and Michalski 2016). Investments are mandatory for making the changes in the public transport and it may be difficult for the company to make investments alone. Government has to take initiative in making the investments along with the different companies as this investment falls under public spending and the government has a different budgetary allocation for the same purpose. The area where it is important to invest are the road and rail infrastructure (Novellani 2014). The prime focus will be to focus on the general infrastructure so that the problems related to the logistics get reduced and the operations of the company become smooth. Moreover, there needs to be more number of dedicated freight corridors so that the distinction becomes obvious among the different types of transports and there is a smooth flow of traffics. Smooth flow will ensure rapid transportation and at the same time, improve the feasibility (Luo 2013). A dedicated single party management is required to manage the network access and manage the overall transportation. This fact is again in the hands of the government and the management needs to be changed. On the part of the company, certain small changes in the managerial functionaries can affect the performance of the company. Transparency and single window for clearing the different issues regarding the functioning of the company is of prime importance. This act needs to be made both at the government level as well as at the company level (Nikolaenko and Shugaley 2014). Pricing is an important criteria for the changes to be implemented and the company must try to make the pricing policies as commodity based and necessary allowances must be reflected in the growth of the freight networks. The interpretation must be made with an ease of interpretation as well as consistency among the different stakeholders. The role of the government is indispensable in the functioning of the logistics and to bring about change in the particular domain. To bring a change in the existing process, it is the government who has to invest funds in the in the development of the infrastructure. Logistics will develop only when the existing infrastructure is matured and developed and the company will not have any problem in operating (Ning 2013). Government will create and build infrastructure for the entire industry and not for any one particular company. This uplifts the industry and helps them to achieve the objectives of the companies. The impact will be on the entire economy of the area and this will help the company in attracting investments and boost the entire economy. On the other hand, as per the statements provided by Anand et al (2012) planning plays an important role in the logistics division and the planning is to be made for the long-term value creation, rather than for the short-term value creation. Moreover, the planning must be made on a neutral basis and it is important for the company to remain partial and look at the greater good of all the business houses. If the planning is done properly then it will really improve the conditions of the logistics in NSW. Planning for the sake of planning is not all, proper implementation of the same plan is also important. Implementation stage is vital issues in any governing body and the government of NSW must try to stick to the plan and implement it properly. This is an useful tool and the government when implements it properly makes for a useful decision making. Single management or a single window screen for clearing all the issues related to the logistics is very much important. It will reduce the level of redundancy and at the same time, the work will be very fast. Fast movement of the different issues and quick decision-making is very much important in implementing changes. Changes are important in any concern and at the same time it is important for the government to take charges of all the different vital matters related to it. Conclusion After analyzing the entire report, it can be concluded that Qube Logistics is a market leader in the field of logistics and this company has an ambitious plan of expanding the operations of the company. This company is facing different issues relating to logistics and those problems are highlighted in the report. The problems that are highlighted are severe in nature and the company must take urgent action to rectify the course of action and make amendments urgently. It is observed that the company alone can make not all the changes in the logistics division and the government has to intervene with related matters. The matters in which the government has to take part are of public interest in nature and it is important that all those factors are given due importance. Reference Anand, N., Quak, H., van Duin, R. and Tavasszy, L., 2012. City logistics modeling efforts: Trends and gaps-A review.Procedia-Social and Behavioral Sciences,39, pp.101-115. Barbati, M., Bruno, G. and Genovese, A., 2012. Applications of agent-based models for optimization problems: A literature review.Expert Systems with Applications,39(5), pp.6020-6028. De Rosa, V., Gebhard, M., Hartmann, E. and Wollenweber, J., 2013. Robust sustainable bi-directional logistics network design under uncertainty.International Journal of Production Economics,145(1), pp.184-198. Ferreira, M.A.M., Filipe, J.A., Andrade, M. and Coelho, M., 2012. Using infinite servers queue systems busy period to solve logistics problems.International Journal of Academic Research,4(3). Grobelny, J. and Michalski, R., 2016. A Concept of a Flexible Approach to the Facilities Layout Problems in Logistics Systems. InInformation Systems Architecture and Technology: Proceedings of 36th International Conference on Information Systems Architecture and TechnologyISAT 2015Part I(pp. 171-181). Springer International Publishing. Hemmelmayr, V.C., Cordeau, J.F. and Crainic, T.G., 2012. An adaptive large neighborhood search heuristic for two-echelon vehicle routing problems arising in city logistics.Computers operations research,39(12), pp.3215-3228. Luo, J., 2013.Modelling of quayside logistics problems at container terminals(Doctoral dissertation, University of Southampton). Mancini, S., Gonzalez-Feliu, J. and Crainic, T.G., 2014. Planning and optimization methods for advanced urban logistics systems at tactical level. InSustainable Urban Logistics: Concepts, Methods and Information Systems(pp. 145-164). Springer Berlin Heidelberg. Min, H. and Kim, I., 2012. Green supply chain research: past, present, and future.Logistics Research,4(1-2), pp.39-47. Nikolaenko, A.E. and Shugaley, O.A., 2014. Forming optimal routes in the problems of transport logistics by use of GIS technology.Astronomical Schools Report,10(2), pp.141-144. Ning, L., 2013. Analysis of e-commerce logistics problems under the background of information.Electronic Test,8, p.071. Novellani, S., 2014. Models and algorithms for the optimization of real-world routing and logistics problems.4OR, pp.1-2. Pedraza Martinez, A.J., Stapleton, O. and Van Wassenhove, L.N., 2013. On the use of evidence in humanitarian logistics research.Disasters,37(s1), pp.S51-S67.

The Nutritional Requirements of a Healthy Diet for Children and Young People Essay Example

The Nutritional Requirements of a Healthy Diet for Children and Young People Paper Food groups| Outline the nutritional requirements of a healthy diet for children and young people. | Describe examples of healthy meals and snacks | | Bread, other cereals and potatoes | Children need carbohydrates to give them energy as they are very active. | One carbohydrate meal could be :Baked potato:Bake a potato in the oven prick the potato a couple of time with a fork before putting I the oven. Leave in the oven for 10 minutes when fully cooked you can put any filling inside i. e. tuna or cheese etc. | | Fruit and vegetables| Children need fruit and veg as they need vitamins . hey need vitamins to keep their skin healthy. | Vegetable soup:With vegetable soup you can add any type of vegetable i. e. tomatoes dice the tomatoes. Put the olive oil or butter into a pan and leave to cook if you would like more flavour add garlic or onion. Once cooked add wine or stock and leave for an hour to cook. | | Milk and diary food| Calcium to make their bones and teeth healthy as they are gr owing. | Pasta and cheese:Fill a pan half way with water and add the pasta leave to boil for 10 minutes. Grate the cheese add to the pasta. | | Meat , fish and alternatives| Children need protein to develop muscles and strength. Fish pie:Choose a type of fish you would like to make the fish pie with cook the fish add water and milk in the baking tray with the copped up fish cook for 5 – 8 minutes. Once the fish has cooked add any vegetables to the fish mix the fish and vegetables into mash and put in the oven for 40 minutes. | | Fatty and sugary foods| Children need small amounts of sugar and fats in their diet. | Ice cream:3 vanilla pods 568ml whole milk 50g skimmed milk powder 4 egg yolks 90g caster sugar misk together and put in the freezer till ready to eat. Add fruit| |