Types of Cardiac Arrhythmia Resulting From Centrifugal Acceleration

Types of Cardiac Arrhythmia Resulting From Centrifugal Acceleration Abstract Cardiac arrhythmia is one of the many health conditions that form the basis of aviation medicine. The absence of adequate information around the condition necessitates studies to that effect. The current paper sought to determine the types of cardiac arrhythmia that result from aviation related movement.Advertising We will write a custom research paper sample on Types of Cardiac Arrhythmia Resulting From Centrifugal Acceleration specifically for you for only $16.05 $11/page Learn More The study relied on findings made in centrifugal training experiments, where subjects are usually placed in a human centrifuge. The objective was to expose the subjects to +Gz forces, which are similar to the ones in a military jet or a commercial flight. During such exercises, the tolerance level of the subjects was determined relative to the G-forces. It was found that sinus arrhythmia, premature atrial contraction, premature ventricle contraction, and atrial fibrill ation are the common cardiac arrhythmias during such exercises. Introduction Aviation Medicine An Overview There are certain health-related problems that are unique to the aeronautical and aviation industry.[1] Rayman points out that aviation medicine can also be referred to as flight or aerospace therapy.[1] The idea behind this kind of healthcare is the need for a medicinal approach in tackling the wellbeing of people in aerospace industries. Pilots and astronauts are good examples of individuals who are covered by aviation medicine. The principle behind this field is the fact that the patients find themselves physiologically affected by aviation-related factors, such as gravity. Advancement in the aerospace and aviation sectors imply that most of the aforementioned factors will increasingly affect the persons in the industry. Hanada, Hisada, and Koichiro affirm that progress is inevitable in the aviation industry.[2] An example is the case of air force pilots. The need to develop faster and effective jets means that the aerodynamic factors will be modified. Consequently, the pilots end up being affected by some of these forces. The advancements made in aviation medicine rely on its relevance to the world of aerospace. Whinnery indicates this importance by outlining the fact that the United States Air Force (herein referred to as USAF) has a School of Aerospace Medicine.[3] Such institutions justify the reasoning that research in aviation medicine is important. In a study to determine the state of affairs in Singapore in relation to this field, Gan, Low and Singh focus on the military and commercial flight areas.[4] In these fields, there is constant development of new and state-of-the-art machinery. However, as aforementioned, the same comes with consequences like increased arrhythmia.Advertising Looking for research paper on health medicine? Let's see if we can help you! Get your first paper with 15% OFF Learn More Technological in novations in medicine are required in such fields as aviation physiology and performance maximization.[4] Other areas in which advancement is required include the selection of medical standards and protection of aircrew from communicable diseases, which may arise during a flight. However, for the purposes of this paper, discussions will revolve around the physiology aspect of aviation medicine. G-Forces in air planes Airplanes are constructed in such a manner that they respond to the laws of aerodynamics.[1] The operation of these laws relies on gravity and how to overcome it. Whinnery brings out the understanding that gravity, as a force, is observed as acceleration.[2] The implication is that there is motion involved. Going by the arguments made in Newton’s laws of motion, it is evident that gravity is characterized by several forces. The study restricts itself to the forces exerted on an aircraft due to gravity, which is referred to as ‘g-force’. According to Gan et al.,[4] g-forces are considered as accelerations, as previously indicated. As a result, one can determine these forces on the basis of their respective weights. By virtue of the acceleration nature of gravity, the g-forces appear to multiply the weights of a given mass. In the context of an airplane, these factors tend to reproduce the weight of the unit mass of the persons in the jet. To appreciate how a pilot will experience this multiplier effect, one ought to obtain the sum of the non-gravitational forces acting on them. The aforementioned non-gravitational forces are considered as the proper accelerations.[1] Their effects include stress and strain on persons in an aircraft. In their study, Whinnery[3] makes the claim that high amounts of g-forces are destructive to the aircraft and to the people. Effects of g-forces on human anatomy G-forces cause strain and stress on the bodies in an aircraft. In line with this, the elements have a physiological effect on human bodies. [1] Hanada et al.[2] affirm this hypothesis in their study on the effects of g-forces on military pilots. Most of the components of the human anatomy have mass. As such, the effects of stress and strain on them vary. Hanada et al.[2] indicate cerebral perfusion as a major impact of these forces. In such cases, the patients tend to suffer from a condition known as G-induced loss of consciousness (herein referred to as G-LOC). Such conditions are common among military pilots during the maneuvers displayed by the fighter jets. Arrhythmias is another common phenomenon resulting from the g-forces, especially in instances where flight crew are taken through centrifuge training.[4] In such cases, the pilots are subjected to the same conditions as those of a plane in the air. Consequently, the developments tend to alter the rhythmic patterns of an individual’s heartbeat. The effects of g-forces are so serious on the human anatomy to the extent that Hanada et al.[2] propose the presen ce of specialists during centrifuge training.Advertising We will write a custom research paper sample on Types of Cardiac Arrhythmia Resulting From Centrifugal Acceleration specifically for you for only $16.05 $11/page Learn More Effects of G-Forces on the Heart General effects An analysis of g-forces makes it apparent that human anatomy is severely affected by stress and strain, as illustrated in the previous section. Advances in aerospace technology imply that human body will continue to be subjected to such forces to determine its tolerance.[1] For the purposes of this study, it is important to understand the effects of g-forces on the heart as an organ in human anatomy. Cardiac arrhythmia The functioning of the heart is largely attributed to its electrical properties.[1] The stresses and strains brought about by the g-forces tend to affect the organ’s electrical attributes. As a result, the heart beat is altered. Conditions of this nature are wha t are referred to as cardiac arrhythmia. The condition is not age or gender specific. Whinnery[3] points out that the condition if often not fatal. However, studies illustrate that cardiac arrest is associated with arrhythmia.[2] Cardiac arrhythmia can occur in one of the compartments of the heart.[1] The same explains why there are different types of the said condition. Rayman[1] points out the existence of four types of cardiac arrhythmia. The first is supraventricular arrhythmia, which is characterized by a fast heart rate.[1] Secondly, there is bradyyarrhytmias. The condition arises when the heart beat is extremely low. In such cases, the blood hardly reaches the brain. The third type is ventricular arrhythmias. The occurence is associated with the lower chambers of the heart.[1] Finally, there is premature beats. It is a type of arrhythmia associated with the upper atria of the heart. The ‘premature beats’ are an indication of a mild form of arrhythmia, whose sympt oms are not easily noticeable.[5] Cardiac arrhythmia in aviation medicine The aviation industry is a sensitive area, which involves out of space explorations and normal flights. The machines involved are quite complex. The sophistication requires the complete application of the pilot’s cognitive abilities. Within the broad spectrum of aviation medicine, cardiac arrhythmia falls under the physiological effects. The heart plays an important role in human anatomy.[6] As such, studies have been conducted to illustrate how best to overcome the condition. Factors influencing g-force provoked arrhythmia During centrifugal training, the participants are subjected to +Gz forces. The procedure leads to stress that affects human anatomical functions. It is evident that cardiac arrhythmia results from the effects of the G-force on the heart. The rhythms are distorted from their normal patterns.[7] It is important to appreciate the factors that influence the occurrence of arrhythmia due t o the G-forces. Over the years, aviation medicine has relied on centrifugal training to obtain information about cardiac arrhythmia. Such information includes the various types of the condition and their influencing factors.[7] Experiments carried out to determine this rely on the use of human centrifuges, which are found in special units. The most common areas where such apparitions are found include special aviation medical departments in military wings.Advertising Looking for research paper on health medicine? Let's see if we can help you! Get your first paper with 15% OFF Learn More One of the factors that influence cardiac arrhythmia during centrifugal training is the magnitude of the +Gz. Ewalina and Lech[7] proved this in a study in which they sought to determine hemodynamic changes resulting from centrifugal acceleration and the corresponding cardiovascular responses. The study reveals that an acceleration of 1Gz is responsible of acute hemodynamic changes. The same magnitude of acceleration was found to be an activator of cardiovascular responses, arrhythmia being one of them.[7] Anti-G straining maneuvers (herein referred to as AGSM) are other factors that influence g-force-provoked arrhythmia. Ewalina and Lech[7] point out that the same has a direct effect on the nervous system, which impacts on the heart’s electrical properties. Such measures are seen as an attempt to reduce the effects of g-forces. They limit the impacts of +Gz on the electrical characteristics of the heart. Other factors include the health status of the subject and the duration of exposure. Latent cardiac medical histories give mixed results. Exposure durations increase the chances of cardiac arrhythmia, which further aggravates the severity of the conditions. Materials and Methods Introduction The current study is hinged on the hypothesis that centrifugal acceleration results in cardiac arrhythmia.[1] The research relies on a series of peer reviewed articles, which provide a detailed discussion of the topic. More importantly, the articles relied on address the issue of g-forces and their effects on human subjects. They illustrate the various types of arrhythmia and their relationship with g-forces. +G Acceleration and Corresponding Detection of Cardiovascular Responses In an experiment, Vettes, Viellefond, and Auffret[6] determined that g-forces have a corresponding cardiovascular response from the heart. The researchers deduced this by carrying out detailed studies on the issue. The subjects used were all male and individually volunteered for the exerci se. The studies were carried out in a laboratory in France. The location, known as the Aerospace Medicine Laboratory of the Flight and Test Center, contained the equipment necessary for this research.[6] The male volunteers had an average age of 37 years.[6] After the preliminary medical check-ups were concluded, all the subjects were found to be medically fit for exposure to g-forces. Preliminary tests carried out at the Central Medical Examination Centre for Flying Personnel, which is situated in Paris.[6] Thirteen of the participants did not have prior exposure to centrifugal acceleration. According to Vettes et al.,[6] +Gz g-forces were required for the study. The said forces are attained when a human centrifuge is rotated longitudinally. The specific centrifuge used in this research had a vertical rotating axis, whose arm was six meters.[6] A gondola is attached at the arm’s extreme end. Human subjects occupy this space. The centrifugal acceleration in this regard is obt ained by means of a perpendicular rotation of the arm relative to the gondola. During this rotation, the apparatus moves along the axis, exposing the subject to the +Gz forces arising from acceleration. To ascertain the responses, certain cardiac parameters are taken into account.[6] Such parameters as the subjects’ rate of heartbeat and arterial pressure were are determined. The study by Vettes et al.[6] required the stoke volume and the subjects’ visual fields to be recorded as part of the preliminary medical analysis. Each of the electrocardiographs was analyzed by means of a special electrode. The electrodes are placed on 3 locations on the subjects’ body. The first two are placed on each of the axillae, while the third is placed on the lumbar spine. In so doing, the researchers minimize the noise that would otherwise be present due to the muscle-related contractions. The arterial pressure on the other hand is obtained by means of a syphgamanomter.[6] The sa id machine is normally inflated by means of an electrovalve that is remotely controlled. To obtain the actual pressure in a subject, a curve on the machine is needed.[6] In addition, there is a microphone placed at a strategic point to detect specific noises. In the study, the researchers were able to record their patients’ rates of heartbeat using a phonocardiograph. However, there are exceptions where the heart rate is determined by taking measurements of 10 systoles from the machine. Safety Criterion The study by Hanada et al.[2] sought to develop a safety criterion for centrifugal training. The study relied on pilots from the Japanese Air Self-Defense forces. Each of the subjects was conversant with F-4, F-15 and F-2 fighter jets.[2] Such familiarity was a requirement to be part of the study. It was meant to ensure that the subjects were all familiar with increased G-forces due to the aircrafts’ high rates of acceleration. As expected, there was a preliminary medic al examination carried out on each of the participants.[7] In addition, the subjects were taken through a pre-determined duration of centrifugal acceleration to obtain specified results. The study created several profiles to analyze the effects of different +Gz forces. The data analysis phase was characterized by anonymity. The names of the pilots were not included in the profiles. G-Force Tolerance In their study, Blue et al.[5] examined levels of tolerance associated with g-forces during centrifugal training. The study revolved around subjects with an interest in spaceflight. The participants were part of Virgin Galactica crew and would- be passengers. An equipment referred to as a ‘Space Training Simulator’ was used in the study. The machine operates like a human centrifuge. Prior to the experiment, a medical examination was carried out. Afterwards, the subjects were taken through an anti-G straining procedure. There was a descriptive representation of the data colle cted in the study. Cardiac Arrhythmias in Flight and Centrifuge Simulations In their article, Ewalina and Lech[7] argue that centrifuge acceleration has an effect on cardiac arrhythmia. Consequently, their study analyzed the two scenarios in which such acceleration is achieved. They examined the rhythm balances when the subjects are in centrifuge training and in actual flight. Ewalina and Lech[7] point out that the two instances have similarities and differences. Ultimately, the research sheds more light on cardiac arrhythmia resulting from centrifugal acceleration. In the study, Ewalina and Lech[7] relied on 20 experienced pilots and 20 students. The student pilots were selected from a group of 3rd and 4th year cadets in the Polish Air Force Officers’ College. According to Ewalina and Lech,[7] the average age of the experienced pilots was 35.3 years. There was an allowance of 4.9 years in the positive and negative extremes. The average height was 176.6 cm, while body mass wa s 79.3kg.[7] The average flying hours of the experienced pilots was estimated at 2620. The trainee pilots, on the other hand, had an average age of 21.9 years and median height of 178.2 cm.[7] Their mean body mass was 78.7kg. They had an average of 252 flight hours on their records.[7] One of the requirements for participation in the experiment was that none of the pilots should take any form of medication. Ethical issues were also taken into consideration, where the participants were required to submit a written consent. The approval to conduct the study was granted by an ethics committee constituted by the ‘Polish Air Forces Institute of Aviation Medicine.’[7] The study required the subjects from the two groups to carry out flight protocols in pairs, where one acted as a pilot, and the other as a passenger.[7] Each of the subjects was required to make 2 flights. In the first flight, the subject was required to act as a ‘pilot’ (herein referred to as AF). The second flight demanded that they act as a passenger (herein referred to as PF). According to Ewalina and Lech,[7] the participants were required to take a break in-between the flight schedules. The study gave an allowance of 1 hour as the duration of time that each pilot should take before taking part in the next flight. To attain consistent results, all the subjects made use of the same TS-11 ISKRA Jet.[7] Once all the pilots had made their required flights, the researchers took a break of two days. During the break, the subjects underwent human centrifuge tests. It is important to note that the subjects did not wear G-suits during the study. The omission was meant to allow the +Gz effects to be conclusively examined. The forces were generated from the maneuvers carried out in the flight program. They ranged from 0.57 G.s-1 to 4Gz when the maneuver involved three successive turns.[7] With regards to the split S maneuver, the acceleration was recorded between 1.7G. s-1 and 5.6 G z.7 The ‘two-successive loop’ maneuver was characterized by an acceleration of 1.4G.s-1 to 5.0Gz. The other maneuvers carried out were the immelman and the one turn. The former had an acceleration of 5.6Gz, while the latter gave results identical to all the other maneuvers.[7] The results from the flight protocols were recorded separately. As aforementioned, the study carried out a centrifuge test. The same was realized using a centrifuge with a radius of 10 meters.[7] The equipment was provided by the Acceleration Tolerance Laboratory, which is situated within the Institute of Aviation Medicine. The latter is a department of the Polish Military. At the resting level, the acceleration was +1.4Gz. Thereafter, it was increased by 1G.s-1 to a maximum of 7Gz. When the human centrifuge was involved, the accelerations were set at levels similar to the aerobatic maneuvers.[7] +GZ and the Electrocardiographic Response Whinnery[3] sought to establish that the g-forces experience d during centrifuge training have an effect on an individual’s electrocardiographic (herein referred to as ECG) response system. The study involved a total of 59 subjects. According to Whinnery,[3] the research relied on the responses of the flight surgeons that developed the acceleration profiles of the subjects. The participants were drawn from the United States Air Force and the United States Navy.[3] The two training profiles developed for the study included the gradual and the rapid onsets. According to Whinnery,[3] observation of the subjects was carried out based on their respective ECG dysrhythmias. The first profile was developed when the participants were allowed to put on a standard anti-g suit. Whinnery[3] points out that the suit was not inflated. There various reasons why inflation was omitted. The major objective was to ensure that the subjects were relaxed and that their loss of peripheral vision was gradual. The maximum limit of +Gz was estimated at +9Gz. It is important to note that the tolerance levels during the centrifuge training were recorded from 2 extremes. There was the relaxed and the straining levels of tolerance.[3] In both cases, the aim was to obtain the proficiency of the anti-g element in the experiment.[3] The researchers analyzed the various symptoms exhibited by the subjects. To achieve this, the results were computed in terms of the average, standard deviation, minimum, and maximum.[3] Whinnery[3] used the ages of the subjects to estimate the results. Of particular interest was the comparison between the ectopy occurrences among the subjects. The incidences were analyzed by means of a correlated proportions test referred to as McNemar.[3] An elaborate outline of the results is discussed in the subsequent sections of this paper. The objective, as already mentioned, is to build on the hypothesis of the current study. The discussions will involve results from studies similar to the ones referred to in this section. Resu lts Introduction to the Results From the materials and methods discussed in the previous sections, it is apparent that there is enough evidence to support the hypothesis made in this paper. The evidence suggests that cardiac arrhythmia is caused by g-forces that result from centrifugal acceleration.[5] The results of previous studies conducted in this field highlight the various types of arrhythmias and the effect of centrifugal acceleration on the rate of heartbeat. In addition, the findings made illustrate the various cardiovascular parameters related to arrhythmia. In line with this, analysis of this condition in relation to centrifuge is outlined in this section. Types of Arrhythmias As aforementioned, there are multiple types of arrhythmias. Each of them has unique characteristics that set it apart from the others.[6] In a study to determine the safety measures needed to be put in place during g-flight training, Hanada et al.[2] found out different types of this condition. The findings are illustrated in Table 2 below: Table 1: Types of cardiac arrhythmia Number of Participants Percentage of Occurrence (%) Type of Arrhythmia 114 58.5 Single PVC 95 48.7 Sinus Arrhythmia 63 32.3 Single PAC 19 9.7 Paired PVC 5 2.6 Ventricular tachycardia 3 1.5 Paroxysmal supraventricular tachycardia 3 1.5 Repeated PAC 1 0.5 Paroxysmal Atrial Fibrillation 1 0.5 Ventricular bigeminy or trigeminy Adapted from: Hanada et al.[2] The study by Hanada et al.[2] reveals 9 types of cardiac arrhythmia associated with centrifuge acceleration. The figures listed in table 1 above were obtained from a research conducted by the Japan Air Self-Defense Force (herein referred to as JASDF). The most common condition recorded during the study was single premature ventricular contraction (herein referred to as PVC) at 58.5 percent. The occurrence of both Paroxysmal Atrial Fibrillation and ventricular bigemny or trigemny was recorded at 0.5% in one of the participants, maki ng it the least common of all. Centrifugal Acceleration and its Effects on the Rate of Heartbeat As previously mentioned, centrifugal acceleration has an effect on human anatomy. The effects of this phenomenon on human body vary between different organs. Studies reveal that centrifugal acceleration gives rise to g-forces. As such, it follows that their effects on the heart touches on its rhythms, leading to cardiac arrhythmia.[7] In their study, Whinnery[3] affirms that g-forces affect an individual’s heart rate. Table 2 below illustrates results of the study by Whinnery.[3] The effects of the forces on the human heart are documented in the table. Table 2: G-force exposure and corresponding heart beat rates Lown grade Ectopy Definition Subjects with highest Lown grade 0 Absence of ventricular premature depolarizations 12 1 5 PVC 31 2 5 PVC 3 3 Multiform PVC 1 4A Paired PVC 8 Source: Whinnery[3] In this research, Whinnery[3] relied on one type of cardiac arrhyt hmia. As illustrated in table 2 above, the study examined the rates of heartbeat in relation to the effects of exposure to +Gz forces. The analysis is based on a Lown grading system. Such a system is used to classify heartbeats with regards to cardiac arrhythmia.[8] Whinnery[3] selected a cluster from the known classifications, as shown in table 2. The experiment analyzed results from a total of 59 participants. It was found that +Gz forces affected an average of 11 subjects. The same is inferred from the data in table 2. Cardiovascular Parameters Studies aimed at examining the effects of centrifugal acceleration rely on specified cardiovascular parameters. Vettes et al.[6] posit that the +Gz forces arising from centrifugal acceleration rely on such factors. They determine such responses as cardiac arrhythmia. The said parameters include an electrogram and the visual field of the subject. In addition, the heart rate and humeral arterial pressure of the participants are factored in t he study. They make up the cardiovascular parameters recorded during such experiments.[6] Vettes et al.[6] point out that increased exposure to g-forces was followed by a corresponding increase in the rate of the individual’s heart beats. The results from their experiments illustrated that peripheral loss of vision among the subjects was an indicator of the effects of the +Gz forces. The latter is regarded as a key symptom indicating the onset of cardiac arrhythmia. The study by Vettes et al.[6] revealed that the highest recorded heart beat per minute was 113, whereas the lowest was 84. In terms of pressure, Vettes et al.[6] illustrated that increased exposure to these forces (up to levels of +3 Gz) resulted in a corresponding rise in arterial pressure. To this effect, blood pressure is treated as an essential parameter in understanding cardiac arrhythmia. The same explains the effects of exposure to g-forces. The scenario is similar to electrocardiographic recordings, which vary depending on the accelerations. In their study, Vettes et al.[6] point out that increased heart pressure was the cause of arrhythmia. The reason is that the pressure led to atrio-ventricular dissociation. Effects of Centrifuge Training on the Heart The major focus of this study is centrifugal acceleration and its effects on human anatomy.[9] Aviation regulations require pilots (and in some cases passengers) to undergo some level of centrifugal training. Such trainings simulate the acceleration likely to be experienced in fast moving aircrafts. An example of such instances involves commercial space-crafts.[5] The high acceleration associated with such crafts requires some training to acquaint the persons with the g-forces. Blue et al.[5] carried out a similar study in which occupants of a spaceflight were subjected to centrifugal-stimulated sub-orbital flight. The objective was to create conditions similar to those in a fast moving aircraft. The participants in the study by Blue et al.[5] were all healthy. The simulation was expected to provide information on how g-forces affect the heart. It was also expected to shed light on the influence of the forces on the occurrence of cardiac arrhythmia. Their study used a total of 81 participants[5]. The research by Blue et al.[5] required healthy individuals. As a result, all the participants were subjected to medical screening.[6] Consequently, the initial number was reduced to 77 subjects. Out of this, 65 were men, while 12 were women. Another batch of 21 participants was subjected to cardiac examinations to check for any latent complications. The medical examinations revealed that 16 had histories of hypertension, while 5 had diabetes. Another 5 had undergone a coronary heart bypass. In addition, 17 participants had a history of hyperlipidemia. Prior to the simulation, there were 2 individuals who were found to have severe cases of peripheral vascular disease. The objective of these tests was to obtain exact re sults from the simulations. The aim was to ensure that the findings made were due to g-forces from centrifugal acceleration and not from latent conditions. The participants with medical histories had little complaints from the centrifugal acceleration in comparison to those without backgrounds of medical conditions. However, both sets of participants complained of nausea. The same is common in cases where subjects are exposed to high centrifugal acceleration. Another effect of this development was greyout. To this end, participants complained of incidences of mild greyout. Interestingly, none of the participants experienced any form of G-LOC. There were, however, incidences where the participants would perform head movements with the sole objective of self-inducing sensations similar to coriolis. Discussion Overview From the various experiments highlighted in the current study, it appears that cardiac arrhythmia is caused by g-forces associated with aerodynamics.[10] The various stu dies made reference to centrifugal acceleration. It is not possible to obtain results from the specific aircrafts that the researchers used to generate centrifugal acceleration. As a result, most studies depend on simulations of conditions found in an aircraft.[11] During such instances, the subjects are rotated at speeds that are almost equivalent to those in an aircraft The objective of such simulations is to expose the subjects to g-forces from acceleration.[12] The specific elements observed are the +Gz forces. The designation ‘z’ implies that on a 3 dimensional plane, the said forces act on the z axis. Their effects on the subject are longitudinal. In addition, they are the most common forces that affect the rhythm of an individual’s heart when in flight.[13] The different levels of exposure to g-forces are a contributing factor to the occurrence of the various types of cardiac arrhythmia. The study by Hanada et al.[2] highlighted three types of arrhythmia c ommon among pilots, especially in military jets. The three were identified as PAC, PVC, and sinus arrhythmias. According to Hanada et al.,[2] the three occurred due to the variant levels of exposure to +Gz. For instance, sinus arrhythmia occurs in instances where subjects are exposed to high g-forces. In such cases, the resulting levels of stress are high. The same has an effect on the heart rate. It distorts the rhythm of these rates once the subject comes to rest. It is noted that PVC and PAC are the most common types of arrhythmia that result from interactions with high-G training.[14] Hanada et al.[2] addressed this issue by pointing out that the two are common in normal day-to-day exercises. The researchers found it prudent to do away with centrifuge in cases where subjects exhibited PAC and PVC.[2] The argument is strengthened by the assumption that the two arrhythmias are a normal occurrence among subjects. The study by Hanada et al.[2] introduced the element of grading the r ate of heartbeat rhythms among subjects. The system is essential in determining the degree or severity with which arrhythmia exhibits itself.[15] In this grading system, arrhythmias that are recorded at a grade of three or higher are regarded as severe. It is noted that 10% of the subjects in the study by Hanada et al.[2] exhibited a paired condition of PVC. The researchers argue that the condition is a direct physiological response to the stress experienced during the centrifugal acceleration in training sessions. The Lown grading system for ectopy was developed against the backdrop of the need to characterize the different types of arrhythmia. The same explains why, in the study by Hanada et al.[2], PAC and PVC are graded according to the degree of exposure to +Gz. An example is in the case where there is paired PVC and PAC, while at the same time single cases of PAC and PVC are noted. In both cases, the Lown format becomes vital in highlighting the severity of the different types of arrhythmia. The Lown system is one of the advancements made in aviation medicine. It is used to determine the types of arrhythmias that are permissible in centrifugal training. An example is evident in the study by Hanada et al.[2], where the system is used to sanction centrifugal training in cases where subjects exhibit paired PVC. However, training sessions are terminated in cases where the arrhythmias go beyond a specific threshold.[2] In such cases, the severity of the condition is determined by such factors as proaxysmal atrial fibrillation. Hanada et al.[2] posit that there are certain tachycardiac arrhythmias that reduce tolerance to G-stress resulting from centrifugal acceleration. In such cases, the subjects exhibit PSVT and VT. Their study revealed that PVST is possibly a major cause of loss of consciousness during centrifugal training.[15] The findings made in the current study are best understood from the perspective of a detailed discussion of centrifugal accelerati on and its effects on the heart. In so doing, the researcher aims to prove that cardiac arrhythmia is a result of centrifugal acceleration. In this section, the specific types of this condition are analyzed in detail. Protocols for Centrifugal Acceleration The findings in this study reveal that centrifugal acceleration is an important component of aviation medicine.[16] The process creates an environment that is similar to that experienced in fast moving aircrafts like fighter jets. Such individuals as military pilots and astronauts are the most affected by the G-forces arising from the acceleration of high speed aircrafts. It follows that such individuals require some form of training to acquaint themselves with the strenuous conditions and to help them bear with the stresses brought about by the forces. Centrifugal training, as already indicated, is the process through which pilots and other crew members are subjected to controlled conditions of G-stress. During such sessions, avi ation medical personnel examine individual subjects’ tolerance to G-forces.[2] It is important to take the subjects through certain protocols. Such a move is necessary as it helps in the attainment of accurate results from the exposure to the said forces. Several studies are used to elaborate the importance of these protocols as indicated in the ‘methods’ section of this paper. The first and most important protocol to follow in centrifugal training is preliminary medical check-ups.[1] The procedure is evident in the studies by Hanada et al.[2] and Whinnery[3], where the subjects are screened for heart related complications. The objective of such preliminary medical examinations is to ensure the effects of G-stress exposure are not confused with the symptoms of latent medical conditions. The second protocol during centrifugal studies is the exposure levels.[3] During the training exercises, the subjects must be exposed to varying levels of +Gz so that a proper com parison can be arrived at. For instance, Whinnery and Hickman[8] sought to study mitrial prolapsed and thus relied on centrifugal acceleration. Their subjects were exposed to stress levels of 1G.15s-1 which were gradually increased. There was also another exposure referred to as the rapid onset exposure in which the subjects experienced g-forces of 1 G.s-1. The initial tolerance level is essential in evaluating cardiovascular reflexes.[8] On the other hand the second tolerance level are useful in determining the subjects’ tolerance in terms of the hydraulics. During these exposure levels, in centrifugal training, it is expected that the subjects end up experiencing total loss of their peripheral sight. The aforementioned protocols are key in ensuring that the results are obtained as expected.[8] Arrhythmia Resulting from Centrifugal Training Overview From the findings in this paper, it is apparent that the rhythm of the heart is distorted by the G-stresses during centrifugal training.[17] As previously mentioned, centrifugal training involves rotation of subjects in a contraption referred to as a human centrifuge. The objective is to expose the participants in such exercises to +Gz forces.[3] Consequently, the individuals in such studies are observed to determine how the G-forces affect their human anatomy, of which the heart is a vital component. The contents of the articles referred to in the current paper reveal that there are 4 major types of arrhythmias that result from centrifugal acceleration.[4] The four include sinus arrhythmia, premature arterial contraction, arterial fibrillation, and premature ventricular contraction.[3] In order to categorize each of the mentioned arrhythmias, the author of the current study made observations depending on the levels of +Gz exposure. A detailed discussion is provided in this section. Sinus arrhythmia According to Rayman,[1] the heart has a specific rhythm to which it beats. Consequently, any external force l ike g-stress tends to distort the normal pattern of this organ, resulting in what is now known as cardiac arrhythmia. From the articles reviewed in this study, subjects in centrifugal training experiments were found to exhibit sinus arrhythmia among other complications known in aviation medicine.[9] The study by Hanada et al.[2] revealed that this complication is common during centrifugal training, where the subject’s heart rate normalizes immediately after a rapid heart-beat rhythm. Interestingly, there were subjects who exhibited this particular kind of arrhythmia prior to centrifuge acceleration and the subsequent exposure to the +Gz forces. As illustrated in table 2, the occurrence of the SA in the participants was recorded at 48%. It is important to appreciate that the high occurrence rate is not really due to the centrifugal acceleration. Hanada et al.[2] argue that the condition is a normal occurrence, especially among persons involved in physical training. Studies ill ustrate that the normal rate of a healthy adult lies between 60 to 100 beats every minute.[1] However, some studies indicate that the pattern varies between the genders. A normal female’s heart rate, for instance, is estimated to fall between 47 and 103 beats for every minute.[17] In men, the estimated rhythm is placed at the range of 43 to 102 beats per minute. Alterations in heart beat rhythm due to sinus arrhythmia are not fatal. There are cases where the condition cannot be detected. As such, members of a flying crew who are found to have the condition are not in danger. Premature arterial contraction (PAC) The human heart is fitted with a pace maker that has electrical characteristics.[1] as a result, when this part is exposed to external forces, there are distortions in its normal functioning. Centrifugal acceleration, as aforementioned, has an effect on the organ. The resultant +Gz forces give rise to G-stress. As mentioned earlier, these stressors tend to affect the n ormal workings of the human anatomy. The pacemaker is among the body parts affected. As a cardiac arrhythmia, premature arterial contraction is a phenomenon where the heart’s pacemaker emits signals before the ‘stipulated’ time.[18] The maker is located above the ventricles, meaning that these chambers respond to the distorted signals. As a result, the heart’s rhythm is altered by the ventricle’s ‘irregular’ response. An arrhythmia of this kind is usually common when an individual is stimulated either through exercises or as a result of such beverages as coffee. However, the same is also true when an individual undergoes centrifugal training.[2] In the study by Hanada et al.,[2] PAC exhibited itself in a number of the subjects used in the experiments. Despite the fact that the condition is not lethal, it can present itself in a manner that would require a discontinuation of the training. In such cases, it is considered as clinically sev ere. Hanada et al.[2] point out that repeated PAC is quite severe and advices intermittent discontinuation of centrifugal training among subjects who exhibit the condition. Premature ventricular contraction (PVC) The heart’s functions rely on the electrical impulses of the pacemaker.[19] In cases where +Gz forces are introduced into the human anatomy, the said impulses are interfered with. When such interferences occur, the functioning of some of the compartments of the heart is impeded, resulting in a distorted rhythm of heart beat. As an example of cardiac arrhythmia, PVC is characterized by the contraction of the heart’s ventricles before the expected electrical signal. The name ‘premature’ is sourced from this irregular contraction of the ventricles. The diagram below is an ECG representation of this condition: Graph 1: Premature ventricular beats Source: Vettes et al.[6] The study by Hanada et al.[2] points out that PVC can exhibit itself in differen t degrees. There is the occasional premature ventricular contraction, which is a mild version of the condition. Subjects who present the said condition are allowed to continue with centrifugal training owing to the fact that it is not harmful. The harmful case of PVC involves repeated PVC and Bigeminy, Trigeiny PVC. However, in spite of the fact that it is more harmful in comparison to occasional PVC, the latter case calls for the termination of centrifugal training after some time. A look at the study by Hanada et al.[2] reveals that 19 pilots exhibited the paired PVC condition. The number of subjects who presented the condition in subsequent training sessions kept on decreasing. The same indicates that despite being a common occurrence due to centrifugal training, PVC is only severe when a subject is exposed to High G-Stress over a long period of time without a break. A case in point is a pilot who travels in an aircraft at speeds that result in a stress of 5Gz.s-1 without taking a break. Such an individual is likely to experience a severe case of PVC, which might lead to cardiac arrest.[18] Artrial fibrillation Exposure to +Gz requires some form of tolerance from the persons participating in the centrifugal acceleration exercises.[19] Increased exposure and the resultant stresses affect the heart’s electrical functions. The atrial happens to be another region of the heart that is affected by the G-forces. According to Rayman,[1] the +Gz forces can increase the rate at which the pacemaker emits electrical impulses. When this happens, the ventricles contract in an irregular and erratic manner, leading to arterial fibrillation.[20] Whinnery[3] points out that exposure to G stress in such centrifugal exercises is characterized by atrial ectopy. As is the case with the other arrhythmias mentioned in this paper, this condition can be mild or severe depending on levels of exposure. For instance, Vettes et al.[6] suggest that the complication is regarded as normal when subjects are exposed to +2G for about five minutes. However, the researchers point out that the condition becomes severe in cases where the G-force is increased to +5G and the subjects exposed to the same for a period of more than five minute. Conclusion Vettes et al.[6] point out that centrifugal training, and by extension centrifugal acceleration, has a direct impact on cardiac arrhythmia. In the context of this study, centrifugal acceleration is regarded as an avenue of generating G-forces to create stress on human anatomy. Aviation medicine makes use of centrifugal training to effectively understand cardiac arrhythmia. In essence, this condition is caused by the distortion of the normal heart beat. Whinnery[3] introduced the element of human centrifuge in their study. The contraption is used in aviation medicine to conduct experiments on centrifugal acceleration. During such experiments, two main factors determine how G-forces give rise to cardiac arrhythmia. The two include the degree of +Gz and the duration of exposure. Intensity and duration are crucial elements in explaining the various types of arrhythmias. Hanada et al.[2] point out that centrifugal acceleration in centrifugal training exercises gives rise to 3 main types of arrhythmias. The analysis points out that sinus arrhythmia, premature atrial contraction, and premature ventricular contraction are the most common conditions. Atrial fibrillation is another type of arrhythmia associated with the exercises. Each of the conditions above is graded on their severity depending on the magnitude of +Gz. in addition, the duration in which the participants are exposed to the forces adds to the severity of the conditions. As such, it is important to pay attention to the degree of these conditions among individuals taking part in centrifugal training. The aim is to avert cases of cardiac arrest. Such occurrences are fatal, especially when the subjects are exposed to real time flight conditions. References Rayman BR. Clinical aviation medicine. New York: Castle Connolly Graduate Medical Publishing; 2000. Hanada R, Hisada T, Koichiro O. Arrythmias observed during high g-training: proposed safety training criterion. Aviation, Space, and Environmental Medicine. 2004; 75(8):689-91. Whinnery EJ. The electrocardiographic response to high +Gz centrifuge training. Aviation, Space, and Environmental Medicine. 1990; August:716-21. Gan WH, Low R, Singh J. Aviation medicine: global historical perspectives and the development of aviation medicine alongside the growth of Singapore’s aviation landscape. Singapore Med J. 2011; 52(5):324-329. Blue SR, Riccitello MJ, Tizard J, Hamilton JR, Vanderploeg MJ. Commercial spaceflight participant G-force tolerance during centrifuge-simulated suborbital flight. Aviation, Space, and Environmental Medicine. 2012; 83(10):929-34. Vettes B, Vieillefond H, Auffret R. Cardiovascular responses of man exposed to +GZ accelerations in a centrifuge. Av iation, Space, and Environmental Medicine. 1980; April:375-78. Ewelina KZ, Lech HK. Cardiac arrhythmias during aerobatic flight and its simulation on a centrifuge. Aviation, Space, and Environmental Medicine. 2012; 82(6):599-691. Whinnery JE, Hickman JR. Acceleration of asymptomatic aircrew with mitral valve prolapsed and significant +GZ induced ventricular dysrhythmias. Aviation, Space, and Environmental Medicine. 1988; 59:711-717. Jeffrey RD, Johnson R, Stepanek J, Fogarty AJ. Fundamentals of aerospace medicine. Baltimore: Lippincot Williams Wilkins; 2008. Whinnery JE. Acceleration-induced ventricular tachycardia in asymptomatic men: relation to mitral valve prolapsed. Aviation, Space, and Environmental Medicine. 1983; 54(1):58-64. Johnston R. Clinical aviation medicine: safe travel by air. Clin. Med. 2001;1:385-8. Rayman RB, MD, MPH, DavMed, et al. Rayman’s clinical aviation medicine. New York: Castle Connolly Graduate Medical Publishing; 2013. Kennealy AJ, Kirland SJ, Sn eider ER. Bradycardia induced by negative acceleration. Aviation, Space, and Environmental Medicine. 1976; 47(5):483-4. Ewelina KZ, Lech HK. Centrifuge breaking effects on cardiac arrhythmias occurring at high +Gz acceleration. Aviation, Space, and Environmental Medicine. 2004; 75:458-60. Whinnery JE. Acceleration-induced atrioventricular dissociation: hemodynamic consequences. Aviation, Space, and Environmental Medicine. 1982; 53(4):432-4. Grossman A, Wand O, Harpaz D, Prokupetz A, Assa A. Acceleration forces and cardiac and aortic indexes in jet fighter pilots. Aviation, Space, and Environmental Medicine. 2011; 82:901-3. Whinnery JE. Post-acceleration chaotic atrial rythm. Aviation, Space, and Environmental Medicine. 1982; 53(4):390-2. Leverett DS, Burton RR. Physiological effect of high sustained +Gz forces on man. Life Sci. Space Res. 1979;17:171-85. Kopka L, Dabrowa R, Bojenko S. Relationship between the value of the Wenckebach point and +Gz tolerance. Aviation, Space, and Envi ronment Medicine. 1984; 55:607-70. Gradwell D, Rainford JD. Ernsting’s aviation medicine. Florida: CRC Press; 2006.

An Aim, Passion and Future Anticipation Essay Example | Topics and Well Written Essays - 750 words

An Aim, Passion and Future Anticipation - Essay Example However, this image is not based on practicality. Accountancy field requires much hard work, critical thinking and theoretical knowledge as any other field of work requires. The special art of tackling with numbers and applying critical thinking is required of the accountants. Accountants require a higher level of attention towards the details of any aspect of their work. They need to be careful when dealing with each and every account. Their accuracy is their professional competence and once it is lost, the work remains inadequately completed or represents wrong image of the company/organization/individual. In addition, accountancy keeps ethical considerations and behavior at the core of its professional requirements. The knowledge about computer and skills in maintaining and updating records is also linked to the accountancy field. I personally believe that I have all these characteristics which urge me to enter the field with confidence. My ethical standards are higher enough to m eet the demands of the accountancy profession. In addition, my habit of getting in touch with the latest technological advancements make it easier for me to adopt any new programs, techniques or technologies which may motivate more accurate and efficient accounts. Having these characteristics led me to practically step ahead in the field by choosing accounting as my majors. Stepping in the accountancy education provides me a ladder to reach the aim of becoming a financial manager of a company. My aim is not to make the records but to attain a level where I may foresee an organization’s future, plan for its future and make policies which may help in taking the organization out of crises positions. I aim to achieve the highest level of financial advising and responsibility of the financial affairs within the organization and prove my competence by keeping the organization financially sound. I enjoy fulfilling the toughest challenges and responsibilities. Unlike many people, I d o not fear responsibilities but they actually give me an energizing feature to strive more, plan, implement and to attain. Accountancy is the field which gets an individual started from a cashier to a higher position official like a financial manager of the company. The step by step promotion of responsibility and duty leads to a more even and gradual development in terms of profession. Hence, I believe that this profession best suits my requirements and temperament. A higher level of accountancy knowledge would be required to attain my long term goal of becoming a financial manager in a reputable company. However, initially I need to develop my understanding by taking up the graduation courses. I aim to complete my membership with ACCA (Association of Chartered Certified Accountants) to familiarize myself with the professional needs and knowledge in practice. I need to have full grasp over accounting, finance, communication (both written and oral in case of writing reports on the f inancial performance and so on) and law. An accountant needs to be well aware of the regulations and laws relating to the accountancy practices in a particular region. Particularly, in larger corporations, companies need to follow the legal frameworks and regulatory requirements of presentation and preparation of financial reports and records. My initial inspiration towards this field is the rapid development of my uncle’s position in his work career. He started off with

Adaptive E-commerce system Literature review Example | Topics and Well Written Essays - 5000 words

Adaptive E-commerce system - Literature review Example Most of these differences arise with differing framework of what e-commerce constitutes. For example quote (year) looked at e-commerce from the perspective of buying and selling and stated that e-commerce covers all industries where the processes of buying and selling is performed over electronic systems. Quote (year) on the other hand viewed e-commerce from the perspective of what is done with a company’s website. To this end, all activities that promoted the regulation of business, whether it involved selling and buying or not formed e-commerce. Examples of such activities were named to include optimization of traffic from search engines, generation of sales and interaction with customers through an online platform. Regardless of the differences in framework for defining e-commerce however, there is one thing that runs through and that is the fact that some level of business that takes place over an electronic medium. As part of the purpose of the study, the literature review is being conducted as a major secondary data collection exercise that will be used to collect data to address the specific objectives. From the background of the study, it would be noted that there is great regard for adaptive e-commerce. This means that the researcher shall approach the literature from a perspective that limits the scope of review to adaptive e-commerce system. This is because of the position held by the researcher that even though e-commerce as a generalised concept of modern business has the potential of opening great doors for companies, there is the need to optimise the outputs of e-commerce. By optimisation, reference is being made to any creative process that ensures that service users are able to have an advantage on the use of e-commerce over their competitors. Meanwhile, quote (year) made claim to the effect that with the competitiveness of the modern global

Brutality of Slavery Essay Example for Free

Brutality of Slavery Essay In history, slavery has been a large problem in The United States and has caused many issues. We know slavery as history, while people like Frederick Douglass and Harriet Jacobs knew slavery as their lives. Frederick Douglass was a man who was born and raised as a slave, he never knew his mother and watched many terrifying things as a child. Another known slave was Harriet Jacobs; she was a slave who was abused in many ways. Both of these slaves lived through hardship and turbulence growing up. Most people could not even fathom the pain and suffering these two slaves endured. They were considered to be chattel slaves. Chattel is a type of slavery. According to Dictionary. com chattel is â€Å"any article of tangible property other than land, buildings, and other things annexed to land. † Slaveholders feel as though their slaves have no rights and they are their own property. Most slaves during this time were chattel slaves and were treated very poorly by there slaveholders. In his essay on brutality toward slaves, Frederick Douglass shares some of the horrors that were his reality. As a slave himself, he understands from first-hand experience how badly slaves were treated. He mentions emotional and physical abuse he received from his slaveholder. He talked about how the slaves were not allowed to know how old they were or information that might expose them to more about their families. Douglass mentioned the fact that slaveholders would whip the slaves until bloody while making other slaves watch. Slaveholders would shoot and kill their slaves if they did not follow orders, Douglass acknowledges. Slaveholders would keep all personal information from their slaves. The fact that a slave would not have the right to know how old they are would create emotional hardship and eliminate an important sense of self. Some slaveholders would not allow the slave to know anything about his or her mother or father. They would give the slaves very little information so they could not investigate further. Douglass was one of the slaves who barely knew his own mother. The most he ever saw her was just a few times at night while he was sleeping. She would take the long trip to see him after a long day in the fields, but she would have to be back before morning came the next day. Only being able to see one’s mother three or four times in a person’s life, and not being able to know anymore information about one’s life, would be considered abuse in many ways. Whipping a slave was a very normal action in this time. Slaves, whether they ‘deserved’ it or not, could be whipped for many reasons. Douglass mentions many times when his slaveholder would whip his own aunt. Douglass said, â€Å"I have often been awakened at the dawn of day by the most heart-rending shrieks of an own aunt of mine, whom he used to tie up to a joist, and whip upon her naked back till she was literally covered with blood. † His slaveholder took great pleasure in whipping and torturing his slaves. It is heartbreaking knowing that it was considered socially and morally okay to commit such brutalities. Douglass talks about a time when a slave named Demby was shot and killed in front of an entire plantation of slaves. The slaveholder told Demby to come to him, but Demby refused, so the slaveholder took out his gun and shot him. A thrill of horror flashed through every soul upon the plantation†¦Ã¢â‚¬  said Douglass. The slaveholder said that he killed him because he was â€Å"unmanageable. † He also said that Demby was setting a bad example for the other slaves and if he did not take care of the problem, the other slaves would follow. Women played a vital role in slavery, the pain and suffering they had to endure was terrible. Women had to bear hardship in many different ways such as sexual abuse, chattel type slavery, and the relationship between the slaveholder, his wife and the slave. All of these rigorous situations are forced upon an African American woman creating emotional and physical abuse. While reading Incidences in the Life of a Slave Girl by Harriet Jacobs, one could notice a constant theme in the slaveholder’s ideology toward the slave. As brought up earlier, most slaves were chattel slaves, meaning that their slaveholders treated them as if they were property and with no respect. Jacobs says, â€Å"He told me I was his property; that I must be subject to his will in all things. † (Jacobs pg. 2). Obviously, Mr.  Flint treated Jacobs as if he had zero respect for her. Jacobs mid teen years is when her life as a slave girl escalated. Mr. Flint, her slaveholder had absolutely no respect for the fact that she was an innocent young girl. â€Å"My master began to whisper foul words in my ear. Young as I was, I could not remain ignorant of their import. † (Jacobs pg. 1). These actions were not uncommon in slaveholder/slave relationships because of the sense of ownership. The wife of the slaveholder and her relationship to the female slave, in this case being Jacobs, could be detrimental. Not only the relationship between the wife and the female slave is important in history, but it also creates a struggle between the African American female and the slaveholder. The wife could be considered psychotic because of the jealously placed in a relationship such as theirs. Jacobs mentioned thatâ€Å"†¦she spent many a sleepless night to watch over me. Sometimes I woke up, and found her bending over me. † Most people, whether in the same relationship as them or not would think that is weird and would have psychotic tendencies. Insidences in the Life of a Slave Girl and Both narratives written by Frederick Douglass and Harriet Jacobs were tools in the abolition of slavery. The narratives gave African Americans a voice. They brought international attention to the issues and brutality of slavery. This basically put pressure on the United States to address the issue. Also, the ideology of slavery is based on the belief that blacks are inferior to whites. When sociologists first began trying to explain inferiority, a big argument was that there was no African literature. These narratives really showed the eloquence of African people.

human nature Essay -- essays research papers

What is human nature? It is very simple. Human nature refers to the patterns of behavior that are typical of our species or our kind. Human undergoes change as all humans grow up they nature seems to change; the environment someone grow up in effects that persons nature. To fully understand human nature Dr. Marvin Harris takes us on trip to time, which makes sense because if we better understand our past and our origin we will better understand our very existence and our nature. We will know more about who we are where we are from and such other questions that puzzle the human mind.   Ã‚  Ã‚  Ã‚  Ã‚  As I mentioned before our environment has a great effect on our nature. For example a theory claimed that, the first humans were originated in Africa in the time frame of 115,00...

Concept Paper on Medical Aid Schemes

MIDLANDS STATE UNIVERSITY Concept paper on the proposed State Universities Medical Fund Distribution List Mrs. V. Chirasha / Deputy Registrar (Human Resources) Author Mr. S. Masiyiwa / Lecturer, Department of Insurance & Risk Management 1. Introduction Healthcare finance and services providers in Zimbabwe were not spared by the economic downturn of the past decade. Most medical aid societies, practically collapsed when co-payments demanded by service providers exceeded their global limits on benefit payaments. For example, patients were being asked to pay Z$10 billion cash as o-payment and the medical aid society would only pay Z$1 million according to their tariffs. This mismatch, saw many clients, the state universities included, canceling their membership to such schemes and retaining the risk themselves, either funded or unfunded. The introduction of the multicurrency system in February 2009 brought the much needed stability to various sectors of the economy. However, the system was not backed by significant foreign currency inflows and as a result economic activity has remained subdued. Many organizations are currently operating below capacity and are downsizing to remain afloat. This development has significantly reduced inflow of contributions to medical aid societies, who although operating, are still to fully recover and offer full scale benefits. 2. Recent developments Contributions made to medical aid societies are made on the understanding that â€Å"if you do not use it you lose it†. This is understandable as medical aid schemes are basically risk pooling and sharing solutions and premised on the concept that the misfortunes of a few should be met by fortunes of many. However, the tight liquidity situation is forcing many entities to adopt innovative risk management strategies intended to retain as much cash as possible and only outsource those risks that exceed their risk appetite. The economic challenges of the past decade, we faced as a nation exposed the limitations of insurance as a risk financing mechanism. We have all learnt that insurance is not â€Å"THE† solution but part of the solution and that there are also equally good alternatives to insurance. Some medium to large scale organizations have since created self administered insurance schemes to cater for a variety of risks they face in their operations, e. g. material damage, health, funeral, superannuation, etc. Cell Insurance Company has spearheaded the adoption of the concept in Zimbabwe through its â€Å"rent-a-cell† captive arrangement and today it administers a lot of these schemes. However, a worrisome development in Zimbabwe is the transfer of the superannuation and morbidity risk to the employees by cash strapped or unscrupulous employers. Recently most if not all of the state university staff had no membership to any medical aid or health insurance scheme. They were paying for their health and related expenses from personal resources. The extent to which this approach could be used was obviously limited due to the low salaries and allowances staff is currently receiving. The state universities have started receiving funding from the fiscus and renewed their membership to medical aid societies. However, the concept is still the same: if you do not use it, you lose it! How many times have been to the doctor lately, once, twice or none? Literally, medical aid societies are getting richer at the expense of the members, university staff included. Retaining in-house the contributions state universities currently pay to various medical aid societies and health insurance schemes could make a difference to the underfunded institutions. 3. Suggestions for the state universities It is against the above background that I propose that the state universities should consider setting up a unified independent medical benefit fund to finance health and related risks the state university staff are exposed to on a daily basis. It is also proposed that both the employer (state universities) and the employees should make periodic contributions to the fund, the employer paying 80% and the employees meeting the balance of 20%. 4. Costing basis According to latest personnel records, the state universities employ about 3100 in total. Costing of commercial health and self insurance schemes is based on the â€Å"law of large numbers†. The larger the statistical base, the more accurate the loss ratio becomes. Many schemes operating in Zimbabwe today actually started as in-house schemes with even fewer numbers, e. g. FLIMAS and First Mutual. The 3100 university employees constitute a sizeable number, to allow for costing of the proposed medical benefit fund. In addition to the level of benefits required, existing university clinic utilization figures should be analysed and included in the costing model. 5. Advantages of the proposed scheme The proposed scheme has the following advantages: – Contributions to the fund should be lower as members will not pay for medical aid society or insurer’s administration and profit margins. – Interest from the investment of funds will accrue to the benefit fund – Any profits will accrue to the benefit fund Benefits can be tailor made, improved and enhanced with time as the fund grows – There will be no disputes with medical aid society or insurers over claims settlement – There would be a strong incentive by members to reduce claims and control losses – Global limits can be increased easily with minimum or no increase in contributions fr om the employer and employers – Improvement in staff morale can be achieved thereby increasing productivity and the restoration of financial independence and dignity. 6. Disadvantages of the proposed scheme The proposed scheme has the following disadvantages: – The claims statistics, which are used to decide on contributions will come from a narrow base – A catastrophic loss (although remote) could occur in the formative years and wipe out the fund. However, catastrophe cover can be separately arranged with leading reinsurers for a very low premium to cover the fund against an accumulation of claims above the expected budget in any given accounting period. – Individual small claims may not affect the fund too much but their aggregate effect may have catastrophic effects. Catastrophe cover, described above can also mitigate this risk – There will be need to employ additional staff to handle the fund’s administrative matters. True, but use of existing clinics and facilities at state universities should reduce the number of additional staff required. – There may be a temptation to dip into the fund and pay for unrelated activities. This must be resisted by the board of management/trustees. In any case the business of the fund should be separate from that of sponsoring universities. If the †dip† is to be allowed it should be a loan based on prevailing commercial bank loan terms and conditions. – Benefits from the basic insurance principle of spreading risk will be lost. From the foregoing, it can be concluded that the advantages far outweigh the disadvantages. The disadvantages, although real, are highly theoretical and remote. 7. Establishment of a technical working committee To expedite the process a technical committee consisting of representatives from the state universities should be set up. The committee should consist of both management representatives (50%) and employee representatives (50%). This intended to ensure buy in at the early stages and also incorporated the various stakeholders’ interests and ideas in the scheme. 8. The mandate The technical committee must be mandated to carry out the following tasks: 10. 1 Drafting of the constitution The proposed benefit fund will be run according to its Rules and Regulations as enshrined in its Constitution. The technical committee will be responsible for drafting the Rules and Regulations, which will include, inter alia: ) The name and objects of the proposed benefit fund b) Board of management/trustees, appointment and composition, meetings, its powers and functions c) Membership issues e. g. eligibility, application, termination, deprivation of membership, etc d) Subscriptions e. g. level, frequency and mode of payment of subscriptions. e) Beneficiaryship e. g. eligibility, application and termination of benefi ciaryship. f) Schedule of benefits e. g. nature and amounts of benefits, eligibility for benefits, waiting periods, claims for benefits, rejection of claims, ex-gratia payments. ) Assets, liabilities, rights and obligations of the medical fund h) Actuarial valuation i) Dissolution/wing-up of medical benefit fund j) Amendment of rules e. g. power, requirements for amending the rules k) General information for members e. g. benefit exclusions, lodging of members’ complaints and requests, payments of awards not supported by receipts, payment of service providers, list of approved providers, letters of guarantees for services provided outside Zimbabwe, shortfalls, travel cover on holiday, business or study. ) Promotion of the medical fund for acceptance by target service providers and establishing working relationships with them 2. Benefit design The technical committee must develop a number of benefit options which members can choose from. I propose the following plans, that I h ave christened, for want of better names, the university premier plan, university medium plan and the university standard plan. a) University Premier Plan This would be similar to the CIMAS Medexec Plan/PSMAS Pinnacle Plan and is meant to provide executive benefits for the principal officers and senior management. ) University Medium Plan This would be similar to the CIMAS Private Hospital Plan/ PSMAS Select Plan and is meant to provide members who want global limits higher than those provided under the University Standard Plan described below: c) University Standard Plan This should be the entry point and would be similar Excel Plan from PSMAS which currently covers most staff. The plan will pay for consultation and treatment received from Government, Mission, Municipal & Private Hospitals, general practitioners and specialists up to a limit, per person per annum 3. Registration of the fund with the authorities The technical committee should be mandated to register the proposed medical benefit fund in terms of the Medical Services Act, Chapter 15: 13 and any other applicable and relevant legislation. 9. Administration The technical committee should consider the following issues that affect the efficient running of the business of the proposed medical benefit fund. 9. 1. Location of registered office and other offices. This could be either in Harare or Bulawayo with satellite offices at all state universities. Any other center could be considered for the location of the head office. My suggestion is based on the density of service providers in Harare and Bulawayo. Most members would be referred to these big centers for specialist medical tests and treatment. Existing facilities could be used as satellite offices e. g. the existing clinics could be expanded and resourced to offer a variety of services normally available from general practitioners. This will save on costs. 2. Staffing issues Additional staff will be required especially for the head office. This will include the principal officer, finance manager, membership and claims administrators. However, they should be very few, because most of the work will be done from satellite offices. Initially there may be a lot of work when the office is set up but that should stabilize with the effluxion of time. 3. Finance and claims administration This could be centralized at head office and payments to service providers and refunds to members made once every fortnight i. e. only on two occasions per month. 4. Dispensary It is advisable to buy the essential drugs from source and keep them in stock for use by members. It will also save on costs. Railmed currently operates such a facility countrywide for the benefit of railway employees scattered across the country. The state universities should use the existing clinics for a similar purpose. Alternatively, mutually beneficial arrangements (drug schemes) can be made with leading private pharmacies to allow members’ access to drugs without paying for them upfront. 5. Approved provider network For the members to benefit, the scheme should be promoted for broader acceptance by as many service providers as possible so that members are not inconvenienced in the time of need. The management of the medical fund should promote the scheme and establish working relationships with all health service providers. This can also save on cost as it is possible to negotiate preferential rates. 6. Access to technical advice The state universities have a large pool of experts on their payroll. The technical committee should tap on that expertise. This will not only serve on cost but show the world that we can use knowledge to the benefit of mankind and practice what we preach! 10. Conclusion Emerging trends in risk management indicate that more and more organizations are electing funded risk retention strategies in an effort to contain cost and get more value for their money. State universities should embrace the philosophy and design and implement robust enterprise wide risk management strategies that mitigate the risks they are exposed to. For a start, establishing a unified independent medical benefit fund to finance the morbidity risk university staff are exposed to will be a good step in that direction. Proposed State Universities Medical Benefit Fund Benefit Limits Schedule General Practitioners, Specialists, Public & Private Hospitals) | |Services |Benefit Limits (US$) | | |General Practitioner |Paid in full | | |Physician specialist |Paid in full | | |Hospitalisation | | | |Prescription drugs | | | |Rehabilitative services | | | |Haemodialysis |Paid in full | | |Chemotherapy |Paid in full | | |Chronic disease drugs |Paid in full | | |Dental services | | | |R efraction |Paid in full | | |Optical |Paid in full | |Maternity |Paid in full | | |Family planning | | | |Hearing aids | | | |Pathology |Paid in full | | |Radiology |Paid in full | | |Blood transfusion |Paid in full | | |Psychiatric care |Paid in full | | |Prosthetic appliances | | | |Ambulance |Paid in full | | |Air Evacuation |Paid in full for life threatening situations| | | |only subject to prior authorization by board| | | |of management/trustees | | |Foreign treatment |Local benefit limit apply subject to prior | | | |authorization by board of | | | |management/trustees | ———————– [pic]

Degree and Certificate Options for Business Majors

A business degree, diploma, or certificate is one of the most practical options for individuals wishing to pursue higher education. Business majors can apply their education to almost every facet of the workforce. Business is the backbone of every industry, and every industry needs trained professionals to manage operations. If you arent sure what you want to do after graduation,  business is a great option. Program Options for Business Majors There are many different program options open to aspiring business majors. Those who have a high school diploma can choose to enter a business diploma or business certificate program. Another good option is an associate program in business. For business professionals who already have work experience and an associates degree, a bachelor degree program with a focus on general business or a business specialty is a great choice. Business majors who already have a bachelors degree are a good candidate for a masters degree in business or an MBA degree. Both options will help to propel an individual forward within their career. The final program option for business majors is the doctorate. Doctorate degrees are the highest level degrees that can be earned in business study. Business Diploma and Certificate Programs Business diploma and certificate programs offer aspiring business majors a chance to earn an undergraduate diploma or certificate in a short period of time. Coursework is often accelerated, allowing students to learn a great deal in a one or two semester time frame. Programs can usually be taken online or at an institution of higher learning  and can focus on anything from general business to accounting to some other specialization. Associate Degree Programs in Business Associate degree programs are the perfect starting point for aspiring business majors. The education gained in an associate degree program can lead to a good job in the business arena  and will also help to lay the foundation needed for the pursuit of a bachelor degree and beyond. On average, it takes anywhere from 18 months to two years to complete an associate degree program in business. Bachelor Degree Programs in Business A bachelors degree program in business ought to be considered by anyone who wishes to climb the corporate ladder quickly. A bachelors degree is often the minimum degree required for many positions within the field. Most business programs last two years, but certain universities over accelerated programs that can be completed in one years time. Masters Degree Programs in Business A master degree program in business can greatly enhance career prospects. A masters program will allow you to focus specifically on one topic. The right program can train you to be an expert in your field. Most business programs last two years, but accelerated programs are available. MBA Degree Programs An MBA degree, or Master of Business Administration degree, is one of the most sought after and respected degrees in the business world. Admissions are often competitive, and most programs require a bachelors degree and at least two to three years of formal work experience. MBA programs last anywhere from one to two years, and usually result in a higher salary for graduates. Doctorate Degree Programs in Business Doctorate degree programs in business are the final step in the academic ladder. Students who earn a doctorate in business are qualified to work as a consultant, researcher, or teacher in the field of business. Most doctorate programs require students to choose a specific area of financing, such as finance or marketing, and last anywhere from three to five years.