Active or Passive Third Stage of Labour: Pros and Cons

Active or Passive Third Stage of Labour: Pros and Cons Introduction This dissertation is primarily concerned with the arguments that are currently active in relation to the benefits and disadvantages of having either an active or passive third stage of labour. We shall examine this issue from several angles including the currently accepted medical opinions as expressed in the peer reviewed press, the perspective of various opinions expressed by women in labour and theevidence base to support these opinions. It is a generally accepted truism that if there is controversy surrounding a subject, then this implies that there is not a sufficiently strong evidence base to settle the argument one way or the other. (De Martino B et al. 2006). In the case of this particular subject, this is possibly not true, as the evidence base is quite robust (and we shall examine this in due course). Midwifery deals with situations that are steeped in layers of strongly felt emotion, and this has a great tendency to colour rational argument. Blind belief in one area often appears to stem from total disbelief in another (Baines D. 2001) and in consideration of some of the literature in this area this would certainly appear to be true. Let us try to examine the basic facts of the arguments together with the evidence base that supports them. In the civilised world it is estimated that approximately 515,000 currently die annually from problems directly related to pregnancy. (extrapolated from Hill K et al. 2001). The largest single category of such deaths occur within 4 hrs. of delivery, most commonly from post partum haemorrhage and its complications (AbouZahr C 1998), the most common factor in such cases being uterine atony. (Ripley D L 1999). Depending on the area of the world (as this tends to determine the standard of care and resources available), post partum haemorrhage deaths constitutes between 10-60% of all maternal deaths (AbouZahr C 1998). Statistically, the majority of such maternal deaths occur in the developing countries where women may receive inappropriate, unskilled or inadequate care during labour or the post partum period. (PATH 2001). In developed countries the vast majority of these deaths could be (and largely are) avoided with effective obstetric intervention. (WHO 1994). One of the central argumen ts that we shall deploy in favour of the active management of the third stage of labour is the fact that relying on the identification of risk factors for women at risk of haemorrhage does not appear to decrease the overall figures for post partum haemorrhage morbidity or mortality as more than 70% of such cases of post partum haemorrhage occur in women with no identifiable risk factors. (Atkins S 1994). Prendiville, in his recently published Cochrane review (Prendiville W J et al. 2000) states that: where maternal mortality from haemorrhage is high, evidence-based practices that reduce haemorrhage incidence, such as active management of the third stage of labour, should always be followed It is hard to rationally counter such an argument, particularly in view of the strength of the evidence base presented in the review, although we shall finish this dissertation with a discussion of a paper by Stevenson which attempts to provide a rational counter argument in this area. It could be argued that the management of the third stage of labour, as far as formal teaching and published literature is concerned, is eclipsed by the other two stages (Baskett T F 1999). Cunningham agrees with this viewpoint with the observation that a current standard textbook of obstetrics (unnamed) devotes only 4 of its 1,500 pages to the third stage of labour but a huge amount more to the complications that can arise directly after the delivery of the baby (Cunningham, 2001). Donald makes the comment This indeed is the unforgiving stage of labour, and in it there lurks more unheralded treachery than in both the other stages combined. The normal case can, within a minute, become abnormal and successful delivery can turn swiftly to disaster. (Donald, 1979). chapter 1:define third stage of labour, The definition of the third stage of labour varies between authorities in terms of wording, but in functional terms there is general agreement that it is the part of labour that starts directly after the birth of the baby and concludes with the successful delivery of the placenta and the foetal membranes. Functionally, it is during the third stage of labour that the myometrium contracts dramatically and causes the placenta to separate from the uterine wall and then subsequently expelled from the uterine cavity. This stage can be managed actively or observed passively. Practically, it is the speed with which this stage is accomplished which effectively dictates the volume of blood that is eventually lost. It follows that if anything interferes with this process then the risk of increased blood loss gets greater. If the uterus becomes atonic, the placenta does not separate efficiently and the blood vessels that had formally supplied it are not actively constricted. (Chamberlain G et al. 1999). We shall discuss this process in greater detail shortly. Proponents of passive management of the third stage of labour rely on the normal physiological processes to shut down the bleeding from the placental site and to expel the placenta. Those who favour active management use three elements of management. One is the use of an ecbolic drug given in the minute after delivery of the baby and before the placenta is delivered. The second element is early clamping and cutting of the cord and the third is the use of controlled cord traction to facilitate the delivery of the placenta. We shall discuss each of these elements in greater detail in due course. The rationale behind active management of the third stage of labour is basically that by speeding up the natural delivery of the placenta, one can allow the uterus to contract more efficiently thereby reducing the total blood loss and minimising the risk of post partum haemorrhage. (ODriscoll K 1994) discuss optimal practice, Let us start our consideration of optimal practice with a critical analysis of the paper by Cherine (Cherine M et al. 2004) which takes a collective overview of the literature on the subject. The authors point to the fact that there have been a number of large scale randomised controlled studies which have compared the outcomes of labours which have been either actively or passively managed. One of the biggest difficulties that they experienced was the inconsistency of terminology on the subject, as a number of healthcare professionals had reported management as passive when there had been elements of active management such as controlled cord traction and early cord clamping. As an overview, they were able to conclude that actively managed women had a lower prevalence of post partum haemorrhage, a shorter third stage of labour, reduced post partum anaemia, less need for blood transfusion or therapeutic oxytocics (Prendiville W J et al. 2001). Other factors derived from the paper include the observation that the administration of oxytocin before delivery of the placenta (rather than afterwards), was shown to decrease the overall incidence of post partum haemorrhage, the overall amount of blood loss, the need for additional uterotonic drugs, the need for blood transfusions when compared to deliveries with similar duration of the third stage of labour as a control. In addition to all of this they noted that there was no increased incidence of the condition of retained placenta. (Elbourne D R et al. 2001). The evidence base for these comments is both robust and strong. On the face of it, there seems therefore little to recommend the adoption of passive manage ment of the third stage of labour. Earlier we noted the difficulties in definition of active management of the third stage of labour. In consideration of any individual paper where interpretation of the figures are required, great care must therefore be taken in assessing exactly what is being measured and compared. Cherine points to the fact that some respondents categorised their management as passive management of the third stage of labour when, in reality they had used some aspect of active management. They may not have used ecbolic drugs (this was found to be the case in 19% of the deliveries considered). This point is worth considering further as oxytocin was given to 98% of the 148 women in the trial who received ecbolic. In terms of optimum management 34% received the ecbolic at the appropriate time (as specified in the management protocols as being before the delivery of the placenta and within one minute of the delivery of the baby). For the remaining 66%, it was given incorrectly, either after the delivery of the placenta or, in one case, later than one minute after the delivery of the baby. Further analysis of the practices reported that where uterotonic drugs were given, cord traction was not done in 49%, and early cord clamping not done in 7% of the deliveries observed where the optimum active management of the third stage of labour protocols were not followed. >From an analytical point of view, we should cite the evidence base to suggest the degree to which these two practices are associated with morbidity. Walter P et al. 1999 state that their analysis of their data shows that early cord clamping and controlled cord traction are shown to be associated with a shorter third stage and lower mean blood loss, whereas Mitchelle (G G et al. 2005) found them to be associated with a lower incidence of retained placenta. Other considerations relating to the practice of early cord clamping are that it reduces the degree of mother to baby blood transfusion. It is clear that giving uterotonic drugs without early clamping will cause the myometrium to contract and physically squeeze the placenta, thereby accelerating the both the speed and the total quantity of the transfusion. This has the effect of upsetting the physiological balance of the blood volume between baby and placenta, and can cause a number of undesirable effects in the baby including an increased tendency to jaundice. (Rogers J et al. 1998) The major features that are commonly accepted as being characteristic of active management and passive management of the third stage of labour are set out below. Physiological Versus Active Management . . Physiological Management Active Management Uterotonic None or after placenta delivered With delivery of anterior shoulder or baby Uterus Assessment of size and tone Assessment of size and tone Cord traction None Application of controlled cord traction* when uterus contracted Cord clamping Variable Early (After Smith J R et al. 1999) physiology of third stage The physiology of the third stage can only be realistically considered in relation to some of the elements which occur in the preceding months of pregnancy. The first significant consideration are the changes in haemodynamics as the pregnancy progresses. The maternal blood volume increases by a factor of about 50% (from about 4 litres to about 6litres). (Abouzahr C 1998) This is due to a disproportionate increase in the plasma volume over the RBC volume which is seen clinically with a physiological fall in both Hb and Heamatocrit values. Supplemental iron can reduce this fall particularly if the woman concerned has poor iron reserves or was anaemic before the pregnancy began. The evolutionary physiology behind this change revolves around the fact that the placenta (or more accurately the utero-placental unit) has low resistance perfusion demands which are better served by a high circulating blood volume and it also provides a buffer for the inevitable blood loss that occurs at the time of delivery. (Dansereau J et al. 1999). The high progesterone levels encountered in pregnancy are also relevant insofar as they tend to reduce the general vascular tone thereby increase venous pooling. This, in turn, reduces the venous return to the heart and this would (if not compensated for by the increased blood volume) lead to hypotension which would contribute to reductions in levels of foetal oxygenation. (Baskett T F 1999). Coincident and concurrent with these heamodynamic changes are a number of physiological changes in the coagulation system. There is seen to be a sharp increase in the quantity of most of the clotting factors in the blood and a functional decrease in the fibrinolytic activity. (Carroli G et al. 2002). Platelet levels are observed to fall. This is thought to be due to a combination of factors. Haemodilution is one and a low level increase in platelet utilisation is also thought to be relevant. The overall functioning of the platelet system is rarely affected. All of these changes are mediated by the dramatic increase in the levels of circulating oestrogen. The relevance of these considerations is clear when we consider that one of the main hazards facing the mother during the third stage of labour is that of haemorrhage. (Soltani H et al. 2005) and the changes in the haemodynamics are largely germinal to this fact. The other major factor in our considerations is the efficiency of the haemostasis produced by the uterine contraction in the third stage of labour. The prime agent in the immediate control of blood loss after separation of the placenta, is uterine contraction which can exert a physical pressure on the arterioles to reduce immediate blood loss. Clot formation and the resultant fibrin deposition, although they occur rapidly, only become functional after the coagulation cascade has triggered off and progressed. Once operative however, this secondary mechanism becomes dominant in securing haemostasis in the days following delivery. (Sleep, 1993). The uterus both grows and enlarges as pregnancy progresses under the primary influence of oestrogen. The organ itself changes from a non-gravid weight of about 70g and cavity volume of about 10 ml. to a fully gravid weight of about 1.1 kg. and a cavity capacity of about 5 litres. This growth, together with the subsequent growth of the feto-placental unit is fed by the increased blood volume and blood flow through the uterus which, at term, is estimated to be about 5-800 ml/min or approximately 10-15% of the total cardiac output (Thilaganathan B et al. 1993). It can therefore be appreciated why haemorrhage is a significant potential danger in the third stage of labour with potentially 15% of the cardiac output being directed towards a raw placental bed. The physiology of the third stage of labour also involves the mechanism of placental expulsion. After the baby has been delivered, the uterus continues to contract rhythmically and this reduction in size causes a shear line to form at the utero-placental junction. This is thought to be mainly a physical phenomenon as the uterus is capable of contraction, whereas the placenta (being devoid of muscular tissue) is not. We should note the characteristic of the myometrium which is unique in the animal kingdom, and this is the ability of the myometrial fibres to maintain its shortened length after each contraction and then to be able to contract further with subsequent contractions. This characteristic results in a progressive and (normally) fairy rapid reduction in the overall surface area of the placental site. (Sanborn B M et al. 1998) In the words of Rogers (J et al. 1998), by this mechanism the placenta is undermined, detached, and propelled into the lower uterine segment. Other physiological mechanisms also come into play in this stage of labour. Placental separation also occurs by virtue of the physical separation engendered by the formation of a sub-placental haematoma. This is brought about by the dual mechanisms of venous occlusion and vascular rupture of the arterioles and capillaries in the placental bed and is secondary to the uterine contractions (Sharma J B et al. 2005). The physiology of the normal control of this phenomenon is both unique and complex. The structure of the uterine side of the placental bed is a latticework of arterioles that spiral around and inbetween the meshwork of interlacing and interlocking myometrial fibrils. As the myometrial fibres progressively shorten, they effectively actively constrict the arterioles by kinking them . Baskett (T F 1999) refers to this action and structure as the living ligatures and physiologic sutures of the uterus. These dramatic effects are triggered and mediated by a number of mechanisms. The actual definitive trigger for labour is still a matter of active debate, but we can observe that the myometrium becomes significantly more sensitive to oxytocin towards the end of the pregnancy and the amounts of oxytocin produced by the posterior pituitary glad increase dramatically just before the onset of labour. (GÃ ¼lmezoglu A M et al. 2001) It is known that the F-series, and some other) prostaglandins are equally active and may have a role to play in the genesis of labour. (Gulmezoglu A M et al. 2004) >From an interventional point of view, we note that a number of synthetic ergot alkaloids are also capable of causing sustained uterine contractions. (Elbourne D R et al. 2002) chapter 2 discuss active management, criteria, implications for mother and fetus. This dissertation is asking us to consider the essential differences between active management and passive management of the third stage of labour. In this segment we shall discuss the principles of active management and contrast them with the principles of passive management. Those clinicians who practice the passive management of the third stage of labour put forward arguments that mothers have been giving birth without the assistance of the trained healthcare professionals for millennia and, to a degree, the human body is the product of evolutionary forces which have focussed upon the perpetuation of the species as their prime driving force. Whilst accepting that both of these concepts are manifestly true, such arguments do not take account of the natural wastage that drives such evolutionary adaptations. In human terms such natural wastage is simply not ethically or morally acceptable in modern society. (Sugarman J et al. 2001) There may be some validity in the arguments that natural processes will achieve normal separation and delivery of the placenta and may lead to fewer complications and if the patient should suffer from post partum haemorrhage then there are techniques, medications and equipment that can be utilised to contain and control the clinical situation. Additional arguments are invoked that controlled cord traction can increase the risk of uterine inversion and ecbolic drugs can increase the risks of other complications such as retained placenta and difficulties in delivering an undiagnosed twin. (El-Refaey H et al. 2003) The proponents of active management counter these arguments by suggesting that the use of ecbolic agents reduces the risks of post partum haemorrhage, faster separation of the placenta, reduction of maternal blood loss. Inversion of the uterus can be avoided by using only gentle controlled cord traction when the uterus is well contracted together with the controlling of the uterus by the Brandt-Andrews manoeuvre. The arguments relating to the undiagnosed second twin are loosing ground as this eventuality is becoming progressively more rare. The advent of ultrasound together with the advent of protocols which call for the mandatory examination of the uterus after the birth and before the administration of the ecbolic agent effectively minimise this possibility. (Prendiville, 2002). If we consider the works of Prendiville (referred to above) we note the meta-analyses done of the various trials on the comparison of active management against the passive management of the third stage of labour and find that active management consistently leads to several benefits when compared to passive management. The most significant of which are set out below. Benefits of Active Management Versus Physiological Management Outcome Control Rate, % Relative Risk 95% CI* NNT 95% CI PPH >500 mL 14 0.38 0.32-0.46 12 10-14 PPH >1000 mL 2.6 0.33 0.21-0.51 55 42-91 Hemoglobin 6.1 0.4 0.29-0.55 27 20-40 Blood transfusion 2.3 0.44 0.22-0.53 67 48-111 Therapeutic uterotonics 17 0.2 0.17-0.25 7 6-8 *95% confidence interval Number needed to treat (After Prendiville, 2002). The statistics obtained make interesting consideration. In these figures we can deduce that for every 12 patients receiving active management (rather than passive management) one post partum haemorrhage is avoided and further extrapolation suggests that for every 67 patients managed actively one blood transfusion is avoided. With regard to the assertions relating to problems with a retained placenta, there was no evidence to support it, indeed the figures showed that there was no increase in the incidence of retained placenta. Equally it was noted that the third stage of labour was significantly shorter in the actively managed group. In terms of significance for the mother there were negative findings in relation to active management and these included a higher incidence of raised blood pressure post delivery (the criteria used being > 100 mm Hg). Higher incidences of reported nausea and vomiting were also found although these were apparently related to the use of ergot ecbolic

Television and the Nuclear Family Essay -- Television Media TV

Television and the Nuclear Family Television families have been around since the 1950s, of which in the beginning, there were the nuclear families. Nuclear families usually consisted of the father, mother, two or three children and sometimes a pet. One the first families on television were the Nelsons. The Adventures of Ozzie and Harriet debuted in the early 1950s and ran through the middle of the 1960s (Brooks, 16). The family consisted of Ozzie (dad), Harriet (mom), David (older son), and Ricky (younger son). This show actually modeled the Nelson family in real life. Parts of their life were actually on television, making The Adventures of Ozzie and Harriet, in some way, the first reality show. The Nelsons were a real family that was not portrayed by actors, but by the... Television and the Nuclear Family Essay -- Television Media TV Television and the Nuclear Family Television families have been around since the 1950s, of which in the beginning, there were the nuclear families. Nuclear families usually consisted of the father, mother, two or three children and sometimes a pet. One the first families on television were the Nelsons. The Adventures of Ozzie and Harriet debuted in the early 1950s and ran through the middle of the 1960s (Brooks, 16). The family consisted of Ozzie (dad), Harriet (mom), David (older son), and Ricky (younger son). This show actually modeled the Nelson family in real life. Parts of their life were actually on television, making The Adventures of Ozzie and Harriet, in some way, the first reality show. The Nelsons were a real family that was not portrayed by actors, but by the...

Patient Safety Essay -- Nursing

Introduction Keeping patients safe is essential in today’s health care system, but patient safety events that violate that safety are increasing each year. It was only recently, that the focus on patient safety was reinforced by a report prepared by Institute of medicine (IOM) entitled † To err is human, building a safer health system†(Wakefield & Iliffe,2002).This report found that approx-imately 44,000 to 98,000 deaths occur each year due to medical errors and that the majority was preventable. Deaths due to medical errors exceed deaths due to many other causes such as like HIV infections, breast cancer and even traffic accidents (Wakefield & Iliffe, 2002). After this IOM reports, President Clinton established quality interagency coordination task force with the help of government agencies. These government agencies are responsible for making health pol-icies regarding patient safety to which every HCO must follow (Schulman & Kim, 2000). Patient safety must be the first priority in the health care system, and it is widely accepta-ble that unnecessary harm to a patient must be controlled.Two million babies and mother die due to preventable medical errors annually worldwide due to pregnancy related complications and there is worldwide increase in nosocomial infections, which is almost equal to 5-10% of total admissions occurring in the hospitals. (WHO Patient Safety Research, 2009). Total 1.4 million patients are victims of hospital-acquired infection. (WHO Patient Safety Research, 2009). Unsafe infection practice leads to 1.3 million death word wide and loss of 26 millions of life while ad-verse drug events are increasing in health care and 10% of total admitted patients are facing ad-verse drug events. (WHO Patient Safety Re... ...Qualified health care personnel are required to maintain safe health care surrounding. Most im-portant part of the problem is to find the problem, and then only we can fix it. Conclusion It is right of a patient to be safe at health care organization. Patient comes to the hospital for the treatment not to get another disease. Patient safety is the most important issue for health care organizations. Patient safety events cost of thousands of deaths and millions of dollars an-nually. Even though the awareness of patient safety is spreading worldwide but still we have to accomplish many things to achieve safe environment for patients in the hospitals. Proper admin-istrative changes are required to keep health care organization safe. We need organizational changes, effective leadership, strong health care policies and effective health care laws to make patients safer.

My Trip To The Dominican Republic :: essays research papers

My trip to the Dominica n Republic I was to leave to the Dominican Republic at 10p.m. on a Thursday night. My flight was with Tower Air and it was leaving John F. Kennedy airport. I had to be there three hours before departure and I was I was there at 7p.m. It felt like they longest wait of my life. At 9:30p.m,they announced that we would not be leaving on time because the plane had technical difficulties. Our flight would now leave at 12p.m. I couldn’t believe this was happening to me. It was a nightmare. They had already changed my flight like five times before. I was leaving one day, then I was leaving the next and so on. Then they wait for the last minute and the food shop had closed, so there is about a good 200 or so people without food and all upset cursing up a storm. To top it all off, half of the people there were teenagers going to the Dominican Republic to play baseball. Can you imagine? A hundred something kids hungry and sleepy screaming their lungs out. However, the nightmare wasn’t over. They got us on the plane at about 2a.m because the plane wasn’t ready. I couldn’t get on the plane because I kept buzzing when I passed the medal detectors, so that took another 20 minutes. Then we are on the plane and the plane isn’t moving, and we are waiting and waiting and no explanation. After a while the plane begins to move. It when around the run way and then they tell us we must get of the plane. It needed more service repairs. At this point I’m like give me my money back, and in return they call the cops because we were making to much noise. They fix the problem around 5:30a.m and we are off again. Keep in mind we haven’t eaten and no food was given. I didn’t even get water. I thought this was a sign of god and my time had come for me to die, but I made it there in one piece. At our arrival the planes door wouldn’t open and they said we might have to return to New York. I couldn’t believe this. I was ready to jump out a window. Finally we are let out of the plane and I had to wait like three hours for my grandfather to come pick me up.

Forms of Business Essay

The vast majority of small businesses start out as sole proprietorships. These firms are owned by one person, usually the individual who has day-to-day responsibility for running the business. Sole proprietorships own all the assets of the business and the profits generated by it. They also assume complete responsibility for any of its liabilities or debts. In the eyes of the law and the public, you are one in the same with the business. Advantages of a Sole Proprietorship †¢ Easiest and least expensive form of ownership to organize. †¢ Sole proprietors are in complete control, and within the parameters of the law, may make decisions as they see fit. †¢ Profits from the business flow-through directly to the owner’s personal tax return. †¢ The business is easy to dissolve, if desired. Disadvantages of a Sole Proprietorship †¢ Sole proprietors have unlimited liability and are legally responsible for all debts against the business. Their business and personal assets are at risk. †¢ May be at a disadvantage in raising funds and are often limited to using funds from personal savings or consumer loans. †¢ May have a hard time attracting high-caliber employees, or those that are motivated by the opportunity to own a part of the business. †¢ Some employee benefits such as owner’s medical insurance premiums are not directly deductible from business income (only partially as an adjustment to income). Partnerships In a Partnership, two or more people share ownership of a single business. Like proprietorships, the law does not distinguish between the business and its owners. The Partners should have a legal agreement that sets forth how decisions will be made, profits will be shared, disputes will be resolved, how future partners will be admitted to the partnership, how partners can be bought out, or what steps will be taken to dissolve the partnership when needed; Yes, its hard to think about a â€Å"break-up† when the business is just getting started, but many partnerships split up at crisis times and unless there is a defined process, there will be even greater problems. They also must decide up front how much time and capital each will contribute, etc. Advantages of a Partnership †¢ Partnerships are relatively easy to establish; however time should be invested in developing the partnership agreement. †¢ With more than one owner, the ability to raise funds may be increased. †¢ The profits from the business flow directly through to the partners’ personal tax return. †¢ Prospective employees may be attracted to the business if given the incentive to become a partner. †¢ The business usually will benefit from partners who have complementary skills. Disadvantages of a Partnership †¢ Partners are jointly and individually liable for the actions of the other partners. †¢ Profits must be shared with others. †¢ Since decisions are shared, disagreements can occur. †¢ Some employee benefits are not deductible from business income on tax returns. †¢ The partnership may have a limited life; it may end upon the withdrawal or death of a partner. Types of Partnerships that should be considered: 1. General Partnership Partners divide responsibility for management and liability, as well as the shares of profit or loss according to their internal agreement. Equal shares are assumed unless there is a written agreement that states differently. 2. Limited Partnership and Partnership with limited liability â€Å"Limited† means that most of the partners have limited liability (to the extent of their investment) as well as limited input regarding management decision, which generally encourages investors for short term projects, or for investing in capital assets. This form of ownership is not often used for operating retail or service businesses. Forming a limited partnership is more complex and formal than that of a general partnership. 3. Joint Venture Acts like a general partnership, but is clearly for a limited period of time or a single project. If the partners in a joint venture repeat the activity, they will be recognized as an ongoing partnership and will have to file as such, and distribute accumulated partnership assets upon dissolution of the entity. Corporations A Corporation, chartered by the state in which it is headquartered, is considered by law to be a unique entity, separate and apart from those who own it. A Corporation can be taxed; it can be sued; it can enter into contractual agreements. The owners of a corporation are its shareholders. The shareholders elect a board of directors to oversee the major policies and decisions. The corporation has a life of its own and does not dissolve when ownership changes. Advantages of a Corporation †¢ Shareholders have limited liability for the corporation’s debts or judgments against the corporation. †¢ Generally, shareholders can only be held accountable for their investment in stock of the company. (Note however, that officers can be held personally liable for their actions, such as the failure to withhold and pay employment taxes. †¢ Corporations can raise additional funds through the sale of stock. †¢ A Corporation may deduct the cost of benefits it provides to officers and employees. †¢ Can elect S Corporation status if certain requirements are met. This election enables company to be taxed similar to a partnership. Disadvantages of a Corporation †¢ The process of incorporation requires more time and money than other forms of organization. †¢ Corporations are monitored by federal, state and some local agencies, and as a result may have more paperwork to comply with regulations. †¢ Incorporating may result in higher overall taxes. Dividends paid to shareholders are not deductible from business income; thus this income can be taxed twice. Sole proprietorship Also referred to as â€Å"single proprietorship,† a sole proprietorship is the most simple form of business and the easiest to register, through the Bureau of Trade Regulation and Consumer Protection (BTRCP) of the Department of Trade and Industry (DTI). It is owned by an individual who has full control/authority of its own and owns all the assets, as well as personally answers all liabilities or losses. The fact that it is run by the individual means that it is highly flexible and the owner retains absolute control over it. The problem, however, is that a sole proprietor has unlimited liability. Creditors may proceed not only against the assets and property of the business, but also after the personal properties of the owner. In other words, the law basically treats the business and the owner as one and the same. This uniform treatment also has important tax implications. Partnerships and corporations may lessen their tax liability through a myriad of business expenses and other tax avoidance techniques. These tax deductions may not be applicable to a sole proprietorship. Also, the potential growth and reach of a sole proprietorship pale in comparison with that of a corporation. Partnership A partnership consists of two or more persons who bind themselves to contribute money or industry to a common fund, with the intention of dividing the profits among themselves. The most common example of partnerships are professional partnerships, like in the case of law firms and accounting firms. Just like a corporation, it is registered with the Securities and Exchange Commission (SEC). A partnership, just like a corporation, is a juridical entity, which means that it has a personality distinct and separate from that of its members. A partnership may be general or limited. In a general partnership, the partners have unlimited liability for the debts and obligation of the partnership, pretty much like a sole proprietorship. In a limited partnership, one or more general partners have unlimited liability and the limited partners have liability only up to the amount of their capital contributions. Unlike a corporation, which survives even when a member/stockholder dies or gets out, a partnership is dissolved upon the death of a partner or whenever a partner bolts out. Corporation A corporation is a juridical entity established under the Corporation Code and registered with the SEC. It must be created by or composed of at least 5 natural persons (up to a maximum of 15), technically called â€Å"incorporators.† Juridical persons, like other corporations or partnerships, cannot be incorporators, although they may subsequently purchase shares and become corporate shareholders/stockholders. The liability of the shareholders of a corporation is limited to the amount of their capital contribution. In other words, personal assets of stockholders cannot generally be attached to satisfy the corporation’s liabilities, although the responsible members may be held personally liable in certain cases. For instance, the incorporators may be held liable when the doctrine of piercing the corporate veil is applied. The responsible officers may also be held solitarily liable with the corporation in certain labor cases, particularly in cases of illegal dismissal. The biggest businesses take the form of corporations, a testament to the effectiveness of this business organization. A corporation, however, is relatively more difficult to create, organize and manage. There are more reportorial requirements with the SEC. Unless you own sufficient number of shares to control the corporation, you’ll most likely be left with no participation in the management. The impact of these concerns, however, is minimized by the army of lawyers, accountants and consultants that assist the corporation’s management.

Food and beverage Management Essay

I have read and understood the London School of Business and Finance Regulations and Policies relating to academic misconduct. I declare that: This submission is entirely my own original piece of work. It has not been submitted for a previous assessment in LSBF or any other institution. Wherever published, unpublished, printed, electronic or other information sources have been used as a contribution or component of this work, these are explicitly, clearly and individually acknowledged by appropriate use of quotation marks, citations, references and statements in the text. I understand that penalties will be incurred for late submission of work. STUDENT SIGNATURE: Ahonou Rosalie DATE: 21/09/2014 NOTE – Please complete the details below Have you submitted any Reasonable Adjustment Requests? Yes / No Date of submission: TASK 1 Understand different food and beverage production and service systems LO1. 1. 1 The characteristics of food production and food and beverage service systems INTRODUCTION Food production and food and beverage service systems is about an area where menu is planned, raw materials are purchased and received. It is also about Food service where Food and beverage are provided to the guests included a wide range of styles and cuisine types, all alcoholic and non- 1 / 3 alcoholic drinks. To make a successful Food and Beverage Service, you need to develop well interpersonal skills, product knowledge skills to buy raw material. Food and Beverage Production I am going to explain some methods: Traditional Partie Method: the majority of food is buying condiments or raw. It is easy to provide the receipt and store goods, the preparation, cooking, holding and service of food and there are dishwashing facilities as well. That method is good for the staff because the staff can move quickly from their place to the service counter (the distance is short). The communication link-up is necessary for the department and food flow is systematic. There is easy access to raw food materials from storage areas. Centralised Production Method: centralised production methods explain how the separation of the production and service components of the food flow system work or operate by place or time or both. So food that is centrally produced is distributed to the point of the point of service in batches or pre-portioned. It could be transported in a ready-to-eat box or in a ready-to-serve state, for example hot or frozen food. I give some advantages of centralised production methods â€Å"the introduction of a storage stage between production and service allows the production unit to work to maximum efficiency and with a better utilisation of staff and equipment† and â€Å"energy consumption can be reduced by careful scheduling and by a continuous run of single products†. Here is a disadvantage of centralised production method â€Å"hygiene problems or food contamination could have big repercussions than a problem in an individual kitchen. Cook-Freeze Production Methods: the word cook-freeze involves a catering system which is based on the whole cooking of food and followed by quick freezing. That food is stored in a controlled low temperature of -18 degree Celsius or less then is followed by subsequent complete reheating close to the consumer, prior to prompt consumption. The process involves raw food, food storage, pre- preparation, cooking, portioning, blast freezing, cold storage, distribution, regeneration. Cook-Chill Production Methods: it is the same process with Cook-Freeze production. The only different are that the cooking of food is stored in a controlled low temperature, but just above freezing point and then between 0 degree Celsius to +3 degree Celsius. Therefore it has a short shelf life compared to cook-freeze of up to five days including the day of production, distribution time and regeneration. The process involves raw food, cooking, portioning, blast chilling, chill storage, distribution, regeneration. The benefits of Cook-Chill and Cook-Freeze to the employers: there will have a portion control and a reduced waste, the production will be adjusted, the staff time will be fully utilised, no more weekend work and overtime. To the customers: the variety and selection of food will increased, the standards will be maintained with a quality improvement and the services can be maintained at all times even no staff. Sous vide methods: the sous vide system involves the preparation of quality raw foods, pre-cooking when necessary. You put or placed the raw foods into special plastic bags and you vacuum the air from the special plastic bags and then you seal properly the bags. After sealing you steam cooking to pasteurisation temperatures. From then the food product can be served direct to the customers at this stage or can be chilled quickly to +1 degree Celsius to +3 degree Celsius and stored between 0 degree Celsius to +3 degree Celsius for a maximum of twenty-one days. That method increases the potential shelf-life of normal coo-chill in three ways: when you remove the air from the plastic bags the growth of bacteria is restricted. Because the food is cooked at pasteurisation temperatures that helps the destruction of most microorganisms and finally because the food has been sealed within the bags is protected during storage any regeneration from any contamination. Different services of Food and Beverage systems Table d’hote menus: this type of menu contains the popular type dishes and is easier to control because the price has already been fixed for whatever the customer chooses, that setting depend on the main dish chosen. The characteristics of a table d’hote menu are being a restricted menu, offering a small number of courses (three or four), limited choice within each course, fixed selling 2 / 3 price and all the dishes are being ready at a set time. A la carte menus: a la carte menu is a larger menu than a table d’hote menu and offer a variety choice. The menus are listing under the course headings and then the establishment could prepare all the dishes. Those dishes will be prepared to order and each dish will also be priced separately. A la carte menu is more expensive than a table d’hote menu because it contains often the exotic and high cost seasonal foods. Table service: the customer enters in the restaurant and takes seat, he/her makes the order from the menu and the Staff brings it to him/her. After finish dinning the staff clears the table. Sectors where there are food service industry: Bistro, Brasserie, Coffee Shop, First Class Restaurants, Cafeteria, Fast-food outlets and Licensed Bars. For all those sectors, the main aim is to achieve customer satisfaction, for that everything you do should meet the customers’ needs physiologically, economically, socially, psychologically and convenience. The Staff should have knowledge or experience in Food and Beverage service. The restaurant should have service methods and necessary staff skills. They should have a higher level of cleanliness and hygiene; have an idea of value for money or price and also the atmosphere. The staff should know how to make the preparation for service (Mis-en-place), take customer food and beverage order, clean for hygiene, and make the bill. They should control the atmosphere in order to satisfy customers’ needs. 1. 2 The factors that affect recipes and menus for specific systems The restaurant should establish a clear list of menu to inform customers what is available to them. The Staff provides a general presentation of the menu on the course headings that should be attractive, clean, and easy to read for language, price, sales mix with accuracy, show the size and form, layout of the menu, nutritional content, health and eating, and special diets (inform people who are allergic, diabetic, have low cholesterol and low sodium). Also the cultural and religious dietary influences can affect recipes and menus as well. Example Hindus, Jews, Muslims, Sikhs, Roman Catholics, Vegetarians. 1. 3 Comparison of the coast and the staffing implications POWERED BY TCPDF (WWW. TCPDF. ORG).         

Program Analysis

The points of view of the segments are that the Bola virus has become an epidemic in the world and everyone should be alert as to the symptoms to prevent them from getting sick. The man who traveled from Africa to the United States with the virus was said to be traveling for many different reasons. At first all stations seemed to be In sync with not knowing the truths as to the reasons for his travels. One of the first assumptions was that he traveled here to get medical attention to help him be cured of the virus.The programs mention this because there was a recent case of an American man who name from Africa after helping treat the African people with the virus and found out that he contracted it himself. After being quarantined in a hospital he was cured with an experimental drug. They felt he traveled here to get the same treatment. This raised a lot of question for people and the broadcast stations that reported on this subject. I believe the reports are objective for a couple o f reasons.As humans we are afraid of certain things and when those who usually have the ability to be persuasive for many reasons are scared they tend to want to be more objective that subjective o that they will be able to benefit for themselves as well as those who matter most to them, this in return allows others to be informed as well. This is demonstrated through the information provided is more based on fact rather than make up stories to benefit them as a station or a group.The reports from the stations can also be subjective In ways that they assumed the reason for the man's travels and made conclusions off of Information that has not been proved to be fact. This could have been used to gain ratings by coming up with an outrageous reason for his travels. The information that was included that shouldn't have been included is that the stations report that the people that have contracted the virus here in the United States now makes it an epidemic.In reality there is no epidemi c here In the United States because there Is no mass outbreak of the virus to a lot of people. This shouldn't have been Included because It gives people the false sense that there Is a problem with the virus here in America and people have begun to make their own assumptions as to the issue and make precautions that may not be necessary at this mime. I do not think there was any information that was not included, but it seems as if information takes time to get around on the issue.When it was found out that the two nurses had the virus one nurse was able to travel causing other people to possibly be exposed to the virus. With the Issue at hand there are various social who are from America felt the man who traveled from Africa should have been allowed to die. People are not saying this to be meant and inhumane but for reasons of preventing an epidemic here in the United States.For example if the man who name here was treated and survived the virus while thousands are dying in Africa, then that news will spread and people of Africa who have contracted the virus will try to make their way to America in an effort to find a cure. On the other hand people feel like the man should have survived because we were able to treat and cure all American people who contracted the virus, but one man from Africa we could not treat and feel like the man was allowed to die. This cause caused people to feel like the people in charge of the cure or effort to treat people are monsters.Also there are people who want to restrict travel from Africa to the United States not allowing to travel to America from the area's most affected by the virus. At first nothing was done but after a while of concerned people pressuring the President for answers and results there was a plan to scan people at airports for signs of the virus. The news reports reported on this new plan to help prevent cases from entering America, and allowed people to feel relief but it was short lived.Not long after the r eports of the plan to scan people at airports, it has been also reported that signs of the virus are to easily detected at first and people can easily pass the scans and end up showing signs of the virus after they left the airport. This cause the concerns to go back up in America and people are now scared again. Most recently the new process is to also immediately quarantined people who come to America from Africa to ensure that that do not have the virus before allowing them to return to public.This has caused another issue as reports of a woman refusing to be quarantined and planned to sue because she is being kept away from her family, Job, and home. People say that it's or the protection of the country while she feels like she is being imprisoned Just because she traveled to Africa and being treated like someone with a disease. This has caused people to develop their own feelings about the situation but most agree that she should be kept in so that if she possibly did contract the virus in Africa she would not spread it to others she came in contact with.With everything that has been reported and said on the different cases of Bola here in the United States I feel that the majority of the segments are taken with face value with little nationalization for entertainment. With the issue being real and people truly concerned about what can possibly happen is there is an outbreak here in the United States, I feel the majority of the reports are for real information purposes to allow the public to know what's going on in America and how it relates to the people of the country and id the virus is a true concern here.I also feel that there is some entertainment factor here has some shows have begun to make Jokes as to how people can contract the virus and it is completely a Joke. I also hear on the radio that radio personalities are using the situation to get the opinion of the public and allow their voice to be heard on the different situations surround the viru s and people coming from Africa to return home, go to college, and other reasons for coming to the Unites States.In conclusion with so many different stories to follow in news programs there are some that catch your attention for reasons beyond entertainment. I feel like the reporting on the Bola virus are one of the reports in which you want to be he situation is very serious and a huge concern there are still people here that can make a Joke about the situation.Some people may find it funny while some may not and take offense to the things that can be said and done on the television and radio. In the end it is up to us as an individual to decide whether we will pay attention to what's going on and what's being or ignore it. Some ignore it because they know it is not a real issue at this point and will continue to until it becomes a real issue here in America. Till them we will not see people walking around in gloves and masks.