Oligopoly and possible collusion in the UK domestic utilities market Essay

Oligopoly and possible collusion in the UK domestic utilities market - Essay Example Utilities market is essential for every country and any disturbance in the utilities market can have detrimental impacts on the economy of the country. It is of utmost importance that every country ensures that the organizations involved in utilities market are operating smoothly and fairly. The following paper would analyse the domestic utilities market in UK, the organizations involved in providing domestic utilities, and the analysis of the recent hike in prices of the domestic utilities. The paper would attempt to evaluate whether the rise in price of utilities in domestic utilities market in UK is a result of oligopoly and possible collusion in the market. DOMESTIC UTILITIES MARKET IN UK Domestic utilities market in UK is a vast and diverse sector of the UK economy. It includes a number of companies that provide energy and other utility services. The UK utilities market comprises of; the oil, petroleum and gas; nuclear power and coal; water and waste management; renewable energy industries; and energy conservation organisations. The utilities market in the UK plays a significantly important in the economy of the country. ... mers, markets traditions, products and knowledge required in order to succeed in the utilities market in the UK are considerably different than those required in other industries. In other industries, the main objective of the companies is to succeed by way of earning more and more profit. The entry in other commercial industries is comparatively easier therefore the number of firms in other industries is high. The competition within an industry is determined by the number of firms and the availability of substitutes in the market, and the level of prices is determined by the extent of competition in the industry. Therefore in the commercial industries the prices of products are determined by the extent of competitiveness of the industry. This situation is completely different from that of the utilities market. Utilities market have fewer number of companies in the market therefore there is a clear tendency for high prices for the utility services therefore regulatory authorities pla y an important role in the utilities market in order to ensure that the prices of services provided to the citizens are reasonable (Simmonds 2000). Even though the utilities market is different from commercial, industrial and residential markets; it is considerably a big sector in the UK economy. From the perspective of revenue, the UK utilities industry forms a significant proportion of the overall economic growth of the country. In the year 2010, the UK utilities industry had total revenue of $126.3 billion. The most successful segment in the UK utilities industry is the electricity segment. The total revenue of the electricity segment was $57.6 billion. It has been anticipated that the industry will continue to grow and the overall value of the UK utilities industry by the end of the

Incentives can lead to improved performance Essay

Incentives can lead to improved performance - Essay Example Desirable incentives can improve employee motivation and therefore performance if constraints are applied reasonably. This paper explores the relationship that exists between incentives and employee motivation. Naturally, human beings act purposefully. The hope for a reward therefore is a powerful incentive that can motivate people to do certain things. In the organizational setup, incentives can be financial or non-financial, and positive or negative. Positive incentives are those that offer positive assurance that certain needs or wants will be fulfilled. On the other hand, negative incentives re those that are purposely applied to correct the defaults or mistakes of workers. Some common forms of incentives include job security, job satisfaction and job promotion. There are several reasons behind the promise of incentives in an organization. Some of the main reasons include to increase productivity, encourage enthusiasm, encourage job satisfaction, increase commitment, and to shape people’s behavior and attitudes toward work (Harpaz, 1990). Individuals will always do whatever they wish to do or otherwise do what they are motivated to do. Many theorists have defined motivation in various ways. Kreitner defines the term as the psychological process that defines the orientation and purpose of behavior. Others define it as the internal drive to satisfy a need that is not satisfied (Murphy, 2009). From the above definitions, motivation may be assumed to be the inner force that drives people to realize personal and organizational goals. Some of the theorists that have contributed to the understanding of motivation include Abraham Maslow (hierarchy of needs), Skinner (reinforcement theory), Herzberg (two- factor theory), Adams (equity theory) and Vroom (expectancy theory) (Terpstra, 1979). According to Maslow, there are five levels of needs. The lower level needs have

New Hire Essay Example for Free

New Hire Essay Dear Mr. Hendricks, My name is Brad Johnson and I am writing you today because I understand you are looking for a new mechanic for your racing team. I would like to inform you of my experience in order to prove to you that I am the right fit for the job that you are offering. I have been following your career as the owner of the top NASCAR team for quite some time now and have always dreamed of being involved with such a successful race team. I have looked forward to being a mechanic since my freshman year of high school. I already have a racing background and hope to expand my horizons by becoming involved with NASCAR and Hendricks racing. I am only twenty years old, but I have been racing and wrenching on my own machines and vehicles since I was nine years old. I have paid keen attention to your team’s track record and I know that your engines are some of the most reliable engines out on the track each and every week. I would like to become the head mechanic for Hendricks racing someday in the near future, but as of now I would be perfectly fine with working as an apprentice to gain my experience and hopefully take over the head mechanic position. I have not only gained mechanical experience from working on my own vehicles and machines, but I have also gathered experience from work and school. I took auto shop in high school for two years and at that moment I knew what field I was to enter after high school. I also had a part time job at fabrication shop in Morgan Hill, California. This shop was Pacific Fabrication and I worked as an intern to broaden my knowledge in the automotive field. I learned a lot at this shop and continued to pursue my career in this industry. After working as an internship for a year, I decided to take my knowledge even further by joining the ThinkBig program offered by Caterpillar at Delta College in Stockton, Ca. I have been going to school to earn my Associates degree and also to get training to become a journeyman technician. I was hired by Peterson CAT as an apprentice and have been working with Peterson for over a year now. Thankfully they have put me through school and helped me grow in the field of a dealer service technician. I love what I do but am looking to go further in life by gaining  more experience and working on machines that I truly have a passion for. To be honest, many people discount my credibility as a technician because I am very young still and may not be as experienced as most of your other tech’s that work for you, but what I lack in age and knowledge, I make up for in my willingness to learn and my ability to reach my goals. I hope you consider me for such an opportunity. I could be a beneficial asset to your company. I have always been interested in high power engines and would love to become your next engine builder. I have been racing long enough to understand that the key to winning is having high quality engines that produce great power and outlast those in competition. I believe that with time and training I could continue to produce engines for your team with just as good of a track record. I have a keen attention to detail which is a necessity when building these high output engines. When I am put to a task I do not ever cut corners to complete it. I have always put much effort into what I do. I never do anything half-way. I have always given my best effort when it comes to completing a task. With the recent advancements in technology, more and longer term mechanics are finding it difficult to work on these machines. Almost everything now days are controlled by some type of computer system. Just a few years ago the engines in NASCAR were carbureted and completely mechanical. With recent advancements in technology, these cars have all been updated to electronic fuel injection systems. Now that these engines are controlled and programmed by a computer, many older mechanics are not able to comprehend this new style of tuning and adjusting which may lead to drawbacks in your racing team. I have been trained through Caterpillar to work on these newer style engines which are all controlled by computers. Most of the work we have been taught is to use laptops to program and troubleshoot problems which is a necessity for fine tuning these engines to make the most power while maintaining reliability. All in all I am a hard working young man that is eager to learn. With the right opportunity I will become the master mechanic that the Hendricks racing team needs more than ever now with the recent advances in technology. I recognize that I am young and may not be the most experienced applicant, but with my eagerness to learn, attention to detail, and experience with these new style computer systems, I am sure that I would be a great match for the Hendricks racing  team. My background knowledge and experience with racing gives me the leading edge over those general mechanics who have not received any kind of formal training in this field. I will strive to be the best employee and technician you have ever had, and I will do all I can to continue to represent Hendricks racing as the best racing team in the history of NASCAR. Thank you for your time and consideration. Sincerely, Brad Johnson

Elements of Plato in John Donnes The Good Morrow Essay example -- Don

Elements of Plato in John Donne's The Good Morrow There are clear Platonic elements in Donne's "The Good Morrow." The idea that Donne and his lady are halves that complete each other is traceable to Plato's theory of love. Lines 7 and 8 of the poem refer to the Platonic World of Ideas: the lady is presented as the Idea of Beauty, of which all earthly beauty is but an imperfect reflection. My argument, however, is that Plato's cave allegory and his World of Ideas are integral to a full understanding of this highly complex poem. The first reference to the Platonic cave comes in line 4 of the poem: "Or snorted we in the seven sleepers' den?" The seven sleepers are seven young Christians who were walled up in a cave in the year 249. Miraculously, they did not die but slept for 187 years. This miracle of early Christianity is negatively presented by Donne and the plight of the seven "snorters" may have a relationship to Plato's cave: there are fundamental similarities between Plato's cave-dwellers on the one hand, and the seven Christians (and the biblical myth of Exodus, for that matter) on the other hand, according to Downing. In both cases, there is a God who cares for the people involved, even though they are unaware of this fact; in the first case because they are asleep, in the second because they mistake shadows of shadows for reality. They are both trapped in a cave from which they apparently cannot escape. And they both dwell in darkness. In a poet of Donne's complexity, it is not far-fetched to argue that line 4 refers both to the seven Christians and to Plato's cave-dwellers, and that Donne wished us to read it in precisely this way. Such an argument is reinforced by the fact that the line is immediately followed by... ...a Platonic Idea is, of course, a paradox, as the World of Ideas is not only deathless but supposedly has existed since the beginning of time.) Alternatively, one can argue that Donne (or his poetic voice) experiences a transient relationship in this poem that may or may not develop into a Platonic Idea. Like Plato's cave-dwellers who came out into the light, however, he has learned a great deal and become capable, as a consequence, of achieving the Platonic Idea of sexual love in a possibly new, deathless encounter that is "mixed equally." WORKS CITED Donne, John. "The Good Morrow." The Oxford Anthology of English Literature. Vol. 1. Ed. Frank Kermode and John Hollander. New York: Oxford UP, 1974. 1024-25. Downing, Christopher. "How Can We Hope and Not Dream? Exodus as Metaphor: A Study of the Biblical Imagination." Journal of Religion 48 (1968): 35-53.

Global Warming, Human or Nature’s Fault?

Along a busy street, a bearded man looking like a prophet is ringing a medium-sized bronze bell in his right hand and holding a sign in his left hand which reads, â€Å"The end is near.† Is humanity to blame or is it just an environmental phenomenon that is induced by nature?This is the overlying debate that has been revolving around the minds of the people of the world. On one hand, there are those who argue that the threat of global warming is human-induced. While on the other hand, there are also those assert that nature is truly the responsible for this. The issue on global warming has always been put as an agenda in the international community for several years now. However, it has only been in the year 2007 that global warming has been given the attention it warrants or deserves.The recent facts and studies made and collected by numerous countries, agencies and organizations across the world have come to an agreement that the world is facing a substantial threat that may cause catastrophic consequences or results that may alter the history of mankind itself. Therefore, in order to battle this threat, the world is trying to understand the primary cause that is making this phenomenon. In doing so, society is looking at either the human explanation or the natural one.Those who are proposing that global warming has been a human-induced product rely on several factors. First of all, they say that the greenhouse gases have been contributing a significant amount of damage that is drastically changing the world’s climate. The major greenhouse gas contributing end-user sectors are the industrial, transportation, residential, commercial and agricultural (U.S. Greenhouse Gas Reports).Moreover, the pollution brought by cars and other heavy machineries such as equipments used in factories are making the atmosphere worse every minute. The fact is that in the United States, more than 90% of greenhouse gas emissions come from the combustion of fossil fuels (U.S. EPA). There are also the problem of dumping garbage and other waste materials. Another factor for human’s induced climate change is deforestation due to the prevailing focus on progress and development.The main cause of deforestation in some countries is the growing population and subsequent higher demand for agriculture, livestock production and fuel wood (Sucoff, 2002, pp. 358 – 359). Finally, the government and private corporations are cutting costs when it comes to being environmentally friendly.The problem or the excuse most are saying is that economic profits or gains will be cut and funds will be needed for the environmentally friendly technologies (Rudiman, 2005, p.153).Others who are proposing that global warming is nature-induced are forwarding the data and research they made scientifically. The basis for their proposal states that global warming is just an environmental phenomenon made by nature itself. They are proposing that this incident have happen ed already in the past as part of a normal cycle the world goes through (Trenberth, 1997).Moreover, there is even geological evidence which states that the earth's climate changes quite a lot; sometimes colder than today and sometimes warmer.   Some have suggested changes in the sun's output of radiation, or changes in the amount of dust in the atmosphere from volcanoes or meteor impacts as natural causes.The earth's climate changes in response to external forcing, including variations in its orbit around the sun and also volcanic eruptions (Robock & Oppenheimer, 2003, p. 360). In addition, the atmosphere to trap reflected sunlight and thus cause the atmosphere to heat up.The two sides are trying to understand the cause of this phenomenon to further gain valuable knowledge and information in dealing with it. But in essence, it is undeniable that global warming poses a substantial threat to society.Works CitedRobock, Alan, and Clive Oppenheimer. Volcanism and the Earth’s Atm osphere,   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Geophysical   Ã‚   Monograph 139, American Geophysical Union, Washington, DC, 360, 2003.Ruddiman, William. â€Å"How Did Humans First Alter Global Climate?† (PDF). March 2005 issue. Scientific American. 153, 2005.Sucoff, E. Deforestation. In Environmental Encyclopedia. (P.g.358-359). Detroit: Gale, 2003.Trenberth, Dr. Kevin. Global Warming: It’s Happening. Natural Science, December 4,   Ã‚   1997.US EPA. Inventory of U.S. Greenhouse Gas Emissions and Sinks: 1990-1998,   Ã‚   Rep.   Ã‚   EPA   Ã‚   236-R-00-01. US EPA, Washington, DC, 2000.U.S. Greenhouse Gas Inventory – U.S. Greenhouse Gas Inventory Reports | Climate   Ã‚  Ã‚  Ã‚  Ã‚   Change – Greenhouse Gas Emissions | U.S. EPA

Woolly Rhino (Coelodonta) - Facts and Figures

Name: Woolly Rhino; also known as Coelodonta (Greek for hollow tooth); pronounced SEE-low-DON-tah Habitat: Plains of northern Eurasia Historical Epoch: Pleistocene-Modern (3 million-10,000 years ago) Size and Weight: About 11 feet long and 1,000-2,000 pounds Diet: Grass Distinguishing Characteristics: Moderate size; thick coat of shaggy fur; two horns on head    About the Woolly Rhino (Coelodonta) Coelodonta, better known as the Woolly Rhino, is one of the few Ice Age megafauna mammals to be memorialized in cave paintings (another example is the Auroch, the precursor to modern cattle). This is appropriate, since it was almost certainly hunting by the early Homo sapiens of Eurasia (combined with inexorable climate change and the disappearance of its accustomed food sources) that helped drive Coelodonta into extinction shortly after the last Ice Age. (Clearly the one-ton Woolly Rhino was coveted not only for its copious meat, but for its thick fur pelt, which could clothe an entire village!) Aside from its Woolly Mammoth-like fur coat, the Woolly Rhino was very similar in appearance to modern rhinoceroses, its immediate descendants--that is, if you overlook this herbivores odd cranial ornamentation, one big, upward-curving horn on the tip of its snout and a smaller one set further up, nearer its eyes. Its believed that the Woolly Rhino used these horns not only as sexual displays (i.e., males with bigger horns were more attractive to females during mating season), but also to clear hard snow away from the Siberian tundra and graze on the tasty grass underneath. One other thing the Woolly Rhino shares in common with the Woolly Mammoth is that numerous individuals have been discovered, intact, in permafrost. In March 2015, headlines were made when a hunter in Siberia stumbled across the well-preserved, five-foot-long, hair-covered corpse of a Woolly Rhino juvenile, later dubbed Sasha. If Russian scientists can recover fragments of DNA from this body, and then combine them with the genome of the still-extant Sumatran Rhino (the closest living descendant of Coelodonta), it may one day be possible to de-extinct this breed and repopulate the Siberian steppes!

Hydration management in acute stroke patients - Free Essay Example

Sample details Pages: 12 Words: 3680 Downloads: 4 Date added: 2017/06/26 Category Statistics Essay Did you like this example? Introduction Stroke is a global public health concern with many sufferers presenting with varying levels of confusion (Oh and Seo 2007). Management of hydration in acute stroke patients is not standardised and variations in practice can be very wide between different continents. The sheer number of possible comorbidities and the relative ease with which hydration can trigger concomitant problems can lead to increasing incidence and prevalence of long-term patient care resulting from inadequate hydration management. Don’t waste time! Our writers will create an original "Hydration management in acute stroke patients" essay for you Create order Optimum hydration assessment and management are key clinical activities; however, inadequate hydration controls by health professionals persist (Oh and Seo 2007). Research shows that to guide fluid management to desired levels, a regular assessment of the volume status has to be made Scope This literature review is based on works that are found on Medical Literature Analysis and Retrieval System Online (MEDLINE), the Cumulative Index to Nursing and Allied Health literature (CINAHL), Cochrane, Department of Health (DoH), National Institute of Clinical Excellence (NICE), National Medical Council (NMC), World Health Organisation (WHO), Wiley Interscience and CKS databases that relate to hydration in stroke patients and nursing awareness of hydration in stroke patients. There is wide literature on different aspects of stroke and many authors have studied the effects of hydration in stroke patients. This review looks at literature that discusses management of hydration and/or the impacts of variations in hydration management on acute stroke patients outcomes like method of feeding, time- compliance in taking readings or measurements, legal issues and ethical issues. Relevance to clinical practice This literature review looks at relevant studies by experts that are found on credible databases. The purposes of the expert studies are reviewed and analysed to inform better understanding of current nursing practice in hydrating acute stroke patients. Several studies on hydration highlight specific difficulties relating to the assessment and management of hydration in acute stroke patients. There are differences between the management and the assessment of hydration in different hospitals and these complicate improving awareness of managing hydration for nurses in practice. If optimum hydration is directly linked to improved outcomes in acute stroke patients, research will be required to identify and overcome barriers to effective hydration management, including the development of specific tools (and knowledge base) to facilitate interventions that promote optimum hydration in seeking improved outcomes in acute stroke patients. Methods of search and documentation n on-line literature search of MEDLINE, CINAHL, COCHRANE, DOH, NICE, NMC, WHO and CKS from 1999 to May 2009 failed to identify enough relevant articles on hydration in stroke patients. Other sources were then reviewed for available literature on medical journals including the BMJ and American Family Physician. For the on-line computer-based literature searches, the following keywords were used: stroke, fluid balance, hydration, cerebrovascular accident (CVA), dehydration, stroke outcome, cerebrovascular disorders, medical management, artificial nutrition and hydration, dysphagia, dysphasia, pyrexia, acute brain infarction, enteral tube feeding, fluid and electrolyte balance, neurology, withholding treatment, pathophysiology and nurses and hydration Hydration and hydration management in acute stroke patients This literature review looks at one of the issues encountered globally in the treatment of acute stroke patients optimum hydration. It takes a particular look at the nursing awareness, measurement, assessment, methods of intervention and the legal issues associated with hydration in acute stroke patients. Stroke is a debilitating condition and can be caused by an ischaemic event or a subarachnoid/intracerebral bleeding. Stroke patients usually present in hospital with co-morbidities (Oh and Seo 2007). Variations exist in stroke fatalities across geographical regions even within the same continent. Studies by Bhalla et al (2003) across four European centres (London, Dijon, Erlangen and Warsaw) have shown significant variation (after adjusting for case mix) in stroke case fatality, in incontinence, dysphasia, dysphagia, conscious level, pyrexia, hyperglycaemia and comorbidity. There were also significant intervention differences between centres in intravenous fluid use, enteral feedin g, initiation of new antihypertensive therapy and insulin therapy, with the London centre having the lowest uptake of interventions. In another European BIOMED Programme, significant variations in case fatality for stroke between European centres (after adjustment for stroke severity) were observed, with the United Kingdom (UK) centres having the highest case fatality and the lowest levels of independence (Wolfe et al., 1999). There were lower intervention rates in the UK centre to correct abnormal physiological parameters in the acute phase which may reflect a difference in philosophy of acute medical supportive care compared with other European countries (Wolfe et al., 2001). Awareness of optimal hydration balance and assessment of the patients hydration condition (in the care of acute stroke patients) is a fundamental part of critical care nursing and optimising the hemodynamic situation can be seen as a team-effort. One of the important factors determining quality of the circula tion is the amount of circulating blood (Hoff et al 2008). Following a stroke, patients may have swallowing impairment and other changes of the gastro-intestinal (GI) tract that could affect nutritional and hydration status and that lead to aspiration pneumonia (Schaller et al 2006). Such changes affect the ability of the acute stroke patient to lead a normal nutritional life. Although the Schaller et al (2006) work did not show a direct link between hydration and other comorbidities, they agree that impaired hydrational status is associated with reduced functional improvement, increased complication rates, and prolonged hospital stays. Hydration and hydration status Hydration balance is a measure of the bodys ability to manage fluids and electrolytes. In order to identify the urgency of interventions, nursing staff should characterize an individuals fluid and electrolyte imbalance as mild, moderate, or severe based on pertinent information including lab tests and other relevant criteria. It is important to recognize that the main electrolyte in extracellular fluid (ECF) is sodium and that of intracellular fluid (ICF) is potassium (Edwards, 2001). Toto (1998) pointed out that large increases or decreases in fluid volume can cause infarct, coma and confusion. This knowledge becomes significant in maintaining cerebral blood flow and in preventing secondary brain insult after an acute stroke. In a complication, respiratory or metabolic acidosis will promote the movement of potassium from the ICF and give rise to high serum potassium levels, which may affect cardiac function (Edwards, 2001). This phenomenon can be seen in many traumatic insults to th e brain. A basic knowledge of this physiology in addition to the homeostatic mechanisms for fluid and electrolyte balance is a vital foundation for nursing practice, and essential to the nurses role in hydration management. Cook et al (2005) highlighted the significance of fluids and hydration in the neuroscience patient and in Cook et al (2004) they highlighted that an understanding of the physiological mechanisms that surround stroke is important for nurses to monitor and treat such patients. Kelly et al (2004) in their study of dehydration and venous thromboembolism (VTE) after acute stroke believed dehydration after acute ischaemic stroke (AIS) is strongly independently associated with VTE, reinforcing the importance of maintaining adequate hydration in these patients. Their study of hydration over a 9-day period showed indication that dehydration was largely hospital acquired and that the association was causal. Although the possibility that VTE was already present at entry to hospital cannot be discounted, tests have shown that VTE is rarely present before the second day post stroke, and then it becomes increasingly prevalent over the next few days. This could be for one of many reasons including poor communication between patient and hospital staff, change of environment for the patient and the physiological impacts of stroke Hydration balance and nutritional/electrolyte balance The differences in how hydration is assessed in different hospitals have been subject of study for some time. The significance of fluid electrolyte homeostasis becomes very relevant in trauma and shock situations such as subarachnoid haemorrhage where an inflammatory response is triggered which causes a significant change in capillary membrane permeability in a short period of time. In such situations, water, electrolytes and albumin move into the interstitial space to permit the site of injury to receive the required factors (third space shift) (Edwards, 2001). A number of physiological mechanisms are required to maintain homeostasis of hydration status, all of which inform proactive nursing assessment, intervention and evaluation. Those with trauma to the nervous system are vulnerable to disruption to the homeostasis of fluid and electrolyte balance (Cook 2005). Older adults may have a poorer capacity to adapt to shifts in acute fluid balance, leading to the possibility of cardiac and renal functions being impaired and, as a result, a lower glomerular filtration rate (Sheppard, 2001). Managing the fluid balance of the stroke patient by intake and output measures needs to be exercised cautiously because even though the patients fluid volume may not have changed, his/her circulatory volume may be significantly lower in instances of major trauma (Edwards, 2001) Good hydration has been shown to reduce the risk of urolithiasis (category Ib evidence) (see Appendix 2), constipation, exercise asthma, hypertonic dehydration in the infant, and hyperglycemia in diabetic ketoacidosis (all category IIb evidence), and is associated with a reduction in urinary tract infections (UTIs), hypertension, fatal coronary heart disease, venous thromboembolism, and cerebral infarct Complications of measurement/control Naso-gastric v PEG, enteral v parentera Patient history taking on presenting in the hospital differs from hospital to hospital. History taking should include assessment of fluid intake and loss, baseline hydrational status, skin turgor, heart rate, blood pressure and urinary output. Normal fluid intake for the average adult is approximately 2-2.5 litres, obtained from food, fluids or metabolic by-products (Edwards, 2001). Methods of measurement are not standardised across hospital settings with Wise et al (2000) showing that faecal fluid losses are often neglected in daily fluid balance charts with the possibility of inaccurate hydration assessment. Fluid assessment must include estimating, as accurately as possible, the quantity of fluid taken in. It must take into consideration the entire processes by which water, potassium and sodium are obtained. Measurements are often mainly focused on the extremes of hydration (optimal hydration and extreme dehydration) and this should not be the case. Assessment of hydrational statu s and need is continuous and begins somewhere along a continuum of severe hypovolaemia/ dehydration to severe hypervolaemia/ overhydration. In looking at dehydration, not only extreme dehydration should be noted. Manz and Wentz (2005) highlight that there is increasing evidence mild dehydration may also account for many morbidities and play a role in various other morbidities. The way in which stroke is managed acutely, such as measures maintaining physiological homeostasis may also vary between different populations (Bhalla et al 2003). The physiological indicators of acute deficits in fluid balance may be masked in individuals where compensatory mechanisms are intact. A history of acute events, mainly from baseline documentation and history taking, may enable better identification of such imbalances (Sheppard, 2001). Fluid and electrolyte homeostasis is brought about by the interaction between the renal, pulmonary, neuroendocrine, integumentary and gastrointestinal systems (Edward s, 2001). According to (Cook 2005), fluid and electrolyte management is a fundamental aspect of the role of the neuroscience nurse. Artificial feeding and fluids are the options for a patient who has an advanced, life-threatening illness and is dying. The patient, family members and doctor can talk about these options and the benefits and risks (Ackermann 2000). Hydration and electrolyte status are crucial mediators to the extent of the neuro-hormonal response to trauma. Edwards (1998, 2001) highlighted that homeostasis is maintained by a constant movement of water, sodium and potassium between intra- and extracellular compartments. While the movement of water and electrolytes between the cellular compartments is highly significant, it is important to recognize that in acute and chronic illness intracellular fluid (ICF) is reduced and extracellular fluid (ECF) increased almost to the extreme (Edwards, 2001). This is highly relevant for cerebral metabolism, because transport of oxyge n, glucose, proteins and other products for cellular metabolismà ¢Ã¢â€š ¬Ã¢â‚¬ and their by-productsà ¢Ã¢â€š ¬Ã¢â‚¬ may be severely impaired. Stroke may affect ones level of alertness, perception of thirst, ability to access liquids, and ability to swallow them when offered. Stroke victims with such impairments may be at increased risk for diuretic-induced dehydration (Churchill et al 2004). Managing hydration balance is of crucial importance and the mechanisms for the adequate monitoring and controls need to be in place. Nursing management questions in the assessment of hydration in acute stroke patients should include whether use of intravenous fluids during the first week of stroke was recorded. Questions should also include whether the patient was fed orally, by nasogastric tube, through percutaneous gastrostomy tube, by intravenous methods or not at all? The fact that these questions can be raised enforces the need for adequate documentation and recording of acute stroke pa tient records. Bhalla et al (2002) says that the use of artificial ventilatory support with intubation or nasal intermittent positive pressure ventilation should be documented as well as the use of supplemental oxygen given through nasal catheters or masks. Enteral tube feeding is a vital means of feeding and balancing hydration levels in patients with stroke. There are no set standards for hospitals in the UK and hospitals have recorded much variation between them in the timing of the start of enteral tube feeding and whether a nasogastric or percutaneous endoscopic gastrostomy (PEG) tube is used (Ebrahim and Redfern 1999). Some clinicians delay tube feeding for 2 weeks or more, and although early nutrition is unlikely to be harmful, whether any nutritional benefits offset the difficulties and complications of initiating and maintaining early enteral tube feeding is unclear. If the timing or route of enteral tube feeding does affect outcome, the present variation in practice means that large numbers of patients are being denied best treatment. Whether enteral tube feeding via PEG rather than nastrogastric tube or early initiation of enteral tube feeding improve outcomes was tested in the FOOD trials and no evidence of significant benefit from PEG rather than nasogastric tube feeding was found. Neither was any hazard from early tube feeding found (The FOOD collaboration 2003). The explanation for any difference between PEG and nasogastric groups is not clear, but one factor might be the effect of a long-term PEG tube on dependency since more patients in the PEG group were still receiving such tube feeding than in the nasogastric group at follow-up (The FOOD collaboration 2003). The survivors in the PEG group were also more likely to be living in institutions and had lower quality of life. Another intriguing finding was the excess of pressure sores in the PEG group, raising the possibility that those with such tubes might move less or be nursed differently. Wea knesses in this test results include insufficient statistical power to exclude more modest differences between groups; no information about the proportion of eligible patients enrolled in each centre; our use of an informal (although reliable and highly predictive) assessment of nutritional status; absence of precise monitoring of patients daily intake of nutrients (rather than fluids); absence of on-site source data verification or collection of information on changing nutritional status (e.g. in-hospital weights); possible bias due to masking of secondary outcome measures. Although compliance was not 100%, this fact results from the inevitable difficulties of adhering to rigid schedules when patients conditions change. Difficulties with nasogastric feeding in stroke patients (who are often confused and uncooperative) have led to increasing use of PEG tubes at an early stage. Enthusiasm for this method has been encouraged by the results of a trial that reported much lower case fata lity rates in patients fed via PEG (13%) rather than nasogastric tube (57%) (The FOOD trial collaboration 2003). Due to significant alterations in fluid balance after enteral tube-feeding in patients, close attention to the recording of fluid balance such as intake/output measurements, body weights and simple bedside assessments is needed to detect fluid imbalances and other serious complications at an early stage (Oh and Seo 2007). One explanation for the varying and inconsistent readings in fluid hydration between enteral and PEG might b Stroke patients and the impacts of stroke on life Difficulty with swallowing is a common problem in acute stroke patients, and can lead to aspiration pneumonia, dehydration, and exacerbation of any existing malnutrition (Finestone and Greene-Finestone 2003). In Oh and Seo (2007) the authors set out to examine the fluid and electrolyte complications after enteral tube feeding in acute brain infarction patients. The background is that inconsistencies in the results of the water and electrolyte complications associated with enteral tube feeding are partly because of uncontrolled disease-related variables. The implication is that these variables were not adequately managed. Stroke patients very often present with dysphagia and this is very commonly dehydration associated with undernutrition (The Food Trial 2005). Up to half of stroke patients in hospital have dysphagia, which precludes safe oral nutrition for the first few days and can persist for long periods (Mann et al 1999). Although a 50% prevalence can be considered to be high, th e nutritional/fluid status of a stroke patient can rapidly deteriorate in hospital. The difficulty in feeding stroke patients with dysphagia coupled with the discomfort associated with stroke can exacerbate undernutrition and/or dehydration. Studies show that undernutrition shortly after admission is independently associated with increased case fatality and poor functional status at 6 months (The FOOD trial collaboration 2003). The current financial burden of efficiency savings and reduced budgets in the NHS hospitals results in reduced staff numbers so that patients can not be attended to on a one-on-one basis so that ensuring appropriate hydration levels is done by periodic but regular monitoring of charts. An option for the future in this area may be to involve the patients family members in hydration monitoring and provide them with appropriate training if evidence can show that being around loved ones improves outcomes and early warnings. In acute stroke, artificial nutrition t hrough an enteral route is needed because of dysphagia and since oral feeding is unsafe in some dysphagic patients, enteral nutrition is often administered as nasogastric or percutaneous endoscopic gastrostomy (PEG) tube feeding (Finestone and Greene-Finestone 2003). Naso-gastric tube feeding (a prevalent enteral method) has been reported to improve clinical outcomes more than the parenteral route in brain-injured patients (Rhoney et al 2002). Oh and Seo (2007) in their study used 85 subjects, but their work was limited by the fact that it was performed retrospectively and some of the subjects records were incomplete. Also, because the patients in the study were from one hospital it is not conclusively known whether the results can be generalised to the whole population./p Legal and other aspects Japanese physicians attitudes towards artificial nutrition and hydration (ANH) as a life-sustaining treatment (LST) were examined to find out if they withhold or withdraw the LST when treating older adults with stroke-caused profound impairment with no hope for recovery. The study findings show that the informants held different views towards LST because most doctors considered ANH to be indispensable and ANH is automatically provided to patients (Aita and Kai 2006). With the advancement of medical technology, decisions to withhold or withdraw LST are among the most difficult to make for health professionals (British Medical Association 2001). Physicians caring for stroke patients often encounter comatose or semi-comatose patients with severe stroke for whom it is difficult to determine whether or not to continue care (Asplund and Britton, 1989). By administering LST, some patients in this patients group, whose bodily functions other than brain function could remain stable, could pot entially survive for months or years without achieving awareness or being able to interact with others (Aita et al 2008). Certain Japanese physicians have criticized the current efforts regarding life prolonging as Aita et al (2008) states: Prolonging the process of dying like this constitutes the violation of dignity and human rights. The life-prolongation only serves hospital operators who want to make profits by keeping hospital beds occupied. They also said this practice impacted the carers and that some nurses also feel emptiness toward the manipulative life-prolongation when taking care of these elderly patients. In the West, some countries have worked out nation-wide guidelines related to withholding or withdrawing LST that say stroke-caused profound impairment with no hope for recovery is a potential reason to withhold or withdraw LST (British Medical Association, 2001). Ackermann (2000) believes withholding and withdrawing therapy challenge family physicians to be excellent communicators with patients and families and recommends that family physicians should continue to be strong advocates for dying patients. Sprung et al (2003) highlighted differences between withholding and withdrawing therapy showing that withdrawal of therapy is followed by a nearer and more rapid death than withholding therapy, and that physicians and nurses were more inclined towards withholding rather than withdrawing therapy. Food and water are considered symbols of caring (Ackermann, 2000), therefore, it may be natural for physicians to give a special status to ANH as food and water. Whether to withdraw ANH from a patient in persistent vegetative state has also drawn substantial media attention in the U.S. (Casarett et al., 2005; Ganzini, 2006). The findings of the study also suggest that the physicians double standard is partly based on their subjective judgment whether the treatment is ordinary or extraordinary. However, the standard of ordinary/extraordinary care has long been criticized as too vague to guide decision-makers in the U.S. (Beauchamp and Childress, 2001). It is believed the current legal framework has also inappropriately led some physicians to simply continue care regardless of the patients conditions, thus resulting in putting an unnecessary burden on patients. The physicians subjective interpretation of the current legal framework may lead to decisions not to initiate mechanical ventilation in some older adults for fear of facing a situation in which physicians cannot withdraw it at a later stage Conclusion Hypovolemia and hypervolemia occurred frequently after acute stroke but were often not recognized as such by nurses. The nurses predictions of current volume status do not seem sufficiently reliable to serve as a basis for therapeutic decisions. More advanced techniques for bedside assessment of volume status may be indicated for optimizing volume status in patients with acute stroke (Hoff et al 2004). Whereas studies have looked at the optimal method of improving hydration, whether correcting dehydration in stroke improves outcome is not very clear. Given the complexity of the cell death cascade following brain ischemia, novel approaches and combination therapy are inevitable for victims of stroke (Fisher and Brott 2003). The review indicates that standards vary from country to country in the legal framework for withdrawing and withholding hydration and nutrition during end stage care.