Congestive Cardiac Failure: Causes and Effects

Congestive Cardiac Failure: Causes and Effects Analyse Health Information – Case study The scenario relates to Mr Alby Wright who has been admitted into your ward. His patient history and admission form is available for you to review. Mr Wright’s admission states that he has heart failure (congestive cardiac failure). Clearly define heart failure. What organs and which body systems are affected by this disorder? Congestive heart failure is a condition where the heart muscle becomes less strong and is unable to pump as well as it usually would. The ventricles which most important pumping chambers become bigger or thicker and aren’t able to squeeze or relax as well as they should be able to. This makes it easy for fluid retention to occur especially in the legs, abdomen and lungs (better health channel. 2013). This is all usually caused by diabetes, coronary heart disease, previous heart attack, high blood pressure and or other conditions that have damaged the heart and made it weak. Sometimes the fluid that gets in the lungs and it makes it uneasy to breathe and causes shortness of breath when the person is lying down on their back. This is called pulmonary oedema and can cause other respiratory issues if it not treated (American heart association. 2012). Generally if someone was to have heart failure, it would occur on the left side first mostly but can occur in both sides. If someone is experiencing left side heart failure, the left ventricle doesn’t fully empty and is unable to distribute enough oxygen rich blood around the body which causes heightened pressure in the upper chambers of the heart and the veins that are close to the area which is called systolic failure. Because of the build-up of blood in there, it can cause oedema in the legs, lungs and abdominal organs. The kidneys are affected by this hinders the way that they work and it leads to salt and water retention which causes further oedema. In some cases of heart failure, instead of not being able to pump blood around properly out of the left ventricle there is also unsuccessful relaxation of the left ventricle because the muscle has gone stiff which leads to blood pooling (better health channel. 2013) and also that the heart isn’t able to fully fill with blood during the resting period between each heartbeat (American heart association. 2012). Right sided heart failure usually happens because of left sided failure. When the left ventricle has failed, more fluid pressure is then transferred back through the lungs which damages the right side of the heart. When the right side of the heart loses the strength to properly pump, blood builds up in the veins and that causes swelling in the legs and ankles. The cardiovascular system is affected the most by congestive heart failure. The heart has been weakened and is unable to pump blood efficiently and doesn’t function properly in general and the muscle is also weakened. The respiratory system is affected because of the fluid in the lungs which is also known as pulmonary oedema. This can affect your breathing and leave you short of breath. Fluid may also build up in the liver resulting in an impaired capability to get rid of the body’s toxins and to produce the proteins that the body needs to live. The intestines can become not as good at absorbing nutrients and medicines as that would have when they were healthy (providence health network. 2014) Give a brief overview of the normal function of the body systems affected by this disorder. Cardiovascular system is most affected by this disorder. The functions of this system are to basically keep the blood running and pumping through by the arteries, veins, and capillaries (cliffs notes. 2013). The blood carries important nutrients around the body and helps to remove metabolic waste. The heart, blood vessels and blood help to regulate body temperature by controlling the blood flow to the surface of the skin. The white blood cells help to protect the body from foreign toxins and pathogens. Platelets help to clot blood so that you won’t have excessive blood loss and stop bleeding (cliffsnotes. 2013). Respiratory system function is so you can breathe and supply oxygen to your whole body (how stuff works. 2014). This works by breathing; inhaling oxygen filled air and exhaling carbon dioxide air. First you breathe in air through your nose and mouth and it travels down the windpipe and through the bronchial tubes then into the lungs. The diaphragm and abdominal muscles and make the lungs contract and expand so that you are able to breathe in and out. The bronchial tubes connect to blood vessels which carry blood through your body and exchange gases. The digestive system absorbs and moves the nutrients around the body that it needs to work well and gets rid of what the body doesn’t need as waste. First there is ingestion which is when eaten and then makes its way down into the stomach to be stored and waits for digestion. It then moves into the small intestines where the enzymes and bile work to break down the food where the body can absorb more nutrients that it needs and it continues on its way to the large intestine where it absorbs more fluid to make the solid faeces and moves through and gets excreted as waste (how stuff works. 2014). The liver aids in breaking up fats, absorbing them and digesting them. Urinary system works along with other parts of the body such as skin, lung and intestines to keep up the stability of chemicals and water in the body (live science. 2013).This system’s role is to filter and excrete. Kidneys work at reducing blood pressure by reducing the blood volume. The body filters blood to create urine which goes into the bladder and the bladder fills up until it is full and ready to excrete waste that the body does not need which is urination (live science. 2013). 3. Define the signs and symptoms of heart failure, and explain why these signs and symptoms occur. Breathlessness or shortness of breath is a symptom because when the heart starts failing, the blood in the veins gets backed up in the pulmonary veins because it cannot cope with the supply while trying to carry oxygenated blood from the lungs to the heart. At this point, the fluid is starting to pool in the lungs which hinders regular breathing. A person suffering heart failure may suffer with breathlessness upon exertion including exercise or other activities. As the condition progresses, breathlessness or shortness of breath may even be present while at rest or even sleeping which may cause the person to wake up (USCF medical center. 2014). Fatigue occurs when heart failure develops and worsens; the heart cannot pump the adequate volume of blood that is needed to meet all of the body’s needs. To make up for this, the blood is taken away from less vital such as the limbs to supply the heart and brain. Because of this, people suffering with heart failure usually feel tired, w eak and have difficulty doing normal tasks such as walking, going up stairs, or even carrying items. (USCFmedicalcenter.2014). Someone suffering shortness of breath as a symptom of heart failure will also experience fatigue if they are being woken up with breathing difficulties while they are sleeping. Chronic coughing and wheezing is a symptom because of the fluid backup in the lungs which may cause a thick, whitish mucus like substance called phlegm to be coughed up from the lungs which may even be tinged pink from traces of blood (USCFmedicalcenter.2014). Rapid or irregular heartbeat is a symptom because it may speed up to make up for its inability to pump blood around the body properly. People suffering this in heart failure may experience a fluttering sensation of heart palpitations, or a heartbeat that they are aware of and seems irregular or out of the normal rhythm. It may feel like the heart is racing or pounding hard (USCF medical center. 2014). Lack of appetite/ nausea be cause the digestive system isn’t as vital as the heart or brain so the blood has been pulled away from the digestive systems to these areas instead which means there will be problems with digestion including the feeling of fullness or sickness even though they have not eaten anything (USCF medical center. 2014). Confusion/ impaired thinking because unusual sodium levels in the blood and lessened blood flow to the brain can cause bafflement or memory loss even know the person suffering with this may not even realise, and someone else may pick up on this sign before they do (USCF medical center. 2014). Oedema or swelling due to restricted blood flow to the kidneys which means that they produce hormones which lead to the retention of salt and water. This causes swelling of (most often) in the legs, ankles, and feet. Oedema may also cause weight gain (USCF medical center. 2014). Rapid weight gain can occur as a result of oedema and the fluid retention (USCF medical center. 2014). Heart grows in size because it wants to make its pumping power greater so the muscle mass in the heart gets bigger to make this happen. The chambers inside of the heart also grow larger and stretch so that they can fit more blood in. While the heart grows in size, the cells that control its contractions also grow with it. An enlarged heart does not function as well as a normal sized one and the added muscle mass puts stress on the whole cardiovascular system (USCF medical center. 2014). The heart pumps faster as it tries to circulate more blood around the body. If the heart pumps blood too fast for a long period of time, it can damage the heart muscle and hinder its regular electrical signals, which can cause an unsafe heart rhythm disorder (USCF medical center. 2014). Blood vessels narrow because less blood is flowing through the veins and arteries and that means blood pressure can drop to seriously low levels. Because of this, the blood vessels narrow which keeps the blood pressure higher while the hearts power decreases. Narrowing of the blood vessels also limits the amount of blood that can flow through which may contribute to other conditions such as heart disease, clogged or blocked vessels in the legs or other body parts, or stroke (USCF medical center. 2014). Blood flow is diverted away from less vital areas such as the limbs when there is not enough of it to meet the body’s needs and gets given to more crucial organs such as the heart and brain which are the most important for survival. This can cause limb weakness due to lack of blood in the areas. The areas where the blood is diverted from may deteriorate over time from a lack of oxygen (USCF medical center. 2014). Increased urination at night because if the patient suffering heart failure lays down all day, the fluid that has been accumulating in their legs all day may move back up into the blood stream and gets taken to the kidneys and is excreted as urine (heart failure matters. 2014). Low blood pressure because the hearts power has decreased and the veins have narrowed. Chest pain if your heart failure is due to a heart attack. List the information taken on his admission that demonstrates these signs and symptoms. Cyanotic Appetite loss Confusion and anxiety Low blood pressure Temperature below 35.8 degrees Sa02: 87% on air Respirations: 32 Low blood pressure Constipation Do you think his diabetes is related to his leg ulcer and amputated left toe? Explain. Yes. High blood sugar levels in diabetic patients damage nerves and blood vessels which results in poor circulation to the feet and may cause ulcers, infection, and amputation. This is more likely to happen if the patient has had diabetes for a long amount of time, they smoke, they don’t move around much, or their blood glucose levels have been high for an extended period of time (diabetes Australia. 2014). One of the medications he is taking is Lasix. What is the action of Lasix? Which body systems are affected by it? Explain why you think Mr Wright is ordered Lasix. Lasix is a diuretic. It increases the amount of urine that is made in the kidneys and excreted as waste (c health. 2014). It is also used to regulate and control slight to moderate high blood pressure. It affects the urinary system because it involves the kidneys and the cardiovascular system because it involves the heart. I think that Mr. Wright is ordered Lasix to get rid of the excess fluid that would be built up in his body and to lessen the oedema. List three conditions in Mr Wright’s relevant medical history that are commonly associated with ageing. Glaucoma Type 2 diabetes Arthritis Using Mr Wrights admission history and assessment, list the factors that may impact on his safety whilst in hospital and when he returns home. Hypotensive- low blood pressure He needs a walking stick because he is unsteady on his feet He gets anxious, especially about his dog. This can sometimes cause an asthma attack. He gets confused His vision is impaired and gets blurry after he has eye drops and he also needs reading glasses. What other health professionals will be involved in his care and what services can they provide for Mr Wright. Paramedics will care for Mr Wright in the ambulance and pass him over to emergency. Mr Wright needs a doctor to in emergency to diagnose him. General Nurses will be involved to provide care for him and to care for his wounds. A diabetes educator can be involved to help him to understand the needs of his condition and set up an action plan and give him support. A dietician can also help with this condition and set up meal and nutrition plans etc. Exercise physiologist assists patients to have a physical lifestyle to prevent and manage chronic conditions. A pharmacist will dispense his prescriptions so he can have medications and to give information on them. He may be able to talk to a psychologist to improve his anxieties, especially about his dog (better health. 2013). List the nursing documentation you would expect to be used in the care of Mr Wright. Progress notes Medication chart Vital signs chart Nursing history and assessment Care plan Asthma action plan FBC- fluid balance chart Wound monitoring chart Falls risk assessment (tafesa. 2014) UCSF medical center. 2014. heart failure signs and symptoms. [ONLINE] Available at: http://www.ucsfhealth.org/conditions/heart_failure/signs_and_symptoms.html. [Accessed 04 April 14]. heart failure matters. 2014. need to urinate at night. [ONLINE] Available at: http://www.heartfailurematters.org/en_GB/Understanding-heart-failure/Need-to-urinate-at-night. [Accessed 08 April 14]. better health channel. 2013. congestive heart failure. [ONLINE] Available at: http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Congestive_heart_failure_%28CHF%29. [Accessed 08 April 14]. American heart association. 2012. types of heart failure. [ONLINE] Available at: http://www.heart.org/HEARTORG/Conditions/HeartFailure/AboutHeartFailure/Types-of-Heart-Failure_UCM_306323_Article.jsp. [Accessed 08 April 14]. c health. 2014. drug factsheets. [ONLINE] Available at: http://chealth.canoe.ca/drug_info_details.asp?brand_name_id=210#Indication. [Accessed 09 April 14]. providence healthcare network. 2014. congestive heart failure. [ONLINE] Available at: http://providence.net/facilities/heart-failure.html. [Accessed 09 April 14]. pt direct. 2014. major functions of the cardiovascular system. [ONLINE] Available at: http://www.ptdirect.com/training-design/anatomy-and-physiology/cardiovascular-system/major-functions-of-the-cardiovascular-system-2013-a-closer-look. [Accessed 09 April 14]. diabetes australia. 2014. diabetes and your feet. [ONLINE] Available at: https://www.diabetesaustralia.com.au/Living-with-Diabetes/MindBody/DiabetesYour-Feet/. [Accessed 09 April 14]. TafeSA, 2014. Acute Care Flow Charts. In: Flow Charts. s.l.:Government of South Australia. better health . 2013. allied health. [ONLINE] Available at: http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Allied_health. [Accessed 10 April 14]. cliffs notes. 2013. functions of the cardiovascular system. [ONLINE] Available at: http://www.cliffsnotes.com/sciences/anatomy-and-physiology/the-cardiovascular-system/functions-of-the-cardiovascular-system. [Accessed 10 April 14]. how stuff works. 2014. what is the function of the respiratory system?. [ONLINE] Available at: http://health.howstuffworks.com/human-body/systems/respiratory/function-respiratory-system.htm. [Accessed 10 April 14]. how stuff works. 2014. how the digestive system works. [ONLINE] Available at: http://health.howstuffworks.com/human-body/systems/digestive/digestive-system2.htm. [Accessed 10 April 14]. live science. 2013. urinary system. [ONLINE] Available at: http://www.livescience.com/27012-urinary-system.html. [Accessed 10 April 14]. Chikungunya Fever: A Review Of The Literature Chikungunya Fever: A Review Of The Literature The Newala and Masasi Districts of the Southern Province, Tanzania, reported its first dengue-like outbreak in 1952-1953, on the basis that this epidemic involved debilitating joint pains and shorter incubation period, thereby excluding dengue (Robinson 1955). The infection was called chikungunya; a word from the Makonde dialect describing patients contorted posture (Lumsden 1955). Chikungunya is an arthropod borne virus (arbovirus) of the genus: Alphavirus from Togaviridae family. It is transmitted to humans mainly by the day biting mosquito species Aedes aegypti and Aedes albopictus (Townson and Nathan 2008). Moreover, Aedes aegypti eggs collected from the Tanzanian outbreak were used for the first isolation of Chikungunya virus (CHIKV) (Ross 1956). CHIKV contains a positive-sense single stranded RNA genome, enclosed in an icosahedral nucleocapsid, all enclosed in a phospholipid bilayer envelope. Embedded in the envelope are multiple copies of two encoded glycoproteins E1 and E2, a small glycoprotein E3, and a hydrophobic peptide 6K (Strauss and Strauss 1994). However, the roles of these glycoproteins are not elucidated, but it can be assumed that it could facilitate the attachment of the virus to host cell. History Subsequent to the Tanzanian epidemic, several outbreaks have been reported worldwide, including the Indian Ocean Islands; La Reunion (Renault et al. 2007), Mayotte (Sissoko et al. 2008), and the Maldives (Yoosuf et al. 2008). There were outbreaks whereby Chikungunya had concurrence with other infections; with Dengue (Ratsitorahina et al. 2008, Yoosuf et al. 2008) and with Plasmodium falciparum infection (Pastorino et al. 2004). Moreover, Chikungunya have been imported into several European countries; United Kingdom (HPA 2007), France (Hochedez et al. 2007), Germany, Switzerland, Denmark, Poland (Panning et al. 2008), with Italy witnessing its first CHIKV outbreak in 2007 (Rezza et al. 2007). Aim of review The Italian outbreak has demonstrated that only one viraemic person was required to instigate an outbreak and due to increased population movement worldwide, CHIKV could extend to pandemic proportions (Rezza et al. 2007). Furthermore, the outbreaks could have been underestimated due to its concurrence with other infections. Thus, this literature review will demonstrate to the reader that the Western medicine should be planning for CHIKV outbreaks which are becoming increasingly possible due to world climate change. Clinical Features Chikungunya is a mild and self limiting infection (Rezza et al. 2007) with incubation period of 2-7 days (Robinson 1955). Patients usually presents with a number of clinical features, with fever, fatigue, joint pain, anorexia, and nausea presenting as common clinical features (Table 1). Arthalgia and myalgia mainly involves the extremities of wrists, ankles, hands, feet and phalanges, while skin rash and petechiae are manifestations of haemorrhage (Kannan et al. 2009). During the La Reunion outbreak, Gà ©raldin et al. (2008) observed vertical transmissions from mother to child, with newborns presenting with chikungunya infection without prior mosquito bites. These neonates became symptomatic between 3-7 days postpartum, with presentation of fever, pain, poor feeding, disseminated intravascular coagulation (DIC) with gastrointestinal and cerebral bleeding, petechiae, and distal joint oedema. Encephalitis, thrombocytopenia and haemorrhagic fever were presented as severe neonatal infec tions; however, no fatalities were reported (Gà ©rardin et al. 2008). Transmission of CHIKV CHIKV requires two types of hosts to complete its replication cycle. Firstly, Aedes mosquito species transmits the virus to animals, and act as definitive hosts. Secondly, humans and other animals become infected with the virus and act as intermediate hosts. The transmission between the natural hosts (primates, birds, rodents and others) and the definitive hosts involves the sylvatic (main) cycle (Pardigon 2009). By disrupting this cycle, humans became incidental hosts, resulting in urban transmission cycles yielding epidemics. These humans could transmit CHIKV directly to domestic mosquitoes (Gould and Higgs 2009) and indirectly to domestic animals such as fowl, pigeons and goats (Lumsden 1955). When an Aedes mosquito ingests viraemic blood meal, CHIKV replicates in the salivary glands and ovaries, sites where it can be excreted. Upon another blood meal, the mosquito injects the viraemic saliva into a susceptible host. Contrary, within the ovaries, CHIKV is transmitted to the mosqui toes eggs by vertical transmissions (Figure 1). The desiccated nature of these eggs enables it to survive longer periods in the environment, where they are hatched during the rainy season (Gould and Higgs 2009). Figure 1. The overview of CHIKVs transmissions cycle in mosquito and human (Evenor 2010). Aedes mosquito becomes infected after taking a blood meal from an infected intermediate host Upon another blood meal, the Aedes mosquito injects viraemic saliva into a susceptible host The viraemic blood travels to the gut, where CHIKV undergoes replication within the gut wall The egg later developed into a mosquito infected with CHIKV CHIKV travels to the ovaries, where it is transmitted to the mosquitos eggs by vertical transmission The intermediate host becomes viraemic with presentation of clinical features CHIKV penetrated the gut wall, where it is disseminated through the bloodstream CHIKV travels to the salivary glands, where it undergoes replication Distributions of Aedes albopictus and Aedes aegypti Aedes aegypti was the predominant vector during earlier outbreaks in Africa (Lumsden 1955), and it has been implicated in some recent outbreaks in Africa (Gould et al. 2008) and Indonesia (Laras et al. 2005). However, Aedes albopictus have been described as the main vector implicated in a number of recent outbreaks, between 2005 to 2007 (Leroy et al. 2009, Pagà ¨s et al. 2009, Ratsitorahina et al. 2008, Renault et al. 2007, Sissoko et al. 2008). In the Gabonese outbreak involving both vectors, Vazeille et al. (2008) hypothesised that Aedes albopictus is a more suitable vector for CHIKV than Aedes aegypti, as it has a higher susceptibility for the virus. The two vectors have been recovered from several breeding sites with some overlap (Table 2). Tyres have been the main source of Aedes albopictus larval importation into Italy, in 1992, from Atlanta, USA. Consequently, the trade of these used tyres within Italy had caused large infestations of Aedes albopictus in Linguria, Veneto, Lom bardy and Eimlia-Romagna regions, by the end of 1995 (Knudsen et al. 1996). Aedes aegypti larvae predominate inside home, whereas Aedes albopictus larvae predominate outside home (Preechaporn et al. 2006). Table 2. The natural and artificial breeding sites for Aedes aegypti and Aedes albopictus larvae. Natural and artificial breeding sites Incidence of Aedes aegyptilarvae Incidence of Aedes albopictus larvae References Barrels X Gould et al.2008 Drums X X Gould et al.2008, Ratsitorahina et al.2008 Buckets X Ratsitorahina et al.2008 Flower pots X Gould et al.2008 Discarded cans X X Preechaporn et al.2006, Ratsitorahina et al.2008 Coconut shells X Preechaporn et al.2006, Ratsitorahina et al.2008 Clay water jars X Gould et al.2008 Mango tree holes X Lumsden 1955 Wetlands X X Vazeille et al.2008 Discarded tyres X X Preechaporn et al.2006, Ratsitorahina et al.2008 Plant pots X X Preechaporn et al.2006, Ratsitorahina et al.2008 Gardens X Adhami and Reiter 1998 Discarded plastic bottles X Adhami and Reiter 1998, Preechaporn et al.2006 Wet containers X Ratsitorahina et al.2008 Banana trees X Preechaporn et al.2006 Plant axils X Preechaporn et al.2006 Animal pans X X Preechaporn et al.2006 Plastic containers X X Preechaporn et al.2006 Cement tanks X X Preechaporn et al.2006 Ant guards X Preechaporn et al.2006 Preserved areca jars X Preechaporn et al.2006 Small and large earthen jars X X Preechaporn et al.2006 Key: (X):- present, (-):- absent. Effect of climate change Outbreaks have been associated with climatic conditions such as temperatures and high rainfall. Temperatures influence the developmental rate of Aedes albopictus larvae to adult mosquitoes, with the rate optimising at temperatures between 25 to 30oC (Straetemans 2008). Thus, Tilson et al. (2009) argued that mean monthly temperatures above 20oC are required to initiate an outbreak, as illustrated by the Italian outbreak that was initiated in June and subsided in September when the monthly average temperatures were 22oC and fell below 20oC. Mean annual rainfalls over 500mm is required (Straetemans 2008) to provide suitable breeding environment for the mosquitoes to expand their population (Lumsden 1955); as a result, most outbreaks have been associated with high rainfall (Lumsden 1955, Pastorino et al. 2004, Renault et al. 2007, Sissoko et al. 2008, Yoosuf et al. 2009) as illustrated in Table 3. In 2009, the UK Met office (2010) recorded a mean annual rainfall and temperature of 1201.3 mm and 9.2oC, respectively. The rainfall is sufficient to initiate an outbreak; however, the low temperature is insufficient to support the mosquitoes life cycle. Therefore, the question is what would the impact be to the UK if the climatic condition changes to favour this mosquito? Table 3. Mean temperature and the amount of rainfall that were reported during several outbreaks. Country Duration of the outbreak Mean monthly Temperature (oC) Months mean monthly temperature were collected Amount of Rainfall (mm) Months high rainfall were recorded Reference Tanzania 1952 1953 21.8 28.5 Jun Nov 1203 Jan Dec 1952 Lumsden 1955 Bogor Aug Dec 2001 24 26.2 Jan 2000 Dec 2001 NA Laras et al.2005 Bekasi Jan 2002 26.2 29.6 Jan 2001 Dec 2002 1931 Jan Feb 2002 Laras et al.2005 Maldives 2006 2007 NA NA 970 Nov Dec 2006 Yoosuf et al.2009 Key: NA- not available Distribution of Chikungunya outbreak Mayotte (French Overseas Territory), an island of the Comoros archipelago, encountered its first CHIKV outbreak imported from Grand-Comore in mid-April 2005 (Renault et al. 2007), with 6346 reported cases (in two waves), observed by the surveillance system implemented throughout the island by the local French Health Authority, Dass (Direction des affaires sanitaires et socials) Mayotte. The first (minor) wave commenced in April 2005, it later peaked in week 18 and the infection rate diminished in June, with the virus maintaining low levels thereafter, during the temperate and dry season. However, the second (major) wave began during the first week of May 2006, peaked during the hottest and rainiest months around March/April 2006 and reduced to control levels by July 2006 (Sissoko et al. 2008). In March 2005, a chikungunya infection which started in Grande-Comorre was imported into La Reunion (French Overseas Territory), becoming its first severe reported case involving two waves of outbreak, as observed by the epidemiological surveillance system implemented by the islands local Health Authorities (Renault et al. 2007). Firstly, a (minor) wave commenced in March 2005, peaked in May 2005 and decreased at the beginning of July to approximately 100 cases where the level was maintained during the austral winter. By December 2005 the second (major) wave began; however, the capacity of the surveillance system at the time was insufficient to evaluate the number of cases, as the number of cases was increasing exponentially. This resulted in an underestimation of the number of reported cases with possible misdiagnosis with Dengue fever which circulated the island the previous year (Renault et al. 2007). By April 2006, the Regional Health and Welfare Office reported 203 deaths that w ere directly (due to low immune status) or indirectly (in associations with other underlying conditions) attributed with chikungunya infection, with a low mortality rate of 0.3/1000 people (Renault et al. 2007). The Maldives encountered its first CHIKV outbreak involving 11879 confirmed and suspected cases on 121 of the 197 inhabited islands, observed by the surveillance system implemented by the Epidemiology Unit of the Department of Public Health (DPH), from December 2006 to April 2007 (Yoosuf et al. 2008). The outbreak commenced at the beginning of December 2006, peaked in week 6 and subsided to control levels by week 11 before halting in April 2007. The epidemic was thought to be associated with post-tsunami construction activities which provided breeding sites for mosquitoes. Moreover, approximately five to six elderly patients died as result of co-morbidity and other conditions (Yoosuf et al. 2008). Figure 2: Global Distribution of chikungunya virus, 1952 to 2009. The cases represented on the map are either confirmed cases or suspected cases (Evenor 2010). References: 1 Krastinova et al. 2006, 2 Rezza et al. 2007, 3 Pastorino et al. 2004, 4 Sissoko et al. 2008, 5 Lumsden 1955, 6 Tamburro and Depertat 2009, 7 CDC 2009, 8 WHO 2008, 9 Yoosuf et al. 2009, 10 Leroy et al. 2009. Importation into Europe England In 2006, the United Kingdoms (UK) Health Protection Agencys (HPA) Special Pathogens Reference Unit (SPRU) reported 133 imported cases of chikungunya (Table 4). The majority of these tourists had travelled to the Indian Ocean islands (68), between March and August 2006, where outbreaks were circulating, with Mauritius being the main destination site involving 58 imported cases, followed by 6 in the Seychelles, and 4 in Madagascar. However, when the outbreaks were in decline, only one case was detected in December (HPA 2007). Between August and December, 44 cases were imported from India and 10 cases were imported from Sri Lanka, between November and December; countries with reported recent chikungunya outbreaks. Also imported into the UK, where one case from Nigeria, one from Tanzania, one case from Kenya, and one case from Australia. There had been no mention of chikungunya outbreak in these countries. However, the article did not state whether there had been reported sightings of Ae des mosquitoes in UK (HPA 2007). Table 4. The number of cases was identified by different methods from the 133 imported cases, in the UK. Identification of the imported cases Number of cases Laboratory confirmed case 45 Probable case 30 Suspected case 35 Past exposure 23 France The Pitià ©-Salpà ªtrià ¨re Hospital in Paris, France, reported 80 cases of Chikungunya infection imported by tourists who recently visited the Southwest Indian Ocean region, between March 2005 and August 2006. The majority of cases (52) were imported from La Reunion (Hochedez et al. 2007), a popular destination site for French tourists (HPA 2006). Other destination sites reported were; Mauritius with 18, Comoros with 4, Madagascar with 3, and Mayotte with 2 cases (Hochedez et al. 2007). Within the same period, Metropolitan France reported 766 imported cases, which correlated with the two waves of the La Reunion outbreak (Figure 3). At the peak of the first La Reunion outbreak, an average of 20 cases was imported to France monthly. However, between August and November 2005, during the Southern Hemisphere winter, the cases decreased (Krastinova et al. 2006). A month after the peak of the second outbreak, the number of imported cases drastically increased. It can be argued that Fran ce is at risk of future outbreaks, in view that some of its inhabitants are constantly visiting the Southwest Indian Ocean regions (Hochedez et al. 2007), mainly La Reunion and also due to the inhabitation of Aedes albopictus (Krastinova et al. 2006). Figure 3: Correlation between imported cases of Chikunugunya in metropolitan France to the estimated number of cases in the La Reunion outbreak (Krastinova et al. 2006). Italy Chikungunya was apparently imported into Italy by a male tourist coming from the Kerala province in India, who developed febrile illness two days into his holiday. The region he visited was Castiglonia di Cervia in June 2007. This was recorded by Ravenna provinces local health unit in the Emilia Romagna region, northeastern Italy where 205 people developed CHIKV infection (Rezza et al. 2007). The vector, Aedes albopictus, was implicated in the spread of the virus which was then imported from Castiglione di Cervia into Castiglione de Revenna two villages separated by a river. Mosquito control measures implemented in the area resulted in a reduction in chikungunya infection. However, the control measure was not implemented in other villages and therefore a new wave occurred. The virus isolated from the outbreak contained the same mutational change (Ala226Val) in the membrane fusion E1 glycoprotein as the Indian Ocean variant, thereby suggesting that the Kerala strain could have origina ted from the Indian Ocean outbreak (Rezza et al. 2007). Other European Countries Tourism has been one of the main methods of CHIKV distributions worldwide, including its importation into several European countries. In 2006, the Bernhard-Nocht Institute for Tropical Medicine in Hamburg, Germany examined 720 samples from 680 European patients who became symptomatic upon return to Germany, Belgium, Switzerland, Denmark, and Poland from several destinations (Table 2) (Panning et al. 2008). The majority of patients had recently visited countries in the Indian Oceans; Mauritius, the Seychelles, La Reunion and Madagascar, and other countries; Bali, Indonesia, Sri Lanka, India, Malaysia, Kenya and Thailand. Moreover, most of these countries have been implicated in recent CHIKV outbreaks. No outbreaks were reported in these European countries; however, future outbreaks can be hypothesised (Panning et al. 2008). Table 5. The country of origin and the holiday destinations of patients presented at the Bernhard-Nocht Institute for Tropical Medicine in Hamburg, Germany. Exact destinations were only available for 27.8% of patients, and exact itinerary were not available (Panning et al. 2008). Country of origin Number of patients Germany 515 Belgium 99 Switzerland 42 Denmark 22 Poland 2 Total Nos. of patients 680 Holiday Destinations (Regions with Chikungunya Epidemic) Number of patients Mauritius 92 The Seychelles 23 La Reunion 18 Madagascar 9 Bali 2 Indonesia 6 Sri Lanka 5 India 28 Malaysia 2 Kenya 1 Thailand 3 Concurrence with Dengue Fever and Malaria In 2006 and 2007, Madagascar and Gabon reported co-infections between Chikungunya and DENV-1 or DENV-2 respectively (Ratsitorahina et al. 2008, Leroy et al. 2009). Contrary to CHIKV, dengue virus (DENV) is of Flavirivirus genus from Flaviridae family; consisting of four antigenically distinct but closely related serotypes (DENV1-4). It is transmitted by Aedes aegypti and Aedes albopictus, also CHIKV transmission vectors (Cook and Zumla 2009). DENV and CHIKV have similar clinical features (Yoosuf et al. 2008). However, the only difference is that CHIKV has arthalgia (). The extended incubation period of DENV (5-8 days) differentiated it from CHIKV (2-7 days); however, the difference is insignificant (Cook and Zumla 2009). Thus, serological diagnosis can be used to differentiate DENV to CHIKV (Ratsitorahina et al. 2008). Ratsitorahina et al. (2008) and Leroy et al. (2009) confirmed Aedes albopictus as the predominating transmission vector of both CHIKV and DENV1 or 2. However, neither study stated whether the vector could simultaneously harbour both viruses. Moreover, the study by Vazeille et al. (2008) demonstrated that Aedes aegypti has a higher susceptibility to DENV-2 virus and a lower susceptibility to CHIKV; whereas Aedes albopictus is a more efficient vector for CHIKV than DENV-2 (Vazeille et al. 2008 and Moutailler et al. 2009). Leroy et al. (2009) further demonstrated this theory in the Gabon outbreak, as the majority of the patients had CHIKV compared to DENV-2. In May 1999 and February 2000, the Matete and Kingabwa quarters of Kinshasa in the Democratic Republic of Congo (DRC) reported two Chikungunya outbreaks. CHIKV was the main contributing factor in the first outbreak; however, during the second outbreak, evidence confirmed possibility of co-infections between CHIKV and Plasmodium falciparum (Pastorino et al. 2004). Malaria is a parasitic infection, of the Apicomlexa phylum, that mainly infects hosts red blood cells. It is transmitted by Anopheles species, whereas CHIKV is mainly transmitted by Aedes species. Plasmodium falciparum is one of the four species of Human Malaria (including Plasmodium vivax, Plasmodium malariae, and Plasmodium ovale). However, Plasmodium falciparum is the most severe form of Malaria (Cook and Zumla 2009). Pastorino et al. (2004) hypothesised that co-infections could be due to long term latency of Plasmodium falciparum, the presence of both transmission vectors in the area or the pathogens sharing the same vec tors. An experimental investigation by Yadav et al. (2003 as cited by Pastorino et al. 2004) demonstrated that urban Anopheles stephensi (Plasmodium falciparum vector) could transmit CHIKV. Lack of Research We are still in the preliminary stages of understanding the interaction between CHIKV and host immunity (Kam et al. 2009), despite increasing number of reported outbreaks, there are insufficient evidences of up-to-date quality research (Panning et al. 2008). Therefore, outbreaks should be utilised to implement entomological and epidemiological system in improving our poor knowledge of the virus (Pialoux et al. 2007). Chretien and Linthicum (2007) argued that the Italian outbreak should provide opportunities for developed countries to strengthen the public-health system of developing countries in order to reduce the worldwide spread of outbreaks. These can be done by implementing Entomological and Virological surveillance in Aedes albopictus infested areas (Charell et al. 2008). Renault et al. (2007) utilised Deltamethrin insecticides to eradicate adult mosquitoes, whereas Rezza et al. (2007) utilised synergised pyrethrins. Furthermore, both authors utilised the biological larvicide, Bacillus thuringiensis israelensis, to destroy breeding sites (Renault et al. 2007, Rezza et al. 2007); however, Renault et al. (2007) later utilised Fenitrothion and temephos. Other control measures include educating the community on personal protection (Ratsitorahina et al. 2008). Although, no commercial vaccine has been approved, several candidates have been tested including the Formalin inactivated CHIKV vaccine for the Indian strain, DRDE-06, ECSA genotype (Tiwari et al. 2009). Therefore, the author believes that future outbreaks can be avoided if more research on CHIKV is undertaken, and a worldwide surveillance system is implemented. Conclusion This review has demonstrated that tourism is one of the main methods of CHIKV distributions worldwide, as it was the reason of several outbreaks. CHIKV was transported throughout the Southwestern Indian Ocean islands by viraemic tourists visiting different islands (Figure 2) and Kerala, India, which was then imported into Italy (Renault et al. 2007, Rezza et al. 2007, Sissoko et al. 2008, Yoosuf et al. 2008). However, outbreaks require temperatures above 20oC and annual rainfall over 500mm to maintain Aedes mosquitoes populations (Straetemans 2008, Tilson et al. 2009). Therefore, England is one of the least at risk country, as Aedes albopictus is not present, and the temperature is unfavourable to maintain mosquitoes life cycle (HPA 2007, Met Office 2010). Countries such as France and Italy are at high risk, due to the presence of Aedes albopictus and the introduction of CHIKV; although, Italy is the most at risk due to a recent outbreak (Krastinova et al. 2006, Rezza et al. 2007). T he eminent climatic changes could result in rising temperatures and increased rainfall that would favour the establishment of Aedes albopictus worldwide. All these emphasises the need for Western medicine to plan for future CHIKV outbreaks, by implementing a worldwide surveillance system in order to monitor outbreaks and to perform vector control measures (Charell et al. 2008). Chikungunya have concurrence with Malaria and Dengue Fever (Leroy et al. 2009, Ratsitorahina et al. 2008); furthermore, evidence suggests wrong classification of Chikungunya due to its resemblance to Dengue fever. CHIKV is constantly mutating, thus constant development of a new vaccine is required (Tiwari et al. 2009). Thereby, further researches are needed.

Gender Differences in Computer Literacy Essay

Information Technology (IT) has had a positive impact on health care delivery system worldwide, particularly in the areas of disease control, diagnosis, patient management, teaching and learning. Anuobi (2004) pointed out that man has scientifically placed himself in an environment that is global and digital, which predisposes him to constant use of information, its location notwithstanding. Shanahan (2006) believes that the health care industry is in a state of constant and rapid change and due to the increase in scientific knowledge and rapid technological advances, there has been a growing emphasis on the physicians need to efficiently access, retrieve, and use scientific evidences to improve patient care ( Li, Tan, Muller & Chen, 2009). Masood, Khan & Waheed (2010) noted that the availability of affordable computers and the advancement of information technology have resulted in our ability to rapidly and effectively access, retrieve, analyze, share, and store large volumes of information pertinent to patient care and for learning process in a teaching hospital . According to Poelmans, Truyen & Deslà © (2009) during the learning process, students are responsible for the management of their own information processes. After their graduation, the job market expects them to function as mobile knowledge-workers. It is therefore vital that students acquire the right attitudes and skills in order to survive in this information society and to deal with the ceaseless information flood. As Masood, Khan & Waheed (2010) observed, computer skills are vital for medical practitioners of the future. With the medical field being an information intensive profession, to use technology effectively for the advancement of patient care, the medical student must possess a variety of computer skills. However, scholars like Luan, Aziz, Yunus, Sidek, Bakar, Meseran & Atan (2005) have observed that there is a gender gap in the use of ICTs. Accordingly, the purpose of this study was to determine if there is a gender difference in the computer literacy levels of clinical medical students by looking at how they have access to computers, the frequency with which they use computers, if there is gender difference in the use of various software and look at problems they face when using computers. Literature Review Computer literacy has been a subject of educational research for recent years. Computer literacy is defined as the knowledge and ability to use computers and related technology efficiently, with a range of skills covering levels from elementary use to programming and advanced problem solving Lynch (1998). Computer literacy can also refer to the comfort level someone has with using computer programs and other applications that are associated with computers (Wikipedia 2010). Anuobi (2004), described computer literacy as having a basic understanding of what computer is and how it can be used as a resource. To Lynch (1998), computer technology literacy deals with an understanding of an infrastructure that underpins much of today’s life, it also means knowing some basic things about ICT, for example, how to save and open a file, or how to use a word processor (Tella & Mutala, 2008). The needs of a medical student of the millennium generation in a rapidly changing information society has changed, he now has to confront new challenges which are vital to his survival in the information age. Idowu, Adagunodo, & Idowu (2004) indicated that knowledge, skills and confidence with computer technology are now an asset for those entering the competitive employment market. They further pointed out that every aspect of life from education, leisure, and work environment to social interactions is being influenced by computer technology. Moreover, with the increasing use of ICT in education the world over, new skills and competencies are needed by students to be better equipped with the requisite digital literacy competencies. Essentially, gender refers to sets of relationships attributes, roles, beliefs and attitudes that define what being a man or a woman is within the society. It is a socially ascribed attribute as opposed to sex which is a biological attribute ( Oghiagbephan & Asamaigo, 2010). As a result of gender roles assigned by different cultures many women have been brought up to see technology and its use as reserved for on the male gender. According to Munusamy & Ismail (2009) women look at computers and see more than machines, thus considering computers as masculine and complicated to use. According to Asuquo & Onasanya (2006), many factors in and outside the classroom result in girls being turned away from computer technology. These factors include the media depicting men as experts in technology, societal expectations of different goals for boys and girls, the structure of learning tasks, the nature of feedback in performance situations, and the organization of classroom seating. Because these factors are often subtle, they go unnoticed. It is little wonder why girls are not interested in computer technology. This situation has led to what scholars have termed the gender digital divide. Explaining this, Ikolo (2010), stated that the gender digital divide is manifested in the low number of female users if ICTs compared to men. Gurumurty (2004), observed evidences that points towards gender imbalance in the use of computers and other technologies. According to Tella & Mutula (2008), the issue of gender equity as far as access to and use of ICTs continues to be a topical subject not only in developing countries but the world over. However, available indices have began to suggest that, although there is a gender gap in all countries, with the significant growth in access to and increased educational opportunities for more women, the relative difference between men and women is diminishing (Sorenson, 2002, Kay, 2008 & Munusamy & Ismail, 2009). In the 1980s, research on computer literacy focused on the question of whether medical students were ready for the foreseeable omnipresence of computers in the future of doctors’ professional environment and if they possess necessary computer skills Link & Marz (2006). When Poelmans, Truyen & Deslà © (2009) compared the mean scores of computer literacy and its subscales by gender. The results showed a clear pattern in both the global scale and the subscales: male students report a significant higher degree of perceived computer literacy. In a similar study carried out by Link & Marz (2006) to examine the level of computer literacy of first year clinical students in Vinna, the study showed that although 94% of the student attested to accessing and using computers, of this number only 26% of the female students used computers frequently. Citing Ong & Lai, Luan, Aziz, Yunus, Sidek, Bakar, Meseran & Atan (2005) reported that males had more positive attitudes towards ICTs. Gupta’s (2001) study also found significant gender difference in the way females and males rated themselves in their ability to master technology skills. Even though both genders were positive about their computer abilities, males rated themselves higher than females. Kay (2006) reviewed 36 studies on gender and computer use and concluded that the male correspondents have significantly higher perceived computer literacy On whether there was equality of access between the women academics and their male counterparts, 199 (97.1%) answered in the negative while only 6 (2.9%) respondents confirmed that there was equality of access. (Olatokun, 2007). Again, Link & Marz’s (2006) study showed that more male medical students (72%) had access to personal computers (laptops). Respondents were also asked to indicate what computer applications they used. The results depicted that there is marked significant gender difference in application use of computer by male and female subjects. It was clear that male students engaged in applications like word processing, Internet browsing, e-mail, data analysis, programming, and CorelDraw more than the female, except that the females engage in chat and games more than their male counterparts. This result as well can be linked to the issue of fear and anxiety attributed with computer by the female subjects, and may be responsible for their lower engagement in using computer software and applications. Tella & Mutula, 2008). In a survey, Tella & Mutula (2008) found out that, when respondents were asked to state the number of hours that they used computers in a week, the results showed that there were differences in the male and female number of hours spent using computer per week with male medical students spending more hours than the female medical students. While a considerable number of male students spent from 10-25 hours per week, female students spent between 1-4 hours per week. In another study by Rajab & Baqain (2005), a significant difference was found between males and females in the length of time they used computers. When asked about the frequency of computer use, male respondents (56%) were found to use computers more than female respondents (37%) (Munusamy & Ismail, 2009). Rajab & Baqain, (2005) concluded that although both gender of clinical students’ believed themselves to be competent in word processing, more males than females used multimedia presentations (power point). Luan, Aziz, Yunus, Sidek, Bakar, Meseran & Atan (2005), in their study found out that females were better at word processing and presentations and emailing than males. Olatokun (2007), in his study reached the conclusion that 70.7% female used computers for word processing; 98.5% indicated not using ICT for games at all and a total of 84.9% respondents used ICT very often for Internet browsing. Methodology The study employed a descriptive survey method which affords the researcher the opportunity to study the present condition of the computer literacy skills of the clinical medical students. The population of the study comprised of 93 clinical medical students of Delta State University and University of Benin who are in 400 level. The total population was used as the sample size for the study. Data were collected using a self constructed, structured questionnaire that was divided into two sections. Section A was designed to gather bio data while B was meant to obtain data on computer literacy skills of the students. A total of 86 questionnaires were returned. The demographic characteristics of the respondents revealed 50(58.1%) as males and 36 (42%) as females. Data was analyzed using simple percentages.

Sample of Business Plan - 3354 Words

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Understanding Management Accounting And Financial Management Finance Essay - Free Essay Example

Sample details Pages: 5 Words: 1532 Downloads: 4 Date added: 2017/06/26 Category Finance Essay Type Analytical essay Did you like this example? Accounting is a collection of processes and systems used to record, report and interpret the business transactions. It provides an account i.e. explanation or report in financial terms. Don’t waste time! Our writers will create an original "Understanding Management Accounting And Financial Management Finance Essay" essay for you Create order Explanation or report regarding the transactions of an organisation can be viewed. A company named Flight high ventures plc is a producer/retailer of gliding equipment. The business would like to look into expanding their business abroad with an ambitious 20% export target in 2 years time. Companys sales turnover is growing at an impressive 10% yearly and they are looking at ways to improve their productivity even further. The company is planning to set up a new plant to cope with expansion plans. To set up a new plant company will require an initial outlay of  £4m. The RD team of Flight high ventures plc have developed two ways of manufacturing the new product. One method requires a lower initial cash outlay and a second method requires a higher initial outlay but would help in achieving better economies of scale. The methods are however mutually exclusive and a decision will have to be taken as to which method will be more appropriate. Based on the options A B, Investme nt appraisal methods i.e. Accounting rate of return, Payback period, Net present value and Internal rate of return should be calculated to evaluate the R D projects. A conclusion should be made on the results calculated and recommend the firm the best method of manufacturing the new product. Background Accounting is defined as a system for providing financial information to those who have to make decisions and control the implementation of those decisions (Arnold and Turley, 1996). Accounting can also be defined as the process of identifying, measuring and communicating economic information to permit informed judgements and decisions by users of the information (Collier, 2006). Accounting helps in knowing profit and financial position of the organisation and also it helps in planning for the expansion of business. Management accounting is concerned with the provision of information to managers who make decisions about the ways in which an organisations resources should be allocated (Arnold and Turley, 1996). Management accounting is concerned about providing information for management. It provides a wide range of internally used information much of also contributes to the creation of the financial accounts (Ryan, 2004). Uses of management accounting Comparison of accounts with original budgets or forecasts can be done Managing of resources will be better, Trends in the business can be identified and Variations in the income can be highlighted which requires attention. Financial Accounting is the accountability which results in the production of financial statements, primarily for those integrated parties who are external to the business (Collier, 2006). Through financial management and by using the investment appraisal methods a decision should be made on particular investment opportunity of company named Flight high ventures plc. Analysis Accounting Rate of Return (ARR) The ARR method takes the average accounting operating profit that the investment will generate and expresses it as a percentage of the average investment made over the life of the project (Atrill and McLaney, 2008). For any project to be acceptable it must have a target ARR as a minimum. The Companys recent return on capital employed (ROCE) has been 20%. ARR and ROCE ratio takes the same approach to performance management. They both relate the profit to the cost of the assets invested to generate that profit. The minimum target would be based on the rate that previous investments have achieved. ARR has many advantages as a method of investment appraisal. Since ROCE is a widely used measure of business performance shareholders use this ratio to evaluate the management performance. In case of option A the ARR is 8.75% which is very low and does not reach the target. Whereas in case of option B the ARR is 14.87% which is nearly equal to the recent return on the capital employed. If the business is seeking through their investments to generate a percentage rate of return on investment, ARR would be more helpful. It gives a value in familiar percentage terms It can be compared with primary accounting ratios i.e. the companys required rate of return or cost of capital It is a relatively simple concept compared to Discounted Cash Flow methods, such as Net Present Value and Internal Rate of Return It can be used to compare mutually exclusive projects It considers the whole benefits of the project, unlike the payback method Disadvantages It uses accounting profit rather than cash The profit is not directly linked to the primary financial objective of shareholder wealth maximisation It uses average profits and hence it ignores the timing of profits It ignores the time value of money It is a relative measure and so it ignores the size of the initial investment Payback Period (PP) Payback period is the length of time it takes for an initial investment to be repaid out of the net cash inflows from a project (Atrill and McLaney, 2008). Although it is simple concept to understand and easy to calculate, this technique fails to recognise the cash flows beyond the payback period. It only considers the less payback period and ignores the size of the investment and any cash flows that take place after the investment has been recovered. It ignores the size and timing of cash flows. Both the Accounting Rate of Return and Payback period does not consider the time value of money. The time value of the money should be recognised in investment appraisals in order to compare the investment alternatives with different cash flows over different time periods. The payback period of method A is 1 year 183 days and the payback period for method B is 2 years 183 days. We cannot consider the method A since it has less payback period. Method A has less initial investment of  £ 968000 in the year 0 and the payback period is 1 year 183 days. After the payback period the cash flows of the Method A are declined year by year. Whereas in case of Method B it has initial investment of  £1210000, more than Method A and its payback period is 2 years 183 days and the cash flows after the payback period are in increasing order year by year. Net present value (NPV) Net present value is the surplus value offered by an investment opportunity when the required capital investment is deducted from the present value of its future cash flows, discounted at the firms opportunity cost of capital (Ryan, 2004). The NPV for Method A is 554.785 and NPV for Method B is 847.916.Using NPV method it is difficult to determine how much better Method B is than Method A because each has a different initial investment. By ranking the projects a decision can be taken on the methods. Ranking of projects with different NPVs is Cash value added= NPV Initial capital investment CVA for method A is 554.785 968 = 0.5731 CVA for method B is 847.916 1210 = 0.7007 Based on the profitability index or CVA the R D team should choose method B. By discounting the various cash flows of every method, NPV takes account of the time value of the money.NPV takes account of all the relevant cash flows over the life of a project. NPV is the only method o f appraisal in which the output the analysis has a direct bearing on the wealth of the owners of the business. If the choice has to be made between methods, the business should normally select the one with the higher or highest NPV. Method B has the highest NPV. Internal Rate of Return (IRR) The internal rate of return (IRR) of a particular investment is the discount rate that, when applied to its future cash flows, will produce an NPV of precisely zero (Ryan, 2004). The IRR for method A is 42.92% and IRR for method B is 36.66%. If two (or more) competing projects exceed the minimum IRR, the one with the higher (or highest) IRR should be selected. Although if we accept the project with the higher percentage return which will often generate more wealth, this may not always be right because IRR completely ignores the scale of investment. There might be a future problem with the IRR method in handling the projects with unconventional cash flows. We cannot consider method A as it has highest IRR because method A has unconventional cash flows and it has less NPV. So method B can be considered as the best one because it has conventional cash flows and scale of investment is high. Conclusion Method B would be the best choice for R D team to develop the new product for Flight high ventures plc. In case of method B ARR is high whereas the payback period is more, where both the methods ignore the time value of money.NPV of method B is more when compared to method A. NPV takes account into time value of money and discount future cash flows to their present value. NPV is more reliable method of investment appraisal. A business usually selects the project with highest net present value. As the net profit of method B is increasing year by year and the sales turnover is growing at an impressive 10% yearly, it would be the best choice.