Definition of presentation applications,video editing software free trial version free,marketing program price strategy advantages - For Begninners

Mobilisation and project definition is a crucial initial re-commissioning process step performed jointly by the re-commissioning consultant and the client in order to have a clear definition and understanding of the project that is shared by all stakeholders.
The assurance that all stakeholders have been identified, informed and mobilised in their role. Services can range from financial services provided by the banks to technology services provided by the IT company or hospitality services provided by hotels and restaurants or even a blog where an author provides a service (information presentation, interesting reading etc) to his audience. While everyone knows about the 7 Ps of services marketing, the 8th P of Services Marketing has emerged in research very recently.
In integral services management, improving productivity is a requisite in cost management; but quality, as defined by the customer, is essential for a service to differentiate itself from other providers. It has been recognized that overall profitability of a firm may be greatly impacted by focusing on not only at the top-line by improving sales but also focusing on the bottom-line by lowering over-all cost of delivering services.
It has also been established in research that process improvements deliver better standardization and hence better quality in services. Also did you read our article on the The 4 P’s of Marketing – The Marketing Mix strategies from which the 7 P Marketing Mix theory actually evolves? Le violon, ainsi que les autres instruments de sa famille, sont construits selon des regles tres precises et rigoureuses, elaborees au fil du temps par des luthiers, specialistes de cet art, qui conservent jalousement leurs secrets de fabrication.
La forme actuelle du violon est le produit d’une longue evolution, resultant de siecles d’experience et de traditions. Le violon ‘’standard’’ mesure habituellement 59 cm de long. Tout en courbure, vient ensuite le chevillier perce de part en part de quatre trous ou sont inserees les 4 chevilles qui permettent d’attacher et de regler la tension des cordes. Vient ensuite le corps du violon : la caisse de resonnance, qui comporte le fond et la table d’harmonie avec les six eclisses ondulees, collees a la perpendiculaire et qui forment l’epaisseur du violon. A l’extremite du violon, se trouve le bouton, fixe aux eclisses, auquel on fixe l’attache-cordier. Le cordier (ou tire-corde) est maintenu en surelevation au dessus de la table d’harmonie, face a la touche. A peu pres au centre de la table d’harmonie, pose a la perpendiculaire, le chevalet est une petite planche qui sert a surelever, maintenir, tendre et separer les cordes au moyen de petites encoches.
Fixee au bas du violon, la mentonniere, a un double usage : poser le menton, et proteger le bois de la transpiration. A l’interieur du violon, se trouve la barre d’harmonie, elle est collee a la table, du cote des cordes graves dans le sens de la longueur et mesure les ? de la table. Enfin, toujours a l’interieur, se trouve un petit cylindre de bois, place sous le cote droit du chevalet, que l’on appelle l’ame du violon. Aujourd’hui, il faut environ un mois pour construire un violon, delai qui sera evidemment variable selon le luthier et des particularites de la piece fabriquee.
Une fois monte, le violon est recouvert d’un vernis qui resulte d’un savant melange de resines, de pigments et de gomme. Cette premiere presentation du violon, est encore loin de vous livrer tous les secrets de cet instrument. O SlideShare utiliza cookies para otimizar a funcionalidade e o desempenho do site, assim como para apresentar publicidade mais relevante aos nossos usuarios. Early symptomsThe accumulation of malignant plasma cells can result in tiny cracks or fractures in bones.
Bone destructionBone pain, particularly in the backbone, hips, and skull, is often the first symptom of multiple myeloma. Hypercalcemia affects about one-third of multiple myeloma patients.Serum proteinsThe accumulation of M-proteins in the serum (the liquid portion of the blood) may cause additional complications, such as hyperviscosity syndrome, or thickening of the blood (though rare in multiple myeloma patients). DiagnosisBlood and urine testsOften, the original diagnosis of multiple myeloma is made from routine blood tests that are performed for other reasons.
Approximately 5% of multiple myeloma cases are not progressing at diagnosis, and may not progress for months or years. Each stage is subclassified as A or B, based on serum creatinine indicators of normal or abnormal kidney function. Since multiple myeloma often progresses slowly, and since the treatments can be toxic, the disease may not be treated until M-protein levels in the blood are quite high. These side effects disappear after treatment is discontinued.Other drug treatmentsBisphosphonates are drugs that inhibit the activity of osteoclasts. However, with very sensitive testing, a few myeloma cells are usually detectable and eventually lead to a recurrence of the disease, in the bone or elsewhere in the body.PreventionThere are no clearly-established risk factors for multiple myeloma and it is possible that a combination of factors interact to cause the disease. All content on this website, including dictionary, thesaurus, literature, geography, and other reference data is for informational purposes only.
So the classical 4 P structure of the Marketing Mix needs to be modified suitably to incorporate the 8 Ps for services marketing, which was previously known as the 7 Ps only. Services marketing are dominated by the 7 Ps of marketing namely Product, Price,  Place, Promotion, People, Process and Physical evidence.
In services management, often the variable costs are a lot more than fixed costs, and so incremental costs, if managed properly can have a huge impact on productivity.
Quality perception is a crucial differentiating factor on services management and for long term sustainability of the same. Our authors are educators from top QS ranked universities and practitioners from multinational enterprises. Il comporte quatre cordes (Sol, Re, La et Mi) qui produisent du son lorsque le musicien les frotte avec un archet. Cependant, il existe des violons de taille differente, les demis qui mesurent 53 cm, les huitiemes de 44 cm, ou encore les seiziemes mesurant 37cm, utilises par les enfants lors de l’apprentissage.
Toutes les pieces sont soigneusement faconnees dans des materiaux precieux, choisis pour leur qualite sonore et leur esthetique, tels que l’epicea et l’erable pour la caisse de resonnance. La table (le devant du violon), est percee de deux ouies, deux trous en forme de f calligraphies en miroir d’ou s’eleve le son du violon. Au centre du bord inferieur du violon, entre le cordier et le bouton, le sillet du bas supporte la pression du fil de l’attache du cordier.
Il est maintenu en place par la pression des cordes et son role est essentiel car il transmet les vibrations des cordes a la table d’harmonie. Invisible de l’exterieur et si petite, l’ame du violon n’en est pas moins une piece maitresse de l’instrument sur laquelle reposent de precieux equilibres. Petite pince en forme de peigne, elle se place sur le chevalet, ce qui attenue les vibrations.
Malignant plasma cells in the bone marrow can suppress the formation of red and white blood cells and platelets. As malignant plasma cells increase in the bone marrow, replacing normal marrow, they exert pressure on the bone. These particles can block small blood vessels and cause pain and numbness in the toes, fingers, and other extremities during cold weather.Amyloidosis is a rare complication of multiple myeloma. High levels of urea and creatinine in the blood indicate that the kidneys are not functioning properly to eliminate these substances.Protein electrophoresis is a laboratory technique that uses an electrical current to separate the different proteins in the blood and urine on the basis of size and charge. Most patients have stage III multiple myeloma at diagnosis.Prognostic indicatorsPrognostic indicators for multiple myeloma may be used instead of, or in addition to, the staging system described above. These drugs can slow the progression of bone disease, reduce pain, and help prevent bone fractures.
Tell a friend about us, add a link to this page, or visit the webmaster's page for free fun content. So for services, a firm may greatly benefit through proper re-engineering of processes and remodeling the same if required to improve productivity at each stage.
Il peut egalement les pincer pour produire des sons differents, ce que l’on appelle le pizzicato. Le filet, ou plus exactement, les filets, sont trois fines lamelles de bois, en forme de fil, incrustees dans la table et dans le fond, qui suivent et soulignent les courbures du violon. Les cordes, dont le bout est termine par une boucle de metal, sont coincees dans des encoches.


Multiple myeloma accounts for approximately 1% of all cancers and 2% of all deaths from cancer.
About 80% of individuals with multiple myeloma are anemic due to low red blood cell formation.
As overly-active osteoclasts (large cells responsible for the breakdown of bone) remove bone tissue, the bone becomes soft.
Since all of the multiple myeloma M-proteins in the blood and urine are identical, electrophoresis of blood and urine from a patient with multiple myeloma shows a large M-protein spike, corresponding to the high concentration of monoclonal Ig. These patients have stage I blood chemistry but no symptoms.Stage II multiple myeloma fits neither stage I nor stage III. Prognostic indicators are laboratory tests that help to define the stage of the disease at diagnosis, and its progression during treatment.
La touche est en ebene, et les accessoires, les chevilles, le cordier, la mentonniere sont en bois durs tels que l’ebene, le buis, le palissandre, l’alisier, etc. Leur fonction n’est pas qu’esthetique, car ils limitent le risque de fente du violon a la maniere d’un cerclage, en consolidant les bords de l’instrument. Sur certains violons, de petites molettes, les tendeurs, permettent un accordage plus subtil. Il y a deux sortes de sourdines, celles qui feutrent legerement le son du violon que l’on utilisera en orchestre et celles qui reduisent le son afin de jouer ‘’en sourdine’’ sans deranger son voisinage.
Multiple myeloma is a disease in which malignant plasma cells spread through the bone marrow and hard outer portions of the large bones of the body. Low white blood cell formation results in increased susceptibility to infection, since new, functional antibodies are not produced. Fracture and spinal cord compression may occur.Plasmacytomas (malignant tumors of plasma cells) may weaken bones, causing fractures.
Electrophoresis of the urine also can detect Bence-Jones proteins.BonesA bone marrow aspiration utilizes a very thin, long needle to remove a sample of marrow from the hip bone. Fractured bones or weak or collapsed spinal bones, in turn, may place unusual pressure on nearby nerves, resulting in nerve pain, burning, or numbness and muscle weakness.
Usually, the drugs are taken by mouth every 3 to 4 weeks for 6 to 9 months or longer, until the M-protein levels in the blood stop decreasing. Laboratory studies suggest that bisphosphonates may kill or inhibit the growth of multiple myeloma cells. Eventually, multiple soft spots or holes, called osteolytic lesions, form in the bones.Bone marrow is the spongy tissue within the bones.
Proteins produced by myeloma cells also may damage nerves.Calcium from the destroyed bone enters the blood and urine, causing hypercalcemia, a medical condition in which abnormally high concentrations of calcium compounds exist in the bloodstream. In particular, amyloid proteins can accumulate in the kidneys, where they block the tiny tubules that are the kidney's filtering system.
MP usually results in a 50% reduction in M-protein.Dexamethasone, a corticosteroid, sometimes is used to treat the elderly or those in poor health. Pamidronate is the most common bisphosphonate for treating multiple myeloma.The drug thalidomide appears to have several anti-myeloma activities. The breastbone, spine, ribs, skull, pelvic bones, and the long bone of the thigh all are particularly rich in marrow. If 10% to 30% of the cells are plasma cells, multiple myeloma is the usual diagnosis.X rays are used to detect osteoporosis, osteolytic lesions, and fractures. It can drop the M-protein levels by 40% in untreated individuals and by 20% to 40% in patients who have not responded to previous treatment. Thalidomide affects the immune system in various ways and it appears to inhibit myeloma cells, both directly and indirectly.
Bone marrow is a very active tissue that is responsible for producing the cells that circulate in the blood. Computer-assisted tomography (CAT or CT) scans can detect lesions in both bone and soft tissue. Other chemotherapy drugs, including cyclophosphamide, carmustine, doxorubicin, vincristine, and chlorambucil, may be used as well.Multiple myeloma usually recurs within a year after the end of chemotherapy.
These include the red blood cells that carry oxygen, the white blood cells that develop into immune system cells, and platelets, which cause blood to clot.Plasma cells and immunoglobulinsPlasma cells develop from B-lymphocytes or B-cells, a type of white blood cell. Magnetic resonance imaging (MRI) may give a more detailed image of a certain bone or a region of the body.TreatmentRelated disordersMonoclonal gammopathy of undetermined significance (MGUS) is a common condition in which a monoclonal Ig is detectable. However, if thalidomide is taken during pregnancy, it an cause severe birth defects or death of the fetus.The drug allopurinol may be used to reduce high blood levels of uric acid that result from kidney dysfunction. Each B-cell carries a specific antibody that recognizes a specific foreign substance called an antigen. Infections require prompt treatment with antibiotics.BONE AND PERIPHERAL BLOOD STEM CELL TRANSPLANTATION.
Antibodies are large proteins called immunoglobulins (Igs), which recognize and destroy foreign substances and organisms such as bacteria. Over a period of years, about 16% to 20% of those with MGUS will develop multiple myeloma or a related cancer called malignant lymphoma.Occasionally, only a single plasmacytoma develops, either in the bone marrow (isolated plasmacytoma of the bone) or other tissues or organs (extramedullary plasmacytoma). Bone marrow or peripheral blood stem cell transplantations (PBSCT) are used to replace the stem cells of the bone marrow following high-dosage chemotherapy.
When a B-cell encounters its antigen, it begins to divide rapidly to form mature plasma cells. Some individuals with solitary plasmacytoma may develop multiple myeloma.Clinical stagesThe Durie-Salmon system is used to stage multiple myeloma.
Chemotherapy destroys the bone marrow stem cells that are necessary to produce new blood cells. In an autologous transplant, the patient's bone marrow stem cells or peripheral blood stem cells (immature bone marrow cells found in the blood) are collected, treated with drugs to kill any myeloma cells, and frozen prior to chemotherapy.
They produce large amounts of identical antibody that are specific for the antigen.Malignant plasma cellsMultiple myeloma begins when the genetic material (DNA) is damaged during the development of a stem cell into a B-cell in the bone marrow.
Growth factors are used to increase the number of peripheral stem cells prior to collection. This causes the cell to develop into an abnormal or malignant plasmablast, a developmentally early form of plasma cell. Plasmablasts produce adhesive molecules that allow them to bond to the inside of the bone marrow. A growth factor, called interleukin-6, promotes uncontrolled growth of these myeloma cells in the bone marrow and prevents their natural death. Whereas normal bone marrow contains less than 5% plasma cells, bone marrow of an individual with multiple myeloma contains over 10% plasma cells.In most cases of multiple myeloma, the malignant plasma cells all make an identical Ig.
In this treatment, blood is removed and passed through a machine that separates the plasma, containing the M-protein, from the red and white blood cells and platelets.
The blood cells are transfused back into the patient, along with a plasma substitute or donated plasma.Multiple myeloma may be treated with highenergy x rays directed at a specific region of the body. There are five classes of heavy chains, corresponding to five types of Igs with different immune system functions. However, interferon may have toxic effects in older individuals with multiple myeloma.Once multiple myeloma is in remission, calcium and vitamin D supplements can improve bone density. All of the paraproteins from any one individual are monoclonal (identical) because the myeloma cells are identical clones of a single plasma cell.
Individuals with multiple myeloma must drink large amounts of fluid to counter the effects of hyperviscous blood.PrognosisThe prognosis for individuals with MGUS or solitary plasmacytoma is very good. They also cause functional antibodies, which are produced by normal plasma cells, to rapidly break down. However, approximately 15% of all patients with multiple myeloma die within three months of diagnosis. It is the most common type of monoclonal gammopathy, characterized by presence of a monoclonal immunoglobulin (immunoglobulin recognized as a single protein), Bence Jones proteins in the urine, anemia, and lowered resistance to infection.


Thus, multiple myeloma depresses the immune system.In about 75% of multiple myeloma cases, the malignant plasma cells also produce monoclonal light chains, or incomplete Igs.
About 60% respond to treatment and live for an average of two and a half to three years following diagnosis. Called also plasma cell myeloma.Diagnostic procedures to confirm suspected multiple myeloma include blood analyses, quantitative immunologic assays of serum and urine, urinalysis, bone marrow aspiration and biopsy, and skeletal x-rays. Approximately 23% of patients die of other illnesses associated with advanced age.The prognosis for a given individual may be based on the prognostic indicators described above. Findings indicative of the disease are an increased number of plasma cells in the bone marrow (usually over 10 per cent of the total), anemia, hypercalcemia due to release of calcium from deteriorating bone tissue, and elevated blood urea nitrogen, Bence Jones protein in the urine, and osteolytic lesions that give the bone a honeycomb appearance on x-ray and lead to vertebral collapse.Treatment.
Approximately 1% of multiple myelomas are called nonsecretors because they do not produce any abnormal Ig.Osteolytic lesionsAbout 70% of individuals with multiple myeloma have soft spots or lesions in their bones. The median survival for those without plasmablasts, and with a low plasma cell labeling index (PCLI) and low beta 2-microglobulin, is 5.5 years. Treatment of multiple myeloma involves chemotherapy and radiation to relieve pain and manage the acute lesions of the spinal column.
High-dose chemotherapy followed by blood cell rescue has shown some efficacy in certain situations. In part, these lesions occur because the malignant plasma cells rapidly outgrow the normal bone-forming cells. Individuals diagnosed with multiple myeloma who show no symptoms do not usually receive treatment.Patient Care.
The deletion of this chromosome, along with high beta 2-microglobulin, leads to a poor prognosis.With treatment, multiple myeloma may go into complete remission.
Major problems presented by the patient with multiple myeloma are related to anemia, hypercalcemia, bone pain and pathologic fractures, and emotional distress created by trying to cope with the day-to-day physiologic and emotional aspects associated with the diagnosis of a malignant disease.
These are the cells that normally destroy old bone, so that new bone can be produced by cells called osteoblasts. The more common complications to be avoided are infection, renal failure, and the sequelae of spinal cord compression.Transfusions with packed red blood cells can help alleviate and minimize some of the more severe symptoms of anemia.
It is important that the patient be adequately hydrated to improve viscosity of the blood and circulation, to help avoid hypercalcemia, and to maintain kidney function for excretion of the products of protein metabolism. Continued ambulation and moderate exercise help slow down the loss of minerals, especially calcium, from the bones. Osteoporosis, or widespread bone weakness, may develop.There are more than 40,000 multiple myeloma patients in the United States. Other problems are related to the administration of highly toxic antineoplastic drugs.Multiple myeloma. Multiple myeloma is one of the leading causes of cancer deaths among African Americans.In Western industrialized countries, approximately four people in 100,000 develop multiple myeloma.
The incidence of multiple myeloma among African Americans is 9.5 per 100,000, about twice that of Caucasians.
From Damjanov, 2000.multiple organ dysfunction syndrome (multiple organ failure) failure of two or more organ systems in a critically ill patient because of a complex and interrelated series of events.
The offspring and siblings of individuals with multiple myeloma are at a slightly increased risk for the disease.At diagnosis, the average age of a multiple myeloma patient is 68 to 70.
Although the average age at onset is decreasing, most multiple myelomas still occur in people over 40. This procedure is used in mass screenings, but it is not as accurate as other tests because of lack of precise measurement of the amount of medication actually entering the skin.multiple sclerosis (MS) a chronic neurologic disease in which there are patches of demyelination scattered throughout the white matter of the central nervous system, sometimes extending into the gray matter. This cancer is somewhat more prevalent in men than in women.Causes and symptomsAssociationsThe cause of multiple myeloma has not been determined. The disease primarily affects the myelin and not the nerve cells themselves; any damage to the neurons is secondary to destruction of the myelin covering the axon. The symptoms caused by these lesions are typically weakness, incoordination, paresthesias, speech disturbances, and visual disturbances, particularly diplopia. More specific signs and symptoms depend on the location of the lesions and the severity and destructiveness of the inflammatory and sclerotic processes.The course of the disease is usually prolonged, with remissions and relapses over many years. Brief exacerbations, even with acute and severe symptoms, are thought to be the result of a transient inflammatory depression of neural transmission.
Recovery occurs when there has been no permanent damage to the myelin sheath during the attack.
Repeated attacks can, however, eventually permanently denude the axons and leave the yellow sclerotic plaques that are characteristic of the disease.
Once the disease process reaches the stage of sclerosis the affected axons cannot recover and there is permanent damage.The prevalence of MS is not certain because the disease is not one that is reported, and mild cases can be either misdiagnosed or never brought to the attention of a health care provider. It is far more common in the temperate zones of the world than in tropical and subtropical climates. The onset of symptoms most often occurs between the ages of 20 and 40 years, and the disease affects both sexes about equally.The cause of multiple sclerosis is unknown.
It is likely that an inherited immune response is somehow responsible for the production of autoantibodies that attack the myelin sheath.
Some authorities believe that infection by one of the slow viruses occurs during childhood and after some years of latency the virus triggers an autoimmune response. Others believe there is an antigen or environmental trigger for the disease.The diagnosis of multiple sclerosis is difficult because of the wide variety of possible clinical manifestations and the resemblance they bear to other neurological disorders.
There is no definitive diagnostic test for the condition, but persons with objectively measured abnormalities of the central nervous system, a history of exacerbation and remission of symptoms, and demonstrable delayed blink reflex and evoked visual response are diagnosed as having either possible or probable multiple sclerosis. With time and progressive worsening of symptoms the diagnosis can become definite.Treatment. A multidisciplinary approach is required to diagnose the condition and help patients and their families cope with the attendant problems.
Multiple sclerosis has an impact on physical activity and life style, role, and interpersonal relationships; therefore, vocational guidance, counseling, and group therapy are helpful.
It is important that the patient with severe disability maintain a positive attitude, focusing on functional abilities rather than disabilities. Regeneration of the damaged neural tissue is not possible but retraining and adaptation are. Stress due to trauma, infection, overexertion, surgery, or emotional upset can aggravate the condition and precipitate a flare-up of symptoms. Management of MS has been greatly enhanced by the availability of interferons beta-1a and beta-1b. Research support is strong that these medications reduce the frequency and severity of relapses.Many multiple sclerosis patients and their families receive valuable support and encouragement from communication with others coping with the condition. A local chapter of the National Multiple Sclerosis Society is within reach of most persons in the United States.
See schizogony.multiple infectionsimultaneous infection with more than one virus or a combination of virus and bacteria may be caused by one agent lowering resistance to the other. Called also MODS.multiple ovulationan important feature in the technique of embryo transfer. A secretory form of the disease is characterized by the presence of an immunoglobulin recognized as Bence Jones protein (monoclonal immunoglobulin), Bence Jones proteinuria, anemia, and lowered resistance to infection. It's a condition that resembles myeloma but is much more widespread and by itself isn't considered malignant.



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