Is Competition Good

Review of Industrial Organization 19: 37–48, 2001.  © 2001 Kluwer Academic Publishers. Printed in the Netherlands. 37 Is Competition Such a Good Thing? Static Ef? ciency versus Dynamic Ef? ciency MARK BLAUG University of Amsterdam, Amsterdam, The Netherlands Abstract. This paper addresses the rationale for antitrust legislation. It is a striking fact that the legitimacy of antitrust law has been taken for granted in the United States ever since the Sherman Act of 1890 and, until the advent of the so-called Chicago School, it was even taken for granted by conservative American economists. Europeans, on the other hand, have always been lukewarm about legal action against trusts and cartels and this attitude is found right across the political spectrum in most European countries. Nevertheless, in both the U. S. A. and Europe, the ultimate justi? cation for antitrust law derives from economic doctrine regarding the bene? cial effects of competition. But what exactly are these bene? cial effects and how secure is the contention of economists that competition is always superior to monopoly? Surprisingly enough, competition, that central concept of economics, is widely misunderstood by many economists, both as a market phenomenon and as an organizing principle of economic reasoning. I. A Little History of Thought I begin by drawing what I believe is a fundamental distinction in the history of economics, as far back as Adam Smith or even William Petty, between two different notions of what is meant by competition, namely, competition as an end-state of rest in the rivalry between buyers and sellers and competition as a process of rivalry that may or may not terminate in an end-state. In the end-state conception of equilibrium, the focus of attention is on the nature of the equilibrium state in which the contest between transacting agents is ? nally resolved; if there is recognition of change at all, it is change in the sense of a new stationary equilibrium of endogenous variables in response to an altered set of exogenous variables; but comparative statics is still an end-state conception of economics. However, in the process conception of competition, what is in the foreground of analysis is not the existence of equilibrium, but rather the stability of that equilibrium state. How do markets adjust when one equilibrium is displaced by another and at what speed will these markets converge to a new equilibrium? But, surely, all theories of competition do both; existence and stability are tied up together and to study one is to study the other? By no means, however; it is easy to show that, for centuries, competition to economists meant an active process of jockeying for advantage, tending towards, but never actually culminating in, an 38 MARK BLAUG equilibrium end-state. Only in 1838, in Cournot’s Mathematical Principles of the Theory of Wealth was the process conception of competition totally displaced by the end-state conception of market-clearing equilibria. At ? rst this did not succeed in wiping the slate entirely clean of an interest in competitive processes but in the decade of the 1930s – those years of high theory as George Shackle called them – the Monopolistic Competition Revolution and the Hicks-Samuelson rehabilitation of Walrasian general equilibrium theory, forti? d by the New Welfare Economies, succeeded in enthroning the end-state conception of competition and enthroning it so decisively that the process view of competition was virtually buried out of sight. Let me elaborate. It is a striking feature of the language of The Wealth of Nations that the term â€Å"competition† invariably appears with a de? nite or inde? nite article preceding it: â€Å"a competition between capitals†; â€Å"the competi tion with private traders†, and so forth. For Smith, competition is not a state or situation, as it is for Cournot and for us, but a behavioural activity; it is a race – the original sense of the verb â€Å"to compete† – between two or more individuals to dispose of excess supply or to obtain goods available in limited quantities. What we nowadays call competition or the market mechanism was for him â€Å"the obvious and simple system of natural liberty†, meaning no more than an absence of restraints or ree entry into industries and occupations. Neither competition nor monopoly was a matter of the number of sellers in a market; monopoly did not mean a single seller but a situation of less than perfect factor mobility and hence inelastic supply; and the opposite of competition, was not monopoly, but co-operation. Producers in The Wealth of Nations treat price as a variable in accordance with the buoyancy of their sales, much like enterprises in modern theories of imperfect competition. This was not a conception invented by Smith because by 1776, competition had long been analyzed by a whole series of eighteenth century authors as a process which brings temporary â€Å"market† prices into line with cost-covering natural prices, those â€Å"natural† prices were indeed â€Å"the central price, to which the prices of all commodities are continually gravitating†, and in saying that Smith invoked Newtonian language to dignify a conception of price-determination that had a long tradition going back to the seventeenth century. To obtain that end-state in which market prices equal natural prices and the rate of pro? is equalized between industries, there had to be a considerable number of rivals, possessing common knowledge of market opportunities; they had to be free to enter and exit different lines of investment; but that was all and even that much was never spelled out explicitly as necessary prerequisites for competition – only once did Smit h ever mention the number of rival ? rms involved in competition. It was Cournot who ? rst had the notion of sellers facing a horizontal demand curve when their numbers become so large that none can in? uence the price of their own product. Competition, which once meant the way in which ? rms take account of how their rivals respond to their actions, now meant little more than the slope of the average revenue curve depriving ? rms in the limit of any power to make the price. Thus was born, decades before the Marginal Revolution of the 1870s what IS COMPETITION SUCH A GOOD THING? 39 one writer has wittily called â€Å"the quantity theory of competition† (quoted in Blaug, 1997, p. 68). Edgeworth’s Mathematical Psychics (1981) followed Cournot in providing all the trappings of the modern de? nition of perfect ompetition in terms of a large number of sellers, a homogeneous product, perfect mobility of resources and perfect knowledge on the part of buyers and sellers of all alternative opportunities. However, Marshall’s treatment of the competition always carefully labelled as â€Å"free competition† was much closer to Smith’s â€Å"simple system of natural liberty† than to that of C ournot and Edgeworth’s perfect competition. Even Walras hesitated to follow Cournot to the letter. Indeed, it was not until the 1920’s that the modern textbook concept of perfect competition was ? ally received into the corpus of mainstream economics, largely due to the impact of Knight’s classic, Risk, Uncertainty and Pro? t (1921). But it is doubtful whether the idea was in fact fully accepted in 1921 and a good case can be made for the thesis that it was Robinson and Chamberlain a decade later who hammered down the theory of perfect competition in the very process of inventing imperfect and monopolistic competition theory (Machovec, 1995). The replacement of the process conception of competition by an end-state conception, which was ? alized in 1933 or thereabouts, drained the idea of competition of all behavioural content, so that even price competition, the very kernel, of the competitive process for Adam Smith, David Ricardo and John Stuart Mill now had to be analysed as â€Å"imperfect† competition, a sort of deviation from the norm. Indeed, every act of competition on the part of a businessman was now taken as evidence of some degree of monopoly power, and hence a departure from the ideal of perfect competition, and yet pure monopoly ruled out competitive behaviour as much as did perfect competition. II. Perfect Competition, the Unattainable Ideal All I have said so far merely reiterates what Schumpeter said in 1942 and Hayek repeated in 1949: â€Å"perfect competition is not only impossible but inferior, and has no title to being set up as a model of ideal ef? ciency†; â€Å"what the theory of perfect competition discusses has little claim to be called ’competition’ at all and its conclusions are of little use as guides to policy† (quoted in Blaug, 1997, p. 69). But this message, delivered over a half-century ago, fell on deaf ears and the endstate theory of perfect competition is more ? mly in the saddle today than it ever was in the 1940s when Hayek and Schumpeter, not to mention John Maurice Clark (1949, 1961), were writing. And why? The answer is simple: it is that most of us were taught that although perfect competition is rarely if ever attained, nearly-perfect competition is said to be observable in some markets (agricultural markets being a favour ite example) and these approximations to the state of perfect competition somehow replicate many 40 MARK BLAUG f the desirable characteristics of perfect competition; in a word, second-best is so nearly ? rst-best that we may indeed employ ? rst-best as a standard. Open any textbook and what do we ? nd? The concept of perfect competition is said to be like the assumption of a perfect vacuum in physics; descriptively inaccurate, to be sure, but nevertheless productive of valid insights about actual economies. Thus, Samuelson and Nordhaus (1992, p. 295) in the 14th edition of their Economics concede that a perfect and absolutely ef? ient competitive mechanism has never existed and never will â€Å"but the oil crisis of the 1970s† is only one of their many examples of how an empirically empty competitive model can nevertheless produce the right answers to a concrete imperfectly competitive situation (for other textbook treatments, see Blaug, 1997, pp. 69–70). This is prec isely what Reder (1982, p. 12), called the notion of â€Å"tight prior equilibrium†, which he thought was characteristic of the Chicago School of Economics: â€Å"one may treat observed prices and quantities as good approximations to their long-run equilibrium values†. Call this the good-approximation assumption. Unfortunately, the idea of a near or far approximation to perfect competition has absolutely no logical meaning. We seem conveniently to have forgotten the famous Lipsey–Lancaster (1996) second-best theorem published in 1956, according to which we are either at a ? rst-best optimum or it matters not whether we are at second-best or tenth-best because we cannot rigorously demonstrate that doing away with a tax or a tariff that put us at tenth-best will bring us closer to ? st-best in a welfare sense of these terms. This theorem has not been conveniently forgotten; it has been deliberately forgotten because it wreaks havoc with the end-state, ? rst-best conception of competition. Must we therefore cease to give advice on competition policy? I think not; but what it does mean is that instead of gnostic pronouncements about the desirability of any move in the direction of ? st-best perfect competition, we must engage instead in qualitat ive judgements about piecemeal improvements, embracing a dynamic process-conception of competition, which is precisely the old classical conception that Schumpeter, Hayek, Clark and modern neo-Austrians have urged us to adopt. To grasp why it was necessary to revive this tradition, we must spend a moment explaining why modern price theory is so strong on the nature of the competitive equilibrium end-state and so weak on the process by which competition drives a market towards a ? al equilibrium. III. The Awful Legacy of General Equilibrium Theory When Walras literally invented general equilibrium (GE) in 1871, he was just as much concerned with the process-conception of competition known as â€Å"the stability problem† as in what we have called the end-state interpretation of equilibrium known as â€Å"the existence problem† – is simultaneous multimarket-equilibrium possible in a capitalist economy? But gradually, in successive editions of his Elements of Pure Economics, the existence problem came ever more to the fore, while the sta- IS COMPETITION SUCH A GOOD THING? 41 bility problem receded in the background (Walker, 1996). Even so, Walras’s view of how markets adjust in disequilibrium was always somewhat naive. It is a story which we all learn in our ? rst course of economics: in response to the appearance of excess demand and supply, prices adjust automatically as independently acting buyers and sellers â€Å"grope† their way to a ? al equilibrium. When this tatonnement story is well told, it sounds utterly convincing and at such times we are apt to forget that many markets, particularly labour markets and â€Å"customer markets†, react faster in terms of quantities than in terms of prices (as Marshall always insisted in opposition to Walras) and sometimes only in terms of quantities (see Blaug, 1997, pp. 71–75). But prices and quantities aside, what about product ifferentiation and competition by maintenance and service agreements, what about Schumpeterian competition in terms of new products and processes, new methods of marketing, new organizational forms and new reward structures for employees? In short, all the forms of rivalry between producers which Chamberlain and Robinson have taught us to call monopolistic or imperfect competition (the irony of calling what cannot exist, perfect competition, and what always exists, imperfect competition, never ceases to amuse me! . Walras struggled manfully to provide a rigorous solution to the existence problem but never got much beyond counting equations and unknowns to ensure that there were enough demand and supply equations to solve for the unknown equilibrium prices and quantities in the economy. As for the stability problem, he solved that after much hesitation by simply eliminating disequilibrium transactions as â€Å"false trading† (another wonderfully ironic piece of rhetoric). Although he never mentioned the concept of a ? tional auctioneer announcing different prices until an equilibrium price is discovered, whereupon trade is allowed to take place – this is one of those historical myths that subsequent generations have invented – it is dif? cult to avoid the conclusion that he simply gave up the effort to provide a convincing account of how real-world competitive markets achieve GE. Such an account has in fact never been provided even to this date. In 1954, Arrow and Debreu ? nally solved the existence problem by modern mathematical techniques – topological properties of convexity, ? ed point theorems, Nash equilibria, etcetera – of which Walras could never have dreamt but, in so doing, they travelled even further than Walras had from anything smacking of descriptive accuracy: there are forward markets in their GE model for all goods and services in the economy, including all locations and conceivable contingen t states in which these goods and services might be consumed, and yet no one holds cash to deal with the likelihood that income and expenditure may fail to synchronize. They were perfectly candid about this failure to describe actual economies. Indeed, they made a virtue of the purely formal properties of their model. 1 1 As Debreu (1959, p. x) expressed it in his Theory of Value: â€Å"The theory of value is treated here with the standards of rigor of the contemporary formalist school of mathematics . . . . Allegiance to rigor dictates the axiomatic form of the analysis where the theory, in the strict sense, is logically entirely disconnected from its interpretation†. And yet this book claimed to be a work in economics! 42 MARK BLAUG They cracked the existence problem, not to mention the uniqueness problem – is there one unique vector of prices at which GE exists? but they never tackled the stability problem. In other words, after a century or more of endless re? nements of the central core of GE theory, an exercise which has engaged some of the best brains in twentieth-century economics, the theory is unable to shed any light on how market equilibrium is actually attained, not just in a real-world decentrali zed market economy but even in the toy economies beloved of GE theorists. We may conclude that GE theory as such is a cul de sac: it has no empirical content and never will have empirical content. Moreover, even regarded as a research program in social mathematics, it must be condemned as an almost total failure. That is not to say that highly aggregated computable GE models, such as IS-LM, are pointless or that a GE formulation of an economic problem, emphasizing the interdependence of all sectors of the economy, may not prove illuminating but simply that Walrasian GE theory – the notion that the existence of multi-market equilibrium may be studied in a way that is analogous to solving a set of simultaneous equations – has proved in the fullness of time to be an utterly sterile innovation. The real paradox is that the existence, uniqueness and stability of GE should ever have been considered an interesting question for economists to answer: a complete satisfactory proof of all three aspects of the problem would no doubt have been a considerable intellectual feat in logic but would not in any way have enhanced our understanding of how actual economic systems work. IV. The Welfare Implications of GE Of course, Walras hoped to show, not just that GE is possible, but that it is good. But here too he never got much beyond the idea that voluntary exchange between two parties improves both of their welfares – otherwise, why would they have traded? What is true of bilaterial exchange will also be true of competitive exchange between a large number of traders if individual producers cannot themselves set prices, so that all consumers face identical prices for identical homogeneous commodities. This is precisely where the notion of perfect competition as an end-state of rest comes into welfare economics grounded in GE theory. Pareto, who was a much better technician than Walras, carried on where Walras left off. He too was convinced that GE is good for everyone but as a follower of Ernest Mach in philosophy, he hated such metaphysical ideas as maximising happiness, utility, welfare, or call it what you will, and he strenuously objected to interpersonal comparisons of utility (ICU) on the grounds that such comparison could not be operationalised. Pondering these issues, he realised that the one circumstance that avoids ICU is a social state which meets with unanimous approval or at least with the absence of con? ict in which one person is only made better off at the expense of another person. In other words, we want a state which is so ef? cient that there is no surplus, no waste, no slack, â€Å"no such thing as a free lunch†. But is not perfect competition just such a state? Of course, it may leave some people rich IS COMPETITION SUCH A GOOD THING? 3 and some people poor but that will be the consequence of the fact that we started with unequal endowments of the individuals in our economy – some people are born clever and some people have rich parents – but, given those endowments that are not themselves explained by GE theory – no theory ever explains everything – the GE model will grind out the rental prices of all the services of land, labor and capital as well as the prices of all goods , produced with those services. Once we have somehow arrived at the end-state of perfectly competitive equilibrium, it will be impossible to make one person better off without making another person worse off except by interfering with the initial endowments of agents. In this way, Pareto thought that he had ? nally found an admittedly narrow de? nition of the bene? cial effects of competition that was totally free of that positivist bugbear, ICU. The idea, only later called â€Å"Pareto optimality†, fell into oblivion as soon as it was announced but was rescued along with Walrasian GE theory in the 1930s by John Hicks and Nicholas Kaldor. They extended the scope of Pareto optimality by arguing that any economic change, whether from a position of competitive equilibrium or not, was welfare improving if the gains to bene? ciaries of that change were large enough to enable them at least in principle, to bribe the losers voluntarily to accept the change. The existences of such potential Pareto improvement (PPI), as they are nowadays called, still involves no ICU because it is grounded on the voluntariness of market exchange. In short, Hicks and Kaldor (with a prodding from Lionel Robbins) stayed true to the Paretian conception of how an economist should study welfare economics. At ? rst glance, the Hick–Kaldor compensation test does seem virtually to pull a rabbit out of a hat but further re? ection soon showed that the achievement was semantic, not substantive. Why is it a potential and not an actual PI? The moment we try to implement PPI by encouraging gainers and losers to negotiate a bribe, they will engage in strategic bargaining and even without fancy game theory, it is easy to see that they may never reach an agreement. If the change has political signi? cance, the state may then intervene to force the parties to agree – in which case we have said goodbye to our taboo on ICU. No matter how we slice it, in the end we cannot avoid (1) a qualitative judgement from on high of the size of the PPI – remember that there is no objective way short of voluntary trade to measure the magnitude of a gain or a loss to the parties concerned – and (2) an interpersonal comparison of that gain and loss to the respective parties. But all that brings us back to Marshall and Pigou whose Economics of Welfare (1921) had none of Pareto’s compunctions about ICU and was perfectly content to declare that a pound sterling taken from a rich man by a progressive income tax hurt him less than the pleasure it gave the poor man when it was handed over to him. We have not quite reached the end of the story. The Arrow–Debreu proof of the existence of GE in 1954 was almost contemporary with Arrow’s proof of what he labelled the First and Second Fundamental Theorems of welfare economics. The ? st theorem demonstrates that every competitive equilibrium in a decentralized economy is Pareto-optimal, which we have already discussed, and the second 44 MARK BLAUG theorem demonstrates that a Pareto-optimum can always be achieved via perfect competition if lump-sum taxes and transfers are feasible, so that whatever were the original endowments of agents, we can still make everyone better off with a perfectly compe titive economy. Immense pains are taken in every textbook of microeconomics to persuade readers of the validity of those two theorems. And they are valid – as mathematical exercises. Lump-sum taxes and transfers are changes which do not affect economic behaviour and even the most ingenious modern welfare economists have never been able to come up with a convincing example of such things. 2 I think that we may safely conclude that the First and Second Fundamental Theorems of welfare economics are just mental exercises without the slightest possibility of ever being practically relevant. They are what Ronald Coase (1988) called â€Å"blackboard economics†, an economics that is easy to write on a blackboard in a classroom but that bears no resemblance to the world outside the classroom. V. Why Is Competition Good? I contend that perfect competition is a grossly misleading concept whose only real value is to generate examination questions for students of economics. 3 It is misleading because it breeds the view that economics is a subject like Euclidean geometry, whose conclusion may be rigorously deduced from fundamental axioms of behaviour plus some hard facts about technology. But of course this does not imply that competition is bad. I, along with most economists, believe that competition is good. But if perfect competition is impossible, and Pareto-optimality almost impossible, what is the basis of this belief in the desirability of competition? It is based on a concept of dynamic ef? ciency, the outcome of competitive processes, and not the static ef? ciency of Walras, Pareto and the First and Second Fundamental Theorems of welfare economics. The schizophrenia of economists on this issue is simply extraordinary. The manin-the-street favours capitalism because it is ultimately responsive to consumers’ demands, technologically dynamic and produces the goods that are wanted at low cost; of course, it also suffers from periodic slumps, more or less chronic unemployment even in booms, and frequently generates a highly-unequal distribution 2 They would have to be randomly assigned to individuals or else to re? ect some personal noneconomic characteristic, such as more consonants than vowels in one’s last name. It used to be thought that a uniform poll tax was a perfect example of a limp-sum tax but as Mrs. Thatcher discovered it had a most profound effect on economic behaviour: almost a million people disappeared from the electoral roll in Britain because the poll tax could not be collected without a home address. 3 I concede reluctantly that it has its uses for purposes of answering comparative statics questions on taxes and subsidies but even these have much less practical signi? cance than is usually assumed (see Vickers, 1995). IS COMPETITION SUCH A GOOD THING? 5 of income. 4 Still, on balance the good outweighs the bad and without becoming Panglossian, he or she votes for capitalism – and so do virtually all economists. But is this what we teach in our textbooks? To ask the question is to already answer it. Can one actually teach the principles of dynamic ef? ciency? Of course, one can and that is what we do in every course in industrial organization (and in every course in man agement schools), where, alas, we have to undo the brainwashing that students have undergone in their courses on microeconomics. In so doing, we employ historical comparisons and case studies, and these can only cultivate the ability to make informed judgements about speci? c attempts at what Popper called â€Å"piecemeal social engineering†, making the world a little better here and there, because we do not know enough to make the whole world best once and for all. VI. Some Conclusions: Coase and Posner Beliefs in the ef? cacy of antitrust law ? ts neatly into the concept of dynamic ef? ciency, or what Clark called â€Å"workable competition†. A question like: should we break up Microsoft or just reprimand and perhaps ? e the company? does not lend itself to a precise answer by the edicts of economists and it is just as well that it does not. Empirical science frequently proceeds on the untidy basis of what is plausible rather than what can be formally demonstrated beyond any doubt. The structureconduct-performance paradigm of yesteryear, associated with names of Edward Mason and Joe Bain, did j ust that but that has since been superseded by game theory and transaction cost on the one hand and the Chicago School of Richard Posner and Robert Bork on the other hand. In between we ? d Ronald Coase and the widely misunderstood Coase Theorem as the very centre piece of the law and economics movement. Since this so-called inappropriately named theorem picks up a number of the themes in welfare economics that we have discussed above, let us close with a brief discussion of it. As stated by its inventor, George Stigler (1966, p. 113), the Coase Theorem is the proposition that â€Å"under perfect competition private and social costs will be equal† and hence â€Å"the composition of output will not be affected by the manner in which the law assigns liability for damage†. This combines two claims in one, the ? rst of which will be familiar to us: (1) an ef? ciency claim that perfect competition is always optimal if voluntary bargaining between the affected parties to their mutual advantage is possible at zero transaction costs, de? ned as the costs of making deals, negotiating contracts, and policing the enforcement of those contracts (Allen, 2000), and (2) an invariance claim that the ? nal allocation of resources is invariant to different initial assignments of property rights provided these are in fact clearly de? ed. A voluminous literature has shown that both propositions are either highly contentious or else a tautology if perfect competition, perfect information and zero 4 In an instructive essay, Richard Nelson (1981 reiterates my charge of schizophrenia and adds to my list of the bene? ts of a private enterprise system of capitalism that of â€Å"administrative parsimony†, an echo of Hayek’s discussion of the merits of competiti ve prices as information signals. 46 MARK BLAUG transaction costs are rigorously de? ned (Medema and Zorbe, 2000). Lo and behold, however, Coase has argued ever more vehemently that transaction costs can be reduced by appropriate judicial decisions but that they can never be reduced to zero even under Cournot-type perfect competition. Of course, if we de? ne perfect information as literally foreseeing every alternative opportunity under all possible contingencies, now and in the future, it follows immediately that we can write and enforce contracts at zero costs (zero in ? nancial outlays, in time and even in cognitive effort), in which case only increasing returns to scale will prevent us achieving perfect competition. Once transaction costs are zero and competition is perfect, it follows immediately that the distribution of property rights cannot matter. In short, the Coase Theorem is just a logical corollary of perfect competition and perfect information but that does little to persuade us that it is much more than a logical theorem. 5 As for the more controversial invariance claim, income and wealth effects in consumption patterns and the strategic behaviour of the injured and injuring parties as they enter into voluntary bargaining (the old objection to Hicks–Kaldor compensation payments) will certainly make the ? al allocation of resources sensitive to the way in which the law of the moment assigns liability for damage. Are we really to believe that my claim against the American Tobacco Company for giving me lung cancer will be decided in 2002 in exactly the same way it would have been decided in 1940? Coase (1964, p. 105) said it all 35 years ago: Contemplation of an optimal system may provide techniques of analysis that would otherwise have been missed and, in certain special cases, it may go far to providing a solution. But in general its in? uence has been pernicious. It has directed economists’ attention away from the main question, which is how alternative arrangements will actually work in practice. It has led economists to derive conclusions for economic policy from a study of an abstract of a market situation. Richard Posner, in his in? uential textbook, Economic Analysis of Law (1998), now in its ? fth edition, subsumes Pareto optimality and the Coase Theorem in an ef? ciency logic of â€Å"wealth maximization†. He claims not only that common law, statute law and judge-made law should serve to maximize wealth, so that for example entitlements in property law should be shifted to the more productive litigants as evidenced by their willingness to pay, but that legal entitlements and hence resources actually tend to gravitate towards their most valuable use if voluntary exchange is permitted. Without saying so, Posner clearly believes that we can 5 Moreover, as Allen (2000, pp. 904–905) argues quite rightly, the famous Modigliani-Miller Theorem of corporate nance – if capital markets are perfect, the value of a ? rm is invariant to its debt-equity ratio – and the Ricardo Equivalence Theorem of government ? nance – if capital markets are perfect, the level of household wealth is invariant to the ratio of taxes to the size of the public debt – are both special cases of the Coase Theorem because all taxes, debt obligations and equity shares are simply delineation s of property rights; in a world of zero transaction costs, both ? rms and governments could decide on debt levels by tossing a coin. IS COMPETITION SUCH A GOOD THING? 47 isolate PPI, divorcing ef? ciency from equity without committing ourselves to ICU, in short, he believes in classic or rather neoclassical Paretian welfare economics. Although he deals at length with distributional issues arising from liability rules and various forms of taxation, he never lays down any general principles about income redistribution, such as, for example, Pigou did: any transfer of income from the rich to the poor that does not diminish national income was deemed desirable by Pigou. What he argues, when criticized, is simply that users of distributive justice will have to be addressed outside the framework of standard economic analysis (Parisi, 2000). But this is exactly what Pareto, Kaldor and Hicks said years ago. Orthodox welfare economics, including the â€Å"ef? ciency of the common law hypothesis† upheld by Posner, has simply stood still ever since the 1930s. This notion of a neat divorce of ef? ciency from equity, of an objective value-free de? nition of ef? iency, has haunted economics from its outset but it is, of course, a will-o’-the-wisp: there is in fact a different ef? ciency outcome for every different distribution of income, and vice versa. Ef? ciency is necessarily a value-laden term and welfare economics is necessarily normative, that is, a matter of good or bad and not true or false. 6 However, there is real merit in treating ef? ciency and equity questions lexicographically, so that we can be as explicit as possible about our di stributional judgements, but that is not because we can ever decisively separate them. My complaint about Posner is that he evades all these fundamental questions in applied welfare economics. Not only does he fail to tell us how to add equity to ef? ciency but he does not even tell us whether ef? ciency means static ef? ciency or dynamic ef? ciency. There is an almost deliberate fuzziness of language in all his writings, which smacks of ideology rather than science. If we are going to employ the economist’s language of ef? ciency, we ought to be told just how to apply it and why ef? ciency should be our standard for judging the consequences of the law. One of Clark’s old rules of â€Å"workable competition†, such that entry into industries should be kept as free as is technically feasible taking due account of sunk costs, if necessary by antitrust legislation, is more relevant for public policy than Posner’s continual appeal to the principle of wealth maximization. The Chicago school does not deny that there is a case for antitrust law but they doubt that it is a strong case because most markets, even in the presence of high concentration ratios, are â€Å"contestable† (Bork, 1978). How do we know? We know because the good-approximation assumption: the economy is never far away from its perfectly competitive equilibrium growth path! Believe it or not, that is all there is to the â€Å"antitrust revolution† of the Chicago School. 6 Some economists believe, extraordinarily enough, that welfare economics is positive and not evaluative at all (see Hennipman, 1992; Blaug, 1992, chap. 8, 1993). 48 References MARK BLAUG Allen, Douglas W. (2000) ‘Transaction Costs’, in Bouckaert and De Geest, eds. , pp. 893–926. Blaug, Mark (1992) The Methodology of Economics, 2nd edn. Cambridge: Cambridge University Press. Blaug, Mark (1993) ‘Pieter Hennipman on Paretian Welfare Economics: A Comment’, De Economist, 141, 127–129. Blaug, Mark (1997) ‘Competition as an End-State and Competition as a Process’, in Not Only an Economist. Recent Essays. Cheltenham: Edward Elgar, pp. 66–86. Bork, Robert H. (1978) The Antitrust Paradox: A Policy at War with Itself. New York: Basic Books. Bouckaert, Boudewijn, and Gerrit De Geest (2000) Encyclopaedia of Law and Economics, 3 Vols. Cheltenham: Edward Elgar. Clark, John Maurice (1961) Competition as a Dynamic Process. Washington, DC: Brookings Institution. Coase, Ronald G. (1964) ‘The Regulated Industries: Discussion’, American Economic Review, 54, 194–197. Coase, Ronald G. (1988) The Firm, the Market and the Law. Chicago: University of Chicago Press. Debreu, Gerard (1959) Theory of Value. An Axiomatic Analysis of Economic Equilibrium. New Haven: Yale University Press. Hennipman, Pieter (1992), ‘Mark Blaug on the Nature of Paretian Welfare Economics’, De Economist, 140, 413–445. Lipsey, Richard C. , and Kelvin Lancaster (1996) ‘The General Theory of Second Best’, Review of Economic Studies, 24, 1956, pp. 11–32, reprinted in Richard C. Lipsey, Microeconomics, Growth and Political Economy. Selected Essays, Vol. 1. Cheltenham: Edward Elgar, pp. 153–180. Machovec, Frank (1995) Perfect Competition and the Transformation of Economics. London: Routledge. Medema, Steven G. , and Richard O. Zerbe (2000), ‘The Coase Theorem’, in Bouckaert and De Geest, eds. , pp. 36–92. Nelson, Richard R. (1981) ‘Assessing Private Enterprise: An Exegesis of a Tangled Doctrine’, Bell Journal of Economics, 12, 93–100, in Peter Boetke, eds. , The Legacy of Friedrich von Hayek, Vol. III. Cheltenham: Edward Elgar, pp. 80–98. Parisi, Francesco, ed. 2000) The Economic Structure of the Law: The Collected Essays of Richard A. Posner, Vol. I. Cheltenham: Edward Elgar. Reder, Melvin W. (1982) ‘Chicago Economics: Permanence and Change’, Journal of Economic Literature, 20, 1–38. Stigler, George J. (1966) Theory of Price, 3rd edn. New York: Macmillan. Van Cayseele, Patrick, and Rog er Van den Bergh (2000) ‘Antitrust Law’, in Bouckhaert and De Geest, eds. , Vol. III, pp. 467–498. Vickers, John (1995) ‘Concepts of Competition’, Oxford Economic Papers, 47, 1–23. Walker, Donald A. (1996) Walras’s Market Models. Cambridge: Cambridge University Press.

Equality, Diversity and inclusion in work with children and young people. Essay

1.1 How does the equality Act 2010 promote equality and diversity? Obtain your schools Equality of opportunity policy. What is its aim? Identify references to action. The Equality Act protects individuals from unfair treatment and promotes a fair more equal society. Equality and diversity is now a ‘limiting judgement’ in Ofsted inspections. This means that if equality measures are not being implemented efficiently, this will restrict the overall inspection grade. As a school, you must not discriminate against a pupil or prospective pupil because of their disability, race, sex, gender reassignment, religion or belief, or sexual orientation. The objectives at Tutshill School are that all children in our school will learn in an environment free from the effects of and without discrimination, and that the working conditions and environment of our staff and volunteers will also be free from discrimination. Tutshill C of E Primary School strives to ensure that the culture and ethos of the school are such that, whatever the heritage and origins of members of the school community, everyone is equally valued and treats one another with respect. Pupils should be provided with the opportunity to experience, understand and celebrate diversity. Tutshill School will adhere to Gloucestershire LEA’s Racial Harassment in Schools – Guidelines and make all new teachers, student teachers and ancillary staff aware of the policy. 1.2 Why is it important to support the rights of all children and young people to participation and equality of access? All children have the right to access all the opportunities which are on offer in the school provision. Each and every pupil has the right to learn and should not be discriminated against for any reason. In order for us to  achieve this we must involve the children and parents in finding out what works well in school and what doesn’t. This should be supported by high quality teaching and learning experience. I believe that involving the children in this process would make the children more confident and feel more valued within school. 1.3 How is cultural diversity valued and promoted in your school? Discuss its importance. Within Tutshill School opportunities are provided for all children to experience others cultures and ethnic backgrounds. This is promoted through literacy lessons. Every term the children I work with have a new topic for example, Greece and The Romans. With each topic they learn about their cultures such as their religion, language and the different foods they eat. The children in year four studied the Romans and did a play for the other children in assembly and also designed a menu for the whole school to try. The Year five class studied Greece and designed and made holiday brochure for display in their class room and also designed a Greek menu for the school to try. This is to ensure that the children understand and value the social and cultural diversity that could be in their own community as well as around the world. Culture can cut across nationalities and faiths and by promoting cultural diversity and the differences of individuals and groups within school will enhance a child ’s learning and promote knowledge and understanding of all pupils. Diverse cultures in schools should be acknowledged and reflected throughout the curriculum. By supporting and encouraging children to understand and accept cultural diversity will also prevent stereotyping and reduce prejudice and discrimination within schools. Most importantly, it will prepare children and young people for numerous changes that will happen in their lives as adults where they will inevitably be involved in mixing with adults of different cultures and backgrounds. Having watched the Teachers’ TV programme ‘Pride and Prejudice’, about Gypsy, Roma and Traveller children, comment on the following. 2.1 What prejudices do these groups face? Gypsy, Roma and Traveller children face many prejudices throughout their lives. They are not considered part of the community that they live in and often come up against racism, stereotyping, discrimination and abuse not only from other children but adults as well. 2.2 What impact does this have on traveller C/YP? The impact that racism, stereotyping and discrimination have on the children is that they fall out of school or are taken out of school at an early age. Majority of traveller children tend to leave school or are taken out of school at the end of primary level as they find the transition into secondary school a difficult one due to other children and teachers bulling them and having little knowledge or understanding of their culture. The remainder of the children do not often make it past year 9. 2.3/2.4 How have schools tackled prejudice to raise attendance and attainment? Schools have tackled these prejudices by increasing other people’s knowledge about these minority groups. For Example: †¢Celebrate their culture. †¢Looking at the history of the travellers. †¢Increasing awareness of their heritage by having day trips to the Romany life centre. †¢Traveller children making a booklet to educate teachers and pupils, about their religion and how and where they live. †¢Showing the pupils a film about travellers about their skills and how they made a living. To raise attendance and attainment schools have been flexible with rules regarding attendance rates and given extra support especially just before SAT’s. The most important thing I feel is that they treated each and every child the same. 3.1 Explain what is meant by ‘inclusion’? Inclusion means to be fully included, to make people feel valued and respected irrespective of ethnicity, gender, disability, culture, age, religion and sexual orientation. It is about giving equal access and opportunities to everyone. 3.2/3.3 Provide 3 or 4 examples of inclusive practices in your classroom/school. During my time at Tutshill School I have witnessed and been part of several inclusive practices. Example 1. Within year 4 we have a student who is Chinese. During the Chinese New-year SL brought in sweets for everyone so we could celebrate the Chinese new-year with her. She then had time to talk to the class about what she did during their celebrations. Example 2. Throughout each classroom and the school there are displays of children’s work. All abilities are displayed, so the children can see and understand that just because their work may not be the neatest or always correct it will still get to be displayed. Example 3. During P.E all children will be included, whether they have a lower ability or any medical issues. The games that they are playing will be adapted if needed to so that every child has the opportunity to participate.

The Development of Modern Art Essay Example | Topics and Well Written Essays - 2000 words

The Development of Modern Art - Essay Example This paper will discuss five of the best artists in the Contemporary period. Each of these artists will be analyzed in terms of their inspirations, styles, and techniques that they have applied to their works; works of which have contributed to the development of Contemporary Art. The list of contemporary artists includes Jackson Pollock, Willem De Kooning, Andy Warhol, Jenny Holzer, and Kara Walker.Upon the onset of the Modern Period, Jackson Pollock is one of those who had staged a significant feat in art development. Pollock, considered as one of the greatest contemporary painters in American art history, was part of a period where the Modernist Movement of 1920 was slowly transformed into the Post-Modernist Movement of Contemporary art history. In the New World, Pollock was known as an important member of a group of artists called the New York School. The New York School, more of a unified and collective artistic idea rather than a concrete institution, was popularly known as the Abstract Expressionists (Getlein 497). It was in this influence that Pollock acquired his unique style unto his works. His art established a new kind of visual that many had not seen before. In line with the Abstract Expressionists, the artist derived a direct influence from Surrealism. His technique showcased automatism and focused on the aesthetic powers of the unconscious. Being a painter of the mentioned genre, Pollock always exhibited large scale works in the literal sense. He used huge canvass sizes – this was to take his audience into the very essence of his paintings. The emphasis on huge painting canvasses is an essential part of Abstract Expressionists in order to highlight the effect of the entire piece (Getlein 497). The bizarre characteristics of the artist’s works bring out the very sense of post-modernism in his style. The perfection of his â€Å"drip technique† (Getlein 497) brings out the chaos ever present in his works. Yet, amidst this chaos, order, and beauty emerges as the by-product of Pollock’s hard work. This trait of â€Å"order out of chaos† is the true and sole criterion of good post-modern artwork (Libby).

Write course preparation Coursework Example | Topics and Well Written Essays - 250 words

Write course preparation - Coursework Example The digital labor as part of the much wider development comprises of union busting, globalization, casualization, deregulation, and the proletarianization of professions. In a sharing economy the labor of people is shared in a way that seems feudal. These new work arrangements shift the power in the labor market away from the workers. According to Roose, the sharing economy yields utopian outcomes with the empowerment of the ordinary people and increasing efficiency. The on-demand economy reduces full-time employment in addition to reducing the working in a bid to control the carbon emissions. I would not work in firms like Uber because I want to work as a full-time employee. This makes these jobs less appealing than the standard jobs. Due to the rapid growth of human population, especially in the cities, this creates more opportunities for sharing resources and services (Gold 28). However, most of the firms in the sharing economy are having an uneasy time with the regulators. Platforms such as Uber are experiencing explosive growth, which, in turn, has resulted in political and regulatory battles. Therefore, I would advise the sharing economy firms to be cooperative with regulators and also be responsive to the regulators’ legitimate concerns. It is also difficult to evaluate the effect of these new earning opportunities because they are introduced during a period of rapid labor market restructuring and high unemployment rates. Consider taxis, drivers in conventional cab operations are protesting due to Uber’s unfair competition which impacts negatively on their operations. The cab drivers are charged extra such as lease space and insurance while Uber deals with uninsured passengers compromising the safety of the passengers. All workers have equal opportunities to participate in these markets. Therefore, Uber drivers need to be subjected to same licensing, inspection, and regulations that cab drivers are subjected. It operates like

Gandhi Essay Example | Topics and Well Written Essays - 1500 words

Gandhi - Essay Example Ahimsa, being rooted deeply in the Indian culture than in other cultures believes that non-violence is the best way of solving all other forms of conflicts. This is a practice that the Indian culture had been living up to even at present. Gandhi exemplifies best of this practice such that he remained to eat nothing of any meat but of vegetables alone. There were even times when he deprived himself from taking in any kinds of foods to be able to live up to this Indian cultural practice. Racism and social injustice have been dominant in South African culture. Unaware of such change in the society, Gandhi, after finishing his studies in England travels on a first class train ticket. While the excitement coming back to his homeland plays in his thoughts, a rude guard threw poor Gandhi off the train for his being black at the very next station. Shocked beyond words by such injustice, Gandhi realized there is nothing left for him to do but to protest against the law and the government of such injustice and racism. This had become a turning point of Gandhi life as he has realized the need for the poor Indian natives to lift themselves up from the discrimination of the British men. (http://www.film.u-net.com/Movies/Reviews/Gandhi.html, para 1) Gandhi at the same time observed that the most of the Indian minorities lack unity making it easier for the British to take away their self-respect and implement an injustice system in their government. This was the first issue that Gandhi attempted to provide a solution such that they will regain their significant roles in the society that they belong. However, because Gandhi believes in a non-violent act of protests, he begins to form contacts with the Indian worker minority through mingling with them at the same time attempting to kindle within them a sense of injustice. Regardless of their religion, he organized meetings with them to let each one of them know their significance in the society that they belong, know their rights to fair treatment among the British. (http://www.film.u-net.com/Movies/Reviews/Gandhi.html, para 2) Unused to public speaking, Gandhi resorts to direct action wherein he burned his identity card in front of the police which led him to his assaults. (http://www.film.u-net.com/Movies/Reviews/ Gandhi.html, para 2) We hear no talk from Gandhi of war sometimes being a "necessary evil," but only him announcing--and more than once-"An eye for an eye makes the whole world blind." In a scene very near the end of the movie, we hear Gandhi say, as if after deep reflection: "Tyrants and murderers can seem invincible at the time, but in the end they always fall. Think of it. Always." (http://history.eserver.org/ghandi-nobody-knows.txt, para 23) The Hind Swaraj In 1909, Gandhi wrote the "Hind Swaraj" where he condemned the British rule as well as modernization in general. However, the book does not reject the liberal contribution of modernization. Gandhi, however, attempts to integrate its positive elements with a liberating re-interpretation of tradition. (http://www.swaraj.org/interpreting.htm, para 1) He had criticized

Facility and venue management Assignment Example | Topics and Well Written Essays - 1500 words

Facility and venue management - Assignment Example Located directly opposite the transit centre, this facility is accessible by both train and bus terminals and one would just walk a few minutes to be in within minutes. On arrival by plane into the international or domestic terminal, one takes an air train to Roma Street Transit centre and this takes very little time. Arrival bus is followed by disembarking at the transit centre on level 3 then level 2 before walking over the skylink to the escalators and the guest is at the doorstep of this paradise on Earth. The hotel is a multi-purpose and ultra-modern hospitality facility with different kinds of rooms and hall including a main hall, meeting rooms, stage, and kitchen as well, which suits various groups of clients. This facility offers wide variety of services from private functions such as internet surfing, to public activities like social events, meetings, community recreational activities and even travel desk for consultations. 2.0 Design Analysis 2.1 External Design Features Ba sically, Tinbilly Travellers Hotel has a one storey building, which is located on the edge of a 20-acre Roma street Parkland, with brown brick walls and grey top. The building ever looks very clean, sparkling and new. The size of the building is quite big, which is able to contain more than 400 people at the same time and accommodate others in its hostels. Since Tinbilly Travellers Hotel is located within the busy Roma street transit centre, it has a lot more open spaces on the ground floor available for use and a serene water body behind it in Brisbane River which is relatively close to the building. The landscaping in there is good, with a lagoon around the hotel at the back and along the street in which it is located. When one just gets there, local and international guests can feel fresh air and see the wide spaces all over the ground floor. The facility is easy to find and trace due to the big signade â€Å"Tinbilly Travellers Hotel† name on it near the main road along t he Roma street transit centre. With respect of the other feature of open spaces, the quality of the paving and corridors is excellent, probably because of regular maintenance by the hardworking staff and the Tinbilly Travellers Hotel seems quite new comparing to other hospitality facilities in this location. Besides, there are also a few rubbish bins around the building for dropping small scale refuse which is important considering its location within a cosmopolitan environment. There are various options of transport to access the hotel due to its strategic location within the busy city centre. One can drive to the building or readily walk after a short time connection from the air train or bus. Tinbilly Travellers Hotel has no private parking but the guests can use the free street parking that can accommodate many vehicles. The challenge is the ever increasing number of visiting people that strains the street parking and almost locks out some guests besides the gradually fading col our of parking spots lines. The entrance and exit to the Tinbilly Travellers Hotel is just faced to the main road. As the main road has high traffic flux due to the

Promotion of Stroke and Heart Diseases Research Paper

Promotion of Stroke and Heart Diseases - Research Paper Example This essay therefore explores the aforementioned elements in detail. Promotion of stroke and heart diseases Stroke and heart diseases are the third and the first reported diseases respectively that result into high death rate in both men and women in the United States of America. Additionally, they are considered to be the major widespread and high cost diseases that most nations have to deal with. However, it is important for citizens to take the initiative in order to prevent these particular diseases. This is because these type of diseases can be easily prevented and thus reduce the death rates caused by the same. According to research carried out by Smoller et al (2007) 33.6 % of total number of deaths that occurred in the United States of America were as a result of either stroke or other forms of heart diseases. Statistics further indicates that 150,000 deaths that occurred in 2007 in American were individuals below the age of 65. Moreover the aforementioned diseases not only c ause death but also disability with more than 4 million cases in the United States has been caused by the same. ... merica (Smoller et al., 2007).Therefore, treatment of both stroke and heart diseases impacts negatively on the funds and other resources of the country’s health care scheme. However, over the past years the rate of death caused by stroke and heart related illness has reduced considerable in the United States of America. Therefore, it is expected to reduce even further by 2020. However, among certain populations the incidences of the diseases in addition to death rates have remained high. For instance it has been reported that the diseases is commonly prevalent among certain ethnic and racial groups to be specific individuals living in South Eastern regions of the United States of America and those who experience low social economic status. A study carried out by Smoller et al (2007) indicated that African Americans are at a risk of dying from cardiovascular disease as compared to their white counterparts. Additionally, the percentage of women diagnosed with stroke annually is higher than that of men. Moreover, another study carried out by Karasek (1996) reported that American Indian and natives from Alaska have reported high percentage of premature deaths as a result of heart diseases as compared to other ethnic or racial groups in the United States of America. It is important to note that stroke and other forms of heart diseases are easier to prevent rather than to treat. Therefore individuals need to lead a positive lifestyle (Karasek, 1996).Tobacco smoking is one of the factors that can increase the chances of one suffering from either heart disease or stroke. Hence individuals are encouraged to stop smoking. Moreover, people should have a healthy weight and ensure that they are physically active (Kawachi et al., 1994). More importantly, it is important for people

Domestic violence Essay Example | Topics and Well Written Essays - 2750 words

Domestic violence - Essay Example 464; Black et al., 2008). Specifically the term ‘domestic violence’ can either refer to men and women as victims of abuse (Ahmed, 2009, p. 1). However, the rate of abuse inflicted on women and children is much higher as compared to men (Humphreys and Stanley, 2006, p. 13). In the UK, 62% and 38% of domestic abuse victims are female and male respectively (Office for National Statistics, 2014). Specifically the Women’s Aid (2014) reported that at least one (1) incident of domestic violence occurs in this country each minute and that at least two (2) women are killed by their former or current male partner each week. Published on the official website of gov.uk, the Office for National Statistics (ONS) reported that roughly 1.2 million women were victims of domestic abuse and that more than 330,000 women throughout the United Kingdom were sexually assaulted from 2012 to 2013 (gov.uk, 2014). For so many reasons, domestic violence, up to the present time, can still be a ‘hidden crime’ mainly because the victims are ashamed of being abused by their current or former partner (Rose, 2013, pp. 12–13; Womens Aid, 2008). To gain better understanding of the gender differences in domestic violence, this study will purposely analyse and discuss the existence of unequal power distribution between men and women, the main causes of sexual inequality, oppression and gender or racial discrimination. Eventually, strategies that can help The traumatic experiences the victims get from domestic violence can lead to long-term stress, physical injuries, adverse mental and psychological changes and emotional burden such as anxiety and depression (Pearson et al., 2007, p. 38). In line with this, the UK government allocated a total of  £40 million to financially support the funding of ‘local support services’ and ‘national help lines’ for abuse victims up to the end of 2015. However, the Living Without Abuse (2014) has recently reported that the actual costs of

Financial Markets and Institutions Essay Example | Topics and Well Written Essays - 1250 words - 1

Financial Markets and Institutions - Essay Example economy, impact of recent monetary policy on U.S. economy and the strategy for the use of bond markets. Foreign Exchange Market The foreign exchange market is an over-the-counter (OTC) market. The participants of foreign exchange markets are portfolio managers, importers and exporters, commercial banks, central banks, and foreign currency brokers. Types of Transaction and their benefits There are three types of foreign exchange transactions: spot transaction, forward transaction and swaps. A spot transaction includes deliver of the exchange by the seller of the foreign exchange to the buyer, on the spot, and the settlement of deal is within two business days. A forward transaction involves an agreement between the seller and buyer of currency to purchase or sell a preset amount of currency for a rate which is determined in advance at a specified date in the future. A currency swap is defined as a conversion of one currency into another with an agreement to revert it back at some date in the future. Forward transactions are valuable to the U.S. and global economies in several ways. It can fully eradicate risk by locking in now the rate or price at which the transaction is going to be made in future. Forward trading offer the economic benefits of risk control and price discovery as well as rich opportunity for speculation. It provides protection against price changes through hedging. Spot market is also considered as most developed market and central banks have judged it as the neutral market for interventions. Forward transactions also protect the investors and traders from exposure towards the fluctuations of the spot rate known as currency hedging. (Peng, 2008, p.194). Factors Affecting Interest Rates Interest rates are determined by the forces of demand and supply. There are numerous factors that affect the interest rates and these are as follows: First is the monetary supply and demand. The interest rates for saving accounts of U.S. citizens can be affected by the demand and supply of the currency in circulation and more demand and less supply result in a higher rates being offered. Second is the inflation. Inflation rate impact interest rates because every lender desire returns from the loan in order to reflect the reduced purchasing power. They add the expected or existing inflation value to the interest rates to evade losses. Third is the Central Bank policy. It helps to decide the interest rates for saving accounts. Fourth factor is the demand for credit. When the demand for credit is high, then the best savings account interest rates are seen. Interest rates tend to decrease with the decrease in the credit demand. Fifth factor is the economic state of the U.S. It enables to determine the interest rates for saving accounts. Interest rates tend to decrease with the recession and economic prosperity cause the interest rates to go up. Sixth factor is the expectation of the economic growth. Interest rates tend to increase when economic growth is predicted. Seventh factor is the level of competition among financial institutions. When financial institutions compete for consumer business, then the saving accounts and best interest will be seen.

Democratic legislatures Essay Example for Free

Democratic legislatures Essay The Republican party is unreservedly for sound money. It is unalterably opposed to every effort to debase our currency or disturb our credit. It resumed specie payments in 1879, and since then it has made and kept every dollar as good as gold. This it will continue to do, maintaining all the money of the United States, whether gold, silver or paper, at par with the best money of the world and up to the standard of the most enlightened governments. Towards the middle of the week the group of gentlemen participating in these conferences was increased by several accessions from the number of Mr. McKinleys friends in other states, among whom may be mentioned Mr. Henry C. Payne, William R. Merriam and Melville E. Stone. After his arrival Mr. Henry C. Payne became particularly active in getting the conference together and in having the platform typewritten anew, after every change, and in having copies supplied to each participant. On Friday morning Mr. H. H. Kohlsaat of Chicago joined the conference, having come over from Chicago in response to a telegram particularly for that purpose. Mr. Kohlsaats relation to the whole matter was peculiar. The next step for Mr. Hanna and his assistants was to secure some strong endorsements by the State Conventions. Ohio was already in line, having endorsed McKinley for the nomination in the State Convention of 1895. The Convention of 1896 met at Columbus on March 10. Mr. Foraker, who had recently been elected United States Senator, made a lengthy speech, as temporary chairman, enumerating the many reasons why McKinley should receive the united, hearty, cordial, enthusiastic, and unqualified support of Ohio. The platform contained a ringing endorsement, which was greeted with a volley of cheers, and a resolution was adopted instructing the delegates-at-large to vote and work for his nomination. A telegram was received from the Kansas Convention assuring their support of McKinley, to which Ohio replied with enthusiasm. Wisconsin followed nine days later, and then came Oregon, Nebraska, North Dakota, and even Vermont. Indiana fell into line at an early date. Charles W. Fairbanks, who was to preside as temporary chairman of the convention, called upon General Harrison early in the year, and said to him frankly, If you, General, wish to be a candidate, I shall help you. If not, I am for Major McKinley. Harrison replied that he had wanted the nomination in 1892 and desired to succeed himself, but after four years of Democratic administration the thought of reorganizing the Government was intolerable. He added with twinkling eye, Your friend Cleveland is making my administration luminous. Indiana soon after declared for McKinley. McKinley wanted to retain the systems mobility and diversity, to let men fulfill their talents. He championed tariff protection specifically and the Republican party generally because he rightly understood that both promoted national interests. Naturally and honestly echoing the rhetoric of responsible individualism, he did not seek to advance at societys expense. The belief that material security fostered social responsibility might be as idealistic as facile self-sacrifice based on mans alleged innate goodness and rationality, but it at least accepted limitations in democratic politics, and the understandable reluctance of men to abandon old ideals. Some Republicans, and many Democrats, represented only business interests, but McKinleys background, personality, and constituency opened his mind to change and moderation. As a congressman, he favored civil service reform, federal protection of voting rights, and workable business regulation, reflecting the needs and aspirations of an expanding middle and working class. Like Mark Hanna, he had many friends in organized labor, and protection heightened his appeal in shops and factories. He visited the mines, warehouses, forges, and plants in his district, and got a warm welcome from most workers. His uncertain district, which Democratic legislatures regularly gerrymandered, was a blessing in disguise. He never had the luxury of safety. In American politics, a safe constituency was the kiss of death, since it isolated leaders from change and new demands. McKinleys whole congressional career sharpened his talents for compromise. In his own time, he was a liberal Republican, as many followers who later became reformers readily attested. I always felt that McKinley represented the newer view, Robert La Follette recalled. Of course, McKinley was a high protectionist, but on the great new questions as they arose he was generally on the side of the public and against private interests. By 1896, the Ohioan well represented the elements that could give the GOP a long lease on life.

Degrees Of Carpal Tunnel Syndrome Health And Social Care Essay

Degrees Of Carpal Tunnel Syndrome Health And Social Care Essay Carpal tunnel syndrome is a most common compression neuropathy of the upper extremity. It is caused by compression of median nerve in the carpal tunnel. Women are more commonly affected than men. It is commonly seen in age group between 30 and 60 years. Carpal tunnel syndrome usually occurs due to excessive use of the hands and occupational exposure to repeated trauma. Average cross sectional area of the carpal tunnel is 1.7 cm2 with the wrist in neutral position. Passive flexion and extension of the wrist has been increased the carpal tunnel pressure. Wrist extension increases carpal tunnel pressure more than the wrist flexion. Any space occupying mass or swelling of the structures in the tunnel also causes pressure on the median nerve. Mostly, the cause of carpal tunnel syndrome is unknown. Any condition which causes pressure on median nerve at the wrist will result in carpal tunnel syndrome. Obesity, pregnancy, hypothyroidism, arthritis, diabetes and trauma are the common conditions that lead to carpal tunnel syndrome. Repetitive work such as uninterrupted typing which result in tendon inflammation can also cause carpal tunnel symptoms. Carpal tunnel syndrome due to repetitive activities has referred to one of the repetitive stress injuries. In some rare diseases such as amyloidosis, leukemia, multiple myeloma, and sarcoidosis, deposition of abnormal substances in and around the carpal tunnel leads to nerve irritation. Prolonged flexion or extension of the wrists under the patients head or pillow during sleep is believed to contribute to the prevalence of nocturnal symptoms. Usually patient complaints pain, numbness and tingling sensation in the hand and fingers. Symptoms worsening at night typically awakening the patient or occurring on bunching up the hand for tasks such as writing. Carpal tunnel syndrome is the most common cause of acroparaesthesiae often pain and paraesthesiae may be the only symptoms for many months or years. The syndrome is essentially a sensory one; the loss or impairment of superficial sensation affects the thumb, index and middle fingers and may be or may not split the ring finger. There may be wasting and weakness of the thenar muscles. Weakness and atrophy of the abductor pollicis brevis and other muscles supplied by median nerve occur in only the most advanced cases of compression. Degrees of carpal tunnel syndrome are classified as dynamic, mild, moderate and severe. The pathophysiology of carpal tunnel syndrome is typically demyelination. Secondary axon loss may present in more severe cases. With 20 to 30 mm hg compression, the initial insult is a reduction in epineural blood flow. With wrist extension, intracarpal pressures routinely measure atleast 33 mm hg and often upto 110 mm hg in patients with carpal tunnel syndrome. Edema in the epineurium and endoneurium is caused by continued or increased pressure. Carpal tunnel syndrome diagnosed by detailed history collection, phalen maneuver, percussion test, two point discrimination test, vibrometry, monofilament test, distal sensory latency and conduction velocity, distal motor latency conduction, upper limb tension tests. X-ray is taken to check for arthritis and fracture. If there is a suspected medical condition that is associated with carpal tunnel syndrome, laboratory tests may be done. This condition could be mistaken for a brachial neuritis due to cervical intervertebral disc prolapse at C5 C7 level. Nerve conduction tests on the median nerve help to localize the lesion in the tunnel. Both conservative and surgical management options are available in order to reduce pressure over median nerve. The current conservative treatments include non steroidal anti inflammatory drugs, sometimes rest, local injection of corticosteroids, activity modification, ultrasound therapy, carpal bone mobilization, magnetic therapy, night and/or daytime wrist splint positioned at 0 to 15 degrees of extension, nerve and tendon gliding exercises. Anyone of the measures alone or in combination can be effective in treating early carpal tunnel syndrome. Tendon gliding exercises are performed to lubricate and increase gliding of the flexor pollicis longus, flexor digitorum superficialis and flexor digitorum profundus tendons. They are best performed with the hand elevated to concurrently control local edema. Median nerve gliding exercises and the upper limb tension test with median nerve bias can be used as treatment techniques. Modality treatment can also control symptoms and enhance the therapeutic exercise program. Exercise intervention for carpal tunnel syndrome focuses on mobility and strengthening without producing an exacerbation. Stretches for the extrinsic and intrinsic muscles are prescribed for several times each day. If working, a patient should perform them before work. They should be performed slowly and gently; the patient feel only a gentle stretching sensation. In workplace, modification of the job site or complete ergonomic redesign is typically the most helpful approach. In addition yoga, chiropractics, laser treatment have been advocated. Surgery is indicated in advanced cases with objective sensory loss and /or weakness or atrophy of the abductor pollicis brevis. In severe cases surgical division of the transverse carpal ligament relieves the condition. Surgical management includes open carpal tunnel release and endoscopic release. It aims to decompress nerve, to improve excursion and to prevent flexor damage. Splinting is the most popular method of conservative management of carpal tunnel syndrome. Splints are recommended by the American Academy of Neurology for the Carpal tunnel syndrome with light and moderate pathology. Immobilization of the wrist joint in a neutral position with splint will increase the carpal tunnel volume and minimize the median nerve pressure. Wrist Splinting in a neutral position will help reduce and may even completely relieve Carpal tunnel syndrome (Slater RR et al 1999). Ultrasound therapy is more useful in the management of Carpal tunnel syndrome. It has the potential to accelerate normal resolution of inflammation. Ultrasound therapy elicit anti inflammatory and tissue stimulating effects. Ultrasound therapy accelerates the healing process in damaged tissues. Pulsed Ultrasound therapy with the intensity of 1.0 w/cm2, 1:4 for fifteen minutes per session has significantly improved subjective symptoms in patients with carpal tunnel syndrome (Ebenbichler GR et al). Nerve and tendon gliding exercises are used in conservative treatment of carpal tunnel syndrome to decrease adhesions and to regulate venous return in nerve bundles (Rozmaryn et al). Nerve and tendon gliding exercises may maximize the relative movement of the median nerve within the Carpal tunnel and the excursion of flexor tendon relative to one another (Rempel D, Manojlovic R et al). Wrist splint along with nerve and tendon gliding exercises showed significant improvement in reducing symptoms in Carpal tunnel syndrome. (Akalin et al) NEED FOR THE STUDY: Ultra sound therapy, splints, nerve and tendon gliding exercises are significantly effective in reducing symptoms in the treatment of Carpal tunnel syndrome. Combination of various treatments is also useful in reducing symptoms in Carpal tunnel syndrome. Ultrasound therapy helps to increase healing process in damaged tissue. This study aimed to find out the effect of Ultrasound therapy in reducing pain in patients with Carpal tunnel syndrome. STATEMENT OF THE PROBLEM Effect of Ultrasound Therapy in reducing pain in patients with Carpal tunnel syndrome. KEY WORDS: Carpal tunnel syndrome Ultrasound therapy Splint Exercises Pain Visual analogue scale (VAS) AIM: To find out the Effect of Ultrasound Therapy in reducing pain in patients with Carpal Tunnel Syndrome. OBJECTIVE: To study the Effect of Ultrasound Therapy in reducing pain in patients with Carpal Tunnel Syndrome. HYPOTHESIS: 1.6.1. NULL HYPOTHESIS There is no significant effect of Ultrasound Therapy, Splint and Exercises in reducing pain in patients with Carpal Tunnel Syndrome. There is no significant effect of Splint and Exercises in reducing pain in patients with Carpal Tunnel Syndrome. There is no significant difference between the effect of Ultrasound Therapy, Splint and Exercises and Splint and Exercises in reducing pain in patients with Carpal Tunnel Syndrome. 1.6.2. ALTERNATE HYPOTHESIS There is significant effect of Ultrasound Therapy, Splint and Exercises in reducing pain in patients with Carpal Tunnel Syndrome. There is significant effect of Splint and Exercises in reducing pain in patients with Carpal Tunnel Syndrome. There is significant difference between the effect of Ultrasound Therapy, Splint and Exercises and Splint and Exercises in reducing pain in patients with Carpal Tunnel Syndrome. II.REVIEW OF LITERATURE CARPAL TUNNEL SYNDROME DAVID A FULLER, MD, et al (2010) Stated that carpal tunnel syndrome is the most common entrapment neuropathy. The syndrome is characterised by pain, paraesthesia, and weakness in the median nerve distribution of the hand. The etiology of carpal tunnel syndrome is multifactorial which is contributed by various degrees of local and systemic factors. Symptoms of carpal tunnel syndrome are due to ischemia and impaired axonal transport of the median nerve which results from median nerve compression at the wrist. (Lunborg G, Dahlin LB 1992). Elevated pressure inside the carpal tunnel leads to compression. HARVEY SIMON, MD et al, (2009) Stated that carpal tunnel syndrome is considered as an inflammatory disorder caused by medical conditions, physical injury or repetitive stress. JEFFREY G NORVELL, MD et al (2009) Stated that carpal tunnel syndrome (CTS) is caused predominantly by median nerve compression at the wrist because of hypertrophy or oedema of the flexor synovium. Pain is thought to be secondary to nerve ischemia rather than direct physical damage of the nerve. S.BRENT BROTZMAN, MD (2003) Explained that degree of the carpal tunnel syndrome as dynamic, mild moderate and severe. In mild cases, patients has intermittent symptoms, decreased light touch, positive digital compression test and positive tinel sign or phalen test may or may not be present. In moderate cases, patients have frequent symptoms, decreased vibratory sense, muscle weakness, positive tinel sign, phalen test and digital compression test. GERRITSEN AA, DE KROM MC, STRUIJS MA, ET AL (2002) Stated that carpal tunnel syndrome (CTS) is caused by median nerve compression at the wrist and is considered to be the more common entrapment neuropathy. Symptoms of carpal tunnel syndrome include pain, numbness or tingling sensation, paraesthesia, involving the fingers innervated by the median nerve. (Bakhtiary AH, Rashidy Pour AR et al 2004) GELBERMAN RH, HERGENROEDER PT, HARGENS AR, RYDEVIK B, LUNDBORG G, BAGGE U (1981) Fracture callus, osteophytes, anomalous muscle bodies, tumours, hypertrophic synovium, and infection as well as gout and other inflammatory conditions can produce increased pressure within the carpal tunnel. Extremes of wrist flexion and extension also elevate pressure within the carpal tunnel. Intraneural blood flow is affected by compression on nerve. Venular blood flow in a nerve is reduced by pressure as low as twenty to thirty mm Hg. At level of thirty mm Hg, axonal transport is impaired. At forty mm Hg, neurophysiologic changes manifested as sensory and motor dysfunctions are present. Any further increase in pressure will produce sensory and motor block. At level of sixty to eighty mm Hg, complete cessation of intraneural blood flow is seen. In one study, the carpal tunnel pressure in patients with carpal tunnel syndrome averaged thirty two mm Hg, compared with only about two mm Hg in control subjects. RH GELBERMAN, AR HARGENS, GN LUNDBORG, PT HERGENROEDER et al, (1981) Measured intra carpal canal pressures with the wick catheter in 15 patients with carpal tunnel syndrome and in 12 control subjects. The average pressure in the carpal tunnel was raised significantly in the patients with carpal tunnel syndrome. When the wrist was in neutral position, the mean pressure was 32 millimeters of mercury. With ninety degrees of wrist flexion the pressure raised to 94 millimeters of mercury. While with ninety degrees of wrist extension the average pressure was 110 millimeters of mercury. The pressure of carpal canal in the control subjects with the neutral position of wrist was 2.5 millimeters of mercury; with wrist flexion the carpal canal pressure rise to 31 millimeters of mercury, and with wrist extension it increased to 30 millimeters of mercury.  ­Ã‚ ­Ã‚ ­Ã‚ ­Ã‚ ­Ã‚ ­Ã‚ ­Ã‚ ­GEORGE S. PHALEN M.D, et al (1966) Stated that diagnosed Carpal tunnel syndrome has been made in 654 hands of 439 patients during the last seventeen years. The typical patient with this syndrome is a middle-aged housewife with numbness and tingling in the thumb and index, long, and ring fingers, which is worse at night and worse after excessive activity of the hands. The sensory disturbances both objective and subjective must be directly related to the sensory distribution of the median nerve distal to the wrist but pain may be referred proximal to the wrist as high as the shoulder. There is usually a positive tinel sign over the median nerve at the wrist, and the wrist flexion test is also usually positive. About half of the patients also have some degree of thenar atrophy. In clinical practice, Carpal tunnel syndrome is the most commonly seen entrapment mononeuropathy which is caused by median nerve compression at the wrist (PHALEN 1966, GELBERMAN et al 1998). Usually patients show one or more symptoms of hand weakness, pain, numbness or tingling in the hand, especially in the thumb, index and middle fingers (SIMOVIC and WEINBERG 2000). Symptoms are worst during night time and often wakeup the patient. WILLIAM C. SHIEL JR., MD.FACP, FACR, et al Stated that the cause of the carpal tunnel syndrome is unknown. Any condition which causes pressure on the median nerve at the wrist will result in carpal tunnel syndrome. Common conditions such as obesity, pregnancy, hypothyroidism, arthritis, diabetes, and trauma can lead to carpal tunnel syndrome. Repetitive work such as uninterrupted typing result in tendon inflammation can also cause Carpal tunnel symptoms. In some rare diseases such as amyloidosis, leukemia, multiple myeloma, and sarcoidosis, deposition of abnormal substances in and around the carpal tunnel leads to nerve irritation. MEDIAN NERVE LUNDBORG G, DAHLIN LB, et al (1996) Stated that throughout the extremity movement, mobility of the peripheral nerve changes and longitudinal movement of the median nerve mostly occur in the carpal tunnel. In Carpal tunnel syndrome, this physiologic mobility of the median nerve disappears. REMPEL D, MANOJLOVIC R, LEVINSOHN DG, et al (1994) Stated that during the exercise there may be redistribution of the point of maximal compression on the median nerve. This milking effect would promote venous return from the median nerve, thus decreasing the pressure inside the perineurium. NAKAMICHI AND S. TACHIBANA et al Conducted a study the motion of median nerve in patients with carpal tunnel syndrome and normal subjects. Median nerve motion was assessed by axial ultrasonographic imaging the mid carpal tunnel. They concluded that wrist of patients with Carpal tunnel syndrome showed less sliding which indicates that physiological motion of the nerve is restricted. This decrease in nerve mobility may be of significance in the pathophysiology of carpal tunnel syndrome. ULTRASOUND THERAPY BAKHTIARY AH, RASHIDY-POUR A et al (2004) Conducted a study to compare the effect of Ultrasound and laser therapy in patients with mild to moderate idiopathic carpal tunnel syndrome. By electromyography findings, 90 hands in 50 consecutive patients with carpal tunnel syndrome were confirmed and allocated randomly in two groups. One group received low level laser therapy and the other group received ultrasound therapy. Ultrasound treatment (pulsed 1:4, 1.0 W/cm2, 1 MHz, 15 min/session) and low level laser therapy (infrared laser, 830nm, 9 Joules, at five points) were given to the carpal tunnel for fifteen daily treatment sessions. Ultrasound group showed more significant improvement than low level laser therapy group in motor latency, motor action potential amplitude, finger pinch strength, and pain reduction. Effects were also sustained in the follow-up period. They concluded that ultrasound therapy was more effective than laser therapy in the management of carpal tunnel syndrome. EBENBICHLER GR, RESCH KL et al (1998) Studied the efficacy of Ultrasound therapy in patients with mild to moderate idiopathic Carpal tunnel syndrome. Ultrasound with parameters 1MHZ, 1.0 W/cm2 pulsed mode 1:4, 15 minutes per session was applied over the carpal tunnel and compared with Sham Ultrasound. Actively treated ultrasound group showed significant improvement than sham treated wrists in both subjective symptoms and electroneurographic variables. To confirm the usefulness of ultrasound therapy for Carpal tunnel syndrome, more studies are needed. Additional randomized trials comparing conservative therapies for Carpal tunnel syndrome would be useful in selecting appropriate treatments for individual patients. EL HAG M, COGHLAN K, CHRISMAS P et al (1985) Stated that Ultrasound could elicit anti-inflammatory and tissue-stimulating effects as already shown in clinical trials and experimentally (Byl et al 1992, Young and Dyson 1990). In this way, Ultrasound has the potential to accelerate normal resolution of inflammation (Dyson 1989). The results of these studies confirm that Ultrasound may accelerate the healing process in damaged tissues. In mild to moderate carpal tunnel syndrome patients, these mechanisms may explain their findings including pain relief, increased grip and pinch strength, and changed electrophysiological parameters toward normal values better than Laser therapy. WRIST SPLINT Wrist splints help to keep the wrist straight and reduce pressure on the compressed nerve. Doctor may recommend the patients to wear wrist splints either at night, or both day and night, although patient may find that they get in the way when they are doing their daily activities. Some research indicates that ultrasound treatment may help to reduce the symptoms of carpal tunnel syndrome. (BUPAS health information team 2010) BRININGER TL, ROGERS JC et al (2007) Fabricated customized neutral splint and nerve and tendon gliding exercises is more effective than wrist cock up splint and nerve and tendon gliding exercises in reducing symptoms and improving functional status in the treatment of Carpal tunnel syndrome. GERRITSEN AA, DE KROM MC, STRUIJS MA, et al (2002) Immobilization of the wrist joint in a neutral position with a splint will maximizes carpal tunnel volume and minimize the pressure acting on median nerve. AKALIN E, EL O, SENOCAK O, et al (2002) Compared the effect of wrist splint alone to wrist splint with nerve and tendon gliding exercises in the treatment of carpal tunnel syndrome. In their study, both groups showed significant improvement in clinical parameters, functional status scale and symptom severity scale. They also reported significant improvement only in pinch strength in the group with wrist splint in combination with exercises compared with the wrist splint group. MANENTE G, TORRIERI F, et al (2001) Stated that wearing a specially designed wrist splint at night time for four weeks was more effective than no treatment in reducing the symptoms of Carpal tunnel syndrome. SLATER RR, et al (1999) Stated that splinting the wrist in a neutral position will help to reduce and may even completely relieve carpal tunnel syndrome symptoms. SAILER SM, et al (1996) Stated that the optimal splinting regimen depends on the patients symptoms and preferences. To prevent prolonged wrist flexion or extension, night splint use is recommended. BURKE DT, STEWRT GW, CAMBER A, et Al (1994) Stated that carpal tunnel syndrome is the commonest compression neuropathy in the upper limb. Several studies have demonstrated the effect of wrist splint in reducing the symptoms of carpal tunnel syndrome. But the chosen angle of immobilization has varied in the management of carpal tunnel syndrome. Wick catheter measurements of carpal tunnel pressures suggest that the neural position has less pressure and, therefore, greater potential to provide relief from symptoms. KRUGER VL, KRAFT GH, et al (1991) Stated that wrist splint at a neutral angle helps to decrease repetitive flexion and rotation, thereby relieving mild soft tissue swelling or tenosynovitis. Splinting is most effective when it is applied within three months of the onset of symptoms. NERVE AND TENDON GLIDING EXERCISES BAYSAL O, ERTEMK, YOLOGLUS, ALTAY Z, KAYHANA et al (2006) Stated that combination of ultrasound therapy, splinting and exercises is a preferable and an efficacious treatment for patients with carpal tunnel syndrome. ROZMARYN LM, et al (1998) Used nerve and tendon gliding exercises in conservative treatment models to decrease adhesions developed in the carpal tunnel and regulate venous return in the nerve bundles. They reviewed more than 200 hands under consideration for carpal tunnel decompression. Altogether 71% of the patients who were not offered gliding exercises went forward to surgery; only 43% of the gliding exercise group was felt to require surgery. SERADGE et al (1995) Stated that intermittent active wrist and finger flexion-extension exercises reduce the pressure in the carpal tunnel. SZABO et al (1994) Showed that the relationship between median nerve and flexor tendon excursion was consistently linear. They suggested active finger motion of the median nerve and flexor tendons in the vicinity of the wrist to prevent adhesion formation even if the wrist is immobilized. REMPEL D, MANOJLOVIC R, LEVINSOHN DG, et al (1994) Stated that the median nerve movement is increased by nerve and tendon gliding exercises in the carpal tunnel and the flexor tendons excursion is increased in relative to one another. TOTTEN AND HUNTER, et al (1991) Proposed a series of exercises enhancing the gliding of the median nerve and tendon at the carpal tunnel for management of postoperative Carpal tunnel syndrome. They also suggested these exercises for non-operative Carpal tunnel syndrome. LAMINA PINAR, SAIT ADA AND NEVIN GUNGOR ET AL Stated that nerve and tendon gliding exercises included in conservative therapy approaches showed more rapid pain reduction and greater functional improvement in grip strength. HANNAH RICE MYERS, et al Stated that carpal tunnel exercises reduce the tension on the tendons in the tunnel and strengthen the weakened muscles of wrist and forearms. Even though nerve and tendon gliding exercises are effective when used alone, they have a greater effect when used along with other intervention such as splint. For people who are involving jobs with keeping their hands in a fixed position throughout the day such as typing secretaries, these exercises may help to prevent carpal tunnel syndrome from developing. VISUAL ANALOGUE SCALE POLLY E. BIJUR PHD, WENDY SILVER MA, E. JOHN GALLAGHER MD et al (2008) Conducted to study to assess the reliability of the visual analogue scale (VAS) for acute pain measurement as assessed by the intraclass correlation coefficients (ICC) appears to be high. The results showed that the Visual analogue scale (VAS) is sufficiently reliable to be used to assess acute pain. PAUL S. MYLES, MBBS, MPH, MD, FFARCSI, et al (1999) Stated Visual analog scale (VAS) is a tool widely used to measure pain. A patient is asked to indicate his/her perceived pain intensity (most commonly) along a 100 mm horizontal line, and this rating is then measured from the left edge (VAS score). The visual analogue scale score correlates well with acute pain. JOYCE, et al Suggested that visual analogue scale and another scales have been compared in terms of sensitivity, distribution of responses and preferences. Results of these studies appear equal. The visual analogue scale has been described as superior in one study because it was more sensitivity than any other scale. III. METHODOLOGY 3.1 STUDY DESIGN: Pretest and Posttest Experimental group study design. 3.2 STUDY SETTING: The study was conducted at Department of Physiotherapy, K.G.Hospital, Coimbatore. 3.3 STUDY DURATION: 3 weeks for each individual subject and the total duration was one year. 3.4 STUDY POPULATION: Patients with Carpal tunnel syndrome referred to the Department of physiotherapy, K.G.Hospital, Coimbatore. 3.5 STUDY SAMPLE: All patients with carpal tunnel syndrome who referred to Department of Physiotherapy, K.G. Hospital were selected. Among all patients, 20 patients who satisfied inclusive and exclusive criteria were selected and assigned into two groups, 10 of each by using Purposive Sampling method. 3.6 CRITERIA FOR SELECTION: INCLUSIVE CRITERIA: Age group above 30 years. Both sexes. Patients with mild to moderate unilateral carpal tunnel syndrome. Patients with Positive Tinel sign, Phalens test and Digital compression test. EXCLUSIVE CRITERIA: Patients with severe carpal tunnel syndrome Patients having thenar atrophy or denervation on electromyographic findings Patients with a neuropathy other than carpal tunnel syndrome in the past year Patient with history of steroid injection in carpal tunnel in the past 3 months Patients had a prior carpal tunnel release Cervical disc prolapse Degenerative changes of cervical spine Acute upper limb fractures Wrist and fingers stiffness Recent hand surgeries Deqeurains disease Pregnancy Acute Infections of Wrist and Hand 3.7 Variables: Dependent variable Pain. Independent variable Visual analogue scale. 3.8 Orientation of subjects: Before treatment all the patients were explained about the study and procedure to be applied and were asked to inform if they feel any discomfort during the course of the treatment. All the willing patients were asked to sign the consent form before the treatment. 3.9 OUTCOME MEASURES: Pain. 3.10 OPERATIONAL TOOLS: Visual analogue scale 3.11 STUDY PROCEDURE: 20 Patients with carpal tunnel syndrome were selected for this study after due consideration of inclusive and exclusive criteria. 20 patients were divided into 2 groups of 10 each. Group A: 10 patients received ultrasound therapy, splint and exercises. Ultrasound therapy with parameters of 1 MHz pulsed mode, 1:4, 1 w/cm2 is given 15 minutes per day, five times per week. Custom made neutral volar splint is given at night and during day time. Exercises are nerve and tendon gliding exercises. During tendon-gliding exercises, the fingers are placed in five discrete positions. Those were straight, hook, fist, table top, and straight fist. During the median nerve-gliding exercise the median nerve was mobilized by putting the hand and wrist in six different positions. During these exercises the neck and the shoulder were in a neutral position and the elbow was in supination and 90 degrees of flexion. Each position was maintained for 5 seconds. Each exercise is repeated 10 times at each session, 5 sessions per day. The total treatment duration is 3 weeks. Group B: 10 patients received only Splint and Exercises. Custom made neutral volar splint is given at night and during day time. Exercises are nerve and tendon gliding exercises. During tendon-gliding exercises, the fingers are placed in five discrete positions. Those were straight, hook, fist, table top, and straight fist. During the median nerve-gliding exercise the median nerve was mobilized by putting the hand and wrist in six different positions. During these exercises the neck and the shoulder were in a neutral position and the elbow was in supination and 90 degrees of flexion. Each position was maintained for 5 seconds. Each exercise is repeated 10 times at each session, 5 sessions per day. The total treatment duration is 3 weeks. 3.12 STATISTICAL TOOLS: Statistical analysis was done using Student t-test. Paired t test Where, n = Total number of subjects SD = Standard deviation d = Difference between initial and final value = Mean difference between initial and final value. (ii) Unpairedt test: To compare the pre test, post test values of both groups independentt test is used. Where, n1 = Number of subjects in Group A. n2 = Number of subjects in Group B. = Mean of Group A = Mean of Group B s1 = Standard deviation of Group A. s2 = Standard deviation of Group B. S = Combined standard deviation IV.DATA ANALYSIS AND INTERPRETATION TABLE-1 VISUAL ANALOGUE SCALE FOR PAIN GROUP A PAIREDt TEST Mean values, mean differences, standard deviation andt values of Visual Analogue Scale for Group A who underwent Ultrasound therapy, Splint, Nerve and Tendon gliding exercises. S. NO VAS Improvement t value Mean Mean difference Standard deviation 1. Pre test 5.60 3.90 0.70 39.0 2. Post test 1.70 0.67 FIGURE-1 GRAPHICAL REPRESENTATION OF MEAN VISUAL ANALOGUE SCALE FOR GROUP A TABLE-2 VISUAL ANALOGUE SCALE FOR PAIN FOR GROUP B PAIREDt TEST Mean values, mean differences, standard deviation andt values of Visual Analogue Scale for Group B who underwent to Splint, Nerve and Tendon gliding exercises. S. NO VAS Improvement t value Mean Mean difference Standard deviation 1. Pre test 5.40 3.0 0.70 20.12 2. Post test 2.40 0.52 FIGURE-2 GRAPHICAL REPRESENTATION OF MEAN VISUAL ANALOGUE SCALE FOR GROUP B TABLE-3 VISUAL ANALOGUE SCALE FOR PAIN PRETEST VALUES OF GROUP A VERSUS GROUP B UNPAIREDt TEST Mean, mean difference, standard deviation and unpairedt test of pre test v