Biceps Tendon Rupture With Post-operative Complications

Biceps Tendon Rupture With Post-employable Complications Locomotor PBL Experiment Writeup Presentation In this PBL, we watch an instance of biceps ligament burst with post-employable difficulty of heterotopic solidification. We will initially experience the life structures of the upper appendage followed by a conversation of the cracked biceps ligament, heterotopic solidification lastly method of activity of indomethacin. Learning Objectives 1. Osteology of the upper appendage with accentuation on the elbow and wrist 2. The neurovascular gracefully to the upper appendage 3. Developments conceivable at joints of upper appendage and the scope of developments conceivable with respect to the elbow and wrist and the muscles that achieve these activities. 4. Break of distal biceps ligament 5. Heterotopic solidification 6. Method of activity of Indomethacin 1. Osteology of the upper appendage with accentuation on the elbow and wrist Arm The humerus is the biggest and longest bone of the arm district interfacing the shoulder to the lower arm. Proximally, the leader of the humerus expresses with the glenoid cavity of the scapula framing the glenohumeral joint. Distally the humerus verbalizes with the two bones of the lower arm, the ulna and span. The humerus is appeared in more detail in figure 1 beneath. Figure 1 Humerus (1) For Anil’s case we will concentrate a few noticeable highlights on the distal district of the humerus which structures some portion of the elbow. There are two projections on either side of the distal finish of the humerus which are the average and horizontal epicondyle. The average epicondyle ensures the ulnar nerve which passes just posteriorly and furthermore fills in as the connection site for the lower arm shallow flexor muscles. The parallel epicondyle alternately is the connection site for the lower arm extensor muscles. Anteriorly in the middle of these two epicondyles are two articular surfaces: the round surfaced sidelong capitulum which expresses with the sweep and the spool formed average trochlea which explains with the ulna. Additionally anteriorly, the spiral fossa legitimately over the capitulum suits the leader of the range during flexion of the elbow while the coronoid fossa straightforwardly over the trochlea obliges the coronoid procedure of the ulna during flexion of the elbow. Both the outspread and coronoid fossa limit flexion of the elbow. Posteriorly, the olecranon fossa obliges the olecranon procedure of the ulna during augmentation of the elbow. The olecranon fossa forestalls hyperextension of the elbow. Lower arm The lower arm is comprised of two bones: ulna and span. Proximally both of these bones articulate with the humerus though distally just the span straightforwardly expresses with the carpals of the wrist therefore interfacing the arm to the wrist. The ulna and span are appeared in figure 2 beneath. Figure 2 Radius and Ulna (1) The ulna The ulna is the settling bone of the lower arm and is average and longer of the two bones. There is a projection anteriorly at the proximal end called the coronoid procedure which fits into the coronoid fossa during elbow expansion. Posteriorly on the proximal finish of the ulna is the olecranon procedure (which shapes the noticeable quality of the elbow) which fits into the olecranon fossa during elbow expansion. The articular surface between the olecranon and the coronoid explains with the trochlear of the humerus and gives the developments of elbow expansion and flexion. The span The span is the parallel and shorter of the two bones. The leader of the range is a level catch molded procedure that verbalizes with the capitulum of the humerus. The neck of the sweep is a tightening only distal to the head which Anil has cracked. Because of the way that no neurovascular issues were discovered, it is protected to infer that the profound part of the outspread nerve was not harmed for this situation. The spiral tuberosity is distal to the neck on the front site which is the connection point for the ligament of biceps. Wrist The ulna doesn't legitimately express with the carpal bones of the wrist distally. There is an articular circle between the littler distal leader of the ulna and the carpal bones. The span straightforwardly expresses with the scaphoid and lunate carpal bones on its bigger distal end. This is appeared in figure 3 underneath. Figure 3 Wrist joint (1) 2 The neurovascular gracefully of the upper appendage Blood vessel gracefully The upper appendage is provided by the subclavian supply route which branches off from the brachiocephalic trunk on the privilege and aortic curve on the left. The subclavian supply route stretches out from its root to the parallel outskirt of the main rib. It at that point changes its name to the axillary vein which stretches out to the parallel outskirt of teres major after which it turns into the brachial conduit. The brachial supply route stretches out to the cubital fossa of the elbow where it bifurcates into the outspread and ulnar corridor which run down the parallel and average side of the lower arm individually. These two conduits anastomose in the palm of the hand shaping the shallow (mostly provided by ulnar vein) and profound (essentially provided by spiral supply route) palmar curves. The fingers are provided by the advanced supply routes spreading from the palmar curves. The blood vessel gracefully is outlined in figure 4 beneath. Figure 4 Arterial flexibly of upper appendage (2) Venous flexibly There are two fundamental sorts of veins in the upper appendage. Right off the bat, shallow veins which can be seen subcutaneously. There are three primary shallow veins which are the cephalic (horizontally), basilic (medially) and middle cubital (association among cephalic and basilica at the cubital fossa) veins. The shallow veins are appeared in figure 5 underneath. Figure 5 Venous gracefully to upper appendage (3) Also, there are profound veins which as a rule goes with the corridors two by two and have a similar name as the supply routes. Puncturing veins interface the shallow and profound veins to permit blood to consistently discover a route back to the heart. All the veins in the end depletes into the axillary vein, at that point to the subclavian vein, at that point brachiocephalic vein lastly into the heart through predominant vena cava. Apprehensive flexibly The brachial plexus fills in as the nerve flexibly for the upper appendage emerging from spinal nerve roots from C5, 6, 7, 8 and T1. There are 5 terminal parts of the brachial plexus in the arm. Table 1 beneath shows the five terminal nerves with their comparing roots, engine flexibly, tangible gracefully and clinical test. Table 1 Nerves, relating roots, engine flexibly, tactile gracefully and clinical test (4) 3 Movements conceivable at joints of upper appendage and the scope of developments conceivable with respect to the elbow and wrist and the muscles that achieve these activities. The elbow comprises of three joints: the humeroulnar joint from the trochlear indent of the ulnar to trochlear of humerus, the humeroradial joint from the leader of the span to the capitulum of humerus and the prevalent radioulnar joint from the leader of the sweep to the outspread score of the ulna. The humeroulnar and humeroradial joints take into consideration flexion and expansion of the elbow while the prevalent radioulnar joint takes into account pronation and supination. This happens when the leader of the span which is encased in annular tendon traverses the fixed ulna bone. The muscles that move the elbow are appeared in table 2 beneath: Table 2 Main muscles of elbow (5) Developments and extents for the elbow and wrist are appeared in table 3 beneath: Table 3 Movements and extents for elbow and wrist (6) 4 Rupture of distal biceps ligament Side effects Side effects remember expanding for the front of the elbow, serious torment at the elbow and a lump in the upper arm in light of the abbreviated biceps brachii muscle. Since Anil shows no biceps ligament reflex upon evaluation, this is probably going to be a finished burst of the ligament. Cause For this situation, Anil is analyzed to have cracked his distal biceps ligament which appends to the outspread tuberosity. Distal biceps ligament break will in general be brought about by a solitary awful mishap including flexion of the elbow at a correct edge against obstruction. For Anil, the snapping of the rope made his elbow fix unexpectedly. His biceps contracted extra difficult to keep this from occurring however the outrageous pressure in his biceps and ligament prompted the burst of the distal biceps ligament. Treatment Since Anil is still generally youthful at 38 years of age and still needs full utilization of his upper appendage, the careful treatment alternative is generally liked. Now and again the ligament is appended by sewing through openings made in the bone. Anyway the medical procedure for Anil was finished by connecting the ligament deep down utilizing a little metal plate and screws into the range to make sure about the plate as a rule called the endobutton method (7, 8) which has a generally excellent guess of recapturing full versatility in the elbow. Complexities Complexities after the medical procedure incorporate nerve harm and heterotopic solidification. Following two months Anil came back with solidness, trouble in turning his hand over and wrist torment which the specialist analyzed as heterotopic solidification after palpation of a firm mass along the biceps ligament. Direct intercession was not taken as the biceps ligament required chance to completely recuperate. 5 Heterotopic hardening Heterotopic solidification is the development of bone in strange places, for example, delicate tissue. Heterotopic hardening is an outstanding intricacy of distal biceps ligament fix. The current proposed pathogenesis of how heterotopic solidification emerges is the change of pluripotential mesenchymal cells which are selected to the crack recuperating site into osteoblasts that outcomes in ectopic bone arrangement. (9) Bone, ligaments and tendons which are on the whole connective tissue all offer the equivalent mesenchymal foundational microorganism source (appeared in figure 6) and in this way mesenchymal undifferentiated organisms enrolled to advance ligament fix can separate into osteoblasts. Osteoblasts can likewise be pulled out of the bone when the ligament cracks and along these lines can prompt bone testimony. Henceforth extraordinary consideration has been given to cleaning and inundating the su

Southwest Airlines Case Study Essay Sample free essay sample

A large number of individuals fly regular. Southwest air hoses give low-toll travel among 58 metropoliss in the United States. Despite the fact that the air hose industry endured enormously in the wake of September 11. Southwest had the option to proceed to keep solid. Southwest air hose keeps on keeping consistent gross incomes as a great part of the business was influenced by adjustments parents in law/guidelines and rivalry come ining the market. In the undermentioned examination there is a concise introduction to Southwest Airlines and their plan thus what. in the event that anything. they have to make or non make to remain at the top and competitory noticeable all around hose industry. The Problem The significant activity of the organization is whether they can continue turning and at a similar clasp keep up offering similar administrations to their customers. To continue turning. Southwest Airlines needs to break down the outer condition so as to ensure their prosperity. The Analysiss Six components of outer condition The OptionsThe arrangements that will be introduced for Southwest air hoses need to pounce upon two boss issues: 1. We will compose a custom paper test on Southwest Airlines Case Study Essay Sample or on the other hand any comparative subject explicitly for you Don't WasteYour Time Recruit WRITER Just 13.90/page In what capacity will they have the option to keep up their â€Å"Southwest air hoses LUV† 2. The most effective method to keep up their extension and non sway the picture of the air hose. Southwest Airlines has a rundown of boundless alternatives. many will obstruct their picture from the inside out ( representatives to costumiers ) while providing a lot of administrations that will keep up their customers upbeat for a piece. others will do the one time homelike air hose appear to be a cold and enormous noble and doing their picture of LUV to fall. so as to stay away from this and help the organization keep up the two closures these are the arrangements that will be introduced for their predicament. 1. â€Å"Freemium† : What’s free: Web bundle and administrations. some substance. Allowed to whom: clients of the essential adaptation. † ( Chris Anderson. Why $ 0. 00 Is the Future of Business. 02. 25. 08 ) Discovering things and musings that will hold no existent expense to the organization for the administration while having the option to endure down a â€Å"extra† for the exchange great of the customers will expand the overall gains of the organization. 2. Cut expenses: Disembark from the landing area and permit the costumiers stroll to the passage. The organization needs to accept and be originative in the manners they can keep up a reasonable rate for their flights while doing creations to their planes. paying their representatives and keeping up costumiers content with their administrations. 3. Counterbalance losingss with higher menus: Charge exaggerated for an incredibly requested twenty-four hours or for purchasing the ticket a similar twenty-four hours. 4. In flight outsiders promotion: Offer an unending of commercial within the airplane to different organizations. The Recommendations In the wake of contemplating both the examination and the choices that were introduced. it has been concluded that the most ideal way the organization could take is bind together both the first and fourth proposals. The Freemium thought and Advertising within the airplane are things that can be finished in little total of clasp and concocting net gain out of the two things. This will ensure that the LUV that Southwest Airlines appears towards their workers and customers continues being the main priority within the undertaking while non holding to bargain their developing by introducing better approaches to do net out of things that won’t do them put more cash that they could quit fring. These two suggestions will pounce upon and choosing the central issues of the activity: first a way to keep up their â€Å"LUV† streaming and the second one a way to ensure that the developing that has taken topographic point will non drop the organization however on the other hand help them be greater and better. DecisionsThe proposals were the 1s picked in light of the fact that they are the 1s that have the less evaluation of disappointment. what's more, if disappointment somehow managed to be met the effect in the organization would be about or truly close to nothing. Southwest is an extraordinary case review of how to procure representative deal in. to a developing creating concern. The way in to the achievement of the southwest hypothetical record has been in addition to utilize and low factor costs. hitched with solid organization progress to alining esteems. frameworks. developments and plan. By making this Southwest has had the option to delay competitory bit of leeway by releasing the intensity in their work power. Notices Dess. G. . Lumpkin. T. . Eisner. A. . McNamara. G. ( 2011 ) . Vital Management: Text and Cases/Edition 6. Distributer: McGraw-Hill Companies. Inc. Theot. T. ( 2010 ) . Southwest Airlines. Recovered from: hypertext move convention:/es. scribd. com/doc/35327373/Southwest-Airlines-Case-Study Bhutada. S. Ranadive. S. ( n. d. ) . Southwest Airlines. Simply Plane Smart. Recovered from: hypertext move convention:/www. slideshare. net/sarangbhutada/southwest-carriers contextual investigation

An Explanation

An Explanation Several years ago (I believe it was 3 but it may have been 2) there was an MIT student who didnt have quite enough credits to graduate. This happens (especially because HASS requirements are so weird), so they opted to stay another year in order to finish up and graduate. One day, towards the end of this students senior year, a small skirmish took place on the dorms e-mail list between this senior and an undergraduate in the dorm. Things got heated, words were exchanged, and then this happened: Undergraduate This whole argument is silly. Well, thanks for bringing it up then. By the way, congratulations on graduating. Senior Wow, way to make an insulting, totally useless reply to the entire dorm. Undergraduate uhh, he is graduating, right? and graduating people, i presume, wont be staying in the dorm over the summer. so, if my two assumptions are true, i admire [name]s heroism for taking time out of his busy final study schedule to make sure that the portion of summer residents who watch movies are happy. oh, if youre not graduating (whether youre not a senior or otherwise), sorry, thats all i meant by the comment. Senior No, Im not graduating. Yes, Im in the dorm for the summer. Yes, Im in the dorm next year. Anything else? Interested in my personal life? Undergraduate What color underwear do you have on right now? [For the record, it was blue, with penguins.] From then on, every e-mail sent to the Burton-Conner dorm e-mail list (bctalk [at] mit [dot] edu) MUST be signed with the senders underwear color. It has become a tradition. By signing with your underwear color you are saying My e-mail is worth reading. I am willing to tell you my underwear color if youll read my e-mail, thats how worth reading it is. Soooooooo . . . . for all of you prefrosh that came to CPW and hung out around Burton-Conner, you may have seen some snazzy light blue shirts floating around. Maybe they looked a little something like this? These shirts, our unofficial dorm shirts, have the line What color is YOUR underwear? on the back. This is not because we are creepy sexual deviants hitting on you. This is just because we want to know your underwear color. -Snively gray (Thanks to the commenter who provided the exact transcript) Post Tagged #Burton-Conner House

Viking Invasions The Battle of Maldon

In the summer of 991, during the reign of Aethelred the Unready, Viking forces descended on the southeastern coast of England. Led by either King Svein Forkbeard of Denmark or the Norwegian Olaf Tryggvason, the Viking fleet consisted of 93 longboats and first struck at Folkestone before moving north to Sandwich. Landing, the Vikings sought to extort treasure and plunder from the local population. If refused, they burned and laid waste to the area. Ravaging the coast of Kent, they departed and sailed north to strike at Ipswich in Suffolk. Background Battle of Maldon - Conflict Date:Â  The Battle of Maldon was fought on August 10, 991, during the Viking invasions of Britain. Commanders Saxon Ealdorman Brihtnoth Vikings Olaf Tryggvason or Svein Forkbeard The Saxons Respond Having looted Ipswich, the Vikings began moving south along the coast into Essex. Entering the River Blackwater (then known as the Pante), they turned their attention to raiding the town of Maldon. Alerted to the raiders approach, Ealdorman Brihtnoth, the kings leader in the region, began organizing the areas defenses. Calling out the fyrd (militia), Brihtnoth joined with his retainers and moved to block the Viking advance. It is believed the Vikings landed on Northey Island just to the east of Maldon. The island was connected to the mainland at low tide by a land bridge. Seeking Battle Arriving across from Northey Island at high tide, Brihtnoth entered into a shouted conversation with the Vikings in which he refused their demands for treasure. As the tide fell, his men moved to block the land bridge. Advancing, the Vikings tested the Saxon lines but were unable to break through. Deadlocked, the Viking leaders asked to be able to cross so that battle could be joined in full. Though he possessed a smaller force, Brihtnoth granted this request understanding that he needed a victory to protect the region from further raiding and that the Vikings would depart and strike elsewhere if he refused. A Desperate Defense Backing away from the causeway to the island, the Saxon army formed for battle and deployed behind a shield wall. As the Vikings advanced behind their own shield wall, the two sides exchanged arrows and spears. Coming into contact, the battle became hand-to-hand as the Vikings and Saxons attacked each other with swords and spears. After a protracted period of fighting, the Vikings began to focus their assault on Brihtnoth. This attack proved successful and the Saxon leader was struck down. With his death, the Saxon resolve began to waver and much of the fyrd began to flee into the nearby woods. Though the bulk of the army had melted away, Brihtnoths retainers continued the fight. Standing fast, they were slowly overwhelmed by the superior Viking numbers. Cut down, they succeeded in inflicting heavy losses on the enemy. Though having won a victory, Viking losses were such that they returned to their ships rather than press their advantage with an assault on Maldon. Aftermath Though the Battle of Maldon is better documented, through the poem The Battle of Maldon and the Anglo-Saxon Chronicle, than many of the engagements of this period, exact numbers for those engaged or lost are not known. The sources do indicate that both sides took substantial losses and that the Vikings found it difficult to man their ships after the battle. With Englands defenses weak, Aethelred was advised by Archbishop Sigeric of Canterbury pay tribute the Vikings rather than continue an armed struggle. Agreeing, he made an offering of 10,000 pounds of silver which became the first in a series of Danegeld payments. Sources UK Battlefield Resources Centre: Battle of MaldonWuffings: Battle of MaldonBattle of Maldon

Promoting Mental Health Essay - 3042 Words

Promoting Mental Health. The aim of this assignment will be to demonstrate my interventions designed to promote mental health and well being using current national and local policies and campaigns in relation to the patient’s identified needs as well as evidence based therapeutic interventions. Finally I will evaluate my package reflecting on its success or failure. In order to gain a better understanding of mental health promotion, it is important to gain a definition of promoting mental health. Rosie Winterton (2006) quotes ‘Mental health promotion is key to changing attitudes about mental health across society. The National framework for mental health (DOH 1999) implemented national standards and service models for promoting mental†¦show more content†¦The assessment interview was conducted in an isolated room to avoid distractions that may threaten confidentiality and interfere with the effective listening, privacy and dignity of the client, (NMC 2008). I explained to Elizabeth that any information gathered from her would be shared with other health care professionals involved in her care without breaching her confidentiality in compliance to the (NMC 2008) and the (Caldicott Report 1997) unless it was required by the law. Elizabeth’s response was very responsible saying she understood and was willing to co-operate. I c ontinued to engage with Elizabeth using my interpersonal skills; listening, attentiveness, assertiveness, humour, self disclosure and my body language, (Riley 2008). Without these skills I would not have been able to attain the information required to understand her difficulties and formulating sessions. During our initial session, Elizabeth was very open with me about her cannabis use and personal life. Elizabeth explained how cannabis had changed her and destroyed her marriage. Elizabeth expressed her desire of detoxification, to stay clean and to gain employment. Elizabeth explained how her cannabis use had started off in her young teens where smoking cannabis was seen as ‘being cool’. Elizabeth also explained that it had started to affect her mentally in her late 20’s. I assured Elizabeth that her detoxification would be a tough process for her but as a Nurse I will support her. 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Animation Research Paper Free Essays

One company that caught my attention is Buck Animation Studios. They are a small commercial house specializing in design-driven creative, Buck’s directors and artists use animation, visual effects and live action to collaborate with clients, from concept to delivery, producing work that is visceral, innovative, and diverse.From offices in New York and Los Angeles, Buck works with a broad range of clients in the advertising, broadcast, retail, film and entertainment industries It was started in 1973 by a small group of women in Toronto who wanted to produce books for Canadian children, within a few years the mandate had broadened and Kids Can Press was producing books for children around the world. We will write a custom essay sample on Animation Research Paper or any similar topic only for you Order Now More than three decades later and with a long list of award-winning titles, Kids Can’s reputation for quality books has made it a favorite among parents, teachers, librarians — and kids — worldwide.It’s acclaimed list includes many beloved characters such as Franklin the Turtle, the single most successful publishing franchise in the history of Canadian publishing, which has sold over 60 million books in over 30 languages around the world. Kids Can Press has published in partnership with more Canadian public institutions than any other children’s publisher, reflecting the recognized quality of the publishing program. Partners include the Royal Ontario Museum, the Ontario Science Centre, the Federation of Ontario Naturalists, the National Museum, the Museum of Nature, World Wildlife, and the National Hockey League.Kids Can Press books have received critical acclaim through media attention, nominations and awards in the children’s publishing industry, including: Governor General’s Award–winner Wallace Edwards’ Alphabeasts Melanie Watt’s multiple award-winning Scaredy Squirrel series If the World Were a Village by David J. Smith, winner of the Independent Publisher Book Award Ryan and Jimmy and the Well in Africa That Brought Them Together by Herb Shoveller, which was featured on Oprah’s Web site Today Kids Can Press continues to be an industry leader with groundbreaking p icture books, outstanding non-fiction and award-winning fiction.Any children book publishing firm is considered the direct competitor for this company. Even though there are offices in New York any inquiry to employment will be directed to their Canadian operations. As of right now there are no available positions within the company but I am more than welcome to send my resume for review. I feel that with my experience and education I can contribute talented work to this publishing company. Considering this company is an industry leader in publishing children’s books it would be a great opportunity to be a part of.BIBLIOGRAPHY www. Careerbuilder. com/illustrationjobs. html, Nov. 2, 2010 www. kidscanpress. com, Nov. 2, 2010 Shawn F. Reid Professor Voicu SLS3355 Professional Development Nov. 2, 2010 Company Research Another company that I have researched worth working for is â€Å" Reader’s Digest Children’s Publishing†. â€Å"Since 1991, Reader’s Digest Children’s Publishing has been introducing young children to reading through innovative, creative and interactive books. It’s a list that bursts with fun, entertainment and inspiration. We introduce world-class brands and help to create lifelong readers. From Disney Princesses, Disney Pixar Cars and Toy Story to Thomas the Tank Engine, Barbie, Dora, Elmo and all the Sesame Street gang, we bring characters to life through interactive movie theater storybooks, viewers, music players and surprising lift-the-flaps that make kids want to read their books over and over again. With hundreds of titles to choose from, there is a Reader’s Digest book for every child. Reader’s Digest is a leader in the fields of publishing, multi-brand media and marketing and their team is what truly sets them apart. They are constantly on the lookout for talented individuals with a passion for excellence who could contribute to our success, and their own.The company makes it a point to select the best-suited candidates for each open position. The ideal applicant is dynamic, passionate, ambitious and knowledgeable in his or her field of expertise. They use an acronym when they look for people who exhibit FACE ttributes (Fast, Accountable, Candid and Engaged). As of right now there are no available positions within the company but I am more than welcome to send my resume for review. I feel that with my experience and education I can contribute talented work to this publishing company. Considering this company is an industry leader in publishing children’s books it would be a great opportunity to be a part of. BIBLIOGRAPHY www. readersdigest. com, Readers Digest Children’s Publishing, Nov 2, 2010 How to cite Animation Research Paper, Essays

Employees first, customers second free essay sample

1. What was the leadership style Vyneet came with at the beginning of his mandate? Can you give 3 examples of actions he took and which reflect this leadership style and explain? Vineet was without any doubt a transformational leader at the beginning of his mandate. In fact, just before taking the new role, he mentioned that he would destroy HCLT as it was before. He was very focused on his vision of a brand new transformation process and remarked the importance towards innovation that has the analysis of â€Å"what† and the â€Å"how† in a transformation journey. For a transformational leader, the â€Å"what† of the strategy is very important, but is much more important the â€Å"how†. He acknowledged that the first point of this transformation would be to analyze in deep what is going on in the guts of the company, asking directly to their employees. To do so, he followed the â€Å"Mirror, Mirror† strategy, which is a communication exercise that allows the members of the company to look themselves at the mirror and describe what they truly see. Once detected all the needs, he gave an extreme importance to have followers of his vision, and that could only be done by creating an atmosphere of trust towards all the global managers and transmit his vision in the called â€Å"Blueprint meeting†, that he expected that those would transmit their commitment and trust to the levels below. Vineet, as a transformational leader, was fully aware of the importance of identifying the A point (with the Mirror, Mirror strategy), and be able to identify and transmit as clear as possible the B point, where they were all heading to, to avoid uncertainty and reduce the resistance to change. 2. Why does he decide to turn management upside down? How does he do it? Vineet thought that the hierarchies and matrixes that HCLT was holding were obsolete, because they were created many years before and they were not able to create enough added value for the customers, because were the managers the only ones who could be the value creators. His purpose was to change the responsibilities for the value creation, letting the managers focus in their management functions, but allowing and giving flexibility to those who were in reality in contact with the customers on their daily basis, the only ones capable to add extra value to their service; the employees. In the case of IT industry, the value creation lays in hardware design and manufacturing, where the bottom employees are. His idea was to make those managers accountable not only for their teams, but also to all the other members in the value zone that the boss could be influencing in a way or another. To do so, he developed the concept of â€Å"reverse accountability†, that had the purpose to get certain elements of the hierarchy to be more accountable to the value creators, and to apply it, they created the Smart Service Desk, that had the purpose to resolve internal issues between the employees and the functions, giving the employees a directly power of influence. In addition, the employees realized that this allowed them to measure their performance and change the perception about themselves. Another strategy he followed was opening up the 360? degree feedback and survey, which helped people to improve their performance and build trust and transparency towards the organization. 3. What communication techniques does Vyneet use in order to inspire his employees to follow him and to gain their support of his mission? To inspire employees to follow him, Vineet had to create an environment of trust, where they could believe what he was saying and they were willing to follow him wherever he was going. Open communication and honest conversation unveiled the truth and created the need for a change. To do so, HCLT shared the company financial information with all the employees of the company, to create also transparency. Having and communicating a clear vision of the future (Point B) was also key to inspire and motivate people to be committed towards a better future. 4. How does he take decisions? Once created the new environment based on principles like trust and transparency, Vineet took decisions based on being close to the people. Using the Mirror, Mirror strategy he was able to identify the needs of the employees of HCLT, to create an openness to change, build a strategy towards the areas of improvement and communicate them in the Blueprint meeting. The decisions are, in fact, taken by the own employees, but the facilitator role that he took allowed him to agglomerate them, to analyze them together and be able to design the strategy, that with the appropriate atmosphere, would be able to engage the managers, that at the same time could engage the bottom line of the company, and achieve their full commitment. 5. What were the results that derived from turning organizational structure upside-down at the level of the Employees, Organization, Customers, Investors? During the first four years of the HCLT transformation, there were major changes: Employees: They achieved a 70% increase in employee satisfaction, employee attrition felled almost 50% Customers: 70% of their closed deals were won against their direct competitors, growing fivefold. Organization: Their revenues tripled in four years and operating income tripled. 6. What does Vyneet understand by the Value zone? What are the ingredients, in Vyneet? s opinion, to creating value for the organization, the customers and the employees? In HCLT Company the biggest problem identified by Vyneet in the organizational structure was that it did not support the people in what he called the value zone. Value zone is defined as the place where value is truly created for customers. He concluded that inside the culture of the company, communication should be established in all levels . And that this value zone must not stay just inside the pyramid in the company but it should be externalize and fill up between employees and customers. The first change of creating this value zone is to turn the organization upside down making management and managers, including those enable functions, accountable to those who create value not just the other way around. Another ingredient for creating value in the company is by finding something that will differentiate themselves from competitors by creating a real and distinct value. Vyneet also identified that many companies added value by improving their RD centers. In this case he realizes that HCLT has no longer value zone in the technology itself. He believes that something more had to be changed. The transformer employees also called the Gen Y Vyneet identified them as the ones that created the value zone within the company organization but his objective was to put the value zone n the center of the organization. 7. Can you name 2 of the riskiest decisions he took and explain how they could have back-fired? Why do you think they didn? t backfire? One of the riskiest decisions Vyneet did was gather the team of 100 best and brightest of the company for a 3 day conference. In this reunion he will establish the changes that will do and enforce the team to agree with it. The risk he took from this conference was: First not everyone agrees because afraid of changes. Also they don’t support each part of the plan for every new proposal they find new reasons why the plan couldn’t work. And damage their reputation as CEO. Inside his goals the execution of software that enforces transparency of the company was also a risky idea where some employees may use it in the wrong way and damage the environment inside the company. We think it didn’t backfire because Vyneet make it clear that this tool was for enforcing the company communication and making employees realize of the positive effects of it. 8. Vyneet answering the employees? questions directly takes up to 7 hours a week. Don? t you think a CEO? s time is too precious for that? When a company implements a huge change it is necessary to take as much quality time to communicate properly the strategy and giving example and support to the employees. Based on Vyneer perspective, managers must own the following characteristics: Credibility, reliability, intimacy and self orientation. When big changes in an organization occur is important for the employees to feel that they have the support of the CEO. Is not a question if it takes 7 hours a week or more, what is necessary is to follow the characteristics mention before for gaining the trust of every employee. 9. Why does Vyneet place so much importance on trust within an organization? What are his main arguments? How does Vyneet create a culture of trust? To transform a company people must align themselves a work together towards one goal, but this will not happen without a culture of trust. From mirror- mirror exercise until the end of his changes Vyneet explains that trust must be created and follow between manager, employees and customers. Employees start to see the problems of the company as their problems too. They realize that if management is willing to share important information even if it is good or bad and encourage open conversations about the facts it intentions can be trusted. Immediately the CEO will start to see some positive actions in all levels. To get the employees to participated more is important to crate a culture of trust and to do that transparency is needed. He follows 5 steps. First ensure everyone knows the company mission. Second, commitment with the organization. Third, transparency between employees. Fourth, customer to be transparent with the company. And last, share external and internal information. 10. How are generation Y employees different from other employees in Vyneet? s view? Gen Y employees are the ones who create the must value for the customers. They believe in collaboration, and they love to learn. They share everything of their life and ideas in different media networks. And at the same time they expend many hours interacting with society. This Gen Y are the ones how meet the customers and deliver the product service at the same time work together fixing problems and deserve support from the organization. They create the value zone in the organization. 11. What were some of the effects of transparency in the organization? Transparency from Vyneet point of view is an important tool that increase trust inside the company. Some of the approaches that the company did were opening financial information to everyone. In a way this increases the transparency and motivates some of the teams that were doing well. However some employees were demotivated by the information they saw causing embarrassment and complications. At the same time it was a risk because competitors could have access to this kind of information affecting the loss of clients. 12. How does he create accountability in the organization? Vyneet recognize that the company needed reverse accountability. This is define to get elements of the hierarchy to be more accountable to the value zone. He looks to 3 categories of positions: First, the enable function. Second, managerial change of command all the way to the CEO. And third, the influencers who are not part of the hierarchy. 13. Why does he consider passion to be important? Do you agree? He considered passion to be a very important element for employees. HE organized passions into 3 categorize: self, social and secular. He did a survey to discover the core values that are important to people, personally and professionally. The survey turn to be a huge success people started thinking on how passion they were with their actual jobs and learns about others passions and these lead managers to know more about their employees’ passions. Yes we agree that passion is essential in every person lives. It must be take in consideration before every decision making in a way for doing the things that you like and get positive results. 14. When he starts talking about ownership, he is making the step towards a new leadership style. How does he generate ownership? The idea is to transfer responsibility to the employees; this will create a certain feeling for accomplish their goals without been pressure by managers. This will demonstrated at the same transparency and in the future it will end up giving positive results. This will create a sensation in the way that employees perform. They will see ownership of the company as part of them and everything that they do and decisions they take will be for their own benefit and at the same time for the business. 15. What is the leadership style that he embraced towards the end of the book? Why did he consider it necessary to go even further? What are the actions that reflect the shift? Transferring responsibility for change, this was the style and strategy that he mentions at the end of the book. This new way of managing the company transferring to employees’ power is based on 3 reasons: First, for not letting concentrate the power just in the CEO. Second, remove hierarchy of the company through the speed of change. Third, transfer the knowledge with everyone in the organization. In this way the CEO office will not be consider the spiders head but become like a starfish. At the same time he decides to implement and increase the relationship between customer and employee. He starts up with a value portal where employees’ could generate and register new value and creating new ideas, and at the same time share it with customers that will evaluate and rate the ideas based on different criterias. 16. Fortune magazine considers the ? Employees first, customers second? concept as the most modern management idea. Do you think this concept will be implemented on a wider scale in other companies in the future? Why yes, why not? Can you name any other companies you know of who are working towards implementing this concept? How? Regarding the positive results of HCLT creating trust and growth through transparency by making managers and employees own equal responsibilities for change and value creation in order to interact with customers. This new concept idea can be for sure implemented in other companies where the managers like to take risky decision creating new opportunities for differentiating themselves from competitors. We found some companies that used this concept for creating value inside the company. One of the companies is named Mad LTD. Basically this company implements a program design and focus on nurturing young leaders by showcasing and helping to implement their idea improved society.