Activism and the Nineteen-Sixties Essay Example | Topics and Well Written Essays - 750 words

Activism and the Nineteen-Sixties - Essay Example The older generation, the ‘establishment’, was of the WWII period and operated under a nationalistic perspective.   They believed that to be a true patriot was to blindly follow the authority of the governmental powers that be, to support your ‘country’ even when you thought it was wrong.   The young college protesters, the ‘new generation’, the counter-culture redefined this notion of patriotism. They believed that to be truly patriotic was to question the decisions of government and openly dissent when it was judged to be wrong. The philosophical chasm was wide and emotions ran deep on both sides. Those that protested sacrificed much. They suffered the scorn of their parents who couldn’t understand why their children were rebelling against the very foundation of their parents’ beliefs thus causing what was referred to as the ‘generation gap.’ Some war protesters were killed by soldiers of the National Guard as was the case at Kent State and South Carolina State. The protesters and draft-dodgers were thought of as anti-American by the mainstream citizenry who regarded their actions as nothing short of treasonous. This attitude makes one wonder what the ‘greatest generation’ thought they were fighting for during WWII. They fought to defend freedom on foreign soil but were very much opposed to the constitutionally guaranteed right to peacefully assemble in their own country. The war protesters of the 1960s had the courage to act upon their political and philosophical convictions unlike those who are opposed to the Iraq War today. The two conflicts are eerily similar on many fronts yet the public reaction has been very dissimilar. Then as now, those opposed to the war are characterized as unpatriotic or as not supporting the troops, both of which, of course, is patently ridiculous concepts. The major difference is that the draft personalized the conflict for many more Americans. More families had a personal stake in the Vietnam War as opposed to the war in Iraq which only affects a small segment of the population.  

Importance of deadlines Essay Example for Free

Importance of deadlines Essay I have never worked in any job were it is acceptable to miss deadlines. Deadlines should never be disregarded as they are. I can offer no explanation as to why people routinely complain about instructors who do not return graded tests and papers when promised; faculty routinely complain about colleagues who neglect to complete their work on time; and I have seen administrators that simply plead with faculty, time and again, to complete long-overdue assessments or other important work. I’ll grant that in the current economic circumstances, with many academic units at many colleges, universities and branches underfunded and understaffed, faculty and staff alike are being asked to do more and more work with fewer people, fewer resources, and less time. But if we’re being honest we have to admit that the problem of faculty who are unaccountable to deadlines is an older problem than the current economic crisis; within academe the problem is endemic, systemic, epidemic. Regardless of the cause, when the routine, sometimes mundane business of the university is neglected or even just delayed, complications and stress cascade through the ranks, amplifying the problems that fellow faculty, staff, and even students must then deal with and solve. Even worse, sometimes the most egregious offenders when it comes to blowing off deadlines are senior faculty, who should, frankly, know and behave better. One step toward reducing the stress and work we create for others, and ourselves, might be to take more seriously the deadlines that often accompany our work, but that are sometimes neglected when faculty perceive, often quite wrongly, that there are no negative consequences for missing a deadline. Some deadlines are absolutely rigid, such as the filing dates for theses and dissertations, the sorts of deadlines that must be met if one hopes to graduate on time. These rigid deadlines are the types of bureaucratic  deadlines that we have to navigate routinely in order to complete graduate degrees, apply for grants, or otherwise navigate the complex institutions of the modern academy. Other deadlines are effectively rigid. When your department chair or a fellow faculty member assigns you a task with a due date, it behooves all faculty members to regard those sorts of deadlines as rigid, especially if you don’t have tenure. Such deadlines might be negotiable in some circumstances, but they aren’t to be disregarded altogether. Blowing off your campus bookstore’s deadline for textbook orders, for example, may seem like a trivial lapse. But potentially, missing even such a seemingly small deadline creates additional work for the already-swamped employees placing the orders, and it can result in higher costs for students if books have to be rush-shipped or if the window to order used texts is missed. Even though you are unlikely to suffer personally for missing the deadline, others may suffer. A whole other set of the deadlines that we face in academe are self-imposed, milestones that we set for ourselves in order to complete the nebulous, long-running projects that often comprise research and scholarship. Even though such self-imposed deadlines are soft, in that there is no enforcer that will come forward and punish, chastise, or cajole us if we miss them, I think that it’s generally a bad idea to miss even the deadlines that we set for ourselves. Assuming, and this is a big assumption, that the deadlines we set for ourselves are realistic. These soft deadlines can’t be taken too lightly — the ability, or inability, to set and meet goals without external guidance or enforcement will determine whether or not a tenure-track faculty member is able to meet expectations for scholarly productivity and ultimately win tenure. One of the tricks to managing these soft deadlines is learning to set goals that are both meaningful and realistic. It is much easier said than done, and hopefully an advanced graduate student receives extensive mentorship on how to manage the research workload. Cooperative, self-policing structures like writing groups are one way to formalize soft deadlines and hold ourselves  accountable to ourselves and to others to complete, or at least make progress on, our long-term projects. An important part of managing our work is knowing how to differentiate between soft and rigid deadlines, and how to prioritize deadlines across all of the varieties of work required of faculty. Deadlines matter in our interactions with students as well. My feeling is that if I am going to hold students strictly accountable to a deadline, then I too need to be accountable in similar ways. When I give my students writing assignments, each assignment is accompanied by a specifically articulated series of deadlines for when drafts and peer reviews are due, a deadline for each stage of the writing process, each of which students are expected to meet. But my assignments also include deadlines for myself, essentially promises of when I will return things like graded papers. Holding students strictly to deadlines, but then failing to return work in a timely manner, sends a message of hypocrisy to students that they immediately detect and disdain. I hold myself as accountable to self-imposed deadlines, just as I hold my students accountable. By advertising my own deadlines for tasks like grading, in this case on the writing assignment itself, I create a mechanism that forces me to be accountable. When it comes to interacting with colleagues, I also work hard to meet deadlines. As a junior faculty member, I never want to be the squeaky wheel, never want to be the committee member who fails to turn in work on time and holds up other people and an entire process. My unwillingness to be branded as a shirker is in addition, of course, to the glaringly obvious point that it is simply a common courtesy to meet administrative deadlines. Everyone in the university has work to do, much of it important work, and failing to do our own work in a timely, professional manner unnecessarily delays the work of others. There are certainly times when we realize that we will be unable to meet a deadline. If you foresee missing an externally imposed deadline, it’s both courteous and good policy to let interested parties know, sooner rather than  later, that you may be delayed in delivering your work. Such a warning at least allows others involved in the work to improvise an accommodation. Simply allowing a deadline to pass without a word of warning is discourteous and doesn’t allow others to help ameliorate the effects of your own delays. And missed deadlines are almost always noticed, even when the matter at hand may seem trivial. As you progress in your career, you may be asked to peer-review manuscripts that have been submitted to journals in your subdiscipline. It is especially important to meet an editor’s deadlines when conducting reviews of manuscripts. Some disciplines have a culture of turning reviews around quickly, while other disciplines (particularly in the humanities) are notorious for a tradition of taking months, sometimes even over a year, simply to review manuscripts. As a result of slow turnarounds and senior scholars who can sometimes be cavalierly unconcerned about conducting reviews in a timely manner, junior scholars often suffer. I once had a journal hold onto an article of mine for four months, during which time a staffer sent me a cryptic message implying that the article was undergoing review. After four months had passed, I was notified that the editor had decided not to send out the article for review, and to reject it outright. The editor was well within his rights to reject the article, but to take four months to do so was lazy and unprofessional in the extreme, and borderline unethical. Secondarily, because the article had not been sent out to reviewers, but simply sat on the editor’s desk, I did not even have the benefit of the feedback of reviews. Those four months were time that I could have spent revising the article, or submitting it at a different journal. Unfortunately, such stories are legion, and I have heard much more egregious examples of how editors’ or reviewers’ failures to keep to a reasonable schedule have hurt the publication prospects of junior scholars. Unfortunately, we are often tasked with work that feels trivial or futile. Or meaningful work simply piles up into seemingly unmanageable stacks. Every faculty member I know feels overwhelmed at some point in the semester. Nonetheless, when we neglect to complete work in a timely manner, our  colleagues and students sometimes suffer. Sometimes there isn’t as much accountability in the academy as there should be, which is all the more reason to hold ourselves accountable

Accountable Professional Practitioner

Accountable Professional Practitioner Advanced Profession Practice This essay will address the issue of becoming an accountable professional practitioner. I will discuss the issues around accountable professional practice as I see them and explore what these mean for my nursing practice, I will then conclude with the main points I have raised and implications for my future practice. Just what is an Accountable Professional Practitioner? Perhaps it would be best to examine what accountability means within the healthcare setting. The NMC Code (2008) states that â€Å"you are personally accountable for actions and omissions in your practice and must always be able to justify your decisions.† Although this definition is useful it lacks a certain clarity of by what is meant by the term accountability as it gives a general overview without being specific, Savage and Moore (2004) go on to argue this that lack of clarity can lead to indistinctive views that confuse those working in the health care field and it is this lack of precision that can lead to nurses professional conduct being called into question (NMC 2002). Perhaps for the professional practitioner what is useful is to examine what makes you accountable rather than what is accountable, by this I mean how you become an accountable professional practioner, what are the prerequisites required for this. One could argue that perhaps this all begins with critical thinking and reflection, Brittner and Gravlin (2009) argue that critical thinking is essential in todays nursing practice and can assist in making essential choices about patient care and clinical emergencies (St.Cyr All 2009, Toofany 2008, Cirocco 2007). Being a recently qualified nurse this isnt always an easy task to do, because I often lack the skills and knowledge that would allow me to make complex decisions, this is not unusual though as St.Cyr All (2009) highlighted that newly qualified nurses can lack some critical thinking skills for patient care, a useful tool that I have discovered that can enable me to develop my critical thinking abilities are mind maps, as these can increase my knowledge and understanding of a situation by linking concepts, themes and ideas (Toofany 2008) and can assist me in discovering a deeper understanding of the issues and indentify learning needs and positive behaviours to aid my development (St.Cyr and All 2009). To this end I do use mind maps as a way of linking theory and knowledge to gain a better overview of the patient or the clinical situation, it highlights my gaps in knowledge or indeed raises my awareness of what I already know. To move this a stage further by then applying these critical thinking skills to reflection I can begin to critically reflect on my practice. By becoming a critical reflector I am aiding my self-awareness (Horton-Deutsch Sherwood 2008) and developing a deeper understanding of the issues relating to patient care, my own actions and the reasons I choose them (Cirocco 2007, Redmond 2004) challenging my own actions (Forneris Peden-McAlpine 2009) and highlighting any learning needs I may wish to follow up on to aid my development as an accountable practioner by linking theory into practice (Rolfe Gardner 2006, Rolfe et al 2001). The best example of this I can give to date was when I was involved in a clinical emergency with a patient just after a couple of months of qualification, who despite every attempt made died very suddenly, I was left with lots of confusion, anger and upset over the incident and more importantly with the question of could I have done more? Through a process of critical reflection both written then verbally with my mentor I realised that we could have done nothing more, that I acted in a very professional manner throughout the incident and afterwards with the support I offered the family and colleagues, but I needed to go through that process in order to make sense of the situation and highlight possible learning objectives for me including developing coping strategies that would enable me to cope with a sudden death. When a situation very similar occurred again a few months ago I was able to take a more active role and recover from it much quicker knowing I did all that I could to hel p the patient and supporting the family and some colleagues after the incident. Benner (1984) states that this type of actions are that of an advanced beginner working towards becoming a competent nurse whereby by being involved in similar experiences I was able to make sense of a meaningful situation. By beginning to recognise patterns of behaviours and events I am beginning to develop my expertise through increasing my experiential learning knowledge (Benner 1984, Rolfe et al 2001). It is by making meaningful sense of these experiences though a process of critical reflection that have aided and will continue to improve my decision-making skills and self-awareness (Horton-Deutsch Sherwood 2008, Avis Freshwater 2006). It also empowers me to continue to participate in continuing education maintaining and developing professional competences (Griffitts 2002) by identifying learning needs through gaps in my knowledge. In becoming an accountable professional practioner this process of reflection can be a quality standard whereby I take responsibility for my own performance and deliver best quality care (Johns 2004). This links into clinical governance whereby I have to ensure I am prepared to accept accountability and consequences for any decision-making judgements that comes with any new role development (Cronin Rawlings-Anderson 2004). Through the system of clinical governance I can monitor through self-evaluation and feedback the quality of care and service I offer to my patients, families and colleagues ensuring that it is both effective and safe (NHS QIS 2005, Pickering Thompson 2004). There is also the issue of autonomy and accountability. This for me has been to date the biggest struggle in becoming an accountable professional, autonomy can be demonstrated through patient care by using the processes of critical thinking, reflection and your existing knowledge base (Keys 2009) however this can become frustrating when you take on autonomous responsibility but are limited by circumstances and sometimes colleagues to utilise your training and experience (Laperriere 2008). As a mature student who came into nursing as a second career I find myself often perturbed by colleagues who often quote that I am a newly qualified member of staff and it will take time to develop skills especially around issues of patient and family communication without knowing my background. It has be shown that newly qualified mature nurses can use previous life experiences to aid in a problem solving approach (Stuttard 2008) and as many of the skills I have developed over the years are transfe rrable, I would argue that by having these transferrable skills I can offer a wider range of skills and flexibility to my nursing experiences (Shirey 2009) that can aid my self-awareness and autonomy (Postler-Slattery Foley 2003). One of my ways of coping with these frustrations is to develop resilience. By becoming resilient to the negativity or challenges I receive I am able to motivate myself, Roth et al (2007) show that motivation within an autonomous concept and the actual experience of autonomy are essential for self-development and well-being, by using this autonomous motivation I can use it to aid my self-awareness of critical thinking and reflection (Leipold Greve 2009). This is a view supported by Darbyshire Fleming (2007) who state that those who practise autonomy are encouraged to be critical thinkers and self-directed in their learning. Of course within the concept of autonomy comes the acceptance of being responsible and being aware of your own limitations, at all times autonomous practice must be practiced safely with the care of the patients at the forefront it is not a weakness to say I cannot do this or participate in a skill that I know very little about (Richards Edwards 2003) it instead highlights how much I value patient care and respect for those I work with . Autonomy means ownership (Lyon 1990) and by claiming ownership of my practice it could be argued I increase patient safety and increase the quality of care I give my patients (Weston 2008) as well as developing my critical thinking, knowledge and accountability (Atkins 2006). With the above in mind I find myself asking the question of what else can support me in developing into an accountable professional practitioner? Certainly the processes of reflection and critical thinking can help but what I personally find of great use is to utilise the support systems I have around me, I certainly acknowledge how fortunate I am with having the amount of support systems in place to support me compared with some of my fellow colleagues as a result of the Early Clinical Career Fellowship. Currently I have three main formal systems in place a mentor, clinical coach and participation in action learning sets, these systems although very different from each other all have one thing in common and that is to aid my development, in addition to these systems I also have the informal support of my peers and management. My mentor can assist me in adapting to my new environment and offer the support from their own experiences to enable my learning, they are motivated to support and encourage me (Wagner Seymour 2007) to develop and try out new skills with support until I am confident enough to undertake these on my own, in addition to this they provide me with feedback on my progress and can suggest alternatives ways of working, they act as my role model and teacher (Morton-Cooper Palmer 2000). They can also provide me with a safe place to take sensitive issues and challenge my views (May 2003) Participation in action learning sets allows me to be supported and challenged by a group of my peers, it allows me to critically reflect and explore issues to a deeper level to aid my understanding and development and apply any new knowledge I have learned to practice, it can increase my motivation to learn and encourage my critical thinking into linking theory into practice. (Haan Ridder 2006, Rayner et al 2002) In addition to the above I also have my clinical coach. This is a very experienced nurse who can support, mentor, guide and coach me. She provides a higher degree of challenging to my practice encouraging my critical thinking and reflective skills and as she is detached from my clinical area is able to offer observations and questioning of my actions from a neutral perspective (Titchen 2003, Wright Titchen 2003). This all encourages and challenges me into becoming an accountable professional practitioner. In conclusion this essay has raised several points about leads you to become accountable rather than what is accountable. It is a complex dynamic composing of not one element but several that all interconnect almost as if it were a jigsaw puzzle. No one element is more important that the other as they are all necessary to help me in my development as an accountable professional practitioner. As my knowledge, understanding and experiences as a nurse increases so too will my accountability, this in itself will provide new challenges as I prepare myself for these new responsibilities and self-development What is clear for me and has been highlighted as a result of undertaking the essay is how my practice of an accountable professional practitioner can be used as a quality standard of care and measuring tool to ensure that my practice is safe and effective for all of those I work with and as ORourke (2006) states that this standard of care can only be improved on based on my understandin g of roles, autonomy and accountability and that can only be understood once I develop my critical thinking, reflective skills and using my support systems that have been put in place for me. I believe that throughout my career as a nurse even as I work towards becoming an expert nurse (Benner 1984), I will always be working towards becoming an Accountable Professional Practitioner as I will always be critically reflective, learning new skills, developing my autonomous practice and requiring support so to that end I dont think I will ever be a fully accountable professional practitioner but I am accountable for the skills, knowledge and responsibility and level I am at. This brings a strange feeling of comfort rather than fear as I believe this will ensure nursing continues to evolve and develop and I will be there in the midst of it all.

John Lennons Use of Writing in Lyrics Essay -- English Writing Gramma

John Lennon, the late Beatle, and immortal Walrus, said, â€Å"I am he as you are he as you are me and we are all together. See how they run, like pigs from a gun, see how they fly-I’m crying.† And, the strangest thing about it is, after A Hard Day’s Night of typing this into my computer’s grammar checker, the program didn’t indicate a single error. Imagine, three decades before the age of the word processor, Lennon made his words Come Together. Think back to secondary school. What would many of your teacher’s reaction have been had you written what John Lennon did? I think I have an idea how some of my teachers might have reacted. I’d likely have been referred to the guidance counselor for drug counseling, and I’d have been sent home with a note to my parents. Granted, things have changed over the past twenty-five years, and many of today’s teachers realize that â€Å"good† writing consists of more than three-sentence paragraphs and single-subject-single-verb sentences. Where educators could once refer to a universal writing ideology, they must now recognize social diversity as a factor in critical evaluation of students’ work. Understand, I have never taught children in a school environment, and my only insight into what it is like is through reading books and essays, my discussions with friends who teach, you, my classmates, and, of course, my own memories of secondary school. So, when I offer my opinions, I do so humbly. Having said this, you’ll excuse me while I rant about the topic of our October 9th classroom discussion of what makes â€Å"good† writing and how to teach it. I found our discussion of â€Å"If I Learn It’s a Mircal,† by John, the â€Å"remedial† first year community college student, engaging. We talked about â€Å"voice,† and we... ...rtant as making sure he remains long enough to receive what he is asking for. His voice is honest and politically relevant. The teachers who assist him in refining his language and writing skills can take pride knowing that they share a certain part of his successes. I think John Lennon would agree: As this student heads down The Long and Winding Road, he will be grateful to the teachers who have given him his Ticket To Ride. Works Cited Brodkey, Linda. â€Å"On the Subjects of class and gender in ‘The Literacy Letters’†. Cross-Talk In Comp Theory. Ed. Victor Villanueva, Jr. NCTE, Illinois. 639-658. John. â€Å"If I learn it’s a mircal.† ENG 521 class handout. Lennon, John and Paul McCartney. I Am The Walrus. The Beatles. Comet Music Corp. 1967. Whitman, Walt. â€Å"Song Of Myself.† Anthology of American Literature. Ed. George McMichael. Prentice Hall, New Jersey. 2037. John Lennon's Use of Writing in Lyrics Essay -- English Writing Gramma John Lennon, the late Beatle, and immortal Walrus, said, â€Å"I am he as you are he as you are me and we are all together. See how they run, like pigs from a gun, see how they fly-I’m crying.† And, the strangest thing about it is, after A Hard Day’s Night of typing this into my computer’s grammar checker, the program didn’t indicate a single error. Imagine, three decades before the age of the word processor, Lennon made his words Come Together. Think back to secondary school. What would many of your teacher’s reaction have been had you written what John Lennon did? I think I have an idea how some of my teachers might have reacted. I’d likely have been referred to the guidance counselor for drug counseling, and I’d have been sent home with a note to my parents. Granted, things have changed over the past twenty-five years, and many of today’s teachers realize that â€Å"good† writing consists of more than three-sentence paragraphs and single-subject-single-verb sentences. Where educators could once refer to a universal writing ideology, they must now recognize social diversity as a factor in critical evaluation of students’ work. Understand, I have never taught children in a school environment, and my only insight into what it is like is through reading books and essays, my discussions with friends who teach, you, my classmates, and, of course, my own memories of secondary school. So, when I offer my opinions, I do so humbly. Having said this, you’ll excuse me while I rant about the topic of our October 9th classroom discussion of what makes â€Å"good† writing and how to teach it. I found our discussion of â€Å"If I Learn It’s a Mircal,† by John, the â€Å"remedial† first year community college student, engaging. We talked about â€Å"voice,† and we... ...rtant as making sure he remains long enough to receive what he is asking for. His voice is honest and politically relevant. The teachers who assist him in refining his language and writing skills can take pride knowing that they share a certain part of his successes. I think John Lennon would agree: As this student heads down The Long and Winding Road, he will be grateful to the teachers who have given him his Ticket To Ride. Works Cited Brodkey, Linda. â€Å"On the Subjects of class and gender in ‘The Literacy Letters’†. Cross-Talk In Comp Theory. Ed. Victor Villanueva, Jr. NCTE, Illinois. 639-658. John. â€Å"If I learn it’s a mircal.† ENG 521 class handout. Lennon, John and Paul McCartney. I Am The Walrus. The Beatles. Comet Music Corp. 1967. Whitman, Walt. â€Å"Song Of Myself.† Anthology of American Literature. Ed. George McMichael. Prentice Hall, New Jersey. 2037.

Becoming a scholar practitioner

Studying human motivation has been interesting and an adventure. Thinking about what motivates people to do the things that they do is the same as asking myself why I wake up each day to work, to go to school and to be with my family. The course on human motivation for me has become a process of self-awareness and growth.I have learned that motivation is more than just needs and drives, more than intrinsic and extrinsic, more than values and goals, but that it is a complex process that is more than the sum of its parts.Human behavior is governed by the integration of internal and external processes and in order to understand behavior, one must be able to comprehend how the internal and external processes influence the person. I now realize that to be able to understand, predict and change behavior, the most important thing to examine is what motivates and what does not motivate him/her. In the same breath, effecting change to help disadvantaged individuals take control of their lives means providing them with the motivation to do so.The ability to think and examine human motivation theories and apply it to real life situations is in effect one of the enduring traits of a scholar-practitioner. A scholar practitioner is a professional who is committed to both study and explore the field that he/she is involved with and to be able to bring that learning and knowledge to his/her practice of her profession (Beck, 1999).Thus, a scholar-practitioner in the field of clinical psychology would commit herself to research and evaluation of her profession as well as applying what she has learned to her clients which would be most beneficial for them. In the past, scholars were confined to the academe; they researched and gained esteem through their work, and the practitioners practiced and became popular through their clients.However, one begins to see that the scholar and practitioner could learn from each other and by combining research and practice, one becomes a more ef fective instrument of social change. Social change is a giant leap, but nonetheless it starts from the small steps of the scholar-practitioner, for the objective of the scholar practitioner is always for the benefit of the greater number of people, if by helping a small group of people become better persons, then this groups would be able to touch more people and in the process change is facilitated.This course has helped me appreciate the psychology of human motivation and that there are a number of ways to extend that knowledge to real life situations, so that the knowledge is put to good use and I also believe that effecting change without the appropriate knowledge and training is ineffective.I see now that if I want to pursue a life dedicated to the helping profession, I must be able to understand what matters and what motivates the person so I could be of more service to them. I can only become a scholar-practitioner if I continuously seek learning experiences and trainings tha t would keep me abreast of the developments in my field as well as dedicating myself to seek new knowledge and new understanding of human behavior through research.Moreover, I need to translate that knowledge into my practice and therefore be able to give my clients the help they need and empowering them to take control of their lives and become agents of change in their own way. Reference Beck, L. G. (1999). Metaphors of educational community: An analysis of the images that reflect and influence scholarship and practice. Educational Administration Quarterly, 35; 19, 13-45.

Coke vs Pepsi strategy Essay

Coke v. Pepsi – 5 Forces Analysis Industry concentrate produces High intensity (depends on price/advertising cost/ high number of substitutes(low calorie drinks/no carb drinks/ not carbonated drinks like orange juice) Pepsi products /Coke products New Entrants (barriers/rivalry) High Intensity-Brand recognition dominant market/ patents on style and colors Network relationships & high cost of entry established such as distribution, warehouse, bottlers, and shelf-location high marketing costs Coke dominance on international market makes it hard for Pepsi to enter international markets where Coke is dominant (Mexico) Suppliers (Bargaining Power of Supplier) Medium intensity- Coke and Pepsi can and do renegotiate contracts with bottlers on prices, marketing, distribution territories, and etc. High intensity- for new entrants because the bottlers determine price of product (price takers), shelf- place is determined by retailer and less price discount control. There is a small number of important suppliers since Coke and Pepsi supported suppliers to buy other smaller suppliers to keep up with their needs. Buyers (Bargaining Power of Buyers) High Intensity- due to the high number of substitutes, health concerns, and few key buyers (fountain outlets/vending machines) E.g.) Coke and Pepsi battled for the right to sign a contract with fast food restaurants like Burger King. Substitutes ( threat of substitutes) Medium Intensity- high number of substitutes(low calorie drinks/no carb drinks/ not carbonated drinks like Orange juice /ice tea/ flavored water/etc. Low intensity – competition among other pop drink because it’s based on brand recognition.

Free Essays on Analysis Of Sammy In “A&P“

The story of â€Å"A & P† takes place in the 1960’s in an average sized town in Massachusetts. It centers on a young man named Sammy who is partaking in a seemingly ordinary day of work when three young ladies walk into his store wearing only bathing suits. The girls intrigue Sammy and bring suspense and controversy to an otherwise dull scene in an A & P market. Sammy’s opinion of the girls and the A & P go hand-in-hand, off setting each other, as he paints a black and white picture of a grocery store intruded upon by three wondrous strangers of vibrant color. The contrast illustrates the generation gap very effectively. The girls give Sammy an opportunity to express his typical 19-year-old mind-set and pessimistic views of his surroundings in an almost rebellious manner, exposing his desires for a more stimulating lifestyle. Sammy illustrates these outlooks in his portrayal of the girls, the customers, and lifestyle of the townspeople. Sammy’s attitude towards the girls is that of any typical 19-year-old male. He is very critical of their bodies and takes close notice of their beauty as well as their flaws. He is especially drawn to the girl he refers to as â€Å"Queenie†. He views her as the leader of the group and describes her in an admiring and lustful way calling her â€Å"more than pretty† and making a reference to â€Å"the two smoothest scoops of vanilla†¦Ã¢â‚¬  her chest. Sammy’s depictions of the girls are chauvinistic at times, which relays back to his being a lively young man. It is this intrigue with Queenie, borderline infatuation even, which ultimately determines the outcome of the story. His portrayal of the older customers illustrates the dogmatic routine of the townspeople and his contempt for them. Sammy refers to the customers as sheep, which indicates that he thinks they are mindless and unable to think for themselves. His descriptions of them give the story a dreary feel, which in due course clashe... Free Essays on Analysis Of Sammy In â€Å"A&Pâ€Å" Free Essays on Analysis Of Sammy In â€Å"A&Pâ€Å" The story of â€Å"A & P† takes place in the 1960’s in an average sized town in Massachusetts. It centers on a young man named Sammy who is partaking in a seemingly ordinary day of work when three young ladies walk into his store wearing only bathing suits. The girls intrigue Sammy and bring suspense and controversy to an otherwise dull scene in an A & P market. Sammy’s opinion of the girls and the A & P go hand-in-hand, off setting each other, as he paints a black and white picture of a grocery store intruded upon by three wondrous strangers of vibrant color. The contrast illustrates the generation gap very effectively. The girls give Sammy an opportunity to express his typical 19-year-old mind-set and pessimistic views of his surroundings in an almost rebellious manner, exposing his desires for a more stimulating lifestyle. Sammy illustrates these outlooks in his portrayal of the girls, the customers, and lifestyle of the townspeople. Sammy’s attitude towards the girls is that of any typical 19-year-old male. He is very critical of their bodies and takes close notice of their beauty as well as their flaws. He is especially drawn to the girl he refers to as â€Å"Queenie†. He views her as the leader of the group and describes her in an admiring and lustful way calling her â€Å"more than pretty† and making a reference to â€Å"the two smoothest scoops of vanilla†¦Ã¢â‚¬  her chest. Sammy’s depictions of the girls are chauvinistic at times, which relays back to his being a lively young man. It is this intrigue with Queenie, borderline infatuation even, which ultimately determines the outcome of the story. His portrayal of the older customers illustrates the dogmatic routine of the townspeople and his contempt for them. Sammy refers to the customers as sheep, which indicates that he thinks they are mindless and unable to think for themselves. His descriptions of them give the story a dreary feel, which in due course clashe...

New Technology essays

New Technology essays There was new technology released on Monday by Intel Corporation. It was a trio of new chipsets intended to make the richness and speed of digital media, gaming, and broadband for its Pentium 4 and Celeron processor users much better. They are trying to find ways to stay in the market with chipmakers. Intels new lineup, comes at a time when this semiconductor company is struggling to keep its chipset revenue from taking a deeper nosedive. It includes the Intel 845G, 845E, and 845GL, all with built-in graphics and faster data transfer capabilities. The 845 and 845GL are intended for Intel's Celeron processor, whereas the 845G is aimed at more business PCs and home PCs with Pentium 4 processors. This trio of chipsets is already available on the retail market. The chipsets include Hi-Speed Universal Serial Bus (USB) 2.0, a data transport technology that enables faster connections to digital devices and increases bandwidth up to 40 times more than the average USB 1.1 interface. With this type of technology, you can see that Intel is trying to stay alive in a market where even they arent having much luck. Intel is trying to meet the current popularity of digital devices. This includes digital cameras, which balances the overall platform performance of the Pentium 4 processor's speed and makes it easier for users to edit and play digital video, view and edit family photos, handle larger digital files, play games, and listen to music. This will help to reach, gamers and home PC users. All of Intels new chipsets enable surround-sound capabilities with 20-bit audio. Intel has integrated graphics called Intel Extreme Graphics with the Intel 845G. Additionally, USB 2.0 enables users to burn CDs six times faster than normal, and back up data 11 times faster. This will help Intel to grab a share of that market with their new product. Intel has some interesting estimates t ...

Does Michael Kohlhaas present the view that power corrupts Essay

Does Michael Kohlhaas present the view that power corrupts - Essay Example Set in the time of Martin Luther, early to mid sixteenth century, Michael Kohlhaas concerns a horse trader by that name who is upset when he is charged with having improper papers while passing though the area controlled by Junker Wenzel von Tronka. Forced to leave two of his horses and a servant behind as collateral for being able to continue, Kohlhaas later learns that the charges are bogus and sues the Junker for reparations once he discovers the animals and the servant were mistreated. Despite the help of several friends, including Luther himself, the Junker prevails in court, mainly due to the corrupt influence of the Junker’s relations. Enraged, Kohlhaas takes matters into his own hands and forming an army, attacks and burns the castle of the Junker, who had already fled to another city. The band of outlaws attempts to take that city by force, although they are rebuked. Arrested and put into the dungeon in his hometown, the Junker’s influence eventually causes Koh lhaas to be executed. This is in spite of the fact that the suit finally prevailed and both the servant and horses were restored to health. How is that idea still relevant some three hundred years after von Kleis’ death? Who was the Junker? Furthermore, how does the novella present the view that power corrupts? Discussion The author had seen the illusions of power firsthand. First as a soldier and later as a writer and poet filled with wanderlust, von Kleis had visited and lived throughout a Europe ravaged by the excesses of Napoleon, even spending a time in Paris. Reading the story there is little doubt that the Junker, the main antagonist in Michael Kohlhaas, is a thinly veiled version of Napoleon, a non ruler who used brute force, along with influential friends and those loyal to him. Eventually the corrupt Junker is sentenced to two years of prison but unfortunately too late to save Kohlhaas’ life. This facet parallels von Kleis and Napoleon. Although the despot wa s not necessarily responsible for the author’s suicide, unlike Kohlhaas, von Kleis did not live long enough to see Napoleon’s utter defeat a mere four years later. The Junker had a very influential family who helped him secure retribution against Kohlhaas time and again. Even though the great Martin Luther (von Kleis was a great student of the Reformation) arranges an amnesty after Kohlhaas’ criminal acts, the Junker manages to have that overturned and Kohlhaas is imprisoned. It seems the two men had a personal vendetta against each other, for neither was content to relax until the other was totally destroyed. The Junker ultimately loses the lawsuit and his freedom for a short while and his opponent loses his very life. The rulers of a fractioned Germany that still existed in the author’s time likewise presented the evidence of power as a drug. The Governor of Brandenburg is shown as a weak and waffling individual who caves in to pressure and allows Kohlh aas to be rearrested, even though he had personally approved the man’s earlier release. His counterpart in Saxony was especially corrupt, for while he was almost forced to carry out the wishes of the Junker, Kohlhaas had some papers on his person which concerned Poland and their thoughts on invading Saxony. When Kohlhaas swallowed those papers just prior to his

ANOVA Statistics Project Example | Topics and Well Written Essays - 500 words

ANOVA - Statistics Project Example The results of the test were statistically significant, F(3, 14) = 23.39, p The strength of the relationship between the group of kidneys exposed to varying times of ischemia and % water content was very strong, as the value of R-sq. (83.37%) in Minitab output is very high and close to 1. The group of kidneys exposed to varying times of ischemia accounts for 83% (R-sq, taken from Minitab output) of the variance in % water content. Tukey’s pairwise comparisons showed that the % water content in control group is less compared to 30 min ischemia (95% confidence interval for difference is between 1.96% and 5.13%, taken from Minitab output), 60 min ischemia ((95% confidence interval for difference is between 0.87% and 3.56%) and 120 min ischemia (95% confidence interval for difference is between 2.13% and 5.30%). Fisher’s pairwise comparisons showed that the % water content in control group is less compared to 30 min ischemia (95% confidence interval for difference is between 2.38% and 4.72%, taken from Minitab output), 60 min ischemia ((95% confidence interval for difference is between 1.22% and 3.21%) and 120 min ischemia (95% confidence interval for difference is between 2.55% and 4.88%). Furthermore, the % water content in 60

Cover letter Article Example | Topics and Well Written Essays - 500 words - 1

Cover letter - Article Example The best paper I wrote for this course, in my opinion, is the one about smartphones. This is a topic that will continue to build interest, as more and more apps become available and people spend more and more time with their heads bent over these small devices. When I wrote my earliest draft of this piece, I did not include enough in the area of detail to make my own points vibrant enough for the reader. As a result, the ideas that made a lot of sense to me did not come through adequately for my peers who reviewed the paper for me. So when I revised the paper, I needed to go back in and help the reader view the topic from the perspective from which I was viewing it. This did not mean that the reader had to agree with my opinion, necessarily; rather, it meant that I needed to be able to make my perspective understandable. If I continued to have more time on that paper, I would have done some more research about smartphone usage statistics. I have been floored by the number of people I see using these devices in ways that just make no sense to me. I don’t know why people would sit and text while they are driving, and I certainly don’t know why someone would sit and Facebook their way through what is supposed to be a romantic evening out, or even through a family meal. My ongoing weakness is an assumption that the reader can see things the way I see them, or that I don’t have to communicate my own viewpoint thoroughly enough for the reader to be able to understand it. This means that I leave out details that seem obvious to me, for the simple reason that I think the reader should be able to â€Å"see† a point that is clear to me. This means that my points end up being confusing, at times, to the reader. To help with the editing of my smartphone paper, I had several of my peers read through the rough draft. Their purpose was not so much to point out

Rhetorical Analysis The Four Freedoms Essay Example | Topics and Well Written Essays - 500 words

Rhetorical Analysis The Four Freedoms - Essay Example Therefore, he began his address on a note of warning to the Americans, with the assertion that the nation’s international position was â€Å"unprecedented†(2) and raised apprehensions about the security of America by stating that â€Å"at no previous time has American security been as seriously threatened from without as it is today.†(2) What was that threat? He did not specify and he was just trying to create deep anxiety for his audiences. By stating next, that past leaders of America did not aim â€Å"at domination of the whole world,† (7) he was making it clear about the new role of America in the world scenario of politics and the duties and responsibilities involved in it. To highlight the necessity of participation in World War II, he chose to belittle the importance of the previous wars and said they were not â€Å"a real threat against our future or against the future of any other American nation.†(12) Quickly, he had built up the suspense rhetoric well which created some apprehensions like who was the enemy precisely? What were the intentions of the enemy so-projected? What threat he constituted? At the sixth minute of his speech, the President was more vocal about describing the enemy. He specified the enemy as â€Å"the new order of tyranny† (11) who had the hidden agenda and â€Å"that seeks to spread over every continent today.†(11) He said â€Å"every realist knows that the democratic way of life is at this moment being directly assailed in every part of the world–assailed either by arms, or by secret spreading of poisonous propaganda by those who seek to destroy unity and promote discord in nations that are still at peace.†(12) This observation was highly important. He regaled his audience and warned them that the enemy was treacherous on every count. The President was referring to the enemy dictators and their armies, the Communist countries

Final review Assignment Example | Topics and Well Written Essays - 750 words

Final review - Assignment Example In a situation whereby a third quality land is cultivated, the rent commences on the second land quality with an immediate effect. However, the rent can be regulated by the difference in their productive powers as the rent of the first quality land increases since it must always be slightly above the second class. Naturally, the aspect of rising rents would directly take more of the national income (page 91) The paper also reflects on the T. Malthus` objections to Ricardo`s attack on the Corn Laws 1895 and how he responded to these objections in his principle of political economy and taxation. In addition to that, it also discusses how his response strengthened his conclusions about the Corn Laws in 1985. Malthus was a personal friend to Ricardo as well as his opponent on the matters to do with rent whereby Ricardo went on to write a letter to Malthus suggesting that every person to retain his own opinion without terminating the friendship (page 92). According to Ricardo, he referred to the economic rent as a surplus of the personal paper profit over the social gain whereby its value is in control over the resources instead of being directly to the resources. Moreover, there is no representation of gain but a transfer of wealth that was unearned. On the other hand, Malthus objected this opinion by stating that a material gain is stated when the rent is re-invested though the gain is in excess of the social unity. According to John Stuart Mill, the nature of the laws that regulates how we produce products is different from the laws that regulate how we distribute the fruits of that production. Therefore, details on specific examples from the 19th century English labor movement of how the laws of distribution were undergoing change, is also provided in this paper. The existing differences between the laws of regulation in production and distribution come in to nature because both of them undergoes through different processes. However, countries that export produc ts on a large quantity ought to trade perfectly well on a special way, without restrictions for them to gain great advantages. In the context of the quote from Marx`s capital, an explanation of how labor is so important to Marx`s understanding of human self-realization has also been reflected upon. Moreover, a discussion of the role of history among the German philosophical ideas in shaping the Marks idea of human-self realization through labor has also been reflected upon in the discussion. According to Mark, alienation reaches at the peak when labor changes to become wage labor. Out of labor, capitalists are able to higher workers so as to convert the capital goods to final goods. Labor enables the workers to obtain wages that re later used to sustain their families. The more the workers are specialized in their specific areas of labor provision the more alienated they become in reference to the production of products. The employees tend to become more dependent on the production of products as well as the employee when they have set their goals. However the presence of Marx`s differences between the value of labor power also emerged. A provision of detailed explanation on the origin of profits according to Marx is also in this paper. The explanation begins with a discussion of how value is transformed in the production process including the relationship that has been discussed by Marx in the quote. Moreover, it is explained in to details as to why the

Power Bases in Leadership Research Paper Example | Topics and Well Written Essays - 2750 words

Power Bases in Leadership - Research Paper Example The paper tells that contemporary complex organizations require proper leveraging of power in order to achieve organizational goals and objectives. As Bal et al. argue, power is the ability to influence others, which leaders use to enhance the performance levels of their followers and to ensure their superiors and peers arrive at the best decisions. The traditional view of power in an organization revolves around the control that individuals at the tip of organizational hierarchy have. However, leaders of different levels within an organization have access to power, whose effective harnessing is key to organizational performance. The importance of power in the organizational setting justifies studies into it and its influences. The very first argument for the importance of power in an organization stems from the historical role of work groups in human history. People have formed groups to execute tasks and accomplish given goals, which forms the basis of an organization. However, the success of such groups is to a considerable extent dependent on the interrelationship of the individuals making the team. This relationship in an organization entails the dynamics between the leader, the followers and the environment created for the group. A wrong miscarriage of power as depicted by a toxic triangle consisting of destructive leaders with susceptible followers in abuse-conducive environments is a recipe for organizational failure. (Padila, Hogan and Kaiser 176). For instance, the leadership within an organization may develop the habit of exploiting the workforce through the power vested in them. Poor pay, overworking and overt and covert forms of vertical violence among other actions from the leadership are manifestations of such abuse of power (Van Vugt, Hogan and Kaiser 178). The motivation, commitment and thus performance of the employees may wane under such circumstances and thus inhibit productivity. In case the productivity remains high, the increased informed consumerism of today’s market may lead to the products of the firm being shunned when it is deemed that they abuse their employees (Crane et al. 287). Thus, how an organization manages its power within the hierarchy determines the direction and success of the organization. Sources of Organizational Power: The important role of power within an organization leads to the need to establish the bases of power; the different types of power and how they are obtained. There are five general bases of power within an organization; legitimate/positional, reward, coercive, expert and personal power (Kinicki and Williams 138). The discussion will focus on each source of power, critically analyzing how such power can be leveraged for the benefit of the organization, pitfalls and recommendations on how to maximize this power successfully. Legitimate/Positional Power: Positional power arises when a leader occupies a legitimate position of authority. The power is positional in that it reside s in the office held; leaders get this power through being appointed to fill the position (Bal et al. 7). The organization specifies the powers held by the individual in that position and how such an individual can direct the subordinates. The legitimacy of positional power arises from the formal nature of the position. Examples of positions that have power in the organization include managers and chief executive officers. Individuals in such positions hold different levels of power, increasing as people move up in the hierarchy (9). For instance, junior level managers may have the power to recommend a promotion or punishment, while the CEO may offer the last word on the matter. Like any other form of power, the

Rhetorical Analysis The Four Freedoms Essay Example | Topics and Well Written Essays - 500 words

Rhetorical Analysis The Four Freedoms - Essay Example Therefore, he began his address on a note of warning to the Americans, with the assertion that the nation’s international position was â€Å"unprecedented†(2) and raised apprehensions about the security of America by stating that â€Å"at no previous time has American security been as seriously threatened from without as it is today.†(2) What was that threat? He did not specify and he was just trying to create deep anxiety for his audiences. By stating next, that past leaders of America did not aim â€Å"at domination of the whole world,† (7) he was making it clear about the new role of America in the world scenario of politics and the duties and responsibilities involved in it. To highlight the necessity of participation in World War II, he chose to belittle the importance of the previous wars and said they were not â€Å"a real threat against our future or against the future of any other American nation.†(12) Quickly, he had built up the suspense rhetoric well which created some apprehensions like who was the enemy precisely? What were the intentions of the enemy so-projected? What threat he constituted? At the sixth minute of his speech, the President was more vocal about describing the enemy. He specified the enemy as â€Å"the new order of tyranny† (11) who had the hidden agenda and â€Å"that seeks to spread over every continent today.†(11) He said â€Å"every realist knows that the democratic way of life is at this moment being directly assailed in every part of the world–assailed either by arms, or by secret spreading of poisonous propaganda by those who seek to destroy unity and promote discord in nations that are still at peace.†(12) This observation was highly important. He regaled his audience and warned them that the enemy was treacherous on every count. The President was referring to the enemy dictators and their armies, the Communist countries

Power Bases in Leadership Research Paper Example | Topics and Well Written Essays - 2750 words

Power Bases in Leadership - Research Paper Example The paper tells that contemporary complex organizations require proper leveraging of power in order to achieve organizational goals and objectives. As Bal et al. argue, power is the ability to influence others, which leaders use to enhance the performance levels of their followers and to ensure their superiors and peers arrive at the best decisions. The traditional view of power in an organization revolves around the control that individuals at the tip of organizational hierarchy have. However, leaders of different levels within an organization have access to power, whose effective harnessing is key to organizational performance. The importance of power in the organizational setting justifies studies into it and its influences. The very first argument for the importance of power in an organization stems from the historical role of work groups in human history. People have formed groups to execute tasks and accomplish given goals, which forms the basis of an organization. However, the success of such groups is to a considerable extent dependent on the interrelationship of the individuals making the team. This relationship in an organization entails the dynamics between the leader, the followers and the environment created for the group. A wrong miscarriage of power as depicted by a toxic triangle consisting of destructive leaders with susceptible followers in abuse-conducive environments is a recipe for organizational failure. (Padila, Hogan and Kaiser 176). For instance, the leadership within an organization may develop the habit of exploiting the workforce through the power vested in them. Poor pay, overworking and overt and covert forms of vertical violence among other actions from the leadership are manifestations of such abuse of power (Van Vugt, Hogan and Kaiser 178). The motivation, commitment and thus performance of the employees may wane under such circumstances and thus inhibit productivity. In case the productivity remains high, the increased informed consumerism of today’s market may lead to the products of the firm being shunned when it is deemed that they abuse their employees (Crane et al. 287). Thus, how an organization manages its power within the hierarchy determines the direction and success of the organization. Sources of Organizational Power: The important role of power within an organization leads to the need to establish the bases of power; the different types of power and how they are obtained. There are five general bases of power within an organization; legitimate/positional, reward, coercive, expert and personal power (Kinicki and Williams 138). The discussion will focus on each source of power, critically analyzing how such power can be leveraged for the benefit of the organization, pitfalls and recommendations on how to maximize this power successfully. Legitimate/Positional Power: Positional power arises when a leader occupies a legitimate position of authority. The power is positional in that it reside s in the office held; leaders get this power through being appointed to fill the position (Bal et al. 7). The organization specifies the powers held by the individual in that position and how such an individual can direct the subordinates. The legitimacy of positional power arises from the formal nature of the position. Examples of positions that have power in the organization include managers and chief executive officers. Individuals in such positions hold different levels of power, increasing as people move up in the hierarchy (9). For instance, junior level managers may have the power to recommend a promotion or punishment, while the CEO may offer the last word on the matter. Like any other form of power, the

The Effects of Video Games on Children Essay Example for Free

The Effects of Video Games on Children Essay â€Å"Technology is a useful servant but a dangerous master,† says Norwegian politician Christian Lous Lange (1930, no page). Indeed, technological progress made a step forward in humans’ civilization, changed people’s lives and brought new innovations. Virtual reality, as a part of this progress, gave an opportunity to have a look at the world built on imagination with a possibility to be involved in all actions happening there. Computers, PlayStations and other gaming platforms allowing people to interact with a virtual gaming world are becoming popular today, especially among children. Definitely, some video games positively impact on children’s learning skills at schools or colleges, even showing better results in their education. However, these games are one of the controversial issues existing presently. On the level with researchers revealed positive sides of virtual gaming, there have been conducted many other types of research, which discovered some negative effects caused by virtual games. On the one hand, the positive effects of digital games can be linked with an academic education of children. These games can teach young people some subjects at schools or universities, for example, algebra and geometry (Corbett et al., 2001). One of the reasons for this can be that children act actively while playing video games instead of just listening or watching, which make computer games good teachers. Moreover, a practice of video games for educational purposes may be helpful for migrant children. There are several reasons for this such as the possibility to change languages, an opportunity to repeat tasks which were difficult for international students and other reasons. For instance, this practice was successfully used by the Pennsylvania Department of Migrant Education to teach international students (Winograd, 2001). Turning to the negative effects, a serious concern about digital games attributes to violent games, which are gaining popularity among children, whereas educational and challenging games are becoming less popular. Perhaps the most problematic issue connected to the violence in games is the formation of aggression in children’s behavior. According to Park (2014), new research has proven that those children who are addicted to sit hours playing video games are more likely to act themselves in a hostile way than those who are far from spending lots of time in front of gaming platforms. Shooting at people and killing them, acts of stealing and kidnapping, and a clear vision of bleeding profusely – all these factors are responsible for the appearance of kids’ aggressive attitude towards other people. But aggressiveness is not only problem. Other behavioral problems are also caused by violent games such as making some actions normal whereas they are abnormal. For insta nce, well-known game â€Å"Grand Theft Auto† gives a clear vision of actions which are terrible in reality, such as hiring prostitutes and murdering them to take money back, killing pedestrians by driving on the sidewalk in GTA world, carrying out an attack on people randomly and others (Wendling, 2014). In fact, the history shows that over 125 million of duplicates of GTA were sold which makes this game one of the best sellers (Video Game Sales Wiki, 2013). Additionally, demented activities in some video games are awarded with virtual money, reputation and some points, which can spur on children to realize abnormal and even criminal actions in real world. In 2013 two girls from Italy murdered one man and stole his money and then told the police that they felt as playing GTA while committing the crime (Corriere Della Sera, 2013). There can be observed other negative effects too related to behavioral problems caused by violent games. More studies should be undertaken to analyze all these effects in order to minimize negative consequences carried by them. Similarly, we have to concern about non-behavioral effects of virtual games on children as well. First of all, video games lead to deterioration of children’s social skills. According to studies made by a group of specialists, there was found that children addicted to playing games displayed a lower level of social skills compared to normal students (Zamani et al., 2010). The reason for this can be that young people devote their free time to video games instead of talking with coevals and friends, which, obviously, arouses different troubles with communication. The research concluded that children having exposure to playing games avoid communicative relations (Zamani et al., 2010). The explanation concerning why children continuously play video games wa s given in the research: video games are more enjoyable, inform about others, help some children to feel themselves not alone, somehow make children forgotten about existing problems, and video games give an opportunity to participate in game actively and directly (Zamani et al., 2010). Social skills are important in the formation of individuals since relationships and interactions with other people built on communication are pivotal. However, negative effects of video games on children’s social skills continue to worry the majority of people, especially parents. Furthermore, health problems caused by video games are one of the major problems to concern about. Since children may seat sufficient time controller-in-hand, they spend less time on physical activities. Hence, obesity may be a great threat to their health problems. Accordingly, one research indicated that children who play virtual games more than 1.5 hours are more inclined to have obesity problems than those who spend less than 1.5 hours (Rehbein et al., 2010). In addition, vision problems triggered by sitting hours in front of the monitor may serve as another example for health-related problems about video games. Parts of the eye such as pupil, cornea, and iris are vulnerable for long viewing on electronic devices, contributing to eye strain (Gillespie, 2002). Thus, this may have negative outcomes such as deterioration of children’s vision. Another example of health problem caused by computer games is an epileptic seizure. That is why all video game industries are obliged t o have epilepsy warnings on goods they produced in order to prevent this illness. There are more health problems triggered by video games, especially, among children as â€Å"developing† population, since they have recently started their growth in both physical and mental characteristics. In conclusion, technology is not a good or bad invention, it depends on people in what way they use it. Similarly, virtual games have many positive effects in education even giving a better performance of students in academia. Many types of research have proven that interactive computer games are good teachers and may be helpful for migrant students, because of an active interaction with the virtual gaming world, language changing possibilities for international students and repetitiveness of tasks. However, other researchers have shown that violent games may cause some behavioral and non-behavioral problems, which represent a great danger for young people. Behavioral problems include aggressiveness in children, caused by violent actions in the game and non-behavioral problems include deterioration of children’s social skills, as a result of lack of communication. Additionally, health-related problems are also one of the negative effects of video games. Illnesses such as the d eterioration of the eyesight, caused by an extensive viewing of the monitor, obesity, which is triggered by a lack of physical activity, epileptic seizure, and many other health problems, are things which needed to be concerned about by everyone. Finally, even though video games have more bad consequences on children rather than positives, with an effort to get rid of negative effects we should save positive effects of video games.

Case Study On A Patient With Pulmonary Tuberculosis

Case Study On A Patient With Pulmonary Tuberculosis The case that is about to be discussed here revolves around a patient diagnosed with pulmonary tuberculosis. The patient that was clerked, Mrs A, was a 61 year old woman. She was a Malay housewife. Her Body Mass Index value of 26.0 kg/m2 based on her height of 1.58 m and weight of 65 kg indicated that she fell into the overweight range. The patient was admitted to the Accident Emergency mode transferred in from another hospital via an ambulance. She presented symptoms such as shortness of breath(SOB) and her respiratory rate was 20 breaths per minute. She appeared pale and weak and her blood glucose levels were low (2.1 mmol/l) and her blood pressure values indicated she was hypertensive with a value of 152/93 mmHg. Upon physical examination, mild leg swelling was observed. Based on her past medical history, patient was diagnosed with pulmonary tuberculosis for the past 3 months, hypertension for the past 5 years, diabetes for the past 5 years and advanced renal failure for the past 6 months. Upon enquiry, she was seen to be a non-smoker and a non alcoholic. Patient lived with her daughter. Several investigations were performed to evaluate the patients condition. A positive sputum smear test indicated that the patients tuberculosis was still active. Upon renal function assessment, creatinine clearance was calculated and a value of 5.5 ml/min indicated Stage 5 renal failure. Her potassium and urea levels were also above range based on Table 1. Upon haematology assessment, her low blood sugar levels indicated hypoglycaemia and patients haemoglobin count was also low signifying anemia. Chest X ray was conducted on this patient and minor lesions at the apical segments of the upper lobe were seen. This is a typical radiographic representation of patients with tuberculosis. Table 1: Results of the investigations performed Laboratory Test Readings Normal range Sputum Smear Test Positive Renal Function Creatinine, Cr Urea Potassium, K+ 912 ÃŽÂ ¼mol/l 37.8 mmol/l 5.5 mmol/l 44-80 ÃŽÂ ¼mol/l 1.7 8.5 mmol/l 3.5 5.0 mmol/l Haematology Assessment Blood Sugar Level Haemoglobin 2.1 mmol/l 9.8 g/dl 4.5 6.0 mmol/l 13.5 18 g/dl Table 2 provides details about patients drug history giving information about patients drugs and their respective doses. Upon interview, patient informed that she had not been purchasing any over the counter medications. She also has no known drug allergy. Table 2 : Drug History and their respective doses and their indication Drug Dose Duration Indication Rifampicin 300 mg OD 2 months Anti TB Isoniazid 200 mg OD 2 months Anti TB Pyrazinamide 750 mg OD 2 months Anti TB Ethambutol 600 mg OD 2 months Anti TB Pyridoxine 20 mg OD 2 months Treatment of neuropathy Gliclazide 40 mg OD 5 years Anti diabetic Prazosin 2 mg TDS 5 years Anti Hypertensive Furosemide 80 mg OD 5 years Anti Hypertensive Nifedipine 20 mg TDS 5 years Anti Hypertensive Based on the investigations performed, the patient was diagnosed to be suffering from pulmonary tuberculosis and diabetes mellitus. Patients daily condition was monitored and appropriate management was undertaken to control the patients condition. Patients overall progress is tabulated in the table 3 and the observation is recorded. Table 3 : Patients clinical progress and management Day Clinical Progress Management 1 Hypoglycemia = 2.1 mmol/L AFB test positive Chest X ray performed SOB Hyperkalaemia ( 5.5 mol/L) Anemic ( 9.8 g/dL) BP : 152/93 mmHg Strict fluid intake IV Dextrose 10%/24 hours Refer to chest physician Lesions at upper lobes NPO2 to resolve SOB Start on Calcium polystyrene Start Ferrous (IV) sulphate Start antihypertensives Monitor input output 2 AFB test +ve Blood Sugar Level = 3.0 mmol/L BP : 140/90 mmHg Start TB regimen (EHRZ) Continue IV Dextrose 10% Monitor Blood Glucose Continue antihypertensives 3 Blood Sugar level = 3.2 mmol/L Severe renal impairment ( CrCl =5.6 ml/min ) Chest X ray done time to time BP : 130/70 mmHg Continue dextrose infusion Send patient for dialysis Lesions still present Continue antihypertensives 4 No SOB Hypoglycaemia resolved = 5.5 mmol/L AFB +ve BP : 130/75 mmHg Remove nasal prongs Stop Dextrose. Monitor blood glucose Continue TB regimen 6 K+ level in normal range ( 4.5 mmol/L) Blood Sugar level = 6.0 mmol/L CrCl = 7.7 ml/min BP : 130/65 mmHg Stop Calcium polystyrene. Monitor blood glucose Send patient for dialysis 8 Hyperglycemia = 11.1 mmol/L BP : 125/75 mmHg Start on Insulin DM counselling 13 AFB -ve DXT = 10.2 mmol/L BP : 120/70 mmHg Transfer out of isolation Continue insulin. Monitor blood glucose Based on patients presentation and results from investigations performed on day 1, patient was started on dextrose and her blood glucose levels were regularly monitored. Based on patients previous history, a sputum smear test was ordered and two consecutive positive results resulted in the patient being referred to the chest physician. A chest X ray was performed and lesions in the apical segment were present. To resolve patients SOB, patient was started on Nasal Prongs at 3L/min. To control her hyperkalemia, patient was given calcium polystyrene sulphonate powder. Patient was also started on ferrous sulphate infusion to help her cope with her anaemia. A strict fluid intake was imposed on patient to resolve her leg swelling and this was monitored through an input output chart. Her blood pressure (BP) levels were also elevated and patient was given antihypertensives such as nifedipine, prazosin and furosemide to control her BP. On day 2, her sputum smear remained positive and patient was commenced on the intial phase therapy for tuberculosis which consists of isoniazid, rifampicin, pyrazinamide and ethambutol. There was not much improvement in her blood glucose levels and patient was remained on the dextrose infusion. Moving on to day 3, not much improvement was observed and due to patients deteriorating renal function, patient was sent for peritoneal dialysis. By day 4, patient could breath normally and no shortness of breath was seen. Nasal prongs were removed. When her blood glucose levels were monitored, the results indicated patient was within the normal range and dextrose was withheld. Blood glucose levels were still monitored to prevent sudden drops and increase in blood glucose. Her potassium levels were within range by day 6 and calcium polystyrene sulphonate was stopped and potassium levels were monitored as well. Patient suffered from a hyperglycemia episode on day 8 and the patient was given biphasic insulin to treat this condition. By this day, her BP was also in the normal range but the antihypertensives were still continued. On day 13, patient was transferred out of the isolation ward as her sputum smear test produced negative results. Patients condition for tuberculosis was still being monitored. Her blood glucose levels were still in the high range and patient was to be continued on insulin. To summarize this case, patients active tuberculosis state should be managed well to ensure patient does not suffer from further complications that might arise in the future. Patients history was well noted and this helped in treating the patient in early stages. Adequate investigations were performed to assist the healthcare professional team to diagnose the patient and also to manage the patient. Patient was admitted for a long period but the appropriate management that was undertaken resulted in improvement in patients condition. Further care for the patient would improve the patients quality of life in the future Pathophysiology and Incidence Tuberculosis (TB) is an infectious disease that has plagued many nations across the world. Based on the report by World Health Organization (WHO), almost 9.4 million cases of TB were reported 3. It is highly common of those with TB to contract the Human Immunodeficiency Virus (HIV) and a prevalence of almost 1.7 million deaths from TB among HIV-negative people was recorded around the globe 3. In the United Kingdom, an increasing trend in TB incidence has been reported and this is shown in Figure 1. In 2008, a rate of 14 per 100 000 population in the UK were reported to be suffering from TB 4. Malaysia on the other hand has a higher record of TB cases with 103 per 100 000 population being reported in 2007. Table 1 summarizes some of the data obtained from World Health Organization 3. Figure 1: Number of TB cases reported in the UK from 2000 to 2008 4 Table 1: Statistics displaying number of TB cases in Malaysia in 2007 3 All In HIV + people Incidence All forms of TB (per 100 000 population) 103 17 Mortality All forms of TB (per 100 000 population) 121 8.3 Multi-drug Resistant TB (MDR-TB) MDR-TB among new cases (%) 0.1 Notified relapse cases (per 100 000 pop/yr) 61 The bacteria that is responsible for this disease is the acid fast bacilli aerobic bacterium Mycobacterium tuberculosis 1. A key feature that enables this bacterium to survive would be its unique cell wall. Mycolic acids are linked covalently to arabinogalactan that provides a barrier to host defense mechanism. Antigens such as lipoarabinomannan present on the exterior of the cell wall facilitate the survival of the organism within macrophages 1. Tuberculosis is spread usually spread within droplets containing the microorganism that are produced when an infected person coughs, sneezes or even talks 1,2. Figure 1 gives a schematic impression of the progression of the disease. The inhaled droplets are initially trapped by dendritic cells that act to expel any foreign particles out. Most mycobacteria are able to surpass this defense mechanism and travels further to the alveoli where it gets ingested by macrophages 1. It then undergoes intracellular replication that might take duration o f 4 to 6 weeks. Cytokines are further released during this period and this attracts T lymphocytes that are involved in mediating a cell immune response. The next natural defense system step would be the formation of granuloma that contains the activated T lymphocytes and macrophages. These nodular lesions disable further spread of the disease as the environment within restricts the growth of the bacilli and a latent period occurs 1. For less immunocompetent individuals, the granuloma will not be able to contain the bacilli and the active disease takes form 1. Figure 1: Image depicting the progress of tuberculosis 2 The diagnostic tests available are summarized in Table 2. TB can be divided to latent and active and to diagnose each different test has been recommended. For latent TB, Mantoux test can be carried out and those with positive results can be considered for QuantiFERON TB test 5. To diagnose active pulmonary TB, a chest X-ray would be taken followed by multiple sputum samples that are sent for smear test 5. Table 2: Diagnostic tests available for tuberculosis 1 Variable Purpose Time required for results Sputum smear Detect acid fast bacilli Sputum culture Identify M tuberculosis 3-6 weeks with solid media, 4-14 days with high-pressure liquid chromatography Tuberculin skin test/ Mantoux Detect exposure to mycobacteria 48 72 hours QuantiFERON TB-test Measure immune reactivity to M tuberculosis 12 24 hours Chest radiography Visualize lobar infiltrates with cavitation Minutes The drugs that are commonly used in tuberculosis are isoniazid, rifampicin, pyrazinamide and ethambutol. Rifampicin is a bactericidal agent that inhibits RNA synthesis by binding to the ß subunit of RNA polymerase. It can be given via oral administration and can even be distributed to the central nervous system due to its lipophilicity. Metabolism of this drug occurs in the liver and it is usually excreted in the urine. Isoniazid is a bactericidal pro-drug that inhibits ketoenoylreductase enzyme, InhA, that is responsible in synthesizing mycolic acids. Isoniazid can be administered orally, intramuscularly or intravenously and is acetylated in the liver and subsequently excreted in the urine. Pyridoxine 10 mg is given concurrently to minimize this risk. Pyrazinamide is another prodrug that is activated by nicotinamidase to pyrazinoic acid. This component at low pH carries proton into the cell and collapses the proton motive force present in the mycobacterium which results in cell d eath. It is only bactericidal against non growing bacilli forms.. Ethambutol works by binding to arabinosyl transferase enzyme and inhibits the polymerization of the cell wall arabinan component. Table 3 gives the details of the dose and side effects reported with the administration of the tuberculosis drugs. Table 3: Tuberculosis drugs with their respective doses and side effects 6,7 Drug Dose Side effects Isoniazid 5 -8 mg/kg (max 300 mg) Peripheral neuropathy, hepatotoxicty Rifampicin 10 15 mg/kg (max 600 mg) Nausea, vomiting, thrombocytopenia, orange discolouration of urine Pyrazinamide 20 40 mg/kg ( max 1.5 g 50 kg) Nausea , vomitting, hyperuricemia Ethambutol 15 25 mg/kg Neuropathy, red green color blindness Evidence based medication review Treatment for Tuberculosis In the past three decades, no new drugs have been discovered in fighting TB. The 4 drugs have been the gold standard in treating TB The chemotherapy regimen available for tuberculosis therapy can be divided to the initial phase and the continuation phase. In the initial phase, drugs such as rifampicin, isoniazid, pyrazinamide and ethambutol are used 6. These drugs act to decrease the amount of bacteria present and also prevent resistance from emerging from the strains. This regimen is usually for 2 months. The continuation phase would consist of drugs such as isoniazid and rifampicin. Isoniazid was the first drug to be introduced into combating tuberculosis back in the 1950s. Rifampicin , an antibiotic, was later added to the market and was added to the isoniazid regimen in 1967. This resulted in shortening the duration of treatment from 12 months to a 6 to 9 month treatment 9. Addition of pyrazinamide to the regimen decreased the chemotherapy duration further. Clinical studies have indicated that a pyrazinamide containing short course regimen had a sputum negative conversion rate of 70-95% in the first two months compared to the treatment without pyrazinamide 11. The relapse rates recorded from these studies also were only 4%. A clinical study conducted in East Africa compared the four 6-month daily regimens that comprised of Streptomycin, Isoniazid and Rifampicin (SHR), Streptomycin, Isoniazid and Pyrazinamide (SHZ); Streptomycin, Isoniazid and thiacetazone (SHZ) and Streptomycin and Isoniazid (SH) 10. The SHZ regimen that was the most effective amongst all the regimens and the SHR regimen had the lowest relapse rate of 2% 30 months post treatment 10. No significant difference results were obtained from the treatment regimen that was carried out for 18 months 10. This study gives an impression of the efficacy of the isoniazid, rifampicin and pyrazinamide regimen when used together In a Poland study, the efficacy of the 4 different drug regimens containing rifampicin, isoniazid and ethambutol were assessed. During the initial phase, patients were given isoniazid 300 mg, rifampicin 600 mg and ethambutol 25 mg/kg 8. In the continuation phase the regimens given to patients comprised of rifampicin 600 mg, isoniazid 15mg/kg(Regimen A), isoniazid 15 mg/kg rifampicin 600 mg twice a week (Regimen B), Isoniazid 15kg/mg, rifampicin 600 mg ethambutol 50mg/kg once a week (Regimen C) and Isoniazid 15mg/kg, rifampicin 600 mg, ethambutol 50mg/kg twice a week (Regimen D) 8. The result of this study demonstrated that Regimen D had 47% of its patients displaying a significant change in their sputum result to a negative result compared to the other regimens. There were no significant differences in rates between all regimens by the end of the fifth month as all patients had their sputum converted to negative. This study had the limitation of not including pyrazinamide in its regi men but it can be seen that to achieve a quicker rate of sputum negative cultures a regimen containing ethambutol could be used in the continuation phase. A trial conducted by Jindani et al. assessed the effectiveness of daily dosing of the intial phase drugs compared to the intermittent thrice weekly dosing. The drugs that were assessed were isoniazid, rifampicin, pyrazinamide and ethambutol. The doses that were given to the patients were based on WHO recommendations. The outcome measured after 2 months had 77% of the patients with negative sputum cultures after their 2 month stint (p=0.001) 13. A similar study was conducted in Hong Kong with the difference being a 12 month follow up period. By the end of the second month, 94% of patient receiving the daily regimen had improved. 90% of those under the intermittent regimen also had improved by the second month. Over the long term follow up, more relapse cases were recorded but the values were not significant 14. Hypoglycemia Treatment Patient was hypoglycemic upon arrival and dextrose infusion was provided to restore the patients normal blood glucose range. Two forms of treatment are usually available for hypoglycemic attacks namely glucagon and dextrose infusion. A study compared the efficacy between both the options and it was observed that both were capable of treating hypoglycemia effectively. The only disparity observed was the recovery. Patients on dextrose infusion are capable of regaining consciousness by 4 minutes compared to 6 minutes for patients that were on glucagon ( p Table 4 : Results of 51 hypoglycemic patients treated with dextrose 10% and dextrose 50% 27 Dextrose 10% Dextrose 50% Median time needed to attain recovery (minutes) 8 8 Median total dose administered 10g ( p 25g (p Median post treatment blood sugar levels 6.2 mmol/l (p=0.003) 9.4 mmol/l (p=0.003) Diabetes Treatment Oral antidiabetic agents such as gliclazide in the patients drug history would not be sufficient for her to have proper control over her glycemic levels. It was reported that tuberculosis affects the hormonal secretion by interfering with endocrinal organs such as pancreas 15. Rifampicin reduces the concentration of gliclazide by inducing liver microsomal enzymes CYP 2C9 that rapidly eliminates gliclazide from circulating in the system 15,16,17. In a study by Park et al., patients given with 80 mg gliclazide had the concentration of the drug present in the body reduced by 70% on day 7. The elimination half life of the drug also increased 3 fold 17. All these contribute to the inability of the sulfonyluea to reduce the glucose levels in this patient. According to the stepwise approach in NICE guidelines, the next step to manage this patient would be to start the insulin regimen18. The type of insulin that was given was biphasic Mixtard insulin analogue that consists of a short acting analogue and also a long acting analogue. P.V. Rao reported that, due to the insulin resistance present in patients started on anti Tb therapy, the doses of insulin needed to manage these patients increase 15. It is well proven that insulin can achieve better HbA1c levels as a clinical trial by United Kingdom Prospective Diabetes Study (UKPDS) revealed that after 9 years monotherapy with insulin, 28% of patients achieved HbA1c levels below 7% and 42% patients achieved fasting plasma glucose levels below 7.8 mmol/l 19. Hypertension Treatment Patient was suffering from Stage 5 renal disease and the target for blood pressure in this patient would be 125/75 mm Hg 20. First line treatment for this patient would be loop diuretic, furosemide 20. They act by inhibiting the Na+/K+/2Cl- transporter on the ascending limb of loop of Henle which results in natriuresis and hence a fall in blood volume 21. This loop diuretic also performs its vasodilator actions via prostaglandin (PGE2 and prostacyclin) formation. This results in an increased blood flow in the medulla 21. In accordance to SIGN guidelines as well, long acting dihyrdopyridines such as nifedipine and ÃŽÂ ± blockers can be added as supplementary therapy 20. Nifedipine, a calcium antagonist acts by causing vasodilatation due to reduction in peripheral resistance. ÃŽÂ ± blockers such as prazosin block ÃŽÂ ±1 receptors and this results in vasodilation. A study by Vadasz displayed that Furosemide doses at 40 mg did not display any significant changes in systolic blood pressure. However, when the dose was increased to 60 mg, there was a significant reduction in blood pressure 21,22. A combined dose of 40 mg and 60 mg were effective in reducing the diastolic blood pressure. Based on this evidence, it is clear that furosemide on its own is not capable of decreasing blood pressure. When nifedipine was combined with diuretics it was observed that a statistically significant lower risk of cardiovascular events was observed compared to the non-statistically significant difference that was noted with nifedipine monotherapy 22. In another study by Psaty et al, nifedipine did not demonstrate an increase of risk in myocardial infarction compared to the other calcium channel blockers 25. Prazosins efficacy in lowering blood pressure was studied and the lowest effective dose that is capable of reducing blood pressure was noted to be 10mg 26. Doses below 10 mg per day did not significantly reduce the blood pressure compared to the placebo arm. Treatment of Anaemia Patient had very low haemoglobin levels and this was indicative of anaemia. NICE guidelines have recommended that in order to manage anemia, patients are usually given eryhtropoetin stimulating agents and also iron supplements to help produce haemoglobin 23. There has been no evidence in the use of iron supplements in patients with chronic kidney disease prior to treatment with erythropoietin. But it is recommended that the erythropoietin therapy should not be commenced in conditions of complete iron absence 23. In some conditions, where patients were in Stage 5 renal failure also diagnosed with other co-morbidities, treatment with erythropoietin stimulating agents is decided based on clinical judgment by the professional team if the patient were to benefit from the treatment 23. Treatment of Hyperkalaemia Patient was suffering from mild hyperkalemia and it was necessary that this was be treated before it progresses to severe hyperkalemia that might lead to adverse events such as cardiac arrest. A study compared the effectiveness between sodium polystyrene sulfonate and calcium polysterene sulfonate and it is noted that treatement with sodium increases sodium concentration in the body and this escalates the risk of hypertension 24. Treatment with calcium polystyrene sulfonate resulted in 50% decrease in potassium content and an additional advantage of increase in calcium concentration was observed as well 24. Conclusion Based on all the evidence provided for the patients condition, it is clear that the guidelines were adhered in treating the patients individual disease with some minor differences. Tuberculosis treatment for the initial phase was extended for more than 2 months due to the positive result obtained from sputum smear. Patient eventually achieved negative sputum smear and the patient was to be monitored before the patient was commenced on the continuous phase drugs. Effective treatment was undertaken to treat patients hypoglycemia condition, and based on the evidence gathered, dextrose 10% is the suitable treatment option for the patient. The antihypertensive regimen that was chosen was due to the patients renal failure. Nifedipine, prazosin and furosemide collectively controlled the blood pressure of the patient. Ferrous sulphate was chosen as her treatment compared to erythropoietin and this was based on the doctors clinical judgement. Her hyperkalemia which was treated with calcium su lfonate did benefit the patient as her potassium levels were within the normal range at the end of the treatment. PATIENT MEDICATION PROFILE PATIENT DETAILS Name Mrs A Consultant General Practitioner Address Kuala Lumpur Gender Female Weight 65 Height 158 Community Pharmacist Date of Birth (Age) 61 Known Sensitivities None Social History Non smoker Non Alcoholic PATIENT HOSPITAL STAY Presenting complaint in primary care / reason for admission Admission date April Low Sugar Level : 2.1 mmol/L Discharge Date Discharged to Not Known Shortness of breath RELEVANT MEDICAL HISTORY RELEVANT DRUG HISTORY Date Problem Description Date Medication Comments Feb Pulmonary Tuberculosis Feb Rifampicin 6 months Advanced Renal Failure Feb Isoniazid 5 years Hypertension Feb Pyrazinamide 5 years Diabetes Mellitus Feb Ethambutol Feb Pyridoxine 6 months Prazosin 6 months Nifedipine 6 months Furosemide Gliclazide RELEVANT NON DRUG TREATMENT Peritoneal Dialysis Prescribed Medication Start Stop Clinical/Laboratory Tests Date Result 1 Rifampicin Day 1 Sputum Smear Test Day 1 Positive 2 Isoniazid Day 1 Creatinine Day 1 912 Â µmol 3 Pyrazinamide Day 1 Urea Day 1 37.8 mmol/l 4 Ethambutol Day 1 Potassium Day 1 5.5 mmol/l 5 Pyridoxine Day 1 Blood Glucose Day 1 2.1 mmol/l 6 Prazosin Day 1 Blood Pressure Day 1 152/93 7 Nifedipine Day 1 Haemoglobin Day 1 9.8 g/dl 8 Furosemide Day 1 Chest Xray Day 1 Lesions in the apical segment 9 Dextrose Solution Day 1 Day 4 Blood Glucose Day 8 11.1 mmol/l 10 Ferrous sulphate Day 1 Sputum Smear Day 13 Negative 11 Calcium polystyrene sulphate powder Day 1 Day 6 12 Insulin Mixtard Day 8 CLINCIAL MANAGEMENT Diagnosis Pharmaceutical Need Pulmonary Tuberculosis Continue patient on intial phase drugs Hypoglycemia Start patient on dextrose Hypertension Continue antihypertensive treatment Hyperkalaemia Start calcium polystyrene sulphonate powder Anaemia Start ferrous sulphate Advanced Renal Failure Send patient for peritoneal dialysis PHARMACEUTICAL CARE PLAN Date Care Issue/Desired Output Action Output Sub therapeutic doses For Anti TB drugs Discussed with the pharmacist and patients diabetic condition was the reason for the dose regimen Doses were not changed Drug sensitivity testing was not performed Patient is diabetic and is more susceptible for MDR-TB No test was performed Management of patients compliance towards anti tuberculosis drugs -Patient might be hospitalised for a long period of time due to renal failure -DOTS scheme to be implemented upon discharge -Adequate patient education on the importance of completing the regimen is important Hospitalisation or DOTS scheme Renal failure Ethambutol excreted by kidney. Suggest change of medication to 2 Isoniazid + Rifampicin + Pyrazinamide -If treatment continued, monitoring essential Continue treatment as before and patient being monitored AFB test Another 2 samples should be taken for AFB tests before switching to the continuous phase Action yet to be taken Monitor drug toxicity Lab investigations on full blood count, liver function, serum uric acid, serum bilirubin, should be done to ensure no toxicity Eye examination for ethambutol side effects Scheduled appointments for patient Education on side effects of drugs To inform patient about anti Tb drugs side effect and advise patient not to stop the drug and side effects can be controlled ( PZA and arthralgia ) Counseling by pharm

Matthew Arnolds Dover Beach Essay example -- Poem Poetry Essays

Matthew Arnold's Dover Beach Great works of poetry convey a feeling, mood, or message that affects the reader on an emotional, personal level. Great works of poetry can do that -- translate a literal story/theme -- but masterpieces, like Matthew Arnold's "Dover Beach," are a double-edged sword, containing a second, figurative theme -- a message between the lines and underneath the obvious. Not only is Matthew Arnold's 1867 poem, "Dover Beach," a unique and beautiful literary work describing a lover's longing for trust and faith, but on a figurative plain it also stands as a metaphor for that constant evil called war. Literally, "Dover Beach" flows through four irregularly rhymed sections that increase in emotional impact and describe a lover's need for faithfulness in an otherwise dark and unfaithful world. In this traditional sense, the narrator of "Dover Beach" is either a man or woman standing at a window wearily reflecting on the world while staring at the beauty of the night coast. In the first section (Arnold's poem is very prose-like in its lack of a distinct structure or rhyme scheme, sputtering through the first nine lines in an abacdbdce rhyme scheme), the lover declares that "The sea is calm tonight." The poem continues with simple imagery of the atmosphere, describing the full tide, the moon, the beaches of Dover, the night air, the waves, all of which we presume are viewable from the narrator's window. The scene is cemented: a moon-bathed beach, the waves drawing back, only to crash back in a "grating roar of pebbles." "The eternal note of sadness" is set as the lover begins to question the beauty he sees and the love he longs to keep. The next two sections of "Dover Beach" describe a w... ...re ignorant armies clash by night." Whether Arnold intends to imply that these things were murdered and driven from the world by war or that they never even existed in the first place is left to the readers to decide for themselves. On a traditional, literal level, Matthew Arnold's poem, "Dover Beach," is a vivid voice praying for faithful love in a beautiful yet evil and faithless world, but figuratively, the poem is a metaphor for the cycle of war and the darkness it brings to the world. The waves represent the battles, the pebbles the innocent people flung about by their power, and that note of despair present throughout the entire poem hints at no possible end for weary romantics like the poem's narrator. Crying both for the endurance of love and an end to war at the same time, "Dover Beach" stands as a poetic masterpiece of one eternal note: sadness.