The Ethical And Legal Issues Of Healthcare - 1680 Words

Figuring out how to allocate limited quantities of medications and donor organs is among the largest ethical and legal issues in healthcare. There is a concern as to whether or not there will be enough medications to go around in the future and how will these limited quantities be distributed. When shortages happen it is usually because economic incentive for a manufacturer is down. Money is king and if there is no profit to be made in manufacturing these medications then manufactures will not waste production time on them. Drug shortages will be a prevailing issue unless we can figure out how to give drug companies economic incentive to create and distribute these drugs. Until then the supply and demand of these drugs are vulnerable to problems that are inherent to the laws of economics. Allocating the dispersion of donor organs can be difficult ethically and legally for healthcare workers. On one side they want to do right by their patient but they are bound by strict laws and medical guidelines. To speak economically there is simply and excess of demand over supply so many that need those organs will often go without or wait an excessive amount of time. Recently with the Affordable Care Act, research and campaigns to encourage organ donors these problems are being met head on. The Food and Drug Administration is also taking action to prevent future drug shortages and their causes. Major ethical dilemmas and cases will be highlighted in order to demonstrateShow MoreRelatedEthical and Legal Issues in Healthcare Essay1036 Words   |  5 PagesEthical and Legal Issues in Healthcare AIU Online – HLTH320 Individual Project Unit 1 SCENERIO I am a paramedic arriving at an emergency scene. A group of scouts have entered a cave that is now filling with water. They were led into the cave by a rather large scoutmaster. Unfortunately, while leading them out of the cave, the scoutmaster somehow managed to get stuck in a narrow opening with only his head and shoulders protruding out. With his upper torsoRead MoreCritically Evaluate Medical Ethics And Legal Issues1263 Words   |  6 PagesCritically evaluate medical ethics and legal issues Introduction Medical ethics and legal issues have been a key topic in medical field for many years now. It is important for medical professionals to understand the importance of the way we care for patients, it is therefore important to be knowledgeable and aware of the medical ethics and legal issues that govern good patient care. Health care professionals must make decisions based on ethical and legal issues to performance their regular dutiesRead MoreBusiness Practices Of The West Houston Medical Center Organization847 Words   |  4 Pagescommunity, not to mention in order to ensure a successful business. Ethical values can have a focal point on organizational concerns which assist the company in adhere to respectable practices within their establishment or corporation. I am part of the West Houston Medical Center organization, and the hospital’s mission statement states: â€Å"We are a family of dedicated Healthcare professionals committed to providing exceptional healthcare and service by exceeding the expectations of every patient, everyRead MoreThe Legal And Ethical Issues Of Health Care Of A Child Essay1530 Words   |  7 Pagessubject to a plethora of legal, ethical, and professional duties which can be very challenging on a day to day basis. Some of these duties include respecting a patient s confidentiality and autonomy, and to recognize the duty of care that is owed to all patients. As nurses our duties are always professional; however there are legal implications if these duties are breached. We also must consider when it is okay as nurses to breach these duties and therefore ethical issues arise. As nurses oneRead MoreNew Paper1290 Words   |  6 PagesEthics Denise Pica-Branco, Ph.D. Strayer University Identify and explain at least three legal considerations When considering the legalities of this scenario, negligence, vicarious liability, and physician- patient relationship are a few components that affect the outcome of a lawsuit. The amount of legal torts that were violated in this case was enough to cause disputes between patients and healthcare staff. Negligence is a familiar tort that occurs much more than it needs too. UnfortunatelyRead MoreCase Study : Partners Healthcare Systems1460 Words   |  6 PagesCase Study: Partners HealthCare Systems Angela Cisco, Talia Green, Amy Mc Kinnon Glun, Morgan Rodenbaugh, and Marla Bernal Baker College Online Case Study: Partners HealthCare Systems Partners HealthCare is a non-profit, health system located in Boston that created a data based transformation (Davenport, 2013). It integrated a new system that aligned the participating organizations to cohesively run as one and to help shape the future of the organization. The system didn’t stop there as it was responsibleRead MoreEssay on Ethical Viewpoint1447 Words   |  6 PagesBioethics Interview 1 Bioethics Interview Jennifer D. Williams HLT-520 Legal amp; Ethical Principles in Healthcare Dr. Damien Brandeis April 13, 2011 Bioethics Interview 2 Individuals find themselves having to make important decisions every day. Unfortunately situations may occur that prevents a person from being able to make a decision about their medical care. The decision can be a legal or ethical one. In the medical arena someone has to make this tough decision. TheRead MoreOrganizational Ethics697 Words   |  3 PagesETH/316 October 27, 2014 Mario Madrid Organizational Ethics Business policies and practices regarding potentially controversial issues are part of organizational ethics. These ethics are often guided by the law; most business uses ethics in order to be accepted by the public or to have a successful business. Ethical principles can address organizational issues which help the organization to follow good practices within their organization or company. I am part of the Parkland Health amp; HospitalRead MoreHow Dnr Causes an Ethical Dilemma Essay1694 Words   |  7 PagesRunning Head: HOW DNR CAUSES AN ETHICAL DILEMMA How DNR Causes an Ethical Dilemma Deann Morgan HCA 322, Health Care Ethics and Medical Law Dr. David Cole January 22, 2010 Abstract This paper will present an argument of how the process of do not resuscitate (DNR) results in an ethical dilemma for workers in the healthcare field. In presenting the argument, thisRead MoreInformation And Communication Technologies ( Icts )909 Words   |  4 Pagesproblem to the patient. The monitoring systems like infant warmer makes alarms when temperature rises or falls, Numerous risk points contribute to alarm- and monitoring-related adverse events, including alarm fatigue, com-munication breakdowns, training issues, and equipment failures. According to Pelczarski, alarm fatigue is one of the most common contributors to alarm failures. â€Å"Staff become overwhelmed by the sheer number of alarm signals, which results in alarm desensitization and delayed response or

Lecture note Free Essays

In English Composition l, you learned how to analyze an argument for effectiveness, specifically looking at the use of logos (logic), ethos (credibility), and pathos (emotion). This week, you’ll learn how to craft your own arguments. Starting with this week’s Discussion, we’ll take a closer look at constructing logic (logos), which Includes using both deductive and inductive reasoning. We will write a custom essay sample on Lecture note or any similar topic only for you Order Now With inductive reasoning, you move â€Å"from a et of specific examples to a general statement,† making the â€Å"inductive leap from evidence to generalization† (Rosa School, 2012, p. 540). For instance, after looking at a month’s worth of sales receipts, you could determine that Saturday afternoons are when most patrons prefer to shop in your store. Deductive reasoning â€Å"moves from a general statement to a specific conclusion† and works from the model of a â€Å"syllogism, a three-part argument that consists of a major premise, a minor premise, and a conclusion† (Rosa School, 2012, p. 0). Please note that in order to accept your conclusion/argument, your audience should accept the major and minor premises as truths. See the below example, which could be the start of one argument In support of a vegetarian diet: Major premise: Beef contains cholesterol. Minor premise: Too much cholesterol Is bad for one’s health. Conclusion: To remain in good health, people should eat less beef. For the Discussion this week, you’ll practice creating argumentative statements, including your own syllogism. In this week’s Assignment, you’ll take it a step further and write detailed and supported arguments, either for or against the thesis of a professional essay. This will be the first draft of your Synthesis Essay, which you’ll revise in Week 4. It’s important to remember that in a Synthesis Essay, you need to add something new to the conversation. You start with existing knowledge on an Issue (in this case, a professional essay), and then create new knowledge (your argument), making unique and Insightful points. Objective(s): How to cite Lecture note, Papers

Mechanics Intended Transformation

Question: Describe about the Mechanics Intended Transformation. Answer: For the new online system, suggest and explain at least one indicator for each performance criteria of; efficiency, efficacy and effectiveness. Online system of booking has been able to achieve the intended transformation within the minimum use of resource among the four mechanics. For instance, it takes practically fifteen to twenty minutes to explain a problem online, confirm a booking in addition to requesting of auxiliary services such as car was or oil change. The system also enables the mechanics to be able estimate the time and cost of their job through the use of their admin whose main work is also to confirm bookings. The effectiveness of the online system is further demonstrated by the fact they are able to capture important information such as the email of the client in addition to their address thus preventing frauds or any intended malpractice. Other information also includes the model of the car, year of make, odometer reading and the telephone number of the client. Describe dimensions for all stakeholders of impact of your proposed new information system within the business for all stakeholders. Describe the proposed impact of the new system on the organization, groups and individuals. the online system of booking that has been formulated by the organization results into what is known as interface. The developed mode of technology can be used in various ways which includes early booking by the clients, confirmation on the side of the mechanics, additionally, the physical and contact address of the clients is accessible. This makes work easier because the mechanic can be prepared early enough to work on brakes and repair. The client is also able to drop their car at agreed time and pick conveniently without disrupting their schedule. The system is also easy to learn and helps so much when it comes to remunerability. The client can simply have a reminder on their email or even a sticky note about their date with the mechanic. The clients do not have to waste time coming to the garage to book an appointment making the system very efficiency because there is no time for delays for input if output. There are very few mistakes or none at all made by such a system making it very reliable in use. Conclusively, user satisfaction is guaranteed in such a system. To the stakeholders the system developer or rather the producer is able to monitor if the online system is working or a total failure. The clients are which in this case serve as the management play an important role which is to provide a resource for development. The users are able to give a feedback on the online system and finally, the customers, suppliers and competitors are the external forces which brings us to the negative parts of the online system. If a another company or even organization is able to come up with a better system then the clients will automatically flow to the company. identify and justify the organizational form of this business using Mintzbergs classification. The organizational structure of this business is the simple structure or what ids also known as entrepreneurial. There are only four staff. Labor is also loosely divided among the four mechanics and the managerial hierarchy is very small. Transmission technicians and rebuilder is done by one person. Brake repairs by two people, automotive air conditioning reaper is also done by one person. There is no formalization on the behavior of the structure i.e. the training, planning, lesion devices are not frequently used. Use Lyytinen and Hircschheims 4 categories of systems failure in slide 9 and the grid in slide 10;what type of failure is predicted and offer advice to ensure the system success. According to Lyytinen and Hircschheims systems fail because those involved in and affected as well not well put into consideration. He goes ahead to give a 4 dimension of information system failure which apparently matched the one being addressed in this assignment test. I would suggest that that in order to avoid correspondence failure, the clients should actually make time to come and explain to the, mechanic the problem of his or her car physically even after booking. This is for the purpose of clarification in addition to avoiding expectations failures. In order for the process to succeed, its imperative that an IT personnel keeps checking on it regularly and consistently to detect any technical issue and address it as soon as possible.

Research Proposal on Leadership Styles and Staff Retention Essay Example

Research Proposal on Leadership Styles and Staff Retention Essay A leadership style is the behaviour and complex of decisions aimed at the improvement of employee’s work and encouragement people. It is natural that there are many types of leadership which are based on the different approach towards the process and different relations between the boss and his employees. Every company has a specific structure and the leader chooses his own model of staff retention and management which suits to the type of the firm, its goals and priorities. One is able to define several leadership styles: authoritarian, democratic, paternalistic, transactional, laissez-faire. Authoritarian style is the type of leadership which is makes the boss dominant in the company and no one is able to protest against his decisions and to suggest his own plans on the development of the firm. The leader of this type makes all the decisions himself, he is strict and does not provide employees with the freedom of thought asking them to fulfill their duties without creativity. We will write a custom essay sample on Research Proposal on Leadership Styles and Staff Retention specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Research Proposal on Leadership Styles and Staff Retention specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Research Proposal on Leadership Styles and Staff Retention specifically for you FOR ONLY $16.38 $13.9/page Hire Writer Paternalistic style is characterized with the parental attitude of the boss towards his employees. He encourages and teaches them to make the right decisions and controls their work attentively. The relations between the boss and the worker are close, they trust to one another and such companies do not face the problem of employee turnover. Democratic style of leadership is characterized with the formal equality of the boss and employees as they make the decision together relying on their experience and knowledge. Laissez-faire style is characterized with the complete freedom of employees who can make decisions themselves. This style of leadership can be applied only if the employees are top-class experts in their field. Transactional style is the approach towards leadership based on the principle of rewards and punishment and is supposed to be not effective. When the student decides to complete a high-quality research project about leadership styles, he will have to work out vast amounts of materials describing the variety of approaches towards staff retention and employee management. After that the student is ready to select a few interesting and important points which require additional attention and profound research. A good project on leadership styles is supposed to be logical, brief and captive in order to demonstrate the idea of the research succinctly. The student who is not confident in the approach towards the writing of his project is able to find the answer online reading a free example research proposal on leadership styles and staff retention prepared by the skilful writer. It is reasonable to pay attention to the format and structure of the text of a free research proposal sample on leadership styles and staff retention and complete your own university assignment without the serious errors. At EssayLib.com writing service you can order a custom research proposal on Leadership Styles and Staff Retention topics. Your proposal will be written from scratch. We hire top-rated PhD and Master’s writers only to provide students with professional research proposal help at affordable rates. Each customer will get a non-plagiarized paper with timely delivery. Just visit our website and fill in the order form with all proposal details: Enjoy our professional research proposal writing service!

With These Hands, With This He essays

With These Hands, With This He essays Born October fourteenth, forty-five years ago, I wasnt always free. I couldnt always read and write. At this moment I am a free woman, telling my story, writing my story. Life for me wasnt always in Boston nor was the road smooth and straight. It wasnt too long ago that I was picking cotton in Virginia. I was a slave. It was a family tradition. My mother and father were slaves brought to the United States from Ghana. They were two of the middle passage survivors. My family- my mother, father, brother and I- were paid for and owned by the Johnsons. We lived in a shack behind the outhouse on the Johnson plantation. Each morning the four of us rose before dawn, before our masters, to begin the daily toil. We did the field labor and farmed the cash crops mainly cotton and tobacco. My fingers, rubbed so raw from the hot sun and constant harvesting that sometimes at night my mother had to wrap them taught with cloths to stop the bleeding. The piercing Virginia sun burned my back day in and day out. It wasnt until I became older in Mississippi that I had a voice free of hoarseness after the endless parched days my mouth and throat experienced in Virginia. My voice was almost depleted. I was accustomed to it. After dusk was when my family was able to rest for the night. Dinner was what our owners no longer wanted, the leftover after theyd picked through and gluttonously eaten. Sometimes my brother would get so hungry during the day he would sneak a bite of tomato or a berry while we worked. He got caught once and Master Johnson whipped him until his skin tore open like a paged snatched out of a book. Tears swelled in my mothers eyes as she bandaged my brother; she could see the blood-soaked cloth sticking to his skin. My life in Virginia wasnt as bad as some of the other slaves. I endured and I lived. All of a sudden one day while picking cotton, Mas...

Approaches And Methods Of Training Management Essay

Approaches And Methods Of Training Management Essay Training is a systematic process to develop knowledge, skill and attitude from learning experience to achieve maximum performance in an activity (Buckley and Caple 2007). Learning and education both are different but important for organisations. Learning is the process of acquiring knowledge, skills and attitudes by experience, reflection, study and instruction. While education is a series of activities which enables to develop knowledge, skills, values and understanding that allow a broad range of problem solving and analysis (Buckley and Caple, 2007). Training plays an effective role in different kinds of learning and development. The rapid change in global environment pressurized all organisations to enhance their focus on customers. That time of producing, conceiving and marketing products dropped as organisations adopted new ways to compete in the market (Capelli et al, 1997 cited in Rod and Collin, 2000). The successful organisations should have highly skilled and committed em ployees who can survive in this era of competition. Workers learn to enhance their performance and want to be more competent in their roles. Work place learning is very important after education to develop a long career (Legge, 2005). Organisations can get competitive advantage upon rivals through hiring skilled staff and through better training programs. According to Brookes (1995) organisations have to support training department and the least step is to appoint a dedicated staff in personnel for this task. It is important to make a training policy for the company and allocate specific budget for training. This all points to the fact that training and development is a prime business activity which has serious objectives and requires serious management (Nilson, 2003). There are a number of benefits for individuals as a consequence of training procedures; relative to the present positions, individuals may see job satisfaction increase as a result of undergoing training (Clements and Jones, 2002). Intrinsic satisfaction may result from being able to perform a task to a higher standard, where as extrinsic satisfaction may come as a result of increased job skills, which may lead to greater earnings, career prospects and promotion possibilities (Buckley and Caple, 2007). An obvious benefit to individuals is the change from their regular work pattern, which can have recreational benefits as well, for example, less boredom and greater variety during work (Buckley and Caple, 2007). Some of the benefits of training, from an organisation’s perspective included higher employee performance, productivity and possibly acting as a source of competitive advantage. There a number of other potential benefits to organisations of successful training procedures; decrease in wastage and increased productivity; lower labour turnover, saving costs (Rae, 2000); higher customer satisfaction, possibly leading to greater sales; shorter learning cycles for employees, reducing expe nditure (Washington, 1995); lower absenteeism and fewer accidents (Buckley and Caple, 2007). The innovations in technology brought speedy change in business environment. Training plays a critical role for individuals at work to manage careers development and organisational change. Training and learning is a pivotal business function that maximise profit and the company’s long term health (Nilson, 2003, P.2). The implementation of training plan depends on a lot of factors including the proper identification of training need and individual’s recognition for training need (Reid et al, 2004). Proper learning and best utilization of resources equally effect on effective outcomes (Bramley, 1986).

Aids and hiv Essay Example | Topics and Well Written Essays - 1750 words

Aids and hiv - Essay Example HIV infection occurs by the person to person transfer of semen, blood vaginal discharge, pre-semen or breast milk. Major sources of disease transmission are unsafe sex, used needles, breast milk and transmission from mother to baby at birth (Weiss, 1993) (Douek et. al., 2009). Governments and pharmaceutical companies around the world are taking measures to fight against HIV infection. We will specifically emphasize on the role of government & pharmaceutical companies in African countries towards prevention and eradication of HIV/AIDS from masses. Heavy health budgets, quality of life and growth of economy are few of many factors that push governments around the world to invest and legislate to fight against spread of HIV infection. Corporate responsibility, social welfare and philanthropic programs are some of the incentives that drive pharmaceutical companies to push for comprehensive AIDS prevention agenda. Government & pharmaceutical companies use legislation, research grants, dru g control, awareness campaigns and enforcement strategies as tools to counter the spread of AIDS. Pharmaceutical companies and government agencies in developed world are very efficient at promoting the understanding of drug use that leads to HIV infection. Research is being done into how social behaviors promote drug-use that eventually helps in spreading AIDS due to bodily fluid transfer (Williams et. al., 2000). African countries on the other hand generally lack pro-active approach in terms of educating masses regarding the spread of HIV infection. While there are success stories in Africa that include â€Å"The Global Fund to Fight AIDS, TB and Malaria†, â€Å"The United States President’s Emergency Plan for AIDS Relief† (PEPFAR), Senegal and Uganda governmental initiatives to fight AIDS, there are also problems faced in countering the spread of AIDS. These problems include Prevalent corruption in governmental regulatory bodies Lack of political will in most of African leadership Social taboos and norms Lack of institutions and infrastructure Pharmaceutical companies trying to gain profits rather than penetration in African market With lesser amount of money and resources put into fight against AIDS due to factors stated above, a general lack of awareness prevails in most Africa nations. South African health minister, an ardent proponent of alternative medicine therapy for AIDS has been able to convince his followers into avoiding anti-retroviral drugs (an accepted primary source of AIDS treatment). Instead people lacking awareness regarding the treatment of the disease were lured to the false claims of using improved diet, or cheap generic vitamin pills as a simple and relatively inexpensive way to marginally delay the need to start HIV medication. A detailed study by Ben Goldacre, published in his book in 2009, reads out the following lines â€Å"†¦ Alternative therapists like to suggest that their treatments and ideas have not been sufficiently researched. †¦ research had indeed been done, with results that were far from promising.† (Goldacre, 2009, pp.187 – 188) Among the success stories, driven by governmental steps to eradicate the causes of HIV infection, the most noteworthy are the steps taken by Senegal and Uganda governments (UNAIDS, 1999). These include Problems regarding AIDS infection were recognized at promptly. Adequate funding was provided to fight HIV/AIDS. Difficult political decisions were taken to cater for

Approaches to Spanish Culture and Society Essay

Approaches to Spanish Culture and Society - Essay Example According to the study finding memory is usually associated with narratives while sites of the same harbor the locations for second-order remembrance where individuals remember their colleagues at specific locations besides how they victimized people. Many academic experts concur that past memories determine the future while at the same time enabling adaptation to the new order in the modern society. Dominant political authorities play a crucial role in shaping history, which is not a linear process. The political power continues to shift from the ideology through to images embedded in museums, memorials, and monuments. The following features remain part of the memory within the realm of social construction in the modern society. They include among others conflicted and shred persons, public, and official memories, collective recordings, factors that challenge the truth, modernism, and authenticity. As the report declares world hegemonic power and countries practicing the culture of capitalism continue to influence and spread new pieces of information that also erodes the original information involving many ethnic communities and states. Most of the eroded history entails a lot of information throughout their history guiding enlightenment, freedom of the market also referred to by other scholars as market liberalization, and rationalization among many more. The existing literature especially on Spain helps in discovering and digging into the past worth remembering in unprecedented volume and speed.

Narrative Comment Essay Example for Free

Narrative Comment Essay Analyzing the thesis statement of the narrative, it can be seen that it focuses on the importance of decision-making. At the same time, it also allows readers to examine how effective choices can help provide the satisfaction necessary in order to address the individual’s needs in a deeper level. In terms of the narrative’s point of view, it sought to provide readers with a more personal view towards the application of the thesis statement. It can be seen that the actions were made throughout the paper. On the other hand, the selection of an event best suits the thesis statement as there is a clash between the perspective of the author and her father. This experience highlighted how important of sticking up to decisions is vital to achieve acceptance and success. In chronology, the document provides specific attention to details and organization. It provides specific words that portray appropriate use of time. See more: how to start a personal narrative essay examples Though it may lack originality and detail, it is relevant in providing clarity on how detail is given. Similarly, transitions between scenes were also given accordingly. The use of transition words are present in the narrative and helps readers understand the changes happening in each scene. The use of dialogue was also introduced into the document. Here, it allows readers to understand its value and portrays important points in the argument. The writer made considerable attention into citing quotations coming from actors to highlight significant aspects such as the decision to study abroad and the father’s choice to say yes. Lastly, it can be seen that the verb tenses are consistent with what the narrative portrays. At the same time, it also provides strong action verbs especially during the scenes that depict emotions and feelings of the author.

My Philosophy of Teaching Essays -- Educating Educational Teaching Ess

Philosophy of Education Teachers, unlike any other professionals have the chance to shape and change young lives. For this reason, I believe that teaching is one of the noblest professions that one could choose. From the time I was a young boy and watching my father in his classroom I knew always wanted to be a teacher. It always seemed like the perfect career. A career in which I felt was best suited for me. One in which I would want to wake up earlier and earlier every morning because I would be excited at the fact that I knew that I was on my way to help develop the future minds of our world. I believe the intrinsic rewards for this profession are far greater than the extrinsic ones and not too many other professionals can say the same. The way a child can make you feel after accomplishing a goal that they thought was not possible without your help is unimaginable. Teaching is the most important job in the world and it comes with a large amount of responsibility. Teaching is a job that I feel I am suited for. I want to touch the minds of the future; I want to teach. I think that all children have the ability to learn, especially at a young age. I agree with Rousseau and his belief that you can not teach a child until he is ready to learn. I think that if a child does not want learn or is not ready to and learning is forced upon them, it could be detrimental to their educational process. It could put them in a hole to deep to get out of. I believe all children are born innocent, it is their environment and society that shapes them. Most children are curious about the world around them and are always pushing their limits to see how much they can get away with. I know students I will be teac... ...aching them to stay away from drugs, alcohol, and tobacco. I will teach them to use their time wisely to do something productive that will help assist in their success in life. In PE it is about having fun, but at the same time it is about teaching children lifelong skills and having a sense of pride about themselves. Educators are such an important resource in a person’s life. I hope that someday I will be able to touch the heart of a child the way so many of my teachers have touched mine. I wish that I could repay the debt I feel that I owe to so many of my teachers past and present. Learning does not stop in the classroom; it is a continuous process that is life long. I want to be apart of that process. I want to be able to help jump start the minds of our future, and be apart of the all-important association of learning. I want to be a teacher.

Conflict Can Have Tragic Consequences for Ordinary People Essay

As humans, conflict pervades every aspect of our lives; it is inevitable. However, conflict varies on a scale. With a minor conflict being an argument between two friends, which therefore has a minor outcome that soon becomes forgotten, or it can be a severe conflict, such as war, which results in a large life-changing result. The most tragic consequence of war is the impact on innocent parties. The brutalities in history, which ordinary people have faced as a result of conflict resulting into war, are repulsive. People caught in such conflicts face death, mutilation, rape, starvation, homelessness, poverty, disease and the breakdown of families. Even more of an act of violence is that these people who are affected are not even involved in the politics of why the war is occurring. They are simply innocent victims of war who must face the consequences of their countries actions, not their own. Because of Japans attack on Pearl Harbor in 1941 which killed 2,403 people (68 of which were civilians) America retaliated and decided to put an end to the war by forcing Japan to surrender. To do so, American forces, dropped two nuclear bombs on the Japanese cities of Hiroshima and Nagasaki. This attack eventuated to the death of an estimated 200,000 Japanese civilians. Racial, ideological, political and religious conflicts that arise in countries often result in war, with many innocent people being killed in the process of fighting over who is ‘right’. The Holocaust, which was a result of many societies who envied or distrusted Jewish people, and Hitler, who exploited this hatred, secretly attempting genocide in the disguise of subjugating the race which resulted in the death of just under six million Jews. Although the Holocaust is not regarded as a conflict of war because there was no fighting apart from in a few cases, it is considered a racial conflict because of the mass murdering of innocent people who didn’t do anything. Everyone around the world is affected by wars and conflicts because it destroys homes and also drives up the cost of living. The cost of certain items has gone up because the cost of producing them has increased but the labour has decreased due to many being killed or sent into the army. In addition, citizens are affected by having their family members sent off to fight in the war. The change in income can be positive or negative, depending on what job you left behind. For some, being called back into active duty means leaving a 6 figure salary behind. For others, it’s a chance to save up and/or pay off some debts. Another detail often forgotten is that some young families have babies on the way when the father is sent off to war, or very young children. They change so quickly! The fathers are deprived of the joy of watching them grow up, and the children don’t have the advantage of having both parents around to raise them. Conflict created by wars have tragic consequences for ordinary civilians, it could be a positive or negative consequence.

How does Shakespeare present the conflict of good and evil in his play, Macbeth? Essay

How do these extremes reflect the time in which the play was written? (20 marks) The play Macbeth presents the antithesis of good and evil as a concept that is absolute. The play follows the common religious beliefs of the time in presenting three main causes of evil: the total depravity of man, temptation from others and satanic influence. Good is also presented but is not the focus of the play. This is a play about evil, treason and uncertainty – a reflection of the turbulent times of Jacobean England under James I where the conflict between good and evil actions was very real. In examining the three ways in which Shakespeare presents the conflict, a good place to start would be total depravity. Primarily we see this battle of conscience versus will of the flesh personified in the character of Macbeth. In Act 1 Scene 4, after Duncan names Malcom as his successor, Macbeth laments that Malcom is an obstacle: â€Å"On which I must fall down, or else o’erleap, / For in my way it lies.† We can see at this stage Macbeth is still undecided at what his course of action will be. His conscience tells him to give up, to â€Å"fall down†, but if he is to fulfil his desire of becoming king he must â€Å"o’erleap† such hindrances. He goes on to say, â€Å"Stars hide your fires, / Let not light see my black and deep desires.† Evil committed in darkness is a recurring theme across the play. Macbeth wishes to hide his evil deeds in the night, out of the sight of men and arguably out of the sight of God, as light typifies all that is good and at the time God was considered to be the ultimate good. This meaning would not have been lost on a Jacobean audience. The next couplet further emphasises the discord man can experience within himself: â€Å"The eye wink at the hand; yet let that be, / Which the eye fears when it is done to see.† This conveys that man can be blind to his own actions, and not even be aware he is committing evil until his eye fearfully surveys the damage caused. The dual use of rhyming couplets at the end of the speech emphasises how twisted and evil Macbeth is becoming. This idea of man choosing darkness was a common idea of the times. The Puritans believed strongly in the doctrine of Total Depravity, the idea that when given the choice between good and evil man will eventually chose sin by default and is not capable of doing good without divine intervention. In John Calvin’s ‘Institutes of the Christian Religion’ he explains evil as â€Å"a hereditary, depravity and corruption of our nature†. However, Banquo is an example of how the Jacobeans believed a religious man can overcome temptation. He is subjected to the same temptation as Macbeth but in Act 2 Scene 1 he is seen praying, â€Å"Merciful powers / Restrain me in the cursed thoughts that nature / Gives way to repose.† He asks for his depraved nature to be restrained so he will be able to choose to do good. It is possible that he himself is considering killing the king. The â€Å"cursed thoughts† that he speaks of have begun to transpose as nightmares, which represent how darkness is seeping into even the Scottish people’s repose. Sleep would normally be associated with peace and rest, but slowly it becomes a metaphor for death and decay. Following on from that the second way Shakespeare presents good and evil is temptation from others. We see this presented clearly with the scenario in Act 1 Scene 5 between Macbeth and Lady Macbeth. When Lady Macbeth finishes reading Macbeth’s letter she states that she fears, â€Å"thy nature, / It is too full of the milk of human kindness / To catch the nearest way.† She fears that Macbeth’s nature is too kind to take the most direct method to kingship: murdering Duncan. Here we can see how well she knows Macbeth and what drives him. She describes human kindness as â€Å"milk†. We know Lady Macbeth is currently nursing children, and milk in that sense represents all that is good, natural and necessary for survival. She implies that kindness flows as easily from Macbeth as milk from a nursing mother. She continues by saying, â€Å"Thou wouldst be great, / Art not without ambition, but without / The illness should attend it†, implying that Macbeth is an ambitious man who desires to be great, but he refuses to let evil influence his aspirations. He â€Å"wouldst not play false.† She recognises that without any external influence he will never commit the evil deeds that he is tempted towards. This is conveyed to us when she promises to, â€Å"chastise with the valour of my tongue.† The use of â€Å"chastise† creates a violent image, as if she intends to give him the verbal equivalent to a beating. She wishes to pass her boldness on to Macbeth, in variance to the typical submissive attitude that was expected of wives in that era. She further emphasises her dark and rebellious nature when the messenger informs her that Duncan is to stay in her castle that night. With an element of twisted glee she interprets the hoarse cry of the raven to foreshadow, â€Å"the fatal entrance of Duncan / Under my battlements.† She refers to the castle as if it belonged solely to her, and as if the murder of Duncan will be of her doing with minimal help from Macbeth. She is presented to the audience as just as ambitious as Macbeth, if not more. The raven itself is a bird typically associated with darkness, death and evil. It is even more ominous that it has croaked itself hoarse, conveying that evil is already corrupting Scotland before that cataclysmic deed is even committed. Lady Macbeth is adamant that she wants any form of femininity, no matter how mild, to be removed from her so that she can carry out her task efficiently. She expresses a desire to be â€Å"unsexed†. The milk analogy is continued when she asks evil spirits to, â€Å"Take my milk for gall.† She wishes that what she referred to in her previous speech as â€Å"the milk of human kindness† to be removed entirely from her and replaced with malice and evil. When she begins to tempt Macbeth she tells him that, â€Å"Your hand, your tongue; look like th’ innocent flower, / But be the serpent under’t.† She encourages Macbeth to shed his innocent, good exterior and unleash the serpent that lies below. Through the direct contrast between a flower and serpent Shakespeare conveys how incompatible good and evil are – Macbeth must choose one, for he cannot balance both. Shakespeare, through Lady Macbeth, presents good as something fickle and easily corruptible, the weaker side in the conflict between good and evil. Furthermore, referencing to a serpent is a Biblical metaphor of when Eve tempted Adam into sin. That’s not the only time in the Bible that evil women help men fall into sin: other cases include Samson and Delilah and Herod and Herodias. The Bible was taken extremely seriously in Jacobean times, and due to these beliefs that women are easier to tempt than men, Jacobean wives were expected to be submissive and obedient to their husbands, who would keep them on the right track. In his controversial book ‘The Monstrous Regiment of Women’ John Knox stated that â€Å"To promote a woman to bear rule, superiority, dominion, or empire above any realm, nation, or city, is repugnant to nature.† A woman with influence over her husband would have been taboo, but a Queen like Lady Macbeth with power over the country she ruled would have been even more unacceptable in the social hierarchy of society (Knox wrote his book in response to the reign of Elizabeth I, who died three years before Macbeth was produced). King James, who the play was written for, would have been a staunch complementarian. Ultimately Lady Macbeth’s actions lead to her demise, leaving the audience to wonder how differently her life would have been if she had not tempted Macbeth. It could be argued that the tragedy in Macbeth hinged on Lady Macbeth usurping her prescribed role. Many scholars would claim that Shakespeare was a feminist, but even if that was true he would not have been able to express such views under James’s reign. Finally, the most effective way Shakespeare presents the conflict of good and evil in Macbeth is through the involvement of the supernatural and divine. In Macbeth good and evil is not confined to an internal conflict within man but is also represented through a spiritual war with frequent references to God and Satan, the ultimate adversaries. This is best conveyed when Duncan is killed, and then at the climax of the play when good ultimately prevails. In Act 2 Scene 3, when Macduff brings the news of Duncan’s murder, he cries, â€Å"O horror, horror, horror!† The tone of this line is pure shock, and the repetition of â€Å"horror† conveys that the deed is so horrible and inconceivable that Macduff is lost for words. He continues to deplore, â€Å"Confusion now hath made his masterpiece†. In the Bible it reads that, â€Å"God is not the author of confusion†, so that means Duncan’s death could only be a masterpiece of demonic proportions. The audience is given a sense of how heinous a deed this is when he continues; â€Å"Most sacrilegious murder hath broken ope / The Lord’s anointed temple.† In the conflict between good and evil in Macbeth Macduff is presented as being a religious man, like Banquo. He uses another direct Biblical reference, this time citing verses about kingship. Old Testament kings were directly anointed by God, and it is said the body of a holy man is the temple of God’s spirit. Violent imagery is used when he talks about the temple being, â€Å"broken ope†, implying that the spirit was forcibly and criminally removed from its righteous place. Following on from this, the Divine Right of Kings was a major factor in James I’s court. This was a Puritan doctrine that said each king was predestined to take the throne by God and treason against the king was also a blasphemous crime against God. In the epistle dedicatory of the King James/Authorised Bible it reads, â€Å"Great and manifold were the blessings, most dread Sovereign, which Almighty God, the Father of all mercies, bestowed upon us the people of England, when first he sent Your Majesty’s Royal Person to rule and reign over us.† The doctrine’s purpose was routed in kings like James wishing to reinforce their position rather than Biblical fidelity. James was short and did not have the physical appearance of a typical king, and he had recently survived an assassination attempt at the hands of a Catholic group. He had many reason to fear for his right to the throne. The many demonic references were also deep routed in Jacobean culture, where fears of demons, witches and witches were very real. Hundreds of women were burnt as witches and James himself penned an essay named ‘Daemonologie’ after he believed demonic forces tried to kill his wife. To conclude, in Macbeth good ultimately wins the conflict: Macbeth is killed and the throne of Scotland is joined with England. God’s hand is placed back on Scotland in a slightly deus ex machina fashion. Shakespeare presents the audience with many different interpretations of the conflict between good and evil in keeping with the Jacobean culture, the most effective of which I believe is his use of the supernatural.

Elizabeth Arden essays

Elizabeth Arden essays Elizabeth Arden, formally known as Florence Nightingale, changed her name in 1909 with the introduction of her first shop selling facial creams. She began as a normal working girl, taking different odd jobs here and there. Then she was introduced into the cosmetic world by Eleanor Adair, who hired Arden on as a clerical consultant at her London firm in Saks Fifth Ave. There, Arden learned to give facial treatments and studied the basic formulas of make-up, which allowed her the basic knowledge to open her own cosmetics shop. With partner Elizabeth Hubbard the shop flourished, they had a winning product with their own Elizabeth Arden's youthful complexion to advertise it. Later when Hubbard died Arden took over the company to own and manage with only a group of advisees, which she seldom listened to. Elizabeth Arden was an astute businesswoman who not only focused on what the company already had but what it could have. Therefore, she spent much of her time perfecting current products and creating new and innovative products. Her downfalls though were her violent temper, she was a very demanding and difficult employer who easily blew up at hr employees and was often too proud and arrogant to apologize. In 1904, Arden began her career in cosmetics working at the Eleanor Adair shop. Later in 1909, she opened her own shop and facial cream line. In 1914, at a time when women scorned make-up and women who did wear it were gossiped about terribly, Arden opened a new cosmetic line. Where many others had failed in the past, her products and advertising changed the way women viewed makeup forever. In 1940, she began designing and selling clothing. In addition, by 1957 she owned over 150 Elizabeth Arden Salon branches that sold anything from make-up to face cream to clothing. I became interested in writing a report on Elizabeth Arden because I really love make-up, especially Elizabeth Arden and ...

Cultural Analysis Assignment Example | Topics and Well Written Essays - 2000 words

Cultural Analysis - Assignment Example The first part shall give a theoretical background on the importance of culture in the formation of social identity, as well as the proper ways through which cultural analysis must be done. Through this part, the need for an objective assessment of culture will be reinforced through the help of Geert Hofstede’s Five Cultural Dimensions and the GLOBE Cultural Analysis Model. The second part, on the other hand, will zero in on the results of the three interviews conducted as regards the specific culture and traditions of Spain, Canada, and the Philippines. By using first-hand or primary information as obtained from the one-on-one interviews, credibility of data will be strengthened. The last part will be dedicated to an enriching and highly insightful conclusion that will put an end to this study. Importance of Culture: A Brief Overview By definition, culture refers to the set of beliefs, habits, and art forms that crucially characterize a specific group of people in a specific area. Because of this seemingly vast description, cultural representations may include art, literature, religion, lifestyles, and many more. With this, it can be said that the significance of culture is hinged on its capacity to give a unique identity to people. It gives a community certain character and personality that is original and unique. Thus, it is through the learning and passing of these traditions that cultural values are fostered, which in effect, form the founding principles that help govern people’s way of life. Since cultures have their own share of characteristics, objective measures must be used in order to properly understand and appreciate their natures. Two of the most commonly used analytical frameworks are Hofstede’s Cultural Dimensions and the GLOBE cultural analysis model. 1. Geert Hoftstede’s Cultural Dimensions Hoftstede’s model examines cultural differences by highlighting five key dimensions: Power Distance, Uncertainty Avoidan ce, Masculinity vs Femininity, Individualism vs Collectivism, and Long vs Short Term Orientation. 1 Power distance refers to the degree of inequality that exists in a society and how such is accepted by the less powerful groups. Uncertainty avoidance involves a society’s level of tolerance for ambiguity, unstructured situations, and unplanned events. Masculinity vs femininity pertains to the expected gender roles in a society. Individualism vs collectivism refers to the extent of ties that people have with each other. Long vs short term orientation talks about the degree to which a society upholds traditional values. 2. GLOBE Cultural Analysis Model From a functional perspective, the GLOBE model is used as a long-term research effort to explore the effects of culture on leadership, organizational effectiveness, economic competitiveness of societies, and the human condition of the people being examined. Through the GLOBE model, researchers were able to clearly grasp the releva nce of cross-cultural interactions by studying different industries, organizations, and social groups. 2 Analyzing Three Cultures: Spain, Canada, and the Philippines After assimilating the vitality of culture in relation to social identity construction, as well as the various lenses that could be utilized when studying cultures individually, it is now time to focus on the results of the three interviews and expose the characteristics of each country. In order to put more conciseness in the laying

Financial Statement analysis of Dell, Inc, in 2005 Essay

Financial Statement analysis of Dell, Inc, in 2005 - Essay Example Looking further, the strategy of Dell is multi-faceted which does not only include the internal company's internal operations but its external stakeholders as well. It should be noted that Dell's strategy can be summed up as follows: This strategy of Dell is perfect for the hypercompetitive industry it is currently operating in. A hypercompetitive industry, according to Kotler, is one where there is an intense rivalry among the competitors coupled with high buyer leverage, forcing the firms to commit to an efficient value chain which eliminates incompetence in the system which will bring eventually bring down the cost of operation and enhance customer value. In the face of this high competition and buyer power, Dell was able to come up with a strategy featuring a value chain which eliminates wastage and adds customer value. In the IT market, it is important that a player establishes an efficient manufacturing system which reduces or even eliminates wastage in its value chain. Dell has become a pivotal driver of the supply chain revolution in the IT industry because of its adoption of the Toyota Manufacturing System also known as Just-in Time (JIT) inventory system. This, together with its commitment in solely marketing its product directly to customers and the utilization of relationship marketing is very much appropriate for the industry Dell is operating in. As a market leader in its field, Dell is regarded in having the leanest and most efficient manufacturing system, excellent customer service, intensive research, lowest prices, and quality products. It should also be noted that Dell was able to develop its competitive advantage due to its unique strategy. Even though Dell's competitors like Hewlett-Packard, IBM, and Gateway continue to push aggressive strategies to eat up into Dell's market share or at least, capture a more patronage, the firm was already able to create a competitive image, insulating it from attacks. It can be noted that as the sales revenue of other competitors decline or remain flat, Dell manages to record increments. In fact the current strategy utilized by the firm manufacturer has become a sustainable competitive advantage. In contrast to competitive advantage, the business model of Dell is hard and is even impossible to be replicated by its various competitors. It should be noted that some organizations planned to emulate the business model of Dell but failed. Michael Dell, the firm's CEO expressed that competitors will be bound with their present strategies because adopting the business model of Dell wi ll be detrimental especially in their distribution channels. Currently, Dell enjoys its strategic position as a market leader in the IT industry. Due to this, the company is quiet insulated with current strategic issues. The only thing that Dell must address nowadays is the significant decision whether it directly employs its core strategies in its geographic expansion. As the company opted to conquer more lucrative markets outside its home country, Dell is faced with the

To what extent has North Korean foreign policy became less Essay

To what extent has North Korean foreign policy became less isolationist since the Cold War - Essay Example The tension between these two states has led to the loss of million lives in each side of the parallel from 1948 until 2002 (Foreign and Commonwealth Office 2008, cited in Turku, 2009). North Korea claimed that South Korea is a puppet of the United States. In addition, the North Korea accused South Korea of being anti-national and as an aid to foreign aggressors. Kim II Sung, throughout his reign, asked South Koreans to initiate a revolution that would abolish the US fascist military dictatorship. He further reiterated that armed struggle serves as the only means in order for the South Korea to be liberated from colonizers and oppressors. Kim II-Sung asserted that South Koreans, inspired by the construction of the Northern half and achievements in the socialist revolution, will be impelled to seek for reunification of the nation (Turku, 2009). The two nations agreed to discuss normalizing their relations starting on August 1971. The Inter-Korean summit on June 13 to 15, 2000, which is followed on October 2 to 4, 2007 in Pyongyang, marked the greatest progress that these two nations took towards peaceful coexistence. The two nations agreed to produce a joint declaration for national unification in the Korean peninsula and peaceful co-existence in the first summit (Moon 2002, cited in Turku, 2009). These historical summits were facilitated by the â€Å"sunshine policy† of South Korea. This policy has three principles namely, engage in economic terms with North Korea, respect the sovereignty of the North, and lastly zero tolerance for aggression manifested by North Korea (Turku, 2009). The present administration in South Korea abandoned the â€Å"sunshine policy† term; however, its policy still continues to concentrate on cooperation, principles of engagement, and dialogue with the North Korea. A summit that occurred on June 15, 2000 serves as historical milestones for the two nations. What was deemed as impossible in the past finally

Value chain analysis for Starbucks in Australia Essay

Value chain analysis for Starbucks in Australia - Essay Example The practice had helped the Starbucks to maintain quality over the years. However, it increased the dependency on the farmers and the variations in the productions affected the company. This made the price of the coffee in the Starbucks higher and the business was rendered unprofitable. In the case of Australia this was one of the factors for the closure of various shops. (Starbucks Coffee Company, n.d.) Operations: In the case of the Starbucks in Australia, the company operated as in the case of the other countries. There were no modifications of the products and no efforts were made to make the products suit the needs of the people in Australia. The ambience of the stores were similar to that of the other parts of the world which did not provide additional value to the customers in Australia. The main factor for the success of Starbucks in the other parts was the essence on â€Å"coffee culture†. However, in Australia, the â€Å"coffee culture† was already in place and the company could not provide extra facilities to the people. (Why Starbucks failed in Australia, 13th August, 2008) Outbound logistics: The Starbucks operates through the chain of stores in the other parts of the world. In the case of Australia, the company opened over 80 stores that were placed in the urbanized areas. The expansion never took of in a big country like that of Australia and the company had presence only in some of the pockets. (Starbucks goes cold in Australia, 29th July, 2008). Marketing and Sales: Starbucks is a well known brand all over the globe. However, surprisingly, the company has never resorted to the aggressive marketing policies. In the case of Australia, the company never marketed the brand aggressively and there were campaigns like the â€Å"red cups on cars† where starbucks cups were placed on top of cars and taxis. The company depended on the â€Å"word of mouth†

Mercury Problems In Oil And Gas Industries Environmental Sciences Essay

Mercury Problems In Oil And Gas Industries Environmental Sciences Essay Mercury is a natural occurring element and could be present in various stages of oil and natural gas exploration, production and processing. Mercury is not only hazardous to human health and the environment but could also attack process equipment components that have mercury reactive materials, leading to potential catastrophic failure to the plant. The mercury associated with petroleum and natural gas production and processing enters the environment primarily via wastewater, solid waste streams, and air emissions. Wastewater originates in production and oil refining operations in the form of produced water and wastewater respectively. The solid wastes are also generated in production (e.g. drilling muds), transportation (e.g. sludge), and refining operations (e.g. spent mercury adsorbent. The primary opportunities for mercury emission to atmosphere include fuel combustion for process utilities and fugitive emissions from process equipment. Several approaches have been used to reduce mercury emissions from oil and gas production and processing which include mercury waste treatment, recycling and disposal. Mercury is considered as a serious toxic heavy metal to both humans and the ecosystem because of its high toxicity to the central nervous system and the tendency to bio-accumulate in a human body [1]. Mercury is a natural occurring element and could be presenting varying concentrations and of various species in oil and gas fields [2]. It is freely distributed throughout production, processing, transportation and consumption systems. Table 1 shows the range of variations of the mercury content in oil and gas [3]. Wilhelm and Bloom [4] reported that the concentration of mercury in crude oil and natural gas varies between 0.01 ppb and 10 ppm depending on the geologic location, which may exist in three different forms, namely elemental (Hgo), inorganic (HgCl2), organic ((CH3)2Hg), and organo-ionic (ClHgCH3) mercury compounds. Several mercury species shown in Table 2 were detected in natural gas, gas condensate and crude oil. The properties of mercury species are difference in terms of mobility, reactivity, toxicity and bioavaibility [5]. Table 1 Range of Mercury Content in Oil and Gas Fields in the World [3]. Component Mercury Concentration Oil 0.003 21 mg/kg Condensate Gas 0.01 . 10-6 14 000 . 10-6 g/m3 The existing mercury in oil and gas can cause problems during oil and gas exploration, processing and transportation. This mercury needs to be removed from oil and gas streams especially from natural gas, in order to get pure product as well as to protect the process equipment and catalyst used in the downstream processes. For instance, it may cause mechanical failure and gas leakage of cryogenic aluminium heat exchangers. The mercury in the natural gas can degrade the aluminium coldbox materials by three basic mechanisms [Wilhelm, 1994]: amalgamation with various metals (primarily Al, Au, Ag and Zn), amalgam corrosion, and also liquid metal embrittlement (LME) [Coade and Coldham, 2006; Wilhem, 1994]. Besides, reported by Phannenstiel [7], mercury is pointed as a caused of corrosion in gas-gathering system at Groningen field in Holland [8]. Table 2. Approximate Natural Abundance Mercury Compound in Natural Gas and Gas Condensate [2]. Mercury Element Natural Gas Gas Condensate Crude Oil Hg0 >50 of total mercury >50 of total mercury >50 of total mercury (CH3)2Hg HgCl2 Rarely detected (10-50) % (10-50) % HgS Rarely detected suspended suspended HgO Rarely detected Rarely detected Rarely detected CH3HgCl Rarely detected Mining activities such as exploration and processing could also generate mercury waste generate mercury waste in the form of produced water, refinery wastewater, drilling waste, and associated wastes. The mercury wastes need to be treated and disposed due to the environmental and safety considerations. The failure to monitor and control the existing mercury in oil and gas can caused contamination on process facilities and mercury emission to water, soil and atmosphere [U.S. EPA, 2001] Mercury Removal Process From Natural Gas Mercury removal systems are most often located at gas processing facilities that produce the feedstock materials for downstream chemical manufacturing plants. It is properly designed and operated, to make sure the removal systems can scavenge mercury from the feed gas and reduce the impact of mercury on downstream processes [2]. Table 3 summarizes several methods used for mercury removal in natural gas processing. All these methods have limitations that detract from their applicability to natural gas processing [El Ela et al., 2006; El Ela et al., 2008]. Table 3 Mercury Removal Systems for Natural Gas [Bingham, 1990; El Ela et al., 2008 ]. Method Comments Chemisorption on sulfur impregnated activated carbon Most used, cheap; disposal problems Adsorption on activated carbon Low saturation loading Chemisorption on iodine impregnated activated carbon Good for high mercury concentrations Adsorption by amalgamation with a metal: Silver impregnated alumina, silver zeolites, metal sulfides and metal oxides High investment costs, high removal capacity Acid absorption of mercury chromic acid and acidic permanganate Increased corrosivity, through system contamination, low saturations Oxidizing solutions permanganate, sodium hypochlorite, and sodium vanadates Regeneration problems, system contamination Chemical reaction with H2S Increased corrosivity, limited H2S access Condensation and separation Poor removal efficiency, liquid contamination Stripping through liquid hydrocarbons Poor removal efficiency, liquid contamination The basic requirements for successful mercury removal are economics of the process and the removal medium needs to be capable to reducing mercury concentrations to extremely low and acceptable levels. The medium must have a high capacity for an active bonding to mercury so that they can retain the mercury in a form that can be disposed. The examples of commercial mercury removal systems are shown in Figure 1 (c,d), where the Salam mercury removal system is the most efficient removal method ever reported [9]. It is loaded with 19 tons of catalysts PURASPEC Absorbent 1156 (pre-activated sulfide) [El Ela et al., 2008]. Figure 1 (a,b) shows the mercury removal unit located in Malaysia which is the successful systems used to remove mercury from raw condensate [Sainal et al., 2007]. Figure 1. Joint Delivery System (JDS) mercury removal system situated in Kerteh, Terengganu, Malaysia (a), Resak Delivery System (RDS) mercury removal system situated in Kerteh, Terengganu, Malaysia (b), Mercury removal unit at Salam gas processing plant (c), Vessel loading diagram of Salam mercury removal unit (d) [El Ela et al., 2008; Sainal et al., 2007 ] Mercury Waste Generation A wide variety of waste streams contains of mercury generates from oil and gas processing. The mercury in produced hydrocarbons may escape to the environment by several avenues which are generally categorized as wastewater, solid waste streams and air emissions. During exploration and processing, wastewater originates from the produced water, refinery wastewater, drilling waste, and associated wastes (Ahmadun et al., 2009; Frankiewicz et al., 2000; U.S. EPA 2001). Solid wastes are also generated in production (e.g. drilling muds), transportation, refining operations (Juvkam-Wold, 1976; U.S. EPA 2001). Air emissions originate from fuel combustion for process utilities and fugitive emissions in the process equipment (Wilhelm, 1999; U.S. EPA 2001. These are the possible avenues of mercury to be transferred from produced hydrocarbons to the environment (Mussig and Rothmann, 1997; US EPA, 2001). Table 4 shows a wide variety of waste streams that contain mercury generated in conjunction wi th petroleum production and processing (Wilhelm, 1999). Table 4 Petroleum Processing Mercury Waste Streams [Wilhelm, 1999]. Type Matrix Mercury Sludge Hg++ Hydrocarbon Hgo, XHgX, HgS Sludge Water HgS, Hg++ Cleaning Solutions Water Hg++ inorganic compounds Cleaning Solvents Hydrocarbon Solvent Hgo, XHgX Hg Sorbent Carbon, Sulfur HgS, S, Organic compounds. Hg Sorbent Metal Sulfide, Alumina Hgo, XHgX, HgS, Cu, Al2O3 Hg Sorbent Zeolite, Ag AgHg Hg Sorbent Carbon, KI HgI2 Dehydration Fluid Triethylene glycol Hgo, XHgX, Hg++ CO2 Removal Water Hgo, XHgX, Hg++ KCO3 Sour Gas Treatment DEA, TEA Hgo, XHgX, Hg++ amines Catalysts Metal Hg amalgam Filtration Material Clays, Fibers Hgo, XHgX, Hg++ Debris Hgo, XHgX Produced Water Generally, in oil and gas production operation one of the upstream activities involves a primary separation of water, gas and oil followed by treatment of the produced water for discharge or re-use. Produced water is the largest waste stream generated in association with oil and gas production operations which contains various organic and inorganic components. It originates from water that is trapped in permeable sedimentary rocks within the wellbore. The separated water is either disharged (to an ocean, lake or stream) or re-injecting back into rock formations from whence it originated [Hayward Gordon Ltd.; Gallup and Strong]. However, some of the produced water is fairly fresh and is readily re-used for specific purposes such as agricultural, industrial, or treated water use [Sullivan et al., 2004]. There are some major components containing in produced water such as hydrocarbons and organic compounds (e.g. oil, grease, benzene, dissolved organic compounds such as napthalene, toluene, phenanthrene, and pentacholorophenol), salts (e.g. chlorides and sulfides of Ca, Mg, and Na), metals (e.g. lead, chromium, nickel, barium, manganese, iron, strontium, zinc, silver, cadmium, lithium, copper, mercury, arsenic, selenium, and boron), radionuclides and production chemicals [Frankiewicz and Gerlach, 2000; Sumi, 2005]. Moreover, produced waters are typically more saline and have total solid dissolved concentrations from less 100 mg/l to over 300 000 mg/l compared to sea water [Stewart, 2008; U.S. EPA, 2001]. Research by United States Geological survey reported that conventional oil and gas wells produce produced water that increases over time [Sumi, 2005]. In some states in United States, surface discharges of produced water is allowed and is used for stock and watering an agriculture. However, it can be problematic to the environment due to its highly saline nature and contaminated with mercury. Neff [18] reported that, about 8 pounds per year of total mercury are discharged with produced water. The dominant forms of mercury available in produced water are suspended mercury sulfide (HgS) and elemental mercury (Hgo) [2,13]. Similar forms of mercury are also found in produced water associated with gas production in the Gulf of Thailand [Frankiewicz and Tussaneyakul, 1997]. A treatment process to remove mercury from produced water prior to overboard discharge has been developed consisting of a three-phase separator to remove the gas and also condensate [Gallup and Strong, ; Sullivan et al., 2004]. Refinery Wastewater Refinery wastewaters streams typically contain vary widely chemical compositions having a large volume of water (per barrel of oil processed). Moreover, it also contains many regulated organic and inorganic contaminants (soluble or insoluble form) that can restrict its use and disposal thereof. In refineries, wastewater that entering the water treatment system is a composite of water discharge from processing units with different types and functions. The water streams from process units, cooling water and leakage in the system may contain some contaminated hydrocarbons [Veenstra et al., 2008]. The amount of mercury in refinery wastewater cannot be stated in certainty because of very little information is availably reported. The refinery biological water treatment generates several mercury compounds with a wide range of concentrations. The amount less than 5 percent of the total mercury concentration exists as a monomethylmercury, less than 0.01 percent as a dialkylmercury, and less than 0.1 percent as elemental mercury. Moreover, in a range of 10 to 30 percent exits as suspended particulate mercury with less than 10 percent as a labile Hg2+ and between 60 and 90 as an organochelated Hg2+. Reported by Bloom and Falke [21] that the concentration of total mercury in effluents from sewage treatment facilities is in the range of 5 to 20 ng/L. Drilling Wastes The exploration for oil and gas produces the drilling wastes which primarily consist of extracted cuttings and drilling muds. During drilling process, the drilling muds (also termed fluids) which inject into the well bore are identified as the sources of toxic materials that may discharges into aquatic environment surrounding offshore drilling operations [2,22,23]. Drilling muds is generally a viscous, heavy fluid designed to perform a variety of functions such as to transport rock chips (cuttings) from the bottom of the well up and out of the well bore, where the cuttings are screened and removed, and the separated mud is re-used. In addition, the drilling muds act to cool the drill bit, to stabilize the wells walls during drilling process and to control formation fluids that may flow into the well [23]. Besides, it also functions to minimize reservoir damage and limits corrosion. Most drilling muds are engineered slurries made up from drilling fluids, liquid-based mud (such as water-based muds, oil-based muds and synthetic-based muds), barite (optional additives), low gravity solids and treatment chemicals (bentonite clay) [23,24]. The drilled formation cuttings and barite contribute to the existing mercury as a trace mineral in drilling discharges. The concentrations of mercury in barite ores can vary widely from as little as 0.05 ppm to as much as 31 ppm. Moreover, mercury in drilling discharges is completely made of inorganic mercury which is extremely insoluble in water and not readily converted into organic methylmercury. The methylation process, which bioconverted mercury to methylmercury is dependent on several variables including an anoxic environment, low pH, presence of organic materials, low salinity, and warm temperatures. Associated Wastes The process of producing, treating, storing and transporting of oil and gas generates low volumes of a variety of wastes such as sludges, cleaning fluids, process treatment fluids, spent catalysts, spent removal system sorbents, debris and soils [12]. These wastes commonly known as associated wastes which are produced less than 1% of total volume of waste generated by oil and gas exploration and production [2]. Sludge is a semi-solid material tends to aggregate with mixture of one and more liquids and suspended solids. In hydrocarbon processing facilities, sludges are removed from tanks and vessels during maintenance and inspection. Mercury in hydrocarbon sludge is usually higher than the process fluid in the process stream. Since mercury has higher solubility in higher molecular weight organic compounds, it tends to accumulate in the sludges and turn out to be contaminant [12]. Solid wastes such as spent materials (i.e. spent catalyst and spent adsorbents) contain a significant quantity of mercury. The catalysts used in oil refining and chemical manufacturing accumulate mercury during their operations. The spent adsorbent obtained from the separation system, which is designed to remove mercury from gas, liquid and condensate has very high mercury content. Mercury also exists and contaminates the solvent used to liquefy sludge deposit in the process equipment and in process treatment of fluids for dehydration and sweetening processes [12]. Mercury Emissions to Atmosphere Air pollution has been linked to a number of significant problems such as ozone depletion, global climate change, acid rain, environmental degradation, and health effects in humans, plants, and animals. It is created by a number of different of sources and exits in a number of different forms. The point sources in industrial activities include chemical plants, oil refineries, power plants, hazardous waste incinerators and, oil and gas processing. It was estimated that the annual mercury emissions from oil and gas industry to atmophere in US is about 6,300 kg/year [2]. In natural gas industry, the emissions of mercury to the atmosphere could be through a glycol-overhead-gas. In the dehydration process, absorption liquids like glycols are used to absorb water and also mercury. On the elevated temperature, the glycol is regenerated and mercury is evaporated together with water. Therefore, the glycol-overheads containing mercury are released directly to the atmosphere [11]. In oil refinery, volatile and particulate mercury emissions to the atmosphere are claimed to generate mostly from the fuel combustion that are used to fire refinery process heaters and some amount from fugitive emissions. The fuels also include mostly gas and coke [25]. In refinery processing, catalyst is regenerated by using gas and some of the catalyst collect mercury and released it when regenerated. The gas from regeneration process which may contain higher amount of mercury than other typical gas flares is sent to flare [2]. Mercury Contaminated Facilities Mercury enters into gas gathering and processing facilities through the feed gas, from instruments used to measure gas properties and in used-catalyst. Several problems occur due to the existing mercury during the restoration. Mercury contaminated on steel surfaces and creeps by adsorbs into the micro-crevices and pore, although the temperature and pressure are at below condensation and without forming amalgams [11]. The pigging operations of mercury contaminated pipelines can generate sludge and debris that have high in mercury content [11,12]. Furthermore, during maintenance and cleaning activities, spillage of mercury from instruments contaminates buildings and soil [11,12]. Mercury Waste Treatment, Recycling, And Disposal Due to the extreme threat of mercury pollution, several remediation technologies have been developed, aim to remove mercury from wastewaters, although some works have targeted for mercury removal in gas phase. Mercury removal systems that are now prevalent for many processes which employ to protect equipment and catalysts for such systems depend on their chemical properties and process location [10]. Moreover, mercury waste can be treated and disposed by recovery; physical and chemical treatments, incineration and thermal process. Physical, Chemical and Thermal Treatments Physical separation methods depend on elemental mercurys high density and surface tension. This could be achieved by allowing segregation process to taking place. In contrast, mercury compounds differ from elemental since it cannot be physically separated. One of the examples of physical treatment is by using filtration equipment which employs to remove solid mercury from the waste streams. Removal and segregate waste mercury through equipment decontamination, soil remediation, fluid decontamination or disposal sludge processing are accomplished by using chemical treatments, precipitation treatment for filtration and aqueous extraction treatment. In addition, the thermal process (refer to distillation process) is used to remove mercury from the most mercury-contaminated area of oil and gas industry [11,12,26]. Several treatment processes have been developed to remove contaminants (i.e. mercury) from produced water prior to overboard discharge. The treatment processes involved re-injecting produced water back into rock formations from whence it originated. Figure 2 shows the original water treatment process based upon a sequence of stages according to the influent oil and solid content [27]. The first stage is characterized by a de-oiling unit, where water leaves the bottom of the separator and passes through desanding and de-oiling hydrocyclones. The water then enters the chemical treatment process followed by addition of an oxidant (NaOCl), ferric ions and a flocculant sequentially to form a floatable sludge consisting of ferric hydroxide, chemisorbed mercury, ferri-arsenate, and hydrocarbons (known as flotation units). The oxidation-reduction potential of the water is controlled by oxidant addition to allow Hg in elemental form [15,16]. There are several commercial processes available to prevent the mercury contamination at processing facilities. Table 5 summarizes the mercury removal systems for hydrocarbons and water which involve adsorption, chemical precipitation, ion exchange, iron cementation, membranes separation, and activated carbon adsorption [12]. Figure 2 Typical Produced Water Treatment [27] Recycling and Restoration The recovery process known as recycling or reuse method which involve a common process such as gravity separation, filtration, distillation, solvent, and chemical regeneration [28]. Physical methods could be neutralization, precipitation or separation and detoxification (chemical). Equipment decontamination is accomplished using chemical cleaning solutions that selectively oxidize complex elemental mercury deposits. These cleaning solutions consist of aqueous base solution having iodine as a complexing agent and organic solution (alcohol). In the case of incineration, the mercury contaminated waste is burnt at medium or high temperatures. For soil, sludge and debris must be thermally processed to remove mercury. The thermal process uses a vacuum, inert gas, or air as a carrier medium. However, if air is used, sulfur existed in matrix is converted to SO2 and hydrocarbons are oxidized to CO2 and H2O. Anaerobic thermal systems employ selective condensation and/or adsorption to separate sulfur and hydrocarbons from mercury. Spent adsorbent materials are also thermally processed using strictly anaerobic conditions to avoid exothermal reaction involving carbon [12,28]. As described above, mercury contamination can be preventing by using appropriate treatment processes. However, at the end of life cycle of gas installations, it may remain abandoned and need to be restored. For steel factories, scrap materials (i.e. tubings, flowlines, and facilities contaminated mercury) were cleaned before scrapping and added to steel production. Therefore, in European steel factories, the steel has to be cleaned or re-melting if the mercury contamination exceeds 2 to 10 mg per kg steel. In other cases, there are some processes available to clean mercury contaminated in pipelines and equipment such as sand blasting, high pressure water jetting, chemical process, milling techniques and also thermal treatment. Besides, the restoration or intermediate remediation of soil contaminated area is available with several soil cleaning methods [11]. Table 5 Mercury Removal Systems for Hydrocarbons and Water [12]. Method Process Comments Adsorption (Activated carbon, Sulfur, iodine impregnated carbon ) Mercury (Hgo) physically adsorbs and reacts to form non-volatile mercuric sulfide. Low saturation loading. Most used cheap, disposal problems. Prevalent wet collection To bubble gas (contain Hg) through permanganate solution. All Hg species convert to mercuric ion. Accurate, reasonably sensitive, increased corrosivity. Sulfide precipitation Sulfide reacts with ionic forms of Hg to form the insoluble mercuric sulfide and separated by filtration Increased corrosivity Ion exchange To remove ionic Hg from some waste streams. Regeneration problems, system contamination. Reverse osmosis treatment (semi-permeable membranes) Produce a clear permeate and a concentrate containing mercury Effective in treating specialized water streams Iron cementation (metal replacement process) Dissolved mercury cemented in a active metal (Zn or iron) Carried out in acid solution Disposal and Storage Waste materials that contain mercury need to be identified and characterized. They must be treated prior to disposal to avoid the long-term liabilities of burial or storage. Practically, all the mercury and contaminated materials should be accounted and collected because of the potential impacts of mercury into the environments. Removal of mercury from complex mixtures can be accomplished by combination of physical, chemical, immobilization, thermal, electrolytic and in-situ vitrification treatment methods. Sludge is one of the more difficult waste materials to process for treatment and disposal due to the existing of hydrocarbon in the matrix of sludge [12,28]. In the case of drilling fluid, it is often disposed of when a well is completed, and fresh fluid is used for any adjacent wells. Filtration processes have allowed drilling fluid to be reconditioned, so that it can be used for multiple wells before being discarded. Other possible uses for used drilling fluids are to plug-in the productive wells or to spud in new wells. Reuse of oil-based and synthetic-based drilling fluids to drill additional wells is common because of the high cost of the base fluids [29]. Mercury Emission Regulations Mercury is released through emissions from manufacturing, use or disposal activities. Environmental laws and regulations have been introduced by various regulatory bodies in order to protect the environment. Several specific laws such as Mercury Export Ban Act of 2008 and Mercury-Containing and Rechargable Battery Management Act of 1996 have been subjected related to mercury. In the case of environmental statutes such as Clean Air Act, Clean Water Act, Resource Conservation and Recovery Act, and Safe Drinking Water Act, EPA has the responsibility to develop regulations to control some mercury emissions to air, water, or from wastes and products. The stringent regulations were recommended to set an upper-bound limit on the amount of mercury for any facilities. Besides, it is require for every power plant in the country to adopt the maximum available control technologies (MACT). The possible approaches of these MACT are to achieve the reduction in mercury emissions by setting the uniform emissions limits for existing facilities and more restrictive limits for new ones; and the mandatory emissions reductions with an emissions credit trading system. Concluding Remarks Mercury is often present in oil and gas with various concentration and species. Mercury is toxic to both human health and the environment. It also leads to the potential of plant failure. Mercury emissions from oil and gas exploration, production, and processing into the environment could be via wastewater (produced water, refinery wastewater), solid waste (drilling waste, refinery waste) and contaminated facilities. The mercury emissions to atmosphere originate from gas processing plant, flared gas refineries, and fuel burning for process utilities. To minimize the amount of mercury emissions, several techniques for monitoring and removal of mercury have been developed. These include segregation, treatment, recovery, and disposal of mercury waste in the process. In treatment process, it involves physical, thermal, and chemical processes to remove the contaminated mercury. The waste materials that contain mercury are usually treated to remove mercury prior to the disposal and storage . Concluding Remarks The financial support from the MOSTI under the e-Science Research Program (Project No. 03-01-06-SF0464) is gratefully acknowledged. Amin-Nejad S., Smith J.S., and Lucas.J (2003). A Visual Servoing System for Edge Trimming of Fabric Embroideries by Laser. Journal of Mechatronics, Pergamon Press, New York. ISSN 0957-4158. 13(6): pp533-551.

Analysis of The Indian in the Cupboard by Lynne Reid Banks Essay

Analysis of The Indian in the Cupboard by Lynne Reid Banks For this month’s book report I read a book called ‘The Indian in the Cupboard’ by Lynne Reid Banks. This book was about a boy named Omri and his small Indian toy. For Omri’s birthday he received a small Indian toy from a friend and a small cupboard from his brother. Omri put his Indian in the cupboard and to his surprise when he opened the cupboard the Indian toy had come to life. Omri has to keep his Indian a secret for fear of an adult finding out. When Omri told his friend Patrick about the toy, Patrick wanted his own. Omri thought it was a bad idea but brought the toy to life anyway. When Omri brought Patrick’s cowboy toy to life, Patrick was very excited, but Omri was afraid he didn’t know that they were real people. Omri decided he would keep them both at his house. Patrick did not like this idea but agreed only if Omri would bring the cowboy and Indian to school the next day. Then all the trouble started. Patrick and Omri were called into the headmaster’s office and the headmaster threatened to call Patrick’s father if he didn’t tell him what was going on. Patrick was so afraid that he showed the headmaster the Indian and the other toy. Luckily the headmaster thought he was seeing things and so he went home. Omri decided that the Indian was too much trouble and that he should put them into plastic again. So Omri locked the Indian into the cupboard and when he opened it again, the toy was p...

Alcoholism: a Menace to the Society Essay

Filipinos love to drink alcoholic beverages, that is. Drinking sessions are seen almost everywhere everyday along the streets and sidewalks, inside homes, in carinderia and corner sari-sari store, and even the upmarket bars and bistros. So phenomenal has been the â€Å"tumahan† tradition that it became the undisputed national pastime and social culture of Filipinos. While local folks’ love for drinking session might have built many a friendship and warm the cockles of good ole acquaintances, it is, at the same, taking toll on the drinkers’ health. Alcoholism, also called alcohol dependence or alcohol addiction, is a destructive pattern of alcohol use that includes tolerance to or withdrawal from the substance, using more alcohol or using it for longer than planned, and trouble reducing its use. Other potential symptoms include spending an inordinate amount of time getting, using, or recovering from the use of alcohol, compromised functioning, and/or continuing to use alcohol despite an awareness of the detrimental effects it is having on one’s life. Alcoholism is appropriately considered a disease rather than a weakness of character or chosen pattern of bad behavior. Many persons have become addicted to alcohol. It undoubtedly has something to do with the euphoric quality of alcohol and the resultant high. According to Vern Mason, â€Å"it is amazing how many kinds of alcohol can come out of the same bottle. It all depends who’s drinking it†. There are basically two types of drinkers who may become alcoholic. Some become chronic alcoholics from the outset almost, steadily drinking larger amounts everyday. Others may drink socially or the binge drinkers on weekends. They sort of steadily increase their drinking. The end result is the same, alcoholism. The damaging effect of alcohol stands among the leading public health problems in the world. It deserves personal concern and national action if we are to remain sober and responsible people. Alcohol abuse is a disease that is characterized by the sufferer having a pattern of drinking excessively despite the negative effects of alcohol on the individual’s work, medical, legal, educational, and/or social life. Alcohol abuse affects about 10% of women and 20% of men in the United States, most beginning by their mid teens. Signs of alcohol intoxication include the smell of alcohol on the breath or skin, glazed or bloodshot eyes, the person being unusually passive or argumentative, and/or a deterioration in the person’s appearance or hygiene. Almost 2,000 people under 21 years of age die each year in car crashes in which underage drinking is involved. Alcohol is involved in nearly half of all violent deaths involving teens. Alcoholism is a destructive pattern of alcohol use that includes a number of symptoms, including tolerance to or withdrawal from the substance, using more alcohol and/or for a longer time than planned, and trouble reducing its use. Alcohol, especially when consumed in excess, can affect teens, women, men, and the elderly quite differently. Risk factors for developing a drinking problem include low self-esteem, depression, anxiety or another mood problem, as well as having parents with alcoholism. Alcohol dependence has no one single cause and is not directly passed from one generation to another genetically. Rather, it is the result of a complex group of genetic, psychological, and environmental factors. There is no one test that definitively indicates that someone has an alcohol-use disorder. Therefore, health-care practitioners diagnose these disorders by gathering comprehensive medical, family, and mental-health information. Alcohol use increases medical risks. Alcohol seriously interacts with a number of drugs as well as several other medications by either increasing their potency or decreasing their effectiveness. Alcohol also prolongs the length of recovery after anesthesia. (Modern Medicine, pp. 160-165) Some signs of a drinking problem include drinking alone, to escape problems, or for the sole purpose of getting drunk; hiding alcohol in odd places; getting irritated when you are unable to obtain alcohol to drink; and having problems because of your drinking. According to the research of Aileen Ludington and Hans Diehl, alcohol greatly affects the human body: Your brain. Alcohol, even in small amounts, causes irreparable damage to brain cells; some die and others are altered. Your heart. Alcohol increases the risk of hypertension, stroke, and damage to the heart muscle. Your lungs. Alcohol depresses respiratory functions. Your reproductive system. In men, alcohol can damage cells in the testes, causing impotence, sterility, and possibly enlarged breasts. In women, alcohol can cause irregular menstrual cycles and malfunctioning of the ovaries. Alcohol has also been linked to birth defects in infants and to fetal alcohol syndrome. Your liver. Because your liver must filter alcohol from the blood, alcohol affects it more than any other organ of your body. Excess calories in alcohol are stored as fat in the liver. Functioning liver cells die from alcoholic poisoning. Scar tissue replaces dead cells, causing cirrhosis. Your immune system. Alcohol weakens the body’s defense against infection and breast cancer. Therefore, I conclude that alcoholism is a disease found in every social and economic class, in every country in the world. The problem is stinging: an alcoholic cannot control the amount he or she drinks; occasional drinkers may dive into the alcohol problem with little control on those little drinking bout. In learning that alcoholism is an illness, a child is provided with a cognitive means by which to understand a confusing, often traumatizing, emotional experience. This could range from a simple conceptualization to a more empathetic understanding of his or her parent. Relabeling the parent’s behavior helps the child feel less out of control. Learning that it is an illness not caused by the child also to helps to improve the child’s reality-testing and reduces anxiety, anger, and guilt. (National Institute of Alcohol Abuse and Alcoholism. â€Å"Underage Drinking. † Alcohol Alert 67 Jan. 2006. ) Trusted adults, clergymen or guidance counselors are worthy ones to be sought for advice. The important thing is to reach out. And if you’re ashamed of your family, try not to be. Many people understand that alcoholism is a disease, you needn’t let shame burden you. Diverting your attention, being preoccupied with worthwhile activities can do a lot to your nerves.

Managing and Reducing Cardiovascular Risk in Type 2 Diabetes Mellitus Essay

Diabetes mellitus is a metabolic disorder in which the body’s capacity to make use of glucose, fat and protein is disturbed due to insulin deficiency or insulin resistance. It is a hormone secreted from pancreas that helps glucose from food to enter the body’s cells where it is transformed into energy required by muscles and tissues to function. Diabetes is caused either because the pancreas does not secrete adequate insulin, or because cells do not react to the insulin that is produced. Due to this reason, an individual with diabetes does not take up glucose appropriately and glucose continues circulating in the blood (hyperglycaemia) harming tissues over time. This damage leads to acute health complications. The classic symptoms of diabetes mellitus are, Polyuria ,Polydipsia ,Polyphagia ,lethargy and weight loss. There are many causes for high blood glucose levels in the body and so a number of types of diabetes exist. Diabetes mellitus occur throughout the world. Based on the study conducted by IDF, the number of diabetics on earth stands at 365 million nearly 8. 5% of the global population. It is more widespread in the more developed countries. The greatest raise in incidence is, however, expected to happen in Africa and Asia, where majority of the diabetes patients will most likely be found by 2030. Diabetes mellitus is categorised into four broad groups: Type 1, Type 2, Gestational diabetes & â€Å"other specific types†. Scientists in US have found a Type 3 diabetes, it is still continuing further study. Type 1 diabetes is absolute insulin deficiency usually affects children and young adults. Type 2 Diabetes is an insidious progressive disease that is often diagnosed late when complication are present. Dunning (2004) described it as a long term complication with neuropathy, cardiovascular disease and retinopathy. It is a universal metabolic disorder affecting more than 2 million people in the United Kingdom and up to 750,000 more are expected to have it without knowing they do. Studies conducted show that 80% of population affected by diabetes live in developing and underdeveloped countries and the majority of people with diabetes is between 40 to 59 years of age. It is also estimated that 183 million people (50%) with diabetes are undiagnosed. It is noticed that Diabetes caused 4. million deaths in 2011 and caused sharp increase in medical expenditure. I am a staff nurse working in the cardiac ward and we often receive patients with cardiac problems as a long term complication of type 2 diabetes. Cardiovascular disease is a major cause of hospital admission and mortality in people with diabetes. Most of them are not diagnosed until they are admitted. During the course of this study the medical history and care and treatment provided to a patient named Mr M Davies who was admitted in my ward is chosen to learn about managing and reducing cardiovascular disease among patients with type 2 diabetes. In 1998 UKPDS pointed out the importance of reducing lipids blood pressure and blood Glucose to reduce the risk of cardiovascular disease. Hypertension leads to thicker, less elastic blood vessel walls and increase the strain on the heart. Studies indicated that there is a linear correlation between the diastolic blood pressure and the eventual outcome of type 2 diabetes. Standl & Schnell (2000) pointed out that as a result of ischemia-induced remodelling subtle changes occur in the heart and the effects of hyperglycaemia on the endothelium of large blood vessels that causes heart to failure. Mr M Davies (Mr.  MD) is a 61-year-old pensioner with a 4 years history of type 2 diabetes. He was diagnosed in 2008 and he had symptoms of hyperglycaemia for 2 years before diagnosis. His fasting blood glucose records indicated values of 6–7 mmol/L, which were explained to him as symptomatic of â€Å"borderline diabetes. † During the preliminary diagnosis, he was advised to reduce weight (â€Å"at least 10 lb. †), but no further action was taken. Other medical problems include obesity and hypertension. He was admitted in the ward with recurrent chest pain. (Appendix 1) This assignment is about managing and reducing cardiovascular risk in type 2 diabetes mellitus. Heart disease is well acknowledged as a chronic problem of diabetes, and is the major reason of morbidity and mortality in patients from middle-age onwards. Type 2 diabetes is associated at the onset with risk factors for heart disease such as hypertension and obesity, raising the question of whether diabetes is the independent risk factor for heart disease. In 2001 Morrish et al pointed out that the majority of cardiovascular deaths are specifically due to heart disease and this is supported by Fisher, Miles, (2008) commenting that heart disease is the major cause of morbidity and mortality at young as well as older ages. Butler (1997) said that increased life expectancy has led to an increase in the number of people over 65 years of in both the developed and developing worlds. Marso (2003) pointed out that due to the clear association between age and the development diabetes, this increase in the number of older individuals in the population will inevitably contribute to the increased prevalence of diabetes. Watkins (2008) mentioned that Type 2 diabetes is a disease of relative prosperity, prosperity leads to overweight and physical indolence. Insulin resistance, increasing with obesity, associated with progressive failure of insulin secretion in relation to ageing underlies the development of diabetes. It is anticipated that by 2025 the number of people with type 2 diabetes will be around 380 million and people with impaired glucose tolerance will be around 418 million. Diabetes is the foremost global cause of premature mortality that is broadly underestimated, because only a few among the diabetic patients die from reasons uniquely related to the condition. Nearly one half of type 2 diabetes patients die prematurely of a cardiovascular reason and approximately 10% die of renal failure. Diabetes is a condition that required to be managed every day. The management of Diabetes can refer to dealing with short term measures like high and low blood sugar to regulating it over the long term for instance by attaining to grips with knowing the condition. All patients with Type 2 diabetes require active dietary management throughout their disease. Watkins (2008) pointed out that weight loss in the obese is extremely valuable but is separate from dietary manipulations to control blood glucose. Treatment typically includes diet control, exercise, monitoring blood sugar at home, and in some cases, oral medication and/or taking insulin. Based on the type diabetes medicines are classified into different groups and each category of diabetes pills functions differently. Commonly used medicines to control diabetes are Sulfonylureas, Thiazolidinediones, Biguanides, Alpha-glucosidase inhibitors, Meglitinides and, Dipeptidyl peptidase IV. Sulfonylureas reduce blood sugar by stimulating the pancreas to produce more insulin. Sulfonylureas medicines like Glimeperide, Gliclazide,. Biguanides improve insulin’s capacity to transfer sugar into cells particularly into the muscle cells. They also stop the liver from releasing stored sugar. Biguanides are not advised to be used in people who have heart failure or kidney damage. Biguanides medicines such as Metformin. Thiazolidinediones like Pioglitazone and Rosiglitazone enhances effectiveness of insulin in muscle and in fat tissue. Alpha-glucosidase inhibitors, such as Precose (acarbose) and Glyset (miglitol) prevent enzymes that help digest starches, reducing the rise in blood sugar. These medicines may cause diarrhea or gas. They can decrease hemoglobin A1c by 0. 5%-1%. Meglitinides, like Prandin (repaglinide) and Starlix (nateglinide) reduces blood sugar level by stimulating the pancreas to secreate more insulin. Dipeptidyl peptidase IV (DPP-IV) inhibitors, such as Januvia (sitagliptin), Onglyza (saxagliptin), and Tradjenta (linagliptin) lowers blood sugar level in patients with type 2 diabetes by accelerating insulin secretion from the pancreas and lowering sugar production. The case history of Mr. MD indicated that he was advised to manage blood sugar level by diet control and regular exercise. It was also advised to take metformin 1000mg twice a day when diet and exercise are not enough to manage blood sugar level. The history showed that Mr. MD was non-compliance with any of these. On admission his random blood sugar was 20 mmol/L. As he was unable to tolerate oral intake due to nausea and chest pain, GKI was commenced for a day to control his blood sugar. On second day his blood sugar level was controlled and he started eating and drinking normally. Mr MD was referred to diabetic specialist nurse and dietician . Diabetic specialist nurse advised to stop GKI and advised to start OHA. Mr. MD commenced on metformin 1000mg three times a day (Learning outcome 1). Metformin has long been accepted as a appropriate first-line choice of oral medicine for Type 2 diabetes as it is the only oral hypoglycaemic agent related with no weight gain or even weight reduction. They decrease hepatic gluconeogenesis, boost peripheral glucose uptake and also lower the absorption of carbohydrate from the gut lumen. Because metformin functions on insulin sensitivity and with only endogenous glucose stimulated insulin secretion, it virtually never causes hypoglycaemia on its own and patients using it with diet and exercise do not need routinely to self-monitor blood glucose. The UK Prospective Diabetes Study (UKPDS, 2002) demonstrated a significant survival advantage for Type 2 patients started on metformin as first-line therapy, with less cardiovascular mortality, although it should be noted that they only used the drug in obese patients. Obesity is a worldwide problem. Barnett (2009) pointed out that obesity and overweight are independent risk factors for cardiovascular morbidity and mortality. Various studies reveal that obesity is a major cardiovascular disease risk factor across world’s populations. Risk of morbidity and mortality begins to increase at body mass index (BMI) >25 kg/m 2 and the risk raises sharply at BMI >30 kg/m 2. Each kilogram of weight put on from the age of 18 years was linked with 3. 1% higher risk of cardiovascular disease. In 1998 Gunnell observed that over weight in adolescence is a forecaster of these dangers in adulthood . These finding were supported by Must in 1992,who explained that this increased risk extends to overweight children and adolescents, who may be at risk of premature cardiovascular morbidity and death. The mechanism by which obesity causes increased cardiovascular morbidity and mortality is attributed to associated co-morbidities and risk factors such as hypertension, dyslipidaemia, type 2 diabetes and insulin resistance. The co-occurrence of some or all of these risk factors along with obesity is termed the cardiometabolic syndrome. On examination it was noticed that Mr.  MD has a high BMI (30. 9). West (2007). Suggested that addressing obesity is an essential aspect of managing diabetes, because type2 diabetes and many other health problems coexist. However it is important to consider the individual’s specific nutritional needs rather than just providing them with a ‘weight loss plan,’ ‘diabetic diet,’ a ‘standard meal plan or information about healthy eating. ’ Mr. MD was referred to the dietician. Dietician gave dietary advice and educated about importance of weight management by diet and regular exercise. He was advised to avoid take-away foods, reduce alcohol consumption and taking balanced food to prevent hypo and hyper glycaemia (Learning outcome 1).. Hypertension-Prevention & Management is very important in the management of metabolic diseases. In 1985 Modan et al pointed out that there is a strong relationship between high blood pressure and insulin resistance. This findings is supported by Reaven, (1999) . He said that the prevalence of insulin resistance in hypertension has been estimated at 50%. Scheen, (2004) proposed several possible mechanisms for this. Coutinho et al. (1999) said that impaired fasting blood glucose is related with high cardiovascular risk particularly if accompanied by hypertension. Henry et al. , (2002) said that in people with diabetes, cardiovascular disease risk is increased two to fourfold compared with those with normal glucose tolerance. This was supported by the study conducted by Heffner et al. , (1998) who said that diabetic people without past history of myocardial infarction may have as high a risk of myocardial infarction as non-diabetic patients with a history of previous myocardial infarction. Non-pharmacological interventions are cheap than pharmacological interventions and have no known dangerous effects. A range of lifestyle changes reduce blood pressure and the occurrence of hypertension. Non-pharmacological interventions such as weight loss in the overweight, exercise programmes, limiting alcohol intake and a diet with increased fruit and vegetables and limited saturated fat content, minimising dietary sodium consumption and increased dietary potassium intake. From the medical history of Mr MD it is noticed that he was taking Ramipril 5 mg/day and bisoprolol2. mg/daily. It is established that where non-pharmacological interventions are not enough to achieve the objectives then Pharmacological interventions are required. Several drug treatments are of proven value in minimising cardiovascular risk in people with diabetes and hypertension. Low-dose aspirin is suggested in diabetes whether or not there is evidence of large vessel disease. Williams et al. , (2004) noticed that the British Hypertension Society recommends 75 mg of aspirin for all with hypertension and diabetes, unless contraindicated. Antihypertensive therapy diminishes the risk of macrovascular complications by around 20%. Reducing blood pressure reduces progression of retinopathy, albuminuria and progression to nephropathy. Staessen et al. , (1997) observed that clinical trials with ACE inhibitors, beta-blockers, diuretics, angiotensin receptor blockers and calcium channel blockers have demonstrated benefit of treatment of hypertension in type 2 diabetes (Learning outcome 1).. On admission blood pressure level of Mr MD was very high. He was recommended treatment with antihypertensive drugs. Consultant prescribed Losartan 100 mg/day and increased ACE inhibitor (ramipril 10 mg/day) and beta-blocker (bisoprolol 5 mg/dayl). Studies show that treatment with ramipril in addition to standard therapy minimised combined myocardial infarction, stroke and cardiovascular death by about 25% and stroke by 33% compared with placebo plus conventional methods. This was supported by Sowers and Haffner, (2002) saying that almost all patients with hypertension and diabetes require combinations of blood pressure reducing drugs to attain the recommended blood pressure targets. During the treatment Mr. MD was advised non-pharmacological methods of blood pressure management and importance of diet control and referred to cardiac rehabilitation for regular exercise. Management of high cholesterol plays an important role in the management of diabetes. Lipid abnormalities are common in type 2 diabetes and can be broadly categorized into two groups: those that are common to the general population, for example elevated total and LDL cholesterol; and additional diabetes-related abnormalities, for example elevated triglycerides and reduced HDL cholesterol. Current US and European guidelines emphasize reducing LDL-C level to less than 100 mg/dL (2. 59 mmol/L). To reduce the cholesterol Mr. MD was undergone intensive lipid-lowering treatment with atorvastatin 80 mg/day. Dietary therapy was also a part of the treatment which was found effective to lower Lipids. Interventions to stabilize lipids in order to decrease the risk of CVD are warranted in people with type 2 diabetes. Both Fibrates and Statins improve lipid profiles in people with diabetes. Many studies have established the safety and effectiveness of the fibrates (gemfibrozil, bezofibrate, fenofibrate) in diabetes. Fibrates stimulate the peroxisome proliferator-activated receptor-a, changing the expression of a number of enzymes that regulate lipid metabolism, including lipoprotein lipase. Statins inhibit hepatic 3-hydroxy-3-methylglutaryl coenzyme A reductase, which is rate restrictive in cholesterol production. Another major strategy in the management diabetes is lifestyle interventions. Lifestyle interventions can progress lipid levels. Studies conducted on weight loss and lipids in type 2 diabetes have varied greatly as to the study diet, design and duration. A Meta-analysis of 89 studies and 1800 subjects with type 2 diabetes reported that a weight loss of 5% or greater reduced triglyceride levels by 10 ±40% and total cholesterol by 5 ±15%. These effects were greatest with very low-calorie diets, and the effects were seen in studies up to 6 months. A variety of diets can alter the lipid profile in people with type 2 diabetes. The organisation of diabetes care is very important in the long term management of diabetes care. Diabetes is the significant disease confronting the United Kingdom’s (UK) health care system. As a result, understanding how best to manage diabetes facilities is an important area if the health system is going to deal with the growth in both the demand for and cost of diabetes treatment. Care should be planed at reducing symptoms and minimizing the danger of long-term problems. It is pointed out that a proper balance of glucose and other cardiovascular risk factors such as smoking, hypertension, inactive lifestyle, dyslipidaemia and obesity is very crucial (UKPDS, 2002) in the organisation care of diabetes.