How does energy drinks at school effect the students Essay

In general, many people on school drink and buy energy drinks, also during school. It is bought so often, because those energy drinks are very cheap and delicious. Those energy drinks are found almost everywhere; at supermarkets, petrol stations, hospitals and more and more. Energy drinks shouldn’t supported so much, because it has very badly side-effects. Researchers have proven that those energy drinks have side-effects. I will sum up the side-effects: -Diabetes, the energy drinks contain much sugar what provokes diabetes, what a very bad decease is. -Hyperactivity, the content of caffeine is very high what leads to very abnormal active childrens at school. -Arteriosclerosis, the drinks also lead to a higher production of calcium in the veins. -Arterial occlusion, because of the drinks people will have a higher cholesterol content. -Fatness, in general, people will higher fat production what leads to fatness. At school must the drinks been banned, and there must be controls to make sure that none of the students drink those drinks. And there must be sanctions when students have those drinks at school or if they drinks them. The parents must be informed about those sanctions, those side-effects. because of this, the parents are capable to talk to their children(s) about these drinks to inform them about the dangers Also the supermarkets have to do something at those things. They can lower their quantity and orders of those drinks, so there will be less bought drinks. Or they can set a limit at the quantity of how much you can buy on 1 day. Advertising can be reduced, like it has been done with tabac. The prices can be raised, so the people are less like to buy many of these drinks. Factories also have to do something at this problem. The quantity of how much they produce can be lowered, this causes a lack of offers what causes higher prices in the stores, and that will reduce the purchase quantity. Change the content of those bad matter and the many side-effects are gone. They also can stop their advertising of this product and stop supporting the drinks. After all, the people have to be careful with those drinks and inform the people about the dangers. There are solutions to solve this problems, but the companies and the consumers have to work along with this, otherwise it won’t help.

Life of Quaid E Azam

ACCF/AHA Pocket Guideline Adapted from the 2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy November 2011 Developed in Collaboration With the American Association for Thoracic Surgery, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons  © 2011 by the American College of Cardiology Foundation and the American Heart Association, Inc.The following material was adapted from the 2011 ACCF/AHA Guidelines for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy (J Am Coll Cardiol 2011;XX:XX–XX). This pocket guideline is available on the World Wide Web sites of the American College of Cardiology (www. cardiosource. org) and the American Heart Association (my. americanheart. org). For copies of this document, please contact Elsevier Inc. Reprint Department, e-mail: [ema il  protected] com; phone: 212-633-3813; fax: 212-633-3820.Permissions: Multiple copies, modification, alteration, enhancement, and/ ordistribution of this document are not permitted without the express permission of the American College of Cardiology Foundation. Please contact Elsevier’s permission department at [email  protected] com. Contents 1. Introduction †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 3 2. Clinical Definition †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. †¦ 6 3. Genetic Testing Strategies/Family Screening †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 4. Genotype-Positive/Phenotype-Negative Patients †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 9 5. Echocardiography †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 10 6. Stress Testing †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 14 7. Cardiac Magnetic Resonance †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 15 8. Detection of Concomitant Coronary Disease †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 17 9. Asymptomatic Patients †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 19 10.Pharmacologic Management†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 21 11. Invasive Therapies †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 26 12. Pacing †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 29 13. Sudden Cardiac Death Risk Stratification †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 30 14. Selection of Patients for Implantable Cardioverter-Defibrillators †¦ 32 15. Participation in Competitive or Recreational Sports and Physical Activity †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â ‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 6 16. Management of Atrial Fibrillation †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 38 17. Pregnancy/Delivery †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 41 2 1. Introduction The impetus for the guidelines is based on an appreciation of the frequency of this clinical entity and a realization that many aspects of clinical management, including the use of diagnostic modalities, genetic testing, utilization of implantable cardioverter-defibrillators (ICDs), and therapies for refractory symptoms lack consensus.The discussion and recommendations about the various diagnostic modalities apply to patients with established HCM and to a variable extent to patients with a high index of suspicion of the disease. Classification of Recommendations The ACCF/AHA classifications of recommendations and levels of evidence are utilized, and described in more detail in Table 1. 3 Applying Classification of Recommendations and LevelRecommendations and Level of Evidence Table 1. Applying Classification of of Evidence Table 1. Applying Classification of Recommendations and Level of Evidence S i z e Class I Benefit >>> Risk f T r e a T m eSni T ee f ffe c T e a T z o Tr Class IIb Class IIa Benefit >>> Risk Benefit Risk Additional studies with broad Additional studies with objectives objectives needed focused needed; additional registryreasonable to perIt Is data would be helpful Class IIa Class I Benefit >> RiskRisk Benefit >>> Additional studies with Procedure/Treatment focused objectives needed should be performed/ Procedure/Treatment should be performed/ administered It administered Is reasonable to perform procedure/administer treatment n Recommendation favor n Recommendation in thatProcedure/Treatment form procedure/administer may be ConsIdered treatment n n Rec ommendation Recommendation’s eSTimaTe of cerTainTy (PreciSion) of TreaTmenT effecT a populations d* ived from multiple zed clinical trials analyses Recommendation that level a procedure or treatment Multiple populations is useful/effective evaluated* n Sufficient evidence from Data randomized multiple multiplederived from trials randomized clinical trials or meta-analyses or meta-analyses n of procedure or procedure treatment treatment is useful/effective being useful/effective n Sufficient evidence from n Some conflicting evidence n favor usefulness/efficacy less of treatment or procedure well established being useful/effective conflicting evidence evidence from multiple from multiple randomized randomized trials or trials or meta-analyses meta-analyses in favor of treatment or procedure usefulness/efficacy less being useful/effective well established conflicting evidence from single evidence from single randomized trial randomized trial oror nonrandomized studies nonrandomi zed studies in favor usefulness/efficacy less of treatment or procedure well established being useful/effective opinion, case studies, or opinion, case studies, standard of care care or standard of may/might be considered is reasonable may/might be reasonable can be useful/effective/beneficial usefulness/effectiveness is is probably recommended unknown/unclear/uncertain or indicated or not well established n n Some Greater multiple randomized trials from multiple randomized or or meta-analyses trialsmeta-analyses b populations d* ived from a ndomized trial ndomized studiesRecommendation that level b procedure or treatment Limited populations is useful/effective evaluated* n Evidence from single Data derived or randomized trialfrom a single randomized trial nonrandomized studies or nonrandomized studies n n Recommendation in that n Recommendation favor n n Recommendation Recommendation’s of procedure or procedure treatment treatment being useful/effective is useful/effective n Some conflicting single n Evidence from n n Some Greater evidence from trial or randomized single randomized trial or nonrandomized studies nonrandomized studies n Recommendation favor n Recommendation in that C ited populations d* sensus opinion ts, case studies, ard of careRecommendation that level C procedure or treatment is Very limited populations useful/effective evaluated* n Only expert opinion, case Only consensus opinion studies, or standard of care of experts, case studies, or standard of care n n n Recommendation Recommendation’s of procedure or procedure is treatment treatment useful/effective being useful/effective n Only expert expert n Only divergingopinion, case studies, or studies, opinion, casestandard of care or standard of care is reasonable should can be useful/effective/beneficial is recommended is probably recommended is indicated oris useful/effective/beneficial indicated n n Only diverging expert Only diverging expert d phrases for commendations shou ld Suggested phrases for writing recommendations is recommended is ndicated is useful/effective/beneficial s treatment/strategy A is Comparative recommended/indicated in effectiveness phrases†  preference to treatment B treatment/strategy A is probably treatment/strategy A is recommended/indicated in in recommended/indicated preference to to treatment B preference treatment B it is reasonableshould be chosen treatment A to choose treatment A over treatment B over treatment B treatment/strategy A is probably recommended/indicated in preference to treatment B it is reasonable to choose treatment A over treatment B ive ess phrases†  4 treatment A should be chosen over treatment B e T menT e ffe c T A recommendation with Level of Evidence B or CClass IIIIIb Benefit Class No orBenefit > Risk Class III Harm Procedure/ Additional studies with broad test treatment objectives needed; additional Cor III: Not No Proven be helpful noregistry data would Benefit benefit Helpful Class II I No Benefit or Class III Harm Procedure/ test Cor III: Not no benefit Helpful Cor III: harm treatment No Proven Benefit does not imply that the recommendation is weak. Many important clinical questions addressed in the guidelines do not lend themselves to clinical trials. Although randomized trials are unavailable, there may be a very clear clinical consensus that a particular test or therapy is useful or effective. Procedure/Treatment Cor III: Excess Cost Harmful harm be w/o Benefit to Patients may ConsIdered or Harmful n n Recommendation’s Recommendation that Excess Cost Harmful w/o Benefit to Patients or Harmful Data available from clinical trials or registries about the usefulness/efficacy in different subpopulations, such as sex, age, history of diabetes, history of prior myocardial infarction, history of heart failure, and prior aspirin use. †  For comparative effectiveness recommendations (Class I and IIa; Level of Evidence A and B only), studies that support the use of comparator verbs should involve direct comparisons of the treatments or strategies being evaluated. n procedure or treatment is usefulness/efficacy less not useful/effective and may well established be harmful conflicting n Greater n evidence from multiple Sufficient evidence fromRecommendation that procedure or treatment is not useful/effective and may be harmful Sufficient evidence from multiple randomized trials or meta-analyses Recommendation that procedure or treatment is not useful/effective and may be harmful Evidence from single randomized trial or nonrandomized studies Recommendation that procedure or treatment is not useful/effective and may be harmful Only expert opinion, case studies, or standard of care COR III: Harm potentially harmful causes harm associated with excess morbidity/mortality should not be performed/ be done administered/ other n multiple randomizedor randomized trials trials or meta-analyses meta-analyses n n Recommendation’s Recommendatio n that n sefulness/efficacy less procedure or treatment is well established not useful/effective and may be harmful conflicting n Greater n evidence from single Evidence from single randomized trial randomized trial oror nonrandomized studies nonrandomized studies n Recommendation’s Recommendation that usefulness/efficacy less procedure or treatment is well established not useful/effective and may n Only diverging expert be harmful opinion, case studies, or n Only expert opinion, case standard of care studies, or standard of care n n n n COR III: COR III: may/might be considered Nomay/might be reasonable Benefit Harm usefulness/effectiveness is is not potentially unknown/unclear/uncertain recommended harmful or indicated not well established harm is not causes associated with excess morbidity/mortality should not be done COR III: No Benefit is not recommended is not indicated should not be performed/ be done administered/ is not useful/ other beneficial/ is not useful/ effect ive bene? cial/ effective should not be done s not useful/ beneficial/ effective 5 2. Clinical Definition The generally accepted definition of hypertrophic cardiomyopathy (HCM), is a disease state characterized by unexplained left ventricular (LV) hypertrophy associated with nondilated ventricular chambers in the absence of another cardiac or systemic disease that itself would be capable of producing the magnitude of hypertrophy evident in a given patient. Clinically, HCM is usually recognized by maximal LV wall thickness ? 15 mm, with wall thickness of 13 to 14 mm considered borderline, particularly in the presence of other compelling information (e. g. , family history of HCM), based on echocardiography.In terms of LV wall-thickness measurements, the literature has been largely focused on echocardiography, although cardiovascular magnetic resonance (CMR) is now used with increasing frequency in HCM. In the case of children, increased LV wall thickness is defined as wall thickness ? 2 standard deviations above the mean (z score ? 2) for age, sex, or body size. However, it should be underscored that in principle, any degree of wall thickness is compatible with the presence of the HCM genetic substrate and that an emerging subgroup within the broad clinical spectrum is composed of family members with disease-causing sarcomere mutations but without evidence of the disease phenotype (i. e. , LV hypertrophy). 6 3. Genetic Testing Strategies/Family Screening Class I 1.Evaluation of familial inheritance and genetic counseling is recommended as part of the assessment of patients with HCM. (Level of Evidence: B) 2. Patients who undergo genetic testing should also undergo counseling by someone knowledgeable in the genetics of cardiovascular disease so that results and their clinical significance can be appropriately reviewed with the patient. (Level of Evidence: B) 3. Screening (clinical, with or without genetic testing) is recommended in first-degree relatives of pati ents with HCM. (Level of Evidence: B) 4. Genetic testing for HCM and other genetic causes of unexplained cardiac hypertrophy is recommended in patients with an typical clinical presentation of HCM or when another genetic condition is suspected to be the cause. (Level of Evidence: B) 7 Class IIa 1. Genetic testing is reasonable in the index patient to facilitate the identification of first-degree family members at risk for developing HCM. (Level of Evidence: B) Class IIb 1. The usefulness of genetic testing in the assessment of risk of sudden cardiac death (SCD) in HCM is uncertain. (Level of Evidence: B) Class III: 1. Genetic testing is not indicated in relatives when pathogenic mutation. (Level of Evidence: B) 2. Ongoing clinical screening is not indicated in genotype-negative relatives in families with HCM. Level of Evidence: B) No Benefit the index patient does not have a definitive 8 4. Genotype-Positive/Phenotype-Negative Patients Class I 1. In individuals with pathogenic mutat ions who do not express the HCM phenotype, it is recommended to perform serial electrocardiogram, transthoracic echocardiogram (TTE), and clinical assessment at periodic intervals (12 to 18 months in children and adolescents and about every 5 years in adults), based on the patient’s age and change in clinical status. (Level of Evidence: B) 9 5. Echocardiography Class I 1. A TTE is recommended in the initial evaluation of all patients with suspected HCM. (Level of Evidence: B) 2.A TTE is recommended as a component of the screening algorithm for family members of patients with HCM unless the family member is genotype negative in a family with known definitive mutations. (Level of Evidence: B) 3. Periodic (12 to 18 months) TTE screening is recommended for children of patients with HCM, starting by age 12 or earlier if a growth spurt or signs of puberty are evident and/or when there are plans for engaging in intense competitive sports or there is a family history of SCD. (Level o f Evidence: C) 4. Repeat TTE is recommended for the evaluation of patients with HCM with a change in clinical status or new cardiovascular event. (Level of Evidence: B) 5. A transesophageal echocardiogram (TEE) is recommended for the intraoperative guidance of surgical myectomy. (Level of Evidence: B) 10 6.TTE or TEE with intracoronary contrast injection of the candidate’s septal perforator(s) is recommended for the intraprocedural guidance of alcohol septal ablation. (Level of Evidence: B) 7. TTE should be used to evaluate the effects of surgical myectomy or alcohol septal ablation for obstructive HCM. (Level of Evidence: C) Class IIa 1. TTE studies performed every 1 to 2 years can be useful in the serial evaluation of symptomatically stable patients with HCM to assess the degree of myocardial hypertrophy, dynamic obstruction, and myocardial function. (Level of Evidence: C) 2. Exercise TTE can be useful in the detection and quantification of dynamic left ventricular outflow tract (LVOT) obstruction in the absence of resting outflow tract obstruction in patients with HCM. (Level of Evidence: B) 11 3.TEE can be useful if TTE is inconclusive for clinical decision making about medical therapy and in situations such as planning for myectomy, exclusion of subaortic membrane or mitral regurgitation secondary to structural abnormalities of the mitral valve apparatus, or in assessment for the feasibility of alcohol septal ablation. (Level of Evidence: C) 4. TTE combined with the injection of an intravenous contrast agent is reasonable if the diagnosis of apical HCM or apical infarction or severity of hypertrophy is in doubt, particularly when other imaging modalities such as CMR are not readily available, not diagnostic, or contraindicated. (Level of Evidence: C) 5.Serial TTE studies are reasonable for clinically unaffected patients who have a first-degree relative with HCM when genetic status is unknown. Such follow-up may be considered every 12 to 18 months f or children or adolescents from high-risk families and every 5 years for adult family members. (Level of Evidence: C) 12 Class III: 1. TTE studies should not be performed more HCM when it is unlikely that any changes have occurred that would have an impact on clinical decision making. (Level of Evidence: C) 2. Routine TEE and/or contrast echocardiography is not recommended when TTE images are diagnostic of HCM and/or there is no suspicion of fixed obstruction or intrinsic mitral valve pathology. (Level of Evidence: C)No Benefit frequently than every 12 months in patients with 13 6. Stress Testing Class IIa 1. Treadmill exercise testing is reasonable to determine functional capacity and response to therapy in patients with HCM. (Level of Evidence: C) 2. Treadmill testing with monitoring of an electrocardiogram and blood pressure is reasonable for SCD risk stratification in patients with HCM. (Level of Evidence: B) 3. In patients with HCM who do not have a resting peak instantaneous g radient of greater than or equal to 50 mm Hg, exercise echocardiography is reasonable for the detection and quantification of exercise-induced dynamic LVOT obstruction. (Level of Evidence: B) 14 7. Cardiac Magnetic Resonance Class I 1.CMR imaging is indicated in patients with suspected HCM when echocardiography is inconclusive for diagnosis. (Level of Evidence: B) 2. CMR imaging is indicated in patients with known HCM when additional information that may have an impact on management or decision making regarding invasive management, such as magnitude and distribution of hypertrophy or anatomy of the mitral valve apparatus or papillary muscles, is not adequately defined with echocardiography. (Level of Evidence: B) Class IIa 1. CMR imaging is reasonable in patients with HCM to define apical hypertrophy and/or aneurysm if echocardiography is inconclusive. (Level of Evidence: B) 15 Class IIb 1.In selected patients with known HCM, when SCD risk stratification is inconclusive after docume ntation of the conventional risk factors, CMR imaging with assessment of late gadolinium enhancement may be considered in resolving clinical decision making. (Level of Evidence: C) 2. CMR imaging may be considered in patients with LV hypertrophy and the suspicion of alternative diagnoses to HCM, including cardiac amyloidosis, Fabry disease, and genetic phenocopies such as LAMP2 cardiomyopathy. (Level of Evidence: C) 16 8. Detection of Concomitant Coronary Disease Class I 1. Coronary arteriography (invasive or computed tomographic imaging) is indicated in patients with HCM with chest discomfort who have an intermediate to high likelihood of coronary artery disease (CAD) when the identification of concomitant CAD will change management strategies. (Level of Evidence: C) Class IIa 1.Assessment of coronary anatomy with computed tomographic angiography is reasonable for patients with HCM with chest discomfort and a low likelihood of CAD to assess for possible concomitant CAD. (Level of E vidence: C) 2. Assessment of ischemia or perfusion abnormalities suggestive of CAD with single-photon emission computed tomography or positron emission tomography myocardial perfusion imaging (because of excellent negative predictive value) is reasonable in patients with HCM with chest discomfort and a low likelihood of CAD to rule out possible concomitant CAD. (Level of Evidence: C) 17 Class III: 1. Routine single-photon emission computed echocardiography is not indicated for detection of â€Å"silent† CAD-related ischemia in patients with HCM who are asymptomatic. (Level of Evidence: C) 2.Assessment for the presence of blunted flow reserve (microvascular ischemia) using quantitative myocardial blood flow measurements by positron emission tomography is not indicated for the assessment of prognosis in patients with HCM. (Level of Evidence: C) No Benefit tomography myocardial perfussion imaging or stress 18 9. Asymptomatic Patients Class I 1. For patients with HCM, it is recom mended that comorbidities that may contribute to cardiovascular disease (e. g. , hypertension, diabetes, hyperlipidemia, obesity) be treated in compliance with relevant existing guidelines. (Level of Evidence: C) Class IIa 1. Low-intensity aerobic exercise is reasonable as part of a healthy lifestyle for patients with HCM. (Level of Evidence: C) Class IIb 1.The usefulness of beta blockade and calcium channel blockers to alter clinical outcome is not well established for the management of asymptomatic patients with HCM with or without obstruction. (Level of Evidence: C) Class III: Harm 1. Septal reduction therapy should not be performed for asymptomatic adult and pediatric patients with HCM with normal effort tolerance regardless of the severity of obstruction. (Level of Evidence: C) 2. In patients with HCM with resting or provocable outflow tract obstruction, regardless of symptom status, pure vasodilators and high-dose diuretics are potentially harmful. (Level of Evidence: C) 19 Fi gure 1. Treatment Algorithm HCM PatientsACE indicates angiotensin-converting enzyme; ARB, angiotensin receptor blocker; DM, diabetes mellitus; EF, ejection fraction; GL, guidelines; HCM, hypertrophic cardiomyopathy; HTN, hypertension; and LV, left ventricular. Treat comorbidities according to GL [HTN, Lipids, DM] Obstructive Physiology No Heart Failure Symptoms or Angina No Yes Yes Avoid vasodilator therapy and highdose diuretics Systolic Function Annual clinical evaluation No Heart Failure Symptoms or Angina LV EF 50 mm Hg) for whom standard medical therapy has failed. (Level of Evidence: C) 4.When surgery is contraindicated or the risk is considered unacceptable because of serious comorbidities or advanced age, alcohol septal ablation, when performed in experienced centers, can be beneficial in eligible adult patients with HCM with LVOT obstruction and severe drug-refractory symptoms (usually New York Heart Association functional classes III or IV). (Level of Evidence: B) 26 Class IIb 1. Alcohol septal ablation, when performed in experienced centers, may be considered as an alternative to surgical myectomy for eligible adult patients with HCM with severe drug-refractory symptoms and LVOT obstruction when, after a balanced and thorough discussion, the patient expresses a preference for septal ablation. (Level of Evidence: B) 2. The effectiveness of alcohol septal ablation is uncertain in patients with HCM with marked (i. e. , >30 mm) septal hypertrophy, and therefore the procedure is generally discouraged in such patients. (Level of Evidence: C) Class III: Harm 1.Septal reduction therapy should not be done for adult patients with HCM who are asymptomatic with normal exercise tolerance or whose symptoms are controlled or minimized on optimal medical therapy. (Level of Evidence: C) 2. Septal reduction therapy should not be done unless performed as part of a program dedicated to the longitudinal and multidisciplinary care of patients with HCM. (Level of Evidence : C) 27 3. Mitral valve replacement for relief of LVOT obstruction should not be performed in patients with HCM in whom septal reduction therapy is an option. (Level of Evidence: C) 4. Alcohol septal ablation should not be done in patients with HCM with concomitant disease that independently warrants surgical correction (e. g. coronary artery bypass grafting for CAD, mitral valve repair for ruptured chordae) in whom surgical myectomy can be performed as part of the operation. (Level of Evidence: C) 5. Alcohol septal ablation should not be done in patients with HCM who are less than 21 years of age and is discouraged in adults less than 40 years of age if myectomy is a viable option. (Level of Evidence: C) 28 12. Pacing Class IIa 1. In patients with HCM who have had a dualchamber device implanted for non-HCM indications, it is reasonable to consider a trial of dual-chamber atrial-ventricular pacing (from the right ventricular apex) for the relief of symptoms attributable to LVOT obst ruction. (Level of Evidence: B) Class IIb 1.Permanent pacing may be considered in medically refractory symptomatic patients with obstructive HCM who are suboptimal candidates for septal reduction therapy. (Level of Evidence: B) Class III: 1. Permanent pacemaker implantation for the performed in patients with HCM who are asymptomatic or whose symptoms are medically controlled. (Level of Evidence: C) 2. Permanent pacemaker implantation should not be performed as a first-line therapy to relieve symptoms in medically refractory symptomatic patients with HCM and LVOT obstruction in patients who are candidates for septal reduction. (Level of Evidence: B) No Benefit purpose of reducing gradient should not be 29 13. Sudden Cardiac Death Risk Stratification Class I 1.All patients with HCM should undergo comprehensive SCD risk stratification at initial evaluation to determine the presence of: (Level of Evidence: B) a. A personal history for ventricular fibrillation, sustained ventricular tach ycardia, or SCD events, including appropriate ICD therapy for ventricular tachyarrhythmias. * b. A family history for SCD events, including appropriate ICD therapy for ventricular tachyarrhythmias. * c. Unexplained syncope. d. Documented nonsustained ventricular tachycardia (NSVT) defined as 3 or more beats at greater than or equal to120 bpm on ambulatory (Holter) electrocardiogram. e. Maximal LV wall thickness greater than or equal to 30 mm. Appropriate ICD discharge is defined as ICD therapy triggered by VT or ventricular fibrillation, documented by stored intracardiac electrogram or cycle-length data, in conjunction with the patient’s symptoms immediately before and after device discharge. 30 Class IIa 1. It is reasonable to assess blood pressure response during exercise as part of SCD risk stratification in patients with HCM. (Level of Evidence: B) 2. SCD risk stratification is reasonable on a periodic basis (every 12 to 24 months) for patients with HCM who have not under gone ICD implantation but would otherwise be eligible in the event that risk factors are identified (12 to 24 months). (Level of Evidence: C)Class IIb 1. The usefulness of the following potential SCD risk modifiers is unclear but might be considered in selected patients with HCM for whom risk remains borderline after documentation of conventional risk factors: a. CMR imaging with late gadolinium enhacement. (Level of Evidence: C) b. Double and compound mutations (i. e. , >1). (Level of Evidence: C) c. Marked LVOT obstruction. (Level of Evidence: B) Class III: Harm 1. Invasive electrophysiologic testing as routine SCD risk stratification in patients with HCM should not be performed. (Level of Evidence: C) 31 14. Selection of Patients for Implantable Cardioverter-Defibrillators Class I 1.The decision to place an ICD in patients with HCM should include application of individual clinical judgment, as well as a thorough discussion of the strength of evidence, benefits, and risks to allow the informed patient’s active participation in decision making. (Level of Evidence: C) 2. ICD placement is recommended for patients with HCM with prior documented cardiac arrest, ventricular fibrillation, or hemodynamically significant ventricular tachycardia. (Level of Evidence: B) Class IIa 1. It is reasonable to recommend an ICD for patients with HCM with: a. Sudden death presumably caused by HCM in 1 or more first-degree relatives. (Level of Evidence: C) b. A maximum LV wall thickness greater than or equal to 30 mm. (Level of Evidence: C) c. One or more recent, unexplained syncopal episodes. (Level of Evidence: C) 2.An ICD can be useful in select patients with NSVT (particularly those 30 mm or Recent unexplained syncope No Yes ICD reasonable Nonsustained VT or Abnormal BP response Yes Other SCD Risk Modifiers* Present? Yes No ICD can be useful Legend Class I Class IIa No ICD not recommended Class IIb Class III Role of ICD uncertainRegardless of the level of recommendatio n put forth in these guidelines, the decision for placement of an ICD must involve prudent application of individual clinical judgment, thorough discussions of the strength of evidence, the benefits, and the risks (including but not limited to inappropriate discharges, lead and procedural complications) to allow active participation of the fully informed patient in ultimate decision making. BP indicates blood pressure; ICD, implantable cardioverter-defibrillator; LV, left ventricular; SCD, sudden cardiac death; SD, sudden death; and VT, ventricular tachycardia. 35 15. Participation in Competitive or Recreational Sports and Physical ActivityClass IIa 1. It is reasonable for patients with HCM to participate in low-intensity competitive sports (e. g. , golf and bowling). (Level of Evidence: C) 2. It is reasonable for patients with HCM to participate in a range of recreational sporting activities as outlined in Table 2. (Level of Evidence: C) Class III: Harm 1. Patients with HCM should not participate in intense competitive sports regardless of age, sex, race, presence or absence of LVOT obstruction, prior septal reduction therapy, or implantation of a cardioverterdefibrillator for high-risk status. (Level of Evidence: C) 36 Table 2. Recommendations for the Acceptability of Recreational Noncompetitive) Sports Activities and Exercise in Patients With HCM* Intensity Level High Basketball (full court) Basketball (half court) Body building†¡ Gymnastics Ice hockey†¡ Racquetball/squash Rock climbing†¡ Running (sprinting) Skiing Soccer Tennis (singles) Touch (flag) football Windsurfing § Moderate Baseball/softball Biking Modest hiking Motorcycling†¡ Jogging Sailing § Surfing § Swimming (laps) § Tennis (doubles) Treadmill/stationary bicycle Weightlifting (free weights)†¡|| Hiking 2 4 4 3 3 3 2 5 4 5 1 3 (downhill)†¡ Skiing (cross-country) 0 0 1 2 0 0 1 0 2 2 0 0 1 1 Eligibility Scale for HCM†  Intensity Level Low Bowling Golf Hor seback riding†¡ Scuba diving § Skating ¶ Snorkeling § Weights (nonfree weights) Brisk walking 5 5 3 0 5 5 4 5 Eligibility Scale for HCM†  *Recreational sports are categorized according to high, moderate, and low levels of exercise and graded on a relative scale (from 0 to 5) for eligibility, with 0 to 1 indicating generally not advised or strongly discouraged; 4 to 5, probably permitted; and 2 to 3, intermediate and to be assessed clinically on an individual basis. The designations of high, moderate, and low levels of exercise are equivalent to an estimated >6, 4 to 6, and

Evaluating a Website for Credibility Essay

A search for men’s health related website conducted using the public search engine Google.com. Men’s Health Network (MHN), http://www.menshealthnetwork.org, is a nonprofit organization reaching out to males and their families focusing on the growing health crisis that affect the premature mortality of men (Men’s Health Network, 2014). Approximately 50% of the population is male; evaluating the sites credibility is important when using it as an educational tool for male patients related to prevention and management of health. Evaluation of website MHN is comprised of spokespersons and advisory board. The website discloses a limited list of spokespersons with title and areas of educational focus. The site states, â€Å"†¦there are over 800 physicians, mental health experts, and other key thought leaders among the MHN Board of Advisors†¦Ã¢â‚¬  (Men’s Health Network, 2014). The readability of the website is not technical, the average person will be able to read the information on the site and be able to understand the intent of the organizations message. The information that is presented is accurate but referencing to studies and citations are lacking or difficult to find. Brief explanations of diseases are summarized followed by links to outside sources such as the American Urology Association, National Institute of Health, or Journal of Men’s Health for additional information. MHN is sponsored by monetary donations from the public as well as internships to promote education to the public and policy makers related to men’s health (Men’s Health Network, 2014). Partnerships are publicly display at the bottom of the website and range from for-profit drug companies such as Glaxo Smith Kline, Bayer and Pfizer as well as nonprofit organizations such as Boy Scouts of America and Veterans Health Council. Since the number of for-profit partnerships with MHN supersedes the  nonprofit partnerships, one can view the information provided on MHN as favoring the for profit companies despite MHN having links to outside sources for information on diseases. MHN website navigation is user friendly with headings at the top of the web pages that are identical on every page. The font utilized is clear, easy to read, and not strenuous on the eyes. All links in headings are operational and link phrases are clearly described to target page. MHN security link states commitment to ensuring user privacy and that any information collected is used only in accordance to the November 2012 policy (Men’s Health Network, 2014). MHN informs that the website will request permission to place â€Å"cookies† on user’s computer. The term â€Å"cookie† is defined and gives the user informed consent. MHN clearly states that clicking links to partnerships and outside sources link takes the user away from MHN site and states, â€Å"we cannot be responsible for the protection and privacy of any information which you provide whilst visiting such sites and such sites are not governed by this privacy statement.† (Men’s Health Network, 2014). Empirical evidence Building credibility for a website requires providing links to reputable organizations which increase traffic, thereby increasing its relevance in search outcomes (Calabro, 2010). MHN achieves this with a banner containing links to other organizations for the reader to get additional information, but the sites that the reader is linked to do not always reciprocate a link back. Calabro (2010) suggests that updating the home page regularly with updated graphics, information, and testimonials are vital to enhancing the websites presence on the internet. MHN, compared to www.nih.org which publicly displays the sites last revision, information contained on the site doesn’t display last revision although there is updating to the site by evidence of seminar announcements, online flyers, and press releases. In a study of 1,442 acute care nurses employed in one large hospital system with readily available library sources, 43% reported starting a search with Google. Of that group 64% reported success in obtaining results using a general search engine such as Google. While 49% started a search using CINAHL or MEDLINE, a much smaller percentage reported successful searching (20% and 24% respectively) of these professional databases. (Miller, Graves, Jones, & Sievert, 2010, p. 3) Not having a subscription to CINAHL or  MEDLINE, according to (Miller et al., 2010), should not hinder knowledgeable nurses in using public search engines for credible information as a tool to educate patients and families. Application to nursing practice Evaluating information found on the internet is important to properly educate patients as MHN provides educational material for men, boys, women and families. The professional nurse can utilize the site resources to aide families to cope with ailments that affect their male loved ones. Nurses can resource MHN to provide information to families to co-pay card programs to curb the high cost of health insurance. Summary MHN demonstrates credibility by the use of expert advising board and links to creditable organizations which have done studies to support their mission. The site is easy to find on public search engines, easy to read for the lay person while giving links to more detailed information for the healthcare professional. References Calabro A 2010 Endhave your presensce on the internet with an improved website.Calabro, A. (2010). Enhance your presence on the internet with an improved website. O&P Business News, 19(12), 18. 201409201149291993026019 Mens Health NetworkMen’s Health Network. (n.d.). Retrieved September 15, 2014, from http://www.menshealthnetwork.org 201409161816071882827044 Miller L C Graves R S Jones B B Sievert M C 2010 Beyond Google: Finding and evaluating web-based information for community-based nursing practice.Miller, L. C., Graves, R. S., Jones, B. B., & Sievert, M. C. (2010). Beyond Google: Finding and evaluating web-based information for community-based nursing practice. International Journal of Nursing Education Scholarship, 7(1), 1-16. doi:10.2202/1548-923X.1961 201409201214161550333619

MKT 300 student as a products Essay Example | Topics and Well Written Essays - 500 words

MKT 300 student as a products - Essay Example I can be reached in confidence at the above telephone numbers or email address and I look forward to hearing from you. My Strengths are that I am quite creative, innovative and a hard worker. Strong commitment, focus, team player orientation, leadership skills and the ability to learn quickly are also some of my strong points. My Weaknesses include the fact that I find it very difficult to take ‘no’ for an answer, as regards to marketing, thus tending to strive to achieve the impossible sometimes Some Actions to Improve My â€Å"Marketability† include Formal Education/Courses and finishing an advertising course along with a formal course in designing and marketing communication. Job Experiences/Projects Completed includes my experience as a marketing intern and assistant with two leading service providers. I will also involve some Extra-Curricular/Volunteer Activities like getting involved with community, church and student activities. Obstacles to overcome include lack of experience in an actual corporate hierarchy. I intend to have my Resume critiqued, and to engage in Personal Interviews, and Letters/Telephone Calls. I will also Work on making my resume more impressive. I will go further to Learn about interview essentials, speech and body language. To work with the marketing team study customer profiling provide inputs to the design team that develops new products and schemes for the different market segment. Good analytical skills and research skills required. Present analysis on the researched market segment by collecting market samples. Must be innovative and creative and look to generate new areas for business. Graduated with a major in Marketing, Bachelors in Business and Management. A four or five year degree in Management with Marketing as major from a renowned university. Good academic record an added advantage. Good analytical

Shinto and Oral Religions Essay Example | Topics and Well Written Essays - 500 words

Shinto and Oral Religions - Essay Example Kojiki is one of the Japanese literatures that had successfully compiled the Japanese mythology and traditional Ancient of Japan including the Shinto Rituals. (Chamberlain, p. i) On the other hand, Nihongi or Nihon Shoki is one of the oldest classical books that tackled the Japanese history (Aston, p. xv). Similar to Kojiki, Nihon Shoki has a series of compiled myths and oral tradition that occurred back in the 8th century (ibid). Oral religion, based on the word ‘oral’, means that a religious practice of a particular religion has been passed on from one culture to another or from one generation to the next generation verbally. Aside from the Kojiki – the records of ancient matters and the Nihongi or Nihon Shoki – the chronicles of Japan which was written back in AD 712 and AD 720 respectively (Chamberlain, p. I; Sakamoto, p. 31), Shinto can be considered as an oral religion due to the fact that there are no other concrete scripture that can be used as a basis of such religion. Shinto is different from oral traditions because the practice of Shinto takes place in four different ways which including: (1) the Shine Shinto which means worship at a public or private shrine; (2) Folk Shinto which includes divination, shamanic healing, abstinence and other forms of purification customs; (3) Sect Shinto which includes the act of participating in one of the thirteen groups of the 19th century; and (4) the State Shinto which includes the act of participating in festivals as a way of honoring the Japanese emperors (Mosher, pp. 168 – 169). Even though there is a strong similarity between Shinto and oral religion, it remains a fact that Shinto can never be considered as an oral tradition due to the fact that the practice of Shrine Shinto, Folk Shinto, Sect Shinto, and State Shinto is being passed on from one generation to another generation based on the actual

Survey result section with pie charts Essay Example | Topics and Well Written Essays - 750 words

Survey result section with pie charts - Essay Example From the results, some teachers felt that direct instruction to the students either individually or in class was an effective method. The numbers were however less (12%) as compared the group the group that preferred a cooperative learning approach moderated by the teacher (76%). In this method the learners would choose the topic of their liking and research on it before teaching their fellow students. None of the teacher preferred thought it was a good idea for the learner to be left to acquire the knowledge alone. This would deny the learner a chance to have a different perspective of the concept like the peers. The case study results indicated that 65 percent of the teachers (15) preferred to resolve the situation by dividing the students into mixed groups and letting them assist each other in learning (Answer 1). Some 22% of the teachers interviewed (5) thought it suitable to teach the whole group at the pace of the slow learner (answer 2). The remaining 13% or 3 of the interviewed teachers thought that the teacher should divide the student according to ability and teach them differently (answer 3). None of the teacher interviewed thought that teaching at the pace of the high level learning ability students was beneficial. From the results, a majority preferred the approach of combining the higher level learning ability with the low level learning students. This means that the students could cooperate with each other to effectively acquire the knowledge from their peers better. It should be noted that it is difficult to determine the learning pace of the slow students. This explains the reason why the method of mixed ability grouping was preferred by the majority. Dividing the group into two was not proposed by many. This because it would be difficult to foster social leaning between the learners and how the learners would benefit from each other is not

Affirmative Action Policies Essay Example | Topics and Well Written Essays - 1750 words

Affirmative Action Policies - Essay Example Only in the late decades of the last century the federal government and the Supreme Court, Republicans and Democrats, and various human rights organizations implemented systematic approach to resolve the problem of discrimination in employment and education, but the results were usually inconsiderable. Racial conflicts and discrimination persisted as well as attempts to eliminate them. In the second half of the 20th century the latter were labeled as 'affirmative action' policies. The origins of these policies dates back to 1961, when President John F. Kennedy issued Executive Order number 10925 proclaiming the 'affirmative action' policy the central axis of the US employment and educational policies. The Civil Rights Act became the next step toward elimination of discrimination in the United States. After its approval in 1964, the necessity emerged to change a number of traditional policies and official procedures, such as seniority status and aptitude tests, which included discriminatory provisions. In 1965 President Lyndon Johnson signed his Executive Order number 11246 stating that all government contractors and subcontractors were obliged "to take affirmative action to ensure that applicants are employed without regard to their race, creed, color, or national origin". The order was immediately followed by a series of lawsuits that supported the policy of affirmative action. Thus, the Supreme Court ruling in Griggs vs. Duke Power Company case invalidated i ntelligence tests and several other discriminating criteria in employment. The newly created governmental institutions, the Office of Federal Contract, had to implement the order (Encyclopedia Americana, 1985: 241). The contemporary meaning of the term 'affirmative action' has not changed over years. The initial purpose of affirmative action also remained unchanged: elimination of racial, sexual, ethnic, disability, or any other discrimination. In 1996, President William Clinton defined affirmative action as "an effort to develop a systematic approach to open the doors of educational, employment, and business development opportunities to qualified individuals who happen to be members of groups that have experienced long-standing and persistent discrimination" (Clinton, 1996: 131). In the recent years the affirmative programs has become one of the most widely discussed domestic issues in the United States. A number of analysts tend to consider the affirmative action policy a very effective tool that significantly reduced discrimination against non-white and female population of the United States. However, there is also an opinion that the affirmative efforts have been nothing but a great illusion from the very beginning: the positive results were made up to justify huge sums of money spent on implementation of affirmative programs. Although both standpoints have seemingly strong arguments, it will be closer to the truth to state that affirmative action policies largely failed. Main Discussion First of all, there are credible data that demonstrates the increase in well-being of some representatives of racial minorities was achieved not at the expense of the white majority, but at the expense of other representatives of the same minority: "The civil rights movement, anti-discrimination

Strategic planning and control Assignment Example | Topics and Well Written Essays - 2000 words - 1

Strategic planning and control - Assignment Example Secondly, you need to realise how to purchases technology and design license. Finally, you must understand how to compare the results between our team and other teams, how to post the final decisions to the CESIM as well. After listening to the teachers explanations, I began to find a way to use CESIM. At the same time, I started to write down some notes about the steps to use the CESIM. After this lecture, I had a preliminary understanding on CESIM. I had a simple plan about how I should do in the first round in the game as well. Combined with the teacher said and I learned before, I thought the most important thing were to increase the production and adjusted the price to the appropriate areas. Although this game is virtualï ¼Å'on the one hand, it helped to practice our skills to use a suitable strategy and control our company. On the other hand, let us know much more about the accounting knowledge, for example we had known the relationship between the demand and supply through the game. The teacher explored growth strategies for businesses, focusing on what a business can do when a market has reached the maturity stage, in order to stay competitive. I learned about the different models that can be used in order to understand what factors would pose risks or opportunities for a business operating in a mature market. At first, the teacher proposed the TOWS Matrix which seemed to be a very simplistic method of examining the firm’s position. I assumed that a competent strategic manager would already understand the firm’s basic competencies and infrastructure without having to conduct such an analysis. However, to build better acceptance of this model, I tried applying it to a real-world organisation, Sony, which was struggling against competition in such a market. Through building a thorough TOWS Matrix for this company, I discovered some issues that I would not have originally considered. I conducted small-scale marketing

Identity among American Indians Essay Example | Topics and Well Written Essays - 1250 words

Identity among American Indians - Essay Example outdated practice as the quantum blood policy can be seen not only as a way for the federal government to reduce the number of Indians who are dependent on its support but also as a way of eventually forcing the dissolution of Indian tribal groupings in time and the eventual assimilation into the mainstream American way of life. In reality, the majority, if not all, the current Indians can be said to be of mixed blood to a certain degree. Miscegenation between European settlers and Indians began within the first century of European arrival in North America and has continued since then to modern times. Moreover, as the other racial groups came to America, they also inevitably mixed with the Indians. In the 2000 census more than 1.6 million American Indians reported descent from two or more races and at the beginning of the twenty first century, at least 40% of American Indians were of mixed blood. The lives of Indians is always complicated by the non Indian opinion of how the Indians should look and act because they are often envisioned as noble savages and are expected to look and act just the way their ancestors did during the time of the Pilgrims at Plymouth or as they are depicted in books and movies. What most people in America do not realize is that the Indians have developed and adapted to the modern world just as they themselves have and that their cultures today are not so different to be distinguishable. It is a fact that many of them live and work in the urban areas of America and that they are so well assimilated that it would be very hard to actually recognize them to be phenotypic Indians. A large number of Indians are marrying outside their own communities and in doing so, the number of mixed race Indians has also increased dramatically. This brings us... Some Indians identify very strongly with their native cultures and actively participate in them while others are all for the abandonment of their culture and see the adoption of mainstream American culture as the only way to secure their future. There are others who take a stand in the middle believing that the best course is to adopt the best from both Indian and American cultures and use them as a basis for their future. The majority of those who support the latter are mixed blood Indians who tend to identify with both cultures but are unable to comfortably fit within either culture. Most of the young unemployed Indians in the reservations would prefer to abandon their culture and go to the cities where they feel that there are better opportunities for them than in the reservations. There are however some Indians who have experienced mainstream American culture and have not found it to be fulfilling. This has led to their rediscovery of their native culture and their participation in it which has filled a void within them. In conclusion, it is my opinion that the current means of identifying and determining who can be considered an Indian and who cannot should be changed. It is my belief that all people with Indian blood, however minimal should be identified as an Indian because doing otherwise as it is being done today is very discriminatory. It should be remembered that no race in the world, whether red, black, white, or yellow, is genetically pure because over the ages, racial mixing has been inevitable.

John Sutter and the Western United States Essay Example for Free

John Sutter and the Western United States Essay During the mid-1800s, people were eager to explore most of the United States in search for a better place to live in. Those who came from Europe settled in most parts of the Eastern United States. But there are those who ventured further, going deeper into the West. One of them is John Sutter, born in Germany and of Swiss descent. He became a captain of the Swiss Army, and was driven away from his family because of debts, going to the United States to look for a greener pasture. According to Albert Hurtado in his book, John Sutter: a Life on the North American Frontier, John Sutter deserves to have a title of an entrepreneur. All his achievements were the product of his hard work and entrepreneurship (Hurtado). He roamed the United States by using these characteristics to earn enough money to fund his ventures. The Eastern part of the United States at that time were already populated, where trade and commerce is flourishing all over the place. He joined a trading venture to New Mexico, where he was successful enough, returning with wine, several mules and money. When he celebrated the Independence Day of 1839 in Monterey California, he met Governor Juan Bautista Alvarado. This meeting paved the way for a settlement grant of more than 48,000 acres of land for Sutter, the start of the monumental â€Å"New Helvetia Settlement† which pioneered American life in the Western United States. One of the few requirements for John Sutter to be awarded the land grant was to become a citizen of Mexico. This would give him thousands of acres of land where he can establish a pioneering settlement. In less than a year after becoming a Mexican citizen, he was awarded the vast lands in the central valley of California. In order to properly run this vast acreage of agricultural lands, he employed various Native Americans, as well as welcomed immigrants from different places. John Sutter’s Fort became a famous stop-over for those wishing to venture into new lands. With this account from Albert Hurtado’s book, we can see that the Western part of the United States at John Sutter’s time promises new beginnings to those who wish for a different life. The East was somehow been congested with various people migrating from other nearby countries. Because of this, some wanted, and even dared to explore other parts of the â€Å"foreign land† they have settled in. But not all parts of the west are conducive for living. In the account of John Bidwell, he describes most of the west especially California as â€Å"the country was brown and parched; throughout the State wheat, beans, everything had failed†¦cattle were almost starving for grass, and the people, except perhaps a few of the best families, were without bread, and were eating chiefly meat, and that often of a very poor quality† (Bidwell). This means that the west may promise a good life, but there are also risks in living there. It is still an uncharted territory for the migrants, and that they were all going to start from scratch. They have no clear idea on how to handle things at first, especially because they did not originate in the area. However, it is also filled with resources just waiting to be exploited. According to Bidwell, the place also has some good points, â€Å"there were no other settlements in the valley; it was, apparently, still just as new as when Columbus discovered America, and roaming over it were countless thousands of wild horses, of elk, and of antelope† (Bidwell). The Western part of the United States was truly a place of uncertainty, wherein you’ll have to risk everything if you choose to settle in the area. John Sutter was able to survive and was successful in establishing a settlement in the area. In a sense, we could say that Sutter was successful in taming the Wild West. Sutter’s Fort housed a number of people ranging from natives to settlers, even those who were lost in their way, and these people contributed well enough in cultivating the vast lands of the settlement. In a few years time, John Sutter became a major supplier of horses, cattle, and wheat (Doti). The Western United States became a melting pot of different cultures. These cultures blended well with each other despite of their differences. This is essential for the success of the settlement, where everyone has to do their part in order for their efforts to flourish. John Sutter bridged the gap between the settlers, the natives and even the bordering Mexicans. Sutter’s works not only gave rise to a new settlement, but also to a new world found in the West. This is a very important contribution in the history of the nation, as it expanded the country’s influence across the borders. The culture in the Eastern United States at that time was generally influenced by the countries which they came from. Most these are European countries that are why they have developed mixtures of various European cultures. On the other hand, the Western United States is not only a mixture of European cultures, but also accompanied by various customs of the Native Americans and the bordering Mexican culture. This diversity has proven great importance in the formation of the Western United States, because western settlements were the products of various cultures cooperating with each other in so that they would achieve peace and order in their respective communities. Works Cited: Bidwell, John. Life in California before the Gold Discovery. 1890. The Century Magazine. November 19 2007. http://www. sfmuseum. org/hist2/bidwell1. html. Doti, Lynne Pierson. John Sutter: A Life on the North American Frontier Book Reviews. 2006. Chapman University. November 19 2007. http://eh. net/bookreviews/library/1116. Hurtado, Albert L. John Sutter: A Life on the North American Frontier. 1st edition ed: University of Oklahoma Press, 2006.

External Factors Affect On Organisations | Case Study

External Factors Affect On Organisations | Case Study External factors have an immediate effect on an organizations planning. Marketing a product takes thorough planning. Managers organize ideas on where to market a product that provides benefits to other countries. Leading globalization can be difficult because other countries may not want to use a product they are unfamiliar with. Therefore, a thorough explanation of why a product would be beneficial in another country is very important (Moon, 2010). The cell phone for instance has brought forth much controversy. Rates, service areas for Internet, communication, contractual agreements, and a wide range of other issues have been broad topics for subscribers of cell phones. To control globalization, cell phone providers must have management teams that extend enough information about products to other countries to determine if the product is marketable around the globe (Moon, 2010). Information is organized through technology; via Internet so customers are better informed regarding price, and other vital information before purchasing. Innovative technology has brought forth social networking sites. Companies such as Google have created blog forums where customers can share thoughts about a product hence, making others aware before purchasing. 1.2.the needs and Expectations of stakeholders in orchid The board of Piramal Healthcare has approved the spin-off of the New Chemical Entity (NCE) from Piramal Life Sciences, reports CNBC-TV18. The unit will then be merged with parent. According to the company filing with BSE, shareholders will be issued one fully paid up equity share of Rs 2 of parent Piramal Healthcare for every four shares of Rs 10 held of Piramal Life Sciences. Investment in NCE research calls for sharper research focus, longer time horizon and higher risk appetite, said a press release. CNBC-TV18 had earlier reported about how Piramal Health is more poised to take the risks arising from the drug discovery business than Piramal Life Sciences. This demerger is expected to be completed in six months, Ajay Piramal was quoted as saying. Piramal hopes, ultimately, to re-absorb Piramal Life Sciences back into the company. According to CNBC-TV18, long-term strategies of the company include hiking capacity in active pharmaceutical ingredients segment and formulations business. 1.3. major changes taking place in the external environment it affects stretegy This process is most applicable to strategic management at the business unit level of the organization. For large corporations, strategy at the corporate level is more concerned with managing a portfolio of businesses. For example, corporate level strategy involves decisions about which business units to grow, resource allocation among the business units, taking advantage of synergies among the business units, and mergers and acquisitions. In the process outlined here, company or firm will be used to denote a single-business firm or a single business unit of a diversified firm. Once the firm has specified its objectives, it begins with its current situation to devise a strategic plan to reach those objectives. Changes in the external environment often present new opportunities and new ways to reach the objectives. An environmental scan is performed to identify the available opportunities. The firm also must know its own capabilities and limitations in order to select the opportunities that it can pursue with a higher probability of success. The situation analysis therefore involves an analysis of both the external and internal environment. The external environment has two aspects: the macro-environment that affects all firms and a micro-environment that affects only the firms in a particular industry. The macro-environmental analysis includes political, economic, social, and technological factors and sometimes is referred to as a PEST analysis. 2.1. Appropriate Tools to analyse Current business Plan What next? This is the question on the minds of the shareholders. We have drawn up a growth blueprint for the company, segregated into short and medium-term business drivers focusing on ramping up of the existing business verticals, creating front-end marketing organisations and entering new high-growth product segments. In the short term, we have identified key areas which will drive business growth for your company. We will cater to the API needs of Hospira and other global innovators in addition to our regular API and formulation sales in the emerging markets. We will strengthen our geographical presence in key regulated markets like the US, Europe and Japan. Currently, we are marketing around 10 products in the oral cephalosporins segment and 5 products in the NPNC (Non-penicillin, Non-cephalosporin) segment. Your company will further strengthen its product basket for catering to these markets. Our focus on acquiring front-end marketing companies possessing infrastructure, people, product registrations and approvals will augur well in the medium term. Our product pipeline in the regulated markets will be filled with our own molecules, ANDAs and in-licensed products. This will help us strengthen our product basket and maximise and internalise value which was earlier shared with our marketing partners. 2.2.Orchid Chemicals in its current market Since inception, your company established a strong foothold in niche therapeutic segments which are relatively uncluttered due to the inherent technical complexity. In doing so, your company grew in size and is now a global name in its operating domains. In recent times, your companys performance in the global and domestic markets could not translate into robust growth for the company and superior shareholder value creation. This was primarily owing to the sizeable debt burden which weighed heavy on your companys profitability. With the debt levels coming down and with a strong growth strategy in place, this is set to change going forward. My fellow shareholders may have a number of apprehensions about the future of the company 2.3.competitive strength and weakness e expect strong year-on-year growth over the next three years by focusing on the non-penicillin, non-cephalosporin (NPNC) segment where we possess a strong basket of over 73 products spanning diverse therapeutic areas. We possess marketing alliances in the US and Europe with prominent players such as Actavis, North Star and Alvogen for 31 NPNC products. We also expect to capitalise on Para IV opportunities; our 8 Para IV FTF filings provide a revenue potential of about US$ 80 Mn. A favourable outcome in any patent challenge litigation could result in our being awarded the 180-day exclusivity. 3.1. strategic options What next? This is the question on the minds of the shareholders. We have drawn up a growth blueprint for the company, segregated into short and medium-term business drivers focusing on ramping up of the existing business verticals, creating front-end marketing organisations and entering new high-growth product segments. In the short term, we have identified key areas which will drive business growth for your company. We will cater to the API needs of Hospira and other global innovators in addition to our regular API and formulation sales in the emerging markets. We will strengthen our geographical presence in key regulated markets like the US, Europe and Japan. Currently, we are marketing around 10 products in the oral cephalosporins segment and 5 products in the NPNC (Non-penicillin, Non-cephalosporin) segment. Your company will further strengthen its product basket for catering to these markets. 3.2. comparative understanding of an activity The performance of your company in the first quarter of the current financial year reflects the start of a robust growth journey. Going forward, your company is well poised to ramp up its API and formulations business based on specific product-market contracts and regulatory filings which will help spread the growth canvas wider. We entered into an out-licensing and distribution agreement with the US-based pharma major Alvogen for marketing 8 oral non-antibiotic generic formulations in the US market. These products cater to the high-growth therapeutic segments of CNS and osteoporosis, among others and have a cumulative addressable market size estimated at USD 8 billion. Your company also recently acquired Karalex Pharma, LLC, a US-based generic marketing and sales services company through an all-cash deal for creating a front-end presence in the US market to deliver generic products to the US customers directly. Karalex Pharma is a leading provider of generic pharmaceuticals, focused exclusively on the US healthcare market. 3.4. future organizational strategy Our focus on acquiring front-end marketing companies possessing infrastructure, people, product registrations and approvals will augur well in the medium term. Our product pipeline in the regulated markets will be filled with our own molecules, ANDAs and in-licensed products. This will help us strengthen our product basket and maximise and internalise value which was earlier shared with our marketing partners. 4.1. participation from all stake holders I take the opportunity to thank the Central and State governments, financial institutions, public and private sector banks, government agencies and non-government institutions for extending their support in your companys growth and development. 4.2. potential options for strategy plan I thank your companys valued business stakeholders namely vendors, customers, strategic alliance partners and business associates for their exceptional support during difficult times, in accomplishing our business plans. Most importantly, I acknowledge the critical role played by the employees whose contribution to your companys business growth has been paramount. On behalf of the Board, I would like to thank all the shareholders for their unstinted support in helping your company enhance its technological and business strengths and remain on the growth path. 4.3.strtegy plan includes resorce implication: n the API (Active Pharmaceutical Ingredients) segment, your company increased its cumulative US DMF filing count to 82. The break-up of the total filings is: 30 in the cephalosporin Segment, 39 in NPNC segment, 2 in the betalactam segment and 11 in the carbapenems segment. The cumulative filings of CoS (Certificate of Suitability) for the European market stood at 20 which includes 13 in cephalosporin segment, 6 in the NPNC segment and 1 in the betalactam segment. With a robust product development pipeline, your Companys filing and approval count is poised to increase in the coming months and quarters. 5.1. organizational Values: Most organisations are mostly driven by strategies. We are also driven by values. Corporate Social Responsibility Respect for the Individual Excellence Innovation Value for Stakeholders 5.2 vission and mission statements: Vision Enriching Lives through Innovation in Healthcare Mission Discovery to Delivery Orchid is a vertically integrated pharmaceutical company with established research, manufacturing and marketing capabilities across multi-therapeutic domains. We successfully leverage our penchant for science and technology to create niche products and manufacturing platforms leading to attractive growth. 5.3. Future Management Objrctive: Innovation drives growth. Sensitive to market needs and committed to innovation, here at Orchid we focus on niche product manufacturing platforms, combining cutting-edge technology and the best minds in the business. Valuing People We value individuality and creativity. Our unique People and Process Paradigm helps achieve the twin objective emphasis on regulatory and compliance on one hand, while fostering innovation and creativity on the other. Peak Performance We seek to build a sustainable organisational eco-system where one is constantly motivated to attain new heights and empowered to discover new avenues for growth. Quality Quality has always been a strong part of Orchids proposition. Our quality initiative covers all aspects including product quality, operational quality, environmental quality and finally a good quality of life for our people. Harmony with Society We seek to balance environmental impact and economic interest in all our business activities. Committed to the development of the society, culture and economy, we dutifully observe laws; demonstrate high ethical standards and endeavour to preserve the environment. 5.4. Evaluating Stretegy Plan Government: It has the mechanics to receive and document the needs of society. It also has the legislative and administrative power to take forward development programs. Industry: It has the strength of technology and managerial skills required to identify solutions and execute projects in a time-bound manner. NGOs and other Institutions: They penetrate deep into the community to propagate ideas and act as a vibrant feedback mechanism. We have always believed that enhancing the social well-being of individuals would add a lot more meaning to our overall business existence. Caring for the people and the community has therefore been an important facet of our business philosophy. We are happy that we have influenced the lives of several people in the vicinity of our facilitates through the several initiatives and programmes undertaken by the Trust. 6.1. Schedule for implementing stretgic planning Our oral non-cephalosporin formulations facility specialises in the manufacturing of nutraceutical products. The facility produces a range of dietary supplements for the advanced markets. Many other high-value products like anti-diabetics, cardio vascular drugs (CVS), anti-depressants and anti-epileptics are manufactured in this facility to cater to the emerging markets. 6.2. To gain commitment from stake holders We have a long tradition of successful collaborations. Our approach to partnerships has been path-breaking and successful in the Indian pharmaceutical industry in terms of product and market coverage and leveraging each others partnership strengths. They are an essential and integral part of our research and business strategy. Every day, we commit ourselves to aligning our capabilities with business opportunities and everything we do is based on being easy to work with to ensure mutual success. We continuously engage in new projects to aid technology development, development of new molecules, chemical process enhancement and innovative drug delivery systems development 6.3.monitoring the evaluation system for the implementation of a strategy plan rchid has emerged as a full-fledged pharmaceutical corporation with end-to-end connectivity from discovery to delivery. Each alliance we build is based on a shared vision with well-defined goals and objectives. We have the ability to leverage and represent our entire portfolio of products and services based on their core competencies, partner great models, build and sustain operations. By pooling the talents of our science and business teams, we have engaged in numerous collaborations with a range of companies and research institutions. We look to build upon our existing strengths as well as to create new areas of expertise. Lab Report: Heat Capacity Ratio For Gases Lab Report: Heat Capacity Ratio For Gases Jekathjenani Ratnakumaran Introduction: Heat capacity of gases is the amount of heat required to increase the temperature of one mole of the gas through one degree Celsius at constant pressure or volume. Heat capacity at constant pressure (Cp), the volume will increase and heat capacity at constant volume (CV), the pressure will increase. The main physical properties of gases are compressed in the state, expand themselves to fill the entire containers, and thus obeys the second law of thermodynamics. It occupies more space, compare to liquids and solids. Gases has no fixed shape. The physical state of the gases can be defined by, PV = nRT P- pressure of the gas, V- Volume of the gas, T- Temperature of the gas, n- number of moles of the substance present on the gas and R- Gas constant. The purpose of this study is to determine the value of the heat capacity ratio, ÃŽ ³ = Cp/CV for giving gases such as argon, oxygen, nitrogen and nitrous oxide using adiabatic expansion. This experiment is mainly based on measuring the pressure of the gases. Pressure can be measured by the force applied by the collision of the molecules or atoms with the surface or the walls of the tube. Pressure is measured in psi (Pounds per Square Inch) unit using manometer (P.Atkins et al, 2008). At room temperature, nitrogen is a colorless diatomic molecule of gas. It occupied 78.09% of earths atmosphere. Nitrogen occurs in all living organisms and about 3% of nitrogen are available in human body. Similarly, oxygen is a colorless, diatomic molecules and occupied about 20.95% earths atmosphere. Its a highly reactive organic element and also it plays an important role in the respiration mechanism. Argon is another important gas, also called as inert gas as it is stable. It occupied about 0.93% of earths atmosphere and its colorless, nontoxic element. Nitrous oxide is a colorless, nonflammable gas and also known as laughing gas. It also takes place in the earths atmosphere as it is produced by the bacteria in the soil and ocean. Adiabatic expansion is the process which takes place with no transfer of heat between the system and surroundings. The ratio, ÃŽ ³ will be compared with the theoretical value. Using the adiabatic expansion, three states of gas such as before the expansion (P1), immediately after expansion (P2) and after returning to room temperature (P3) can be observed. Based on these values, the heat capacity ratio can be determined. The ratio of heat capacity can be calculated using the following formula, ÃŽ ³ ratio of heat capacity Cp- heat capacity at constant pressure Cv- heat capacity at constant volume Methods: This experiment was conducted by following the procedure given in the laboratory manual by the department of chemistry, Trent University. Related questions Answers: Ideal gas law, PV = nRT As the density, Ï  = m/V, the density can be calculated using the above equation, Ï  = PM / RT P = Pressure; M = Molar mass; R = gas constant; T = Temperature For Nitrogen, P = 14.476 psi = 1.018 kg/cm2 T = 22 0C = 295 K M = 0.028 Kg /mol R = 8.314 Jm3/Kmol = 84.784 x 10-6 m3 kg/cm2.K-1mol-1 Using the above calculation method, density of remaining gases was calculated. For oxygen, Ï  = 1.301 Kgm-3 For argon, Ï  = 1.595 Kgm-3 For nitrous oxide, Ï  = 1.790Kgm-3 PV = nRT P = 14.550 psi = 0.9900 atm V = 30 L R = 0.08206 Latm/Kmol T = 295K n = 1.227 mol Molecules = n x 6.022 x1023 = 7.389 x 1023 molecules the carboy holds under prevailing laboratory conditions. For nitrogen, Collision frequency of molecules of nitrogen can be calculated using the following formula, N = 6.022 x 1023/ mol A = 0.60 m2 P = 0.985 atm = 99808.5066 pa R = 8.314 J/K mol = 8.314 Kg m2 /s2 K mol M = 28 g / mol = 0.028 Kg/mol T = 295 K Z = 1.736 x 1027 s-1 Results: Table 1 represents the observations and reading of pressure obtained for the Argon, Oxygen, Nitrogen and Nitrous Oxide. The unit of pressure is recorded in psi. Figure 1 represents the heat capacity ratio of the given gases: nitrogen, Oxygen, Argon and Nitrous Oxide. Data Analysis Calculations: For Nitrogen: ÃŽ ³1 = 0.02773 / 0.02111 = 1.3134 Mean value Nitrogen, ÃŽ ³ = (ÃŽ ³1 + ÃŽ ³2 + ÃŽ ³3) / 3 = (1.3134 + 1.2476 + 1.2834) / 3 = 1.2814 Discussion: The experiment was conducted with careful consideration to get the result as close as to the real value. However, due to the some experimental error involved in this experiment, the calculated values are not close to the literature value. The calculated heat capacity ratios for the given gases: nitrogen, oxygen, argon, and nitrous oxide are 1.2815, 1.0248, 1.4268, 1.0163 respectively. The literature heat capacity ratio values are 1.4000 (nitrogen), 1.6667 (argon), 1.4000 (oxygen) and 1.3100 (nitrous oxide) (P.Atkins et al, 2008). Figure 1 represents the heat capacity ratio of the given gases. Based on the graph shown on figure 1, heat capacity ratio of oxygen and nitrous oxide are lower than the nitrogen and argon. In comparison with the literature value, nitrogen and argon are closer to the calculated heat capacity value. However, the calculated percentage error is 8.46% and 14.4% respectively. In the case of oxygen and nitrous oxide, calculated value more deviated from the literatu re value and the calculated percentage error are 26.8% and 22.42% respectively. These differences between the calculated and literature value heat capacity ratio value occurred due to the experimental error. Equipments used in this experiment were used by the previous batch. As the experiment was conducted using the pre setup equipments, there might be an error in the flow of gases through the tubes. Due to these occurrences, there might be changes in the pressure. Since the flow rate of gases are in larger amount, it could have heavily affected the final results. Gas leak is one of the major concern which lead to decrease in pressure and affected the result. Moreover, the adjustment made at the flow rate of gases also might be lead to the error in the heat capacity value. As the digital manometer is open ended to the atmosphere, there might be an error due to the unstable atmospheric pressure. Furthermore, due to the weather condition (winter), temperature and pressure changes and might not favored to conduct the experiment. Conclusion: In conclusion, the heat capacity ratio of nitrogen, oxygen, argon and nitrous oxide were calculated using the adiabatic expansion. In order to get accuracy of result, the precision can be improved by more attention on the experimental procedure and handling the equipments. Also, accurate result can be made by observing the measurements such as notifying the pressure of gases and units in a proper manner. References K.Lunder et al (1999); Heat Capacity Ratios For Gases: The Sound Velocity Method, Physical Chemistry 301, Augustana College P. Atkins and J. de Paula, Atkins’ Physical Chemistry, 8th ed., W. H.Freeman and Co., New York (2006).

Reliability And Validity Assessment

Reliability And Validity Assessment What forms of reliability and validity do Grogan et al. (2000) establish for their patient satisfaction questionnaire (PSQ) measure? Briefly (one paragraph each) review the forms established. 1) Grogan et al.s (2000) chose an internal reliability to check for the consistency or inconsistency of their inter-subscales.   They performed Cronbachs alpha analysis to measure the correlation of each subscales on the general satisfaction subscale. The results showed a high level of correlation coefficient, which range between .74-.95, indicating that the subscales are internally reliable. Using internal reliability (Cronbachs alpha) is efficient and most widely used, however, the expression of its result could only be in terms of consistency and inconsistency. Moreover, the Cronbachs alpha allows items to be discarded from the analysis just to get a better alpha value (Vehkalnti, 2004). Furthermore, the present result showed a strong alpha value of doctor subscale (.95), therefore, it is reasonable to exclude doctor subscale from the five-factor domain, since it is very similar to the general satisfaction subscale. 2) Grogan et al. (2000) chose an internal validity way of assessment (focusing on the inference from the cause and effect of a variable on another variable). Grogan et al. used a construct validity test by using the Confirmatory Factor Analysis (CFA), the Pearsons product moment correlation (PPMC), and the Analysis of Covariance (ANOVA). The CFA was used to identify the approximate closeness of the 40 items to fit on the appropriate factor of the five-factor model (doctors, nurses, access, appointments, and facilities), which was suggested to embody patients satisfaction. The result showed a low value of   measure and high value of non-normed fit index (NNFI), which indicated that the items were having a good fit with the five-factor model. The PPMC test was used to look at the correlation of the subscale on the general satisfaction subscale. The result showed a positive significant correlation, which means ANOVA was used to compare the five different subgroups (patients divided ac cording to age) on the 46-items satisfaction scores. The results showed a significant difference of age group, with a greater satisfaction of older patients on the service provision, than younger patients. Construct validity is widely use because its relevant and clear measurements, but the present study did not measure a low correlation scores of items to indicate that the items were irrelevant. Moreover, construct validity is also subjective (in terms of judging the items, where the researchers believe that the items measure what they suppose to measure). Also briefly review other forms that might be established and how this might be achieved. 1) Test-retest reliability might be another good way to test for reliability of items measurements. This can be done by giving the questionnaire to the same respondents (patients) at different occasions, preferably three months after the initial test (Kline, 1993). The correlation of scores between the two tests can be compared. If the correlation coefficient is high, this means that the questionnaire (the subscale items) are reliable and consistence. This can be done by analysing the Cronbachs alpha value, which needs to be greater than .70 to be reliable but not greater than 1 (preferably not greater than .95). Moreover, test-retest should not only be carried out to the patients who had full respondent rates but also to those who had partially respondent rates (17% of the patients), just to check the presence of any specific group of patients that might think the questionnaire was not reliable to them. 2) Alternate-form of reliability can be used to assess reliability of the items, which can be done by using a different wording for each of the items (but having the same meaning) to measure the patients satisfaction based on the five-factor dimensions. According to Litwin (1995), the items created should not be identical but similar to each other, and the test should be his should be given to the same patients at different times. The correlation between their scores will show the reliability of the measurement of the questionnaire. By looking at Cronbachs alpha, high correlation of the items indicates high consistency of measurement. 3) Interobserver reliability is a method that can be used to find how well the inter-subscale is (Litwin, 1995), which measures how the five-factor domains agree with the 46-items questionnaire, by allow the professionals from each domains (such as the doctors, nurse, people who responsible for the environment factor, people responsible for the access factor, and people who are responsible to provide the facilities) to answer the questionnaire to assess their own satisfaction of the service provision. The data can be analysed by using Pearsons correlation to find out the correlation coefficient of the items and the satisfaction. High correlation indicates higher reliability of the subscale. 4) External ways of assessing the validity would be good to mentioned, in which the inter-subscale can be generalized across different patients, places and times. This can be achieved by doing a sampling model and proximal similarity model approaches, in which the questionnaire is first distributed to a sample population, then to its nearby population, and lastly to the outside population. The analysis of scores from these populations can be done by using ANOVA, and the significant correlation can be revealed. If their correlation is significant (p 5) Criterion validity is a good way of analysing the researchs validity as poor criterion tests would lead to inefficient technique of measurement. It has two major forms: predictive validity and concurrent validity. The predictive validity can be applied to find out how well the service of general practitioners could predict the patients satisfaction in the future. This can be done by asking the five domain factors (doctors, nurses, etc) and the patients to fill in the questionnaire separately. Then, the scores will be calculated by factor analysis (CFA) to see if the domain factors fit with five-factor model and by the PPMC to see the correlation on satisfaction. If the domains score fits with the model and have high correlation coefficient, this could predict that the patients score would also be similar. In contrast, concurrent validity cannot be applied because it could not be compared to the gold-standard questionnaire of patients satisfaction as it was none. 6) Content validity can be addressed in terms of finding how adequate the items are to reflect its domain. This can be examined by using CFA, in which it is to find the proximate knowledge of the items adequacy (i.e. to know which specific five-factor domain was the item belongs to). 7) Method bias to measure the present of any biased items in the questionnaire. This can be done by using logistic regression. The items are considered to be biased if they have characteristics that only allow the respondent to give a certain answers, bias to the aim of the study. REFERENCES Carmines, E. G. Richard, A. Z. (1979). Reliability and validity assessment. London: Sage. Grogan, S., Conner, M., Norman, P., Porter, I. (2000). Validation of a questionnaire measuring patient satisfaction with general practitioner services. Quality in Health Care, 9, 210-215. Kane, T. M. (2001). Current concerns in validity theory. Journal of Educational Measurement, 38(4), 319-342. Kerlinger, F. N. (1986). Foundations of behavioural research. London: Holt, Rinehart and Winston. Kline, P. (1986).   A handbook of test construction.   New York: Methuen. Kline, P. (1993). The handbook of psychological testing. New York: Routledge. Litwin, M. S. (1995). How to measure survey reliability and validity. London: Sage. Loewenthal, K. M. (2001). An introduction to psychological tests and scales. Hove: Psychology press . Rubin, H. R., Gandek, B., Rogers, W. H. (1993. Patients’ ratings of outpatient visits in different practice settings: Results from the medical outcomes study. Journal of the American Medical Association, 270, 835-840. Vehkalahti, K. (2000) Reliability of Measurement Scales. Retrived November 18, 2009, from  http://ethesis.helsinki.fi/julkaisut/val/tilas/vk/vehkalahti/

Outlaw by Scott McGough :: essays research papers

Outlaw, by Scott McGough tells 2 people’s stories and their adventures through the plane of Kamigawa and how they are tied with the war against the kami (spirits). Toshiro Umezama, a rogue mage-ochimusha (dishonored warrior), has been traveling with his fellow oath-brother Kobo, an ogre, through the forest, when they accidentally found themselves in a party of kistune (foxfolk) and humans. Michiko Konda, daughter of the daimyo (powerful feudal lord), left the walls of her kingdom and traveled to a great library in the wizard school, Minamo. When she was separated from her friends, she found herself lead by a foxfire to a kistune city where her sensei, Pearl-Ear was visiting. Sharp-Ear, Pearl-Ear’s brother, Pearl-Ear, 3 kistune samurai, Michiko, and her 2 friends traveled into the forest to search for the secluded orochi (snakefolk), known for their distrust of anything of the outside world.   Ã‚  Ã‚  Ã‚  Ã‚  When Toshi and Kobo ran into Michiko’s party, they talked for a short while, and they were attacked by the orochi. The parties fought well, but were defeated and captured. Toshi escaped and found Kobo dead tied to a tree. He rescues Michiko and flies away on a battle moth. West of the forest in a cave, Toshi holds Michiko for ransom, but he is met by the little Mochi, the Kami of the Cresent Moon. He showed the two the reason for the kami war: Daimyo Konda took a powerful kami from the spirit world and used Michiko’s birth to power the ritual to bring it into the material world. When the two learned this, Toshi decided to be employed to Michiko and promise to help her (with correct pay of course). The rest of Michiko’s party escaped the orochi territory, and tracked the ochimusha to the cave and were followed by the snakes. While the kistune were trying to get Toshi out, Mochi brought out the patron spirit of darkness: Myojin of Night’s Reach to get Toshi to accept its blessings. As he did, he went out of the cave, killed the snakes and their patron spirit, Myojin of Life’s Web, on his own, with the help of the blessing of the patron of darkness. Outlaw by Scott McGough :: essays research papers Outlaw, by Scott McGough tells 2 people’s stories and their adventures through the plane of Kamigawa and how they are tied with the war against the kami (spirits). Toshiro Umezama, a rogue mage-ochimusha (dishonored warrior), has been traveling with his fellow oath-brother Kobo, an ogre, through the forest, when they accidentally found themselves in a party of kistune (foxfolk) and humans. Michiko Konda, daughter of the daimyo (powerful feudal lord), left the walls of her kingdom and traveled to a great library in the wizard school, Minamo. When she was separated from her friends, she found herself lead by a foxfire to a kistune city where her sensei, Pearl-Ear was visiting. Sharp-Ear, Pearl-Ear’s brother, Pearl-Ear, 3 kistune samurai, Michiko, and her 2 friends traveled into the forest to search for the secluded orochi (snakefolk), known for their distrust of anything of the outside world.   Ã‚  Ã‚  Ã‚  Ã‚  When Toshi and Kobo ran into Michiko’s party, they talked for a short while, and they were attacked by the orochi. The parties fought well, but were defeated and captured. Toshi escaped and found Kobo dead tied to a tree. He rescues Michiko and flies away on a battle moth. West of the forest in a cave, Toshi holds Michiko for ransom, but he is met by the little Mochi, the Kami of the Cresent Moon. He showed the two the reason for the kami war: Daimyo Konda took a powerful kami from the spirit world and used Michiko’s birth to power the ritual to bring it into the material world. When the two learned this, Toshi decided to be employed to Michiko and promise to help her (with correct pay of course). The rest of Michiko’s party escaped the orochi territory, and tracked the ochimusha to the cave and were followed by the snakes. While the kistune were trying to get Toshi out, Mochi brought out the patron spirit of darkness: Myojin of Night’s Reach to get Toshi to accept its blessings. As he did, he went out of the cave, killed the snakes and their patron spirit, Myojin of Life’s Web, on his own, with the help of the blessing of the patron of darkness.

Puritan Values in America Today Essay -- essays research papers

Purely Americans The Puritan people migrated to what is now present-day America due to their persecution in Europe. Their religion observed many beliefs that did not agree with other European Christians. These ideals stayed with the Puritans as they settled in America to build their idealistic, utopian society. Even though Puritan society was largely unsuccessful in meeting their expectations, several of their fundamental values are still exemplified by Americans today. These beliefs included the dislike of anything dull, an intense hatred of tyranny, and the idea that America is a shining example for the rest of the world to follow. The Puritans left no room in their lives for idleness of any kind, they strongly believed unoccupied hands were tools of the devil. A vast majority Puritans also had virtually zero patience for what they presumed to be ignorant people. Powerful attention grabbing speeches were delivered about avoiding idle people and being unoccupied themselves. Subsequently, Modern America also hates to be bored, there is a continuous need to be entertained. ...

Islam Is the Way of Life Essay

Thank yuo Mrs. Chairman. Well, good morning everyone. I would like to utter my very first salam to the honourable judges, respected teachers and fellow friends. My name is Noor Husna Bt. Ahmad Toha and I’m from the red team. The reason why am I standing here today is to give a speech entitled â€Å"Islam is the Way of Life†. First and foremost, I believed that each one of us had already heard the phrase â€Å"Islam is the Way of Life† quite often but what does it really means? So today, let’s make ourselves clear with it. Teachers and students, Islam guides from the cradle to the grave. It guides us in all aspects of life rather than just prayer and worship. The way of life of Prophet Muhammad P.B.U.H is the way of life of Islam. His 24 hours of life is the perfect model for the people to follow until the Dooms Day. His way of speech, dresiing, his dealing with the wives, children and people in general, his sitiing, walking, sleeping, eating and even his way in the lavatory are model to us. His dealing as the ruler of the Islamic nation, as the judge, as the commander in chief of army, as the head of the family are examples to follow. Prophet Muhammad had once said, â€Å"I have left two things with you which if you hold onto, you shall not misguided; The Book of God and my example. Humans are made to obey The Creator. Following the Sunnah are one of the many ways to show our devotion to Allah, and the most important is surely to be gracious and respectful to Allah’s Messenger as stated in the Holy Quran in the first sentence of Surat Al-Hujurat which means, â€Å"O you who believe, do not put yourselves forward before Allah and His Messenger, but fear Allah: for Allahis He Who hears and knows all things. We can see a lot of scams in the business nowadays which is very contrary to what has been taught to us by the Prophet. It is a compulsary to us to be fair and honest in trading. Deceiving is completely forbidden. Cheating in business does not benefits anything but it is more likely to gives bad effect to our own life.