The Main Influences On Gestalt Psychology - 757 Words

d reflection on the main influences on Gestalt psychology and how they contributed to its development. Since being discovered, gestalt psychology created vital contributions to the psychology of thinking and problem solving influenced by thinkers, including, Immanuel Kant, Ernst Mach and Johann Wolfgang von Goethe. This paper will reflect on the main influences on Gestalt psychology, their contributions, and the principles of perceptual organization. According to the Merriam-Webster, the definition of gestalt psychology is: the study of perception and behavior from the standpoint of an individual s response to configurational wholes with stress on the uniformity of psychological and physiological events and rejection of analysis into discrete events of stimulus, percept, and response One of the main influences on Gestalt psychology , and their ideas influenced the later development of cognitive psychology. The gestaltists argued that understanding mind and behavior could not be achieved by trying to dissect conscious experience into its sensory elements, or by reducing complex behavior to elementary stimulus-response units. Rather, their emphasis was on phenomenologically whole experiences, and before long their movement came to be identified with this catch phrase: The whole of an experience is greater than the sum of its individual parts. Three german gestalt pioneers emigrated from Europe to the US, Max Wertheimer, Kurt Koffka, and Wolfgang Hohler.Show MoreRelatedThe Theories Of Gestalt Psychology1503 Words   |  7 PagesDevelopment of Gestalt Psychology Phrases such as â€Å"seeing the forest from the trees† and â€Å"the whole is greater than the sum of the parts† have roots grounded in the same ideals of Gestalt psychology. These phrases best describe the purpose of Gestalt psychology in how they emphasize focusing on the big picture and not just the colors. The Gestalt concept of perception is how the mind understands the world around it by seeing it in whole forms, not simple elements. The human brain and consciousnessRead MoreGeslalt Psychology1501 Words   |  7 PagesGestalt psychology means unified whole. Gestalt psychology does not look at things as individual elements but as a whole. The three main founders who established the school of gestalt psychology were Max Wertheimer, Kurt Koffka as well as Wolfgang Kohler. The foundations of the Gestalt psychology are perception, memory and learning. Some of the principles of Gestalt psychology are isomorphism, productive thinking as well as reproductive thinking w hich will be elaborated in this essay. One of theRead MoreGestalt And Humanistic Modes Of Thought800 Words   |  4 PagesGestalt and humanistic modes of thought share the idea that people have free-will and are able to make their own choices in life; also, a high importance is placed on a person’s experiences and personal viewpoint (Hergenhahn Henley, 2014). Phenomenology, or the introspective analysis of whole conceptual experiences, features prominently in both ideologies (Hergenhahn Henley, 2014). Another shared viewpoint is that human beings are unique, and as such there is a limit to what can be learned fromRead MoreThe Physiological And Psychological Workings Of Emotions1592 Words   |  7 PagesHappiness for People Who Can’t Stand Positive Feeling, said, in a blog, that no one actually has a clue what an emotion really is. However, there are theories attempting to define what an emotion is, starting with behaviourism and Gestalt psychology; two of the main schools of thought that have attempted to define an emotion. In the Stanford Encyclopaedia of Philosophy, behaviourism is said to ‘promote the scientific study of behaviour’ , particularly that of individual persons and animals ratherRead More Empiricism and Behaviorism Essay1384 Words   |  6 Pagesthe twentieth century, the field of Psychology found itself in a war between two contending theoretical perspectives: Gestalt psychology versus Behaviorism. With its roots within the United States, behaviorists in America were developing a theory that believed psychology should not be concerned with the mind or with human consciousness. Instead, behavior and the actions of humans would be the foremost concern of psychologists. Across the Atlantic, Gestalt psychology emerged by placing its criticismRead MoreSchool of Thought1108 Words   |  5 PagesPage1 When psychology was first established as a science it separated from biology and philosophy, the debate over how to describe and explain the human mind and behavior began. The first school of thought, structuralism, was advocated by the founder of the first psychology lab, Wilhelm Wundt. Almost immediately, other theories began to emerge and vie for dominance in psychology. The following are some of the major thought that have influenced our knowledge and understanding of psychology: StructuralismRead MorePananaliksik Sa Filipino797 Words   |  4 PagesGestalt Psychology Gestalt psychology[-0] is a school of psychology based upon the idea that we experience things as unified wholes. This approach to psychology began in Germany and Austria during the late 19th century in response to the molecular approach of structuralism. Instead of breaking down thoughts and behavior to their smallest elements, the gestalt psychologists believed that you must look at the whole of experience. According to the gestalt thinkers, the whole is greater than the sumRead MoreDescartes Influence on Psychology926 Words   |  4 PagesDESCARTES INFLUENCE ON PSYCHOLOGY Descartes Influence on Psychology DESCARTES INFLUENCE ON PSYCHOLOGY Renà © Descartes was a famous French mathematician, scientist, and philosopher throughout the mid 1600’s. He is often regarded as the father of modern philosophy; however, his highly influential ideas have also impacted many other scientific fields, including the world of psychology. Descartes contributions in philosophy and biology have had a significant influence on modern psychology. He introducedRead MoreScientific Principles Of The Work Of Wilhelm Wundt Essay966 Words   |  4 Pagesthe work of Wilhelm Wundt; this will be done through looking at his approach to psychology, his lab and the impact he had on psychology in general. The essay will then consider the Gestaltists approach to psychology by looking at their main beliefs, experiments and their legacy and link it to the scientific principles. Finally, it will summarize the influence both Wundt and the Gestaltists had on establishing psychology as a science. Scientific principles describe the steps of psychological researchRead MoreAdlerian Therapy and Gestalt Therapy: A Compare and Contrast4370 Words   |  18 PagesCompare contrast Adlerian Therapy and Gestalt Therapy Introduction This paper will carry out a comparative analysis of the two most important psychological therapies, the Adlerian Therapy and the Gestalt Therapy. Adlerian Therapy This therapy was named after Alfred Adler. Some of the main components of a person that are taken into consideration by the therapy include concepts of inferiority, superiority held by a person, social interests, likes and dislikes, lifestyles, priorities and birth

A Study of the Modernism Elements in William Faulkners...

Introduction At first talking about the author can be essential to go through the topic. William Faulkner was born in New Albany, Mississippi in 1897. He became Famous from the set of novels that explore the South’s historical legacy, fraught and violent present. His works are usually rooted in his fictional city in the county of Mississippi, Yoknapatawpha. This setting which was the microcosm of the south he imaginarily knew it very well. He could look into as binoculars which he could go through the society and people. He was particularly interested in the moral implications in the history. It - â€Å"A ROSE for Emily†- was first published on April 30, 1930. This is the time of the high modernism with the rise of its elements. Faulkner once†¦show more content†¦The narrators talks about the conflict between Emily and the â€Å"new generation† on the tax notices they send and she is not willing to pay due to theColonel Sartoris, the town’s previous mayor who suspended Emily`s tax after her father`s death, because once he had loaned to the city. In the next section, it is flashbacked thirty years ago. The time when her father has already dead and she has just abandoned by her beloved man. In section three and four, after her father`s death, the summer after. She was sick for a long time. The streets were being paved by new contracts with a northerner, Homer Baren who was Emily`s beloved. She poisoned and murdered him. Many years passes until her death. And in the last section, it is the funeral ceremony taking place and after when the secret is revealed after forty years when Homer was disappeared.According to Schwab, William Faulkner told the story after Emilys death in a series of flashbacks to show time standing still for Emily.The narrator seeks through the character`s mind and shifts the sign as an element of a modernism text. Another remarkable form of writing which is significant form of modernism text is the use first person narr ation while it is not usually seen in the traditional ones. Of investigating the theme of the story – tradition versus change – it can be discussed about the monuments represented in the story. When Emily dies the whole town went to the funeral of a

Counseling Ethics Doctor Susan Lim

Question: Write about theCounseling Ethicsfor Doctor Susan Lim. Answer: Introduction The moral theories assist a person in making judgment regarding the right or wrong actions. In the recent years, several moral theories have emerged which assist a person in determining whether an action is morally correct or not. In certain situations, moral dilemma arises where taking a specific course of action can result in harm to some other people, whereas taking another course of action can result in harm to some other people. In this regard, a person can take help of moral theories to take ethical decisions. In professional practices, it is important to maintain ethical behavior in order to maintain the integrity of the profession. Several accreditation societies follow stringent have implemented stringent rules in order to maintain the integrity of the profession. In this regard, it is important to take into consideration the moral theories and adopt a specific morality framework so that a person chooses the best action in case of ethical dilemma. In this regard, the present essay evaluates the case of Doctor Susan Lim and her ethical dilemma. Her ethical decision is defended using deontological moral theory. In addition to it, a decision making framework is proposed which can assist the doctor in future decisions. The Ethical Dilemma of Doctor Susan Lim Susan Lim is one of the most prominent doctors in Singapore. She handled the case of breast cancer of the sister of Queen of Brunei. The sister was admitted in her hospital and she provided all the care to the patient. Later, the Royal Family of Brunei accused her of charging high fees. When she realized that the Singapore Medical Council and the Brunei royal family are accusing her, Doctor Susan Lim faced the ethical dilemma of whether she should reveal confidential information related to the royal family and their relations with the Brunei government (John Harding, 2011). In order to defend her situation, she needs to reveal sensitive information which can impact adversely on other stakeholders (Broad, 2000). Different Stakeholders in the Ethical Dilemma The stakeholders can be identified as all those people who will be affected by the decision of the Doctor. In the below section, the major stakeholders are identified: Doctor Susan Lim She is the primary stakeholder of the case. She provided services to the patient and obtained training and facilities so that the patient can be provided with excellent treatment. Later, she charged fees from the patient according relative to the services provided to her. However, she was accused of high fees which resulted in a case against her. In order to present her defense, she needs to reveal information which will damage the repute of her patients family. If she will not reveal it, it will make her defense week. Singapore Medical Council The Singapore Medical Council (SMC) is a statuary board which regulates the professional conduct and ethics of the medical practitioners. It develops the guidelines for the medical practitioners for ethical conduct (Singapore Medical Council, 2017). Susan Lim overcharged her client which is breach of the ethical guidelines of the organization. Royal Family of Brunei In the present case, the victim is the royal family of Brunei. The family was heavily charged. The fees imposed upon the family were very high in comparison to the services offered. Getting influenced by the wealth and affluence of the family, she hikes her service charges. Moreover, when she faced charged for overcharging, she also tried to exploit the vulnerable relations of Brunei government and the royal family. 8-Step Decision Making Model Ethical decision making is an important part of a professionals life. While confronted with the ethical dilemma, it is important to follow guidelines so that minimum stakeholders are negatively affected with the ethical dilemma. In this situation, 8-step ethical guide is proposed to assist the doctor in taking the best fit decision. Gather the Facts: In this phase, an individual should obtain all the facts and information related to the case. Moreover, it is important that all the possible alternatives and their impact on the stakeholders are examined. The doctor should also examine the extent of impact on different stakeholders for ethical decision-making. In the present case, the stakeholders are Brunei family, Doctor Susan Lim and Singapore Medical Council. If Doctor Lim exposes the vulnerable relations between Brunei Family and government, it will spread bad name for the family and the government. Moreover, this information is not directly linked with the case; therefore, it is not sure that it will be positive for the case. Definition of the Ethical Issue: In this phase, an individual or organization needs to define the ethical issue or dilemma. In the present case, the ethical dilemma for the doctor is that whether she should reveal the information related to the vulnerable relations between the Brunei Government and the Royal Family. If she will reveal the sensitive information, it will do potential harm to her past client. It is also against the professional integrity. Moreover, if she does not reveal the information, her chances of getting prosecuted will increase. Identification of Affected Parties In the present case, the affected parties are Brunei Family, Singapore Medical Council, and the Brunei Government. If the doctor will reveal the information, it will adversely impact on the Brunei government and the royal family. Identification of Consequences In this phase, an individual has to identify all the possible consequences which can occur from a certain action. In this phase, the decision-maker has to evaluate all the alternatives based on their consequences and their impact. In the present case, if the doctor needs to reveal the information to protect herself from accusation. However, it may cause negative impact on the reputation of Brunei Family and the Brunei government. Identification of Obligations In the present case, doctor has obligation towards her past client and the Singapore Medical Council. According to the professional ethics of doctor-patient confidentiality, the doctors or the medical practitioners cannot reveal the sensitive information regarding their clients (Miller, 2008). If Doctor Susan Lim reveals the information, it will breach the confidentiality of the patient. Moreover, according to the principles of professional conduct of the Singapore Medical Council, a professional should maintain the professional integrity and should not engage in behavior which causes potential harm to the client. Consideration of Personal Character and Integrity In this phase, the decision maker has to evaluate his personal character and values. Every person grows with a specific set of beliefs and virtues. The doctor should consider self-evaluation and adopt the practices which align with his personal character. According to the case-study, it can be identified that the Doctor has been successful in his career and brought several technologies in Singapore. She has contributed a lot for the welfare of the Singaporean society. Therefore, it can be critiqued that the moral standards of the person are high (Jacob, Decker Hartshorne, 2010). Identifying Different Alternatives In good decision-making, it is important that the person should identify different alternatives and their impact on the stakeholders. In the present case, the primary stakeholders of the company are Brunei government and the doctor. There are two alternatives to the situation, either the doctor can opt to reveal the sensitive information regarding the vulnerable relations between Brunei government and the royal family or choose to conceal it. Taking the Final Action In this phase, it is correct action is taken after the evaluation of all the alternatives. Accordingly, it is proposed that the Doctor should opt to conceal the information regarding the sensitive relation between Brunei government and royal family. Justification with the Ethical Theories In the recent years, a large number of moral theories have emerged which tries to develop a framework through which the righteousness of the actions could be determined (Sher, 2012). The most common moral theories are utilitarianism and deontology. The utilitarianism is the most common and popular theory which states that an action could be categorized as right or wrong based on its consequences. According to this theory, if an action has positive outcomes on the stakeholders then it is a morally correct action. In contrast to it, if the consequences of the action are bad for the society or the stakeholders, then that action will be considered as an immoral action. The utilitarianism is based on the utility theory which states that the best action is one which has maximum utility. In this moral theory, the utility is defined as the sum of all the benefits derived from an action and subtracting from it the sufferings imposed from the action. According to this theory, the utility of ac tion is the only determinant of the possibility of an action. The theory dictates that a person should consider the interest of all the stakeholders involved rather than considering only self-interest. This theory states that the interest of all the stakeholders should be considered equally (Dreier, 2009). When this theory is applied on the case of Doctor Susan Lim, it can be evaluated that the doctor should decide to conceal the facts known to her. She should consider the interest of patient, her family and the Brunei government. It can be analyzed that there are certain shortcomings of this theory. For instance, nobody can determine the future consequences of a certain action. If the doctor chooses to conceal the information regarding the relations between Brunei government and the Royal family, it can have negative impact on the society or in the filed case. In the application of this theory, it can be critiqued that favoritism influences the decisions. In utilitarian decision ma king, the basic instincts of a person take over and a person takes a decision in personal favor (Jacobs, 2008). The deontological theory is a normative ethical theory. It states that the ethical position of an action could be determined according to certain rules. It is different from utilitarianism in which the focus is on consequences rather than the action itself. However, deontological theory emphasizes on the morality of the actions. In the context of the professional ethics, there are certain ethical codes which need to be followed for integral and ethical conduct (Waluvhow, 2003). According to this theory, the doctor should not deviate from rules, in spite of the consequences. The professional Code of Conduct developed by Singapore Medical Council (SMC) states that all the medical professionals should follow ethical conduct in their medical practices (Haidt, 2012). It includes charging he client in proportion to the services provided to them. Moreover, all the medical professionals should follow the basic integrity and confidentiality principles. It means that the doctors or the healthc are professionals should not reveal sensitive information which can cause potential harm to the clients. The deontological theory has certain shortcomings. It can be evaluated by the application of the deontological principles on the case study that a person cannot deviate from the rules in order to prevent future disasters. They can also not breach duty to prevent violations caused by other people. In essence, when a person follows the deontological principles he cannot deviate from the principles even in complex situations. Conclusion It can be concluded that Susan Lim should decide to not reveal the sensitive information related to the Brunei family and the government. The decision is reached by the application of 8 step decision making model. According to the utilitarianism theory, a person should consider the benefit of all the stakeholders rather than self-interest. Therefore, according to this theory, the action is justified. The deontological theory states that a person should abide by certain rules and regulations in any situation. According to this theory, the decision of concealing the information is morally correct. References Asia One Health. 2016. Surgeon billed Brunei patient $40m over 4 years. Retrieved December 10, 2016 https://health.asiaone.com/health/health-news/surgeon-billed-brunei-patient-40m-over-4-years Broad, C.D. (2000). Five Types of Ethical Theory. Psychology Press.Chew, R. (2011). DOCTORS FEES AFTER SUSAN LIMS CASE Implications for the Medical Profession. May 3, 2017 from https://www.sma.org.sg/UploadedImg/files/Publications%20-%20SMA%20News/4511/Insight.pdf Haidt, J. (2012). The Righteous Mind: Why Good People are Divided by Politics and Religion. Penguin UK. Hinman, L.M. (2012). Ethics: A Pluralistic Approach to Moral Theory. Cengage Learning. Jacob, S., Decker, D.M., Hartshorne, T.S. (2010). Ethics and Law for School Psychologists. John Wiley Sons. Jacobs, J. (2008). Dimensions of Moral Theory: An Introduction to Metaethics and Moral Psychology. John Wiley Sons. John Harding. (2011). Dr Susan Lims threatening letter to Foreign Minister George Yeo. Retrieved December 10, 2016 https://johnharding.com/2011/03/dr-susan-lims-threatening-letter-to-foreign-minister-george-yeo/ Miller, T.W. (2008). School Violence and Primary Prevention. Springer Science Business Media. Sher, G. (2012).Ethics: Essential Readings in Moral Theory. Routledge. Singapore Medical Council. (2017). About SMC. Retrieved 4 May 2017 from https://www.healthprofessionals.gov.sg/content/hprof/smc/en.html Waluvhow, W.J. (2003). The Dimensions of Ethics: An Introduction to Ethical Theory. Broadview Press.

Journal of Evaluation in Clinical Practice

Question: Discuss about the Journal of Evaluation in Clinical Practice. Answer: Introduction: While searching research article specific to the research questions, it is important to use specific search terms so that search process is defined and appropriate article with the search term is retrieved. Use of keywords in electronic databases provides specificity to the search. These key words indicate the topic, which the database is able to retrieve after matching it with entered key words (Shariff et al. 2013). There are various models that aids a nurse in clinical judgment. The Tanners model of clinical judgment and the evidence based practice framework are two relevant models to support nurse in clinical judgment during practice. Tanners model of clinical judgment proposes following the stage of recalling patient situation, noticing, interpreting, responding and reflection-on-action to engage in clinical learning and develop professionally in their career. This helps to analyze the biasness, ethical perspective, level of knowledge or experience in conducting a clinical task. This is a kind of self-assessment to judge clinical scenario and provide effective care to patients (Mariani et al. 2013). On the other hand, evidence based practices enables nurse to improve their clinical skills by integrating research evidence in nursing practice. This provide an extended role in which the Tanners model helps to identify the limitation in skills of nurses and the evidence based practice framework p rovides the opportunity to implement best practice by the application of best evidence in daily practice (Melnyk and Fineout-Overholt 2011). Randomized controlled trial is the highest level of evidence, which aims to determine the cause-effect relationship between an intervention and outcome. The main advantage is that it reduces biasness in the study by means of the randomization process. On the contrary, the purpose of systematic review is to present the main findings of different research literature to identify the effectiveness of interventions. It is a means to summarize and appraise the research articles (Olivo et al. 2008). The main of the research study was to examine the impact of telemonitoring based service design for the management of uncontrolled hypertension in patients. Research in this area was considered important due to the poor outcome seen from routine clinical procedure for hypertension treatment. This happened mainly due to infrequent monitoring of blood pressure by patients, poor treatment adherence and reluctance by doctors to intensify treatment. Hence, use of randomized controlled trial will help to evaluate the effect of intervention on health outcome. The primary outcome for the study include mean daytime ambulatory systolic blood pressure six months after the intervention and secondary outcome include both the daytime ambulatory systolic and diastolic blood pressure. Other indicators of secondary outcome measures included adherence to drugs, cholesterol level of patients, exercise tolerance and health related quality of life (McKinstry et al. 2013). In the study by McKinstry et al. (2013), participants were asked to self-measure their blood pressure twice every morning and evening by means of telemonitoring equipment. Through this means, the device could automatically transmit reading to mobile phones. Participants could share the feedback of blood pressure to other clinicians. The sample size of 400 participants is adequate for the study because the researcher utilized statistical method to estimate the sample size requirement for the study. This consideration wass based on study design and by means of calculation regarding appropriate size that could help to identify difference between telemonitoring and usual care (Zhong 2011). Post 6 months of intervention, the mean difference in daytime systolic ambulatory blood pressure between telemonitoring and usual care group was 4.3 mm Hg (95% confidence interval 2.0 to 6.5). This data tells that difference between blood pressure reading for telemonitoring and usual care arm. As the blood pressure fell between both group, the mean daytime systolic blood pressure revealed the difference for the two arms. On the other hand, 95% confidence interval means that of 100 different samples are taken, about 95 of the 100 confidence interval will contain the true mean value. Hence, the mean value within 95% confidence interval will lie between 2.0 to 6.5 and the value will fluctuate between this value. The p value for the mean difference in daytime systolic ambulatory blood pressure between telemonitoring and usual care group was 0.0002. The p value is the probability of finding the observed results when the null hypothesis of a research question is true. In this study, null hypothesis means no difference between blood pressure between two groups. P-value of 0.0002 reveal a statistically high significant. In case of telemonitoring group, the mean daytime ambulatory diastolic blood pressure fell from 87.4 mm Hg to 83.4 mm Hg. The difference in mean value for intervention and control group was 2.3 mm Hg. Although there was no difference in secondary outcome for both grpup, however telemonitoring was effective in lowering the blood pressure. The randomized controlled trial study in patients with uncontrolled hypertension gave positive results such a decrease in daytime ambulatory systolic and diastolic blood pressure. More compliance with intervention was also found as patients were found to frequently monitor blood pressure readings through the telemonitoring equipment. The intervention was also cost-effective as expense was only required for equipment, training and consultation. I also propose to use telemonitoring for uncontrolled hypertension patients due to positive implications for clinical studies. I would also make it more cost-effective by reducing the duplication of effort due to the time spent in adapting the new technology. This will be done by providing adequate training to staff regarding the efficiently using the telemonitoring equipment so that they become confident in handling it. This would also eliminate the problem of non-compliance with treatment and little attention to constantly monitor the blood p ressure. This intervention will promote easy access to constant blood pressure monitoring and seeking feedback from patients (McKinstry et al. 2013), Number of patients with healed ulcer (good outcome) in control group (Bandage A)= 65% Number of patients with no healed ulcer (bad outcome) in control group= 35% Number of patients with healed ulcer (good outcome) in intervention group (Bandage B)= 85% Number of patients with poor healing of ulcer (poor outcome) in intervention group (Bandage B)= 15% Bad outcome Good outcome Total Intervention group 15% (A) 85% (B) 100 Control group 35% (C) 65% (D) 100 A+C= 50% B+D= 150% 200 Relative risk of healing (RR)= = (15/ 100)/(35/100) = 0.428 Therefore, the relative risk of poor outcome in healing of leg ulcer is 0.428 If the risk is less than 1, it indicates that intervention group have less risk compared to control group. Absolute risk difference (ARD)= Difference in absolute risk between control and intervention group= 85%-65%- 20% Number needed to treat (NNT)= Inverse of absolute risk reduction= 1/ 20= 5 This indicates that atleast 5 people needed to treated to avoid poor outcome in healing leg ulcer The value of RR according to calculation is 4.28. As relative risk is the proportion of risk present between intervention and control group, this value suggest that the risk of bad outcome is more in control group compared to intervention group. The value for ARD is 20 %. This is simply the difference between risk compared to relative difference between risk. NNT value of 5 indicates that a minimum of people is needed to be treated to avoid the risk of poor outcome in healing. Bandage B is considered over Bandage for healing ulcer because its relative risk is low compared to Bandage A. While implementing any new intervention, it is necessary to evaluate the evaluate the chances of risk outcome. The minimum is the risk outcome, the more efficacious is the intervention. Hence, Bandage B should be considered over Bandage for treating leg ulcer. Part three: Implementation of EBP There are many barriers to implementing the new researching finding in clinical setting. These are: Organizational barrier- Due to lack of support in encouraging staffs to utilize evidence based intervention, health care professional continue to use traditional method of care. T compromises the desired quality of care. Issues in developing evidence based policy- To effectively integrate new research findings, appropriate policy development is needed. However, this is difficult due to the hectic procedure and initial arrangement to supply adequate information system. Complexity and size of research- Nurses and staffs face barrier in interpreting the complex research data and evaluating their relevance in particular practice area. Lack of training- When health care staffs are not adequately trained in evidence based care, it acts as a barrier in the integrating it in research practice (Sadeghi?Bazargani et al. 2014). This subject helped me prepare for my role as a junior clinician as I got to learn new things about the ways to apply best evidence in practice. The evaluation and analysis of the randomized controlled trial gave me new insight regarding the purpose of such studies and how it contributes to clinical intervention. Secondly, use of different models such as evidence based framework and the Tanners model of clinical judgment supported me in developing my critical reflection skill. This tool can be effectively used to judge clinical situation, interpret issues and contemplate best action to solve patient issue. Currently, there is also a focus on implementing evidence based care in practice and the evidence based framework will effectively guide me in retrieving the best evidence that can be applied in clinical setting. Reference Mariani, B., Cantrell, M.A., Meakim, C., Prieto, P. and Dreifuerst, K.T., 2013. Structured debriefing and students' clinical judgment abilities in simulation.Clinical Simulation in nursing,9(5), pp.e147-e155. McKinstry, B., Hanley, J., Wild, S., Pagliari, C., Paterson, M., Lewis, S., Sheikh, A., Krishan, A., Stoddart, A. and Padfield, P., 2013. Telemonitoring based service redesign for the management of uncontrolled hypertension: multicentre randomised controlled trial.BMj,346, p.f3030. Melnyk, B.M. and Fineout-Overholt, E. eds., 2011.Evidence-based practice in nursing healthcare: A guide to best practice. Lippincott Williams Wilkins. Olivo, S.A., Macedo, L.G., Gadotti, I.C., Fuentes, J., Stanton, T. and Magee, D.J., 2008. Scales to assess the quality of randomized controlled trials: a systematic review.Physical therapy,88(2), p.156. Sadeghi?Bazargani, H., Tabrizi, J.S. and Azami?Aghdash, S., 2014. Barriers to evidence?based medicine: a systematic review.Journal of evaluation in clinical practice,20(6), pp.793-802. Shariff, S.Z., Bejaimal, S.A., Sontrop, J.M., Iansavichus, A.V., Haynes, R.B., Weir, M.A. and Garg, A.X., 2013. Retrieving clinical evidence: a comparison of PubMed and Google Scholar for quick clinical searches.Journal of medical Internet research,15(8), p.e164. Zhong, B., 2011. How to calculate sample size in randomized controlled trial?.Journal of thoracic disease,1(1), pp.51-54.

The First free essay sample

In the first part of this lab, E. coli cells were transformed with an R-plasmid carrying a tetracycline resistant gene, giving rise to tetracycline resistant E. coli strain. This was accomplished through transformation, which allowed E. coli to directly uptake the naked DNA molecule carrying the antibiotic resistant gene (1). However, in order to take up the DNA and incorporate them into their genome via recombination, cells must be competent (1). Therefore, E. coli cells which are not competent under normal conditions were treated with cold and high concentration of CaCl2, in order to make them artificially competent (1). The transformants were grown on the LB with the tetracycline antibiotic, and on the LB without the tetracycline. Then the viable competent cells and the viable cells were counted to calculate the frequency of transformation. In the second part of the lab, lateral gene transfer by generalized transduction was done on E. coli cells. In the process of transduction, the transfer of genes is facilitated by bacteriophage, which is a virus that infects a bacterial host (1). We will write a custom essay sample on The First or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Generalized transduction involves lytic infections that kill the bacterial cells, and during the process, bacterial DNA is packaged into a new phage head which in turn injects the DNA into another bacterium (1). In this lab, P1vir phage was used and grown on the donor strain by making a phage lysate. P1vir phage kills bacterial cells by lytic infections, which is required in the generalized transduction (1). On the other hand, the wild-type p1 is a lysogenic phage and therefore could not be used for the generalized transduction (1). In order to prevent excessive killing of the recipient E. oli strain, the P1vir lysate was tittered by serial dilutions. This would also prevent infection and lysis of the transducing particle. In generalized transduction, trp-pyrF region of CSH61 chromosome, which was the P1vir lysate, was laterally transferred to the recipient CSH54 strain. The genotypes of transductants were tested by patching them onto a Petrie plate lacking tryptophan and uracil, whi ch will allow growth of trp+, pyrF+, and not the trp+,pyrF- transductants. Trp gene encodes for trypsin, while the pyrF gene encodes for pyramidines, such as uracil. Thi, his, and pro genes encode for thiamine, histidine, and proline respeictively (1). Finally, the frequency of transductant was used to obtain the distance between the trp and pyrF gene. Discussion In the transformation experiment, E. coli cells were transformed with Plasmid DNA containing the tetracycline resistant gene, and were tested for competency by growing them in LB in presence of tetracycline antibiotic. Tetracycline is a broad spectrum antibiotic that works by inhibiting translation, thus inhibiting protein synthesis. It attaches to the 30S subunit of ribosome and prevents the charged aminoacyl-tRNA from binding (3). As shown on Table 1, Tube 3 and Tube 2 did not have any growth of E. coli cells. Tube 2 contained E. coli cells only, and when cultured on the LB plate in presence of tetracycline antibiotic, the growth was inhibited by the antibiotic. Because the E. coli cells in tube 2 lacked the tetracycline resistant gene contained in the plasmid DNA, it was unable to grow in the presence of tetracycline antibiotic. Tube 3, lacked the E. coli cells and so, there were no cells to grow in the LB plate with or without the tetracycline. Tube 3 instead was used as a control, to test for contamination in the plasmid DNA and the calcium chloride. In tube 1, which contained the E. coli cells and the plasmid DNA containing the tetracycline resistant gene, transformation occurred. As a result, E. coli cells have acquired the tetracycline resistant gene, being able to grow on the LB plate in the presence of the tetracycline antibiotic. Therefore the viable competent cells were counted from tube 1 contents in 102 diluted LB (with antibiotic), which had cells between 30 and 300 colonies. On the other hand, the total viable cells were counted from tube 1 in 106 diluted plate that was grown on LB without the antibiotic. As shown on table. 2, the viable competent cells were calculated to be 24350 cells/100ul and the total viable cells were found to be 370,500,000 cells/100ul. Finally, the transformation frequency, which is the ratio of transformants per viable cell, was calculated and was found to be 6. 49 x 10-05 as shown on table 2. In the generalized transduction experiment, trp gene from the donor strain of CSH61 (P1vir lysate) was laterally transferred to the recipient strain, CSH54. CSH61 strain are trp+, pyrF+ and the CSH54 strain are trp-, pyrF-, and because trp and pyrF are linked together on the same chromosomal fragment, they are cotransduced (1). The transductants were identified by selecting for the trp+ marker by growing in absence of tryptophan, however the pyrF marker may be present or absent, depending on the crossover event during recombination. This was identified by patching the transductants onto a Petrie plate lacking tryptophan and uracil. The trp+, pyrF+ transductants will be able to synthesize both tryptophan and uracil, and therefore will grow in this minimal medium (1). However, trp+, pyrF- transductants cannot grow in the medium, because they won’t be able to synthesize uracil (1). As shown on table 3, 57. 5% of transductants were trp+, pyrF+ while 42. 5% were trp+, pyrF-. This means trp is cotransduced with pyrF at 57. 5% frequency, which indicates that they are very closely linked. Markers which are separated by less than 0. 5 minutes are cotransduced at 35-95%, and so, trp which cotransduced with pyrF at 57. 5%, is very closely linked (1). This closely matches the actual cotransduction frequency of 55% between trp and pyrF in E. oli (2). According to the Wu formula, the cotransduction frequency of 57. 5% yielded distance of 0. 084 minutes, which was very close to the distance of 0. 09 minutes at cotransduction frequency of 55% found in literature (2). Bacterial genes can also be analyzed by a method known as Southern blotting (4). In this method, DNA is treated with restriction enzymes, which cuts the DNA into fragments of different size. Then the fragments are run on an agarose gel by electrophoresis, which separates the fragments by size.

Where to Get the Money to Write a Book

Where to Get the Money to Write a Book This is the most common request I receive. Where can I find the money to write my book? This is the second most common request I receive. Where can I find the money to publish my book? First and foremost, you do not need money to write a book. Writing is the most liberating, free-rein, no start-up money required art on the planet. You and the paper. If you need research, you have a phone, the Internet and the library. Easy-peasy. If you need money to publish your book, you are self-publishing. Fine. Nothing wrong with that. Lets make some assumptions here. You wrote the story. Youve edited the story. Youve HAD the story edited. You want that book out in the world and you dont have two dimes to rub together. What do you do? 1. You try to traditionally publish. Yep, this means you have to learn the publishing business. But you want complete control over your book, you say. Do you even know what that means? Can you talk traditional vs. self-pubbing? If you cannot, then stop trying to publish. Learn which road to take before get totally lost and ruin that story 2. You publish an e-book. I know you want to hold paper in your hands, but why not sell e-books until you have the money saved to pay for print? 3. You publish through CreateSpace.com or Lulu.com. This requires you understand formatting, cover design, and so on. If you want someone to publish your book without you thinking about these things, then go back to Item 1. 4. You crowdfund through Kickstarter.com or Indiegogo.com. Not only has Kickstarter funded many books, plays and films, but it makes you develop a defined plan for your book project. Most crowdfunding projects fail because the author doesnt want to think marketing or development . . . doesnt plan deeply enough. Either that or the book is a bad idea to start with. 5. You freelance and save your money from articles and gigs to pay for the publishing. No elaboration needed here. If you think youre good enough to write a book, you should be shrewd and talented enough to make money freelancing. 6. You save money from other sources. Only you can define your other sources. 7. You borrow the money. Gasp! Borrow? What if the book fails? Truth is you need to believe in this book hard enough to be willing to borrow money for it. That means youre more likely to do your homework on the process, edit a few more times, create the start of a platform, and design a short-term and long-term plan. What about grants? Grants should be your last resort. Besides, most grants wont fund a self-published project, especially from a first-time author or a second-timer who didnt sell the first. You have to prove yourself to a certain degree. But hey, with all of the above options and a little bit of elbow grease and sweat, youll be published in no time.

Air Transport Management and Operations Essay Example | Topics and Well Written Essays - 3000 words

Air Transport Management and Operations - Essay Example The different entities in the air traffic are coordinated through a flight schedule, which often comprises of flight legs between airport locations. In addition, the flight schedule itself defines three other layers of schedules, for example, the aircraft schedule, the crew schedule, and passenger itineraries (Sheehan, 2003). Airport management contributes to the industry’s goals indirectly by directing the efforts of all the employees. This is done by the manager in charge of the airport. In addition, management involves planning, organizing, actuating and controlling, performed so as to determine and achieve objectives by the use of the employees. Managers in the airport industry must think of their actions in advance before implementing them as they can either lead to losses or benefits. Airport operations of controlling different runways and different aircrafts, as well as the safety of the passengers, require some plan rather than impromptu decisions (Tripathi, 2008). Organizing as a major function of the manager requires the coordination of human as well as material resources in the airport. Further, actuating means that the manager should engage in those activities that are aimed at motivating and directing the employees; while controlling means that; managers should try to ensure that there is no deviation from norm or plan. Whenever there is something wrong in the airport, such as economic problems, security threats, and weather disruptions, the managers must take action to remedy the situation. Managers are also required to use the employees and other resources such as finance, and equipments to attain the goals of the industry. For example, a manager who wants to increase the sales in the airport industry should try not only to motivate the employees but also to provide to increase the advertising budget. Advertising will ensure that consumers are made aware of the quality of

He Enron Accounting Scandal Essay Example | Topics and Well Written Essays - 1250 words

He Enron Accounting Scandal - Essay Example Second is misrepresenting the earnings reports that made the executives enjoy investments as they continued to report fraudulent earnings to investors which still attracted others due to the apparent financial gains that were being reported. Third is that the top company executives were involved in embezzlement as they kept on pocketing investment funds from the unsuspecting investors that led to the bankruptcy of the company. Fourth is the company’s idea of mark to market accounting introduced by skilling that made it the first company to use such as complex method to account for its contracts. (Petrick & Scherer, 2004) This meant income could be recorded even without receiving the money and this increased financial earnings. This was fraudulent especially after the Blockbuster video contract that resulted in losses that were treated as profits by the company. Fifth action was poor financial auditing through the use of reckless standards that did not identify mistakes in repo rting leading to the collapse of the company (Thomas, 2002). Risk management measures to avert the events Initially with the appointment of Skilling to the financial department, the CEO let him implement sophisticated risk control system at Enron. Embracing this new idea as a whole without first having to test it was a bad thing for the company (Culp, 2002). As much as ideas were initiated to adequate screening was made as members of the risk assessment group colluded with the management to approve deals. Therefore the first thing to do would have been to establish a flawless risk assessment group that was answerable to the board to avoid the events that led to the company’s collapse (Healy & Palepu, 2003). Secondly the company’s problems seemed to have emerged from the carefree attitude that was the norm for the management. They turned a blind eye to a lot of malpractices that were happening in the company making its situation worse. The company should have enforced a hands on management style instead of the hands off style that let the company run like a runaway train. Together with this the company should have enforced corporate governance ethics in order to eliminate such malpractices or reduce risks of them happening (Culp, 2002). The company should have also laid down the ground rules especially for the fiance department when it comes to reporting of the company’s earnings and other financial results. A simple accounting method should have been used and one that could be easily understood by shareholders and the board of directors so that people are not deceived into believing they have revenues which they do not actually have (Rosen, 2004). Ethical considerations of the laws applicable to the case The laws that applicable to this case specifically look at the issue of fraud and public misinformation. All financial information concerning the operations of any public owned company or any other company for that matter should be disclos ed at the end of a particular period of time following the laid down rules and regulations of financial reporting. The law requires that company be responsible in their conduct and relationship with various stakeholders so that each of the party enjoys the outcomes that are got from operating the business. The laws also require that the management acts in

How far do you think railway travel influenced notions of identity and Essay

How far do you think railway travel influenced notions of identity and community in colonial India Give specific examples - Essay Example This is because the railway lines were relevant in the formation of imagined communities especially after the division of India into present day India and Pakistan. The train changed the social relations from that she refers to as concrete lived relations to abstract generalities while it also became a sign of collective identity. Travel through the railway in Colonial India also eliminated individual identities to communal ones which led to the doing away with the held social relations. Therefore, travel through railway lines in Colonial India greatly affected how the citizens identify with each other as well as how the community interacts. In this paper we will discuss the notions of identity in colonial India as affected by travel and transport through the railway line. Our focus will be on how travel through railway led to the growth of a sense of national identity amongst people of disparate regions in colonial India and the raising of the consciousness about the social order in the Indian community. The paper will also make a discussion on how travel by railway in colonial India mobilized the people around one political ideology thus givi ng them a sense of identity as one Indian community. The most everlasting and contribution of European Imperialism to its colonies were through the invention of machines and amongst the most important was the invention of locomotives. The locomotives had the potential to move people and goods from one point to another which had serious impacts on the social, cultural, economic and political compositions and identities of societies. Almost all colonial governments used their superiority in technology to annex and exercise control over the affairs of nations. The colonialists used technology such as construction of railway lines rather than ideologies to further their imperialistic ideals over the colonies.2 These could be through the progress and power

Congestive Cardiac Failure: Causes and Effects

Congestive Cardiac Failure: Causes and Effects Analyse Health Information – Case study The scenario relates to Mr Alby Wright who has been admitted into your ward. His patient history and admission form is available for you to review. Mr Wright’s admission states that he has heart failure (congestive cardiac failure). Clearly define heart failure. What organs and which body systems are affected by this disorder? Congestive heart failure is a condition where the heart muscle becomes less strong and is unable to pump as well as it usually would. The ventricles which most important pumping chambers become bigger or thicker and aren’t able to squeeze or relax as well as they should be able to. This makes it easy for fluid retention to occur especially in the legs, abdomen and lungs (better health channel. 2013). This is all usually caused by diabetes, coronary heart disease, previous heart attack, high blood pressure and or other conditions that have damaged the heart and made it weak. Sometimes the fluid that gets in the lungs and it makes it uneasy to breathe and causes shortness of breath when the person is lying down on their back. This is called pulmonary oedema and can cause other respiratory issues if it not treated (American heart association. 2012). Generally if someone was to have heart failure, it would occur on the left side first mostly but can occur in both sides. If someone is experiencing left side heart failure, the left ventricle doesn’t fully empty and is unable to distribute enough oxygen rich blood around the body which causes heightened pressure in the upper chambers of the heart and the veins that are close to the area which is called systolic failure. Because of the build-up of blood in there, it can cause oedema in the legs, lungs and abdominal organs. The kidneys are affected by this hinders the way that they work and it leads to salt and water retention which causes further oedema. In some cases of heart failure, instead of not being able to pump blood around properly out of the left ventricle there is also unsuccessful relaxation of the left ventricle because the muscle has gone stiff which leads to blood pooling (better health channel. 2013) and also that the heart isn’t able to fully fill with blood during the resting period between each heartbeat (American heart association. 2012). Right sided heart failure usually happens because of left sided failure. When the left ventricle has failed, more fluid pressure is then transferred back through the lungs which damages the right side of the heart. When the right side of the heart loses the strength to properly pump, blood builds up in the veins and that causes swelling in the legs and ankles. The cardiovascular system is affected the most by congestive heart failure. The heart has been weakened and is unable to pump blood efficiently and doesn’t function properly in general and the muscle is also weakened. The respiratory system is affected because of the fluid in the lungs which is also known as pulmonary oedema. This can affect your breathing and leave you short of breath. Fluid may also build up in the liver resulting in an impaired capability to get rid of the body’s toxins and to produce the proteins that the body needs to live. The intestines can become not as good at absorbing nutrients and medicines as that would have when they were healthy (providence health network. 2014) Give a brief overview of the normal function of the body systems affected by this disorder. Cardiovascular system is most affected by this disorder. The functions of this system are to basically keep the blood running and pumping through by the arteries, veins, and capillaries (cliffs notes. 2013). The blood carries important nutrients around the body and helps to remove metabolic waste. The heart, blood vessels and blood help to regulate body temperature by controlling the blood flow to the surface of the skin. The white blood cells help to protect the body from foreign toxins and pathogens. Platelets help to clot blood so that you won’t have excessive blood loss and stop bleeding (cliffsnotes. 2013). Respiratory system function is so you can breathe and supply oxygen to your whole body (how stuff works. 2014). This works by breathing; inhaling oxygen filled air and exhaling carbon dioxide air. First you breathe in air through your nose and mouth and it travels down the windpipe and through the bronchial tubes then into the lungs. The diaphragm and abdominal muscles and make the lungs contract and expand so that you are able to breathe in and out. The bronchial tubes connect to blood vessels which carry blood through your body and exchange gases. The digestive system absorbs and moves the nutrients around the body that it needs to work well and gets rid of what the body doesn’t need as waste. First there is ingestion which is when eaten and then makes its way down into the stomach to be stored and waits for digestion. It then moves into the small intestines where the enzymes and bile work to break down the food where the body can absorb more nutrients that it needs and it continues on its way to the large intestine where it absorbs more fluid to make the solid faeces and moves through and gets excreted as waste (how stuff works. 2014). The liver aids in breaking up fats, absorbing them and digesting them. Urinary system works along with other parts of the body such as skin, lung and intestines to keep up the stability of chemicals and water in the body (live science. 2013).This system’s role is to filter and excrete. Kidneys work at reducing blood pressure by reducing the blood volume. The body filters blood to create urine which goes into the bladder and the bladder fills up until it is full and ready to excrete waste that the body does not need which is urination (live science. 2013). 3. Define the signs and symptoms of heart failure, and explain why these signs and symptoms occur. Breathlessness or shortness of breath is a symptom because when the heart starts failing, the blood in the veins gets backed up in the pulmonary veins because it cannot cope with the supply while trying to carry oxygenated blood from the lungs to the heart. At this point, the fluid is starting to pool in the lungs which hinders regular breathing. A person suffering heart failure may suffer with breathlessness upon exertion including exercise or other activities. As the condition progresses, breathlessness or shortness of breath may even be present while at rest or even sleeping which may cause the person to wake up (USCF medical center. 2014). Fatigue occurs when heart failure develops and worsens; the heart cannot pump the adequate volume of blood that is needed to meet all of the body’s needs. To make up for this, the blood is taken away from less vital such as the limbs to supply the heart and brain. Because of this, people suffering with heart failure usually feel tired, w eak and have difficulty doing normal tasks such as walking, going up stairs, or even carrying items. (USCFmedicalcenter.2014). Someone suffering shortness of breath as a symptom of heart failure will also experience fatigue if they are being woken up with breathing difficulties while they are sleeping. Chronic coughing and wheezing is a symptom because of the fluid backup in the lungs which may cause a thick, whitish mucus like substance called phlegm to be coughed up from the lungs which may even be tinged pink from traces of blood (USCFmedicalcenter.2014). Rapid or irregular heartbeat is a symptom because it may speed up to make up for its inability to pump blood around the body properly. People suffering this in heart failure may experience a fluttering sensation of heart palpitations, or a heartbeat that they are aware of and seems irregular or out of the normal rhythm. It may feel like the heart is racing or pounding hard (USCF medical center. 2014). Lack of appetite/ nausea be cause the digestive system isn’t as vital as the heart or brain so the blood has been pulled away from the digestive systems to these areas instead which means there will be problems with digestion including the feeling of fullness or sickness even though they have not eaten anything (USCF medical center. 2014). Confusion/ impaired thinking because unusual sodium levels in the blood and lessened blood flow to the brain can cause bafflement or memory loss even know the person suffering with this may not even realise, and someone else may pick up on this sign before they do (USCF medical center. 2014). Oedema or swelling due to restricted blood flow to the kidneys which means that they produce hormones which lead to the retention of salt and water. This causes swelling of (most often) in the legs, ankles, and feet. Oedema may also cause weight gain (USCF medical center. 2014). Rapid weight gain can occur as a result of oedema and the fluid retention (USCF medical center. 2014). Heart grows in size because it wants to make its pumping power greater so the muscle mass in the heart gets bigger to make this happen. The chambers inside of the heart also grow larger and stretch so that they can fit more blood in. While the heart grows in size, the cells that control its contractions also grow with it. An enlarged heart does not function as well as a normal sized one and the added muscle mass puts stress on the whole cardiovascular system (USCF medical center. 2014). The heart pumps faster as it tries to circulate more blood around the body. If the heart pumps blood too fast for a long period of time, it can damage the heart muscle and hinder its regular electrical signals, which can cause an unsafe heart rhythm disorder (USCF medical center. 2014). Blood vessels narrow because less blood is flowing through the veins and arteries and that means blood pressure can drop to seriously low levels. Because of this, the blood vessels narrow which keeps the blood pressure higher while the hearts power decreases. Narrowing of the blood vessels also limits the amount of blood that can flow through which may contribute to other conditions such as heart disease, clogged or blocked vessels in the legs or other body parts, or stroke (USCF medical center. 2014). Blood flow is diverted away from less vital areas such as the limbs when there is not enough of it to meet the body’s needs and gets given to more crucial organs such as the heart and brain which are the most important for survival. This can cause limb weakness due to lack of blood in the areas. The areas where the blood is diverted from may deteriorate over time from a lack of oxygen (USCF medical center. 2014). Increased urination at night because if the patient suffering heart failure lays down all day, the fluid that has been accumulating in their legs all day may move back up into the blood stream and gets taken to the kidneys and is excreted as urine (heart failure matters. 2014). Low blood pressure because the hearts power has decreased and the veins have narrowed. Chest pain if your heart failure is due to a heart attack. List the information taken on his admission that demonstrates these signs and symptoms. Cyanotic Appetite loss Confusion and anxiety Low blood pressure Temperature below 35.8 degrees Sa02: 87% on air Respirations: 32 Low blood pressure Constipation Do you think his diabetes is related to his leg ulcer and amputated left toe? Explain. Yes. High blood sugar levels in diabetic patients damage nerves and blood vessels which results in poor circulation to the feet and may cause ulcers, infection, and amputation. This is more likely to happen if the patient has had diabetes for a long amount of time, they smoke, they don’t move around much, or their blood glucose levels have been high for an extended period of time (diabetes Australia. 2014). One of the medications he is taking is Lasix. What is the action of Lasix? Which body systems are affected by it? Explain why you think Mr Wright is ordered Lasix. Lasix is a diuretic. It increases the amount of urine that is made in the kidneys and excreted as waste (c health. 2014). It is also used to regulate and control slight to moderate high blood pressure. It affects the urinary system because it involves the kidneys and the cardiovascular system because it involves the heart. I think that Mr. Wright is ordered Lasix to get rid of the excess fluid that would be built up in his body and to lessen the oedema. List three conditions in Mr Wright’s relevant medical history that are commonly associated with ageing. Glaucoma Type 2 diabetes Arthritis Using Mr Wrights admission history and assessment, list the factors that may impact on his safety whilst in hospital and when he returns home. Hypotensive- low blood pressure He needs a walking stick because he is unsteady on his feet He gets anxious, especially about his dog. This can sometimes cause an asthma attack. He gets confused His vision is impaired and gets blurry after he has eye drops and he also needs reading glasses. What other health professionals will be involved in his care and what services can they provide for Mr Wright. Paramedics will care for Mr Wright in the ambulance and pass him over to emergency. Mr Wright needs a doctor to in emergency to diagnose him. General Nurses will be involved to provide care for him and to care for his wounds. A diabetes educator can be involved to help him to understand the needs of his condition and set up an action plan and give him support. A dietician can also help with this condition and set up meal and nutrition plans etc. Exercise physiologist assists patients to have a physical lifestyle to prevent and manage chronic conditions. A pharmacist will dispense his prescriptions so he can have medications and to give information on them. He may be able to talk to a psychologist to improve his anxieties, especially about his dog (better health. 2013). List the nursing documentation you would expect to be used in the care of Mr Wright. Progress notes Medication chart Vital signs chart Nursing history and assessment Care plan Asthma action plan FBC- fluid balance chart Wound monitoring chart Falls risk assessment (tafesa. 2014) UCSF medical center. 2014. heart failure signs and symptoms. [ONLINE] Available at: http://www.ucsfhealth.org/conditions/heart_failure/signs_and_symptoms.html. [Accessed 04 April 14]. heart failure matters. 2014. need to urinate at night. [ONLINE] Available at: http://www.heartfailurematters.org/en_GB/Understanding-heart-failure/Need-to-urinate-at-night. [Accessed 08 April 14]. better health channel. 2013. congestive heart failure. [ONLINE] Available at: http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Congestive_heart_failure_%28CHF%29. [Accessed 08 April 14]. American heart association. 2012. types of heart failure. [ONLINE] Available at: http://www.heart.org/HEARTORG/Conditions/HeartFailure/AboutHeartFailure/Types-of-Heart-Failure_UCM_306323_Article.jsp. [Accessed 08 April 14]. c health. 2014. drug factsheets. [ONLINE] Available at: http://chealth.canoe.ca/drug_info_details.asp?brand_name_id=210#Indication. [Accessed 09 April 14]. providence healthcare network. 2014. congestive heart failure. [ONLINE] Available at: http://providence.net/facilities/heart-failure.html. [Accessed 09 April 14]. pt direct. 2014. major functions of the cardiovascular system. [ONLINE] Available at: http://www.ptdirect.com/training-design/anatomy-and-physiology/cardiovascular-system/major-functions-of-the-cardiovascular-system-2013-a-closer-look. [Accessed 09 April 14]. diabetes australia. 2014. diabetes and your feet. [ONLINE] Available at: https://www.diabetesaustralia.com.au/Living-with-Diabetes/MindBody/DiabetesYour-Feet/. [Accessed 09 April 14]. TafeSA, 2014. Acute Care Flow Charts. In: Flow Charts. s.l.:Government of South Australia. better health . 2013. allied health. [ONLINE] Available at: http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Allied_health. [Accessed 10 April 14]. cliffs notes. 2013. functions of the cardiovascular system. [ONLINE] Available at: http://www.cliffsnotes.com/sciences/anatomy-and-physiology/the-cardiovascular-system/functions-of-the-cardiovascular-system. [Accessed 10 April 14]. how stuff works. 2014. what is the function of the respiratory system?. [ONLINE] Available at: http://health.howstuffworks.com/human-body/systems/respiratory/function-respiratory-system.htm. [Accessed 10 April 14]. how stuff works. 2014. how the digestive system works. [ONLINE] Available at: http://health.howstuffworks.com/human-body/systems/digestive/digestive-system2.htm. [Accessed 10 April 14]. live science. 2013. urinary system. [ONLINE] Available at: http://www.livescience.com/27012-urinary-system.html. [Accessed 10 April 14]. Chikungunya Fever: A Review Of The Literature Chikungunya Fever: A Review Of The Literature The Newala and Masasi Districts of the Southern Province, Tanzania, reported its first dengue-like outbreak in 1952-1953, on the basis that this epidemic involved debilitating joint pains and shorter incubation period, thereby excluding dengue (Robinson 1955). The infection was called chikungunya; a word from the Makonde dialect describing patients contorted posture (Lumsden 1955). Chikungunya is an arthropod borne virus (arbovirus) of the genus: Alphavirus from Togaviridae family. It is transmitted to humans mainly by the day biting mosquito species Aedes aegypti and Aedes albopictus (Townson and Nathan 2008). Moreover, Aedes aegypti eggs collected from the Tanzanian outbreak were used for the first isolation of Chikungunya virus (CHIKV) (Ross 1956). CHIKV contains a positive-sense single stranded RNA genome, enclosed in an icosahedral nucleocapsid, all enclosed in a phospholipid bilayer envelope. Embedded in the envelope are multiple copies of two encoded glycoproteins E1 and E2, a small glycoprotein E3, and a hydrophobic peptide 6K (Strauss and Strauss 1994). However, the roles of these glycoproteins are not elucidated, but it can be assumed that it could facilitate the attachment of the virus to host cell. History Subsequent to the Tanzanian epidemic, several outbreaks have been reported worldwide, including the Indian Ocean Islands; La Reunion (Renault et al. 2007), Mayotte (Sissoko et al. 2008), and the Maldives (Yoosuf et al. 2008). There were outbreaks whereby Chikungunya had concurrence with other infections; with Dengue (Ratsitorahina et al. 2008, Yoosuf et al. 2008) and with Plasmodium falciparum infection (Pastorino et al. 2004). Moreover, Chikungunya have been imported into several European countries; United Kingdom (HPA 2007), France (Hochedez et al. 2007), Germany, Switzerland, Denmark, Poland (Panning et al. 2008), with Italy witnessing its first CHIKV outbreak in 2007 (Rezza et al. 2007). Aim of review The Italian outbreak has demonstrated that only one viraemic person was required to instigate an outbreak and due to increased population movement worldwide, CHIKV could extend to pandemic proportions (Rezza et al. 2007). Furthermore, the outbreaks could have been underestimated due to its concurrence with other infections. Thus, this literature review will demonstrate to the reader that the Western medicine should be planning for CHIKV outbreaks which are becoming increasingly possible due to world climate change. Clinical Features Chikungunya is a mild and self limiting infection (Rezza et al. 2007) with incubation period of 2-7 days (Robinson 1955). Patients usually presents with a number of clinical features, with fever, fatigue, joint pain, anorexia, and nausea presenting as common clinical features (Table 1). Arthalgia and myalgia mainly involves the extremities of wrists, ankles, hands, feet and phalanges, while skin rash and petechiae are manifestations of haemorrhage (Kannan et al. 2009). During the La Reunion outbreak, Gà ©raldin et al. (2008) observed vertical transmissions from mother to child, with newborns presenting with chikungunya infection without prior mosquito bites. These neonates became symptomatic between 3-7 days postpartum, with presentation of fever, pain, poor feeding, disseminated intravascular coagulation (DIC) with gastrointestinal and cerebral bleeding, petechiae, and distal joint oedema. Encephalitis, thrombocytopenia and haemorrhagic fever were presented as severe neonatal infec tions; however, no fatalities were reported (Gà ©rardin et al. 2008). Transmission of CHIKV CHIKV requires two types of hosts to complete its replication cycle. Firstly, Aedes mosquito species transmits the virus to animals, and act as definitive hosts. Secondly, humans and other animals become infected with the virus and act as intermediate hosts. The transmission between the natural hosts (primates, birds, rodents and others) and the definitive hosts involves the sylvatic (main) cycle (Pardigon 2009). By disrupting this cycle, humans became incidental hosts, resulting in urban transmission cycles yielding epidemics. These humans could transmit CHIKV directly to domestic mosquitoes (Gould and Higgs 2009) and indirectly to domestic animals such as fowl, pigeons and goats (Lumsden 1955). When an Aedes mosquito ingests viraemic blood meal, CHIKV replicates in the salivary glands and ovaries, sites where it can be excreted. Upon another blood meal, the mosquito injects the viraemic saliva into a susceptible host. Contrary, within the ovaries, CHIKV is transmitted to the mosqui toes eggs by vertical transmissions (Figure 1). The desiccated nature of these eggs enables it to survive longer periods in the environment, where they are hatched during the rainy season (Gould and Higgs 2009). Figure 1. The overview of CHIKVs transmissions cycle in mosquito and human (Evenor 2010). Aedes mosquito becomes infected after taking a blood meal from an infected intermediate host Upon another blood meal, the Aedes mosquito injects viraemic saliva into a susceptible host The viraemic blood travels to the gut, where CHIKV undergoes replication within the gut wall The egg later developed into a mosquito infected with CHIKV CHIKV travels to the ovaries, where it is transmitted to the mosquitos eggs by vertical transmission The intermediate host becomes viraemic with presentation of clinical features CHIKV penetrated the gut wall, where it is disseminated through the bloodstream CHIKV travels to the salivary glands, where it undergoes replication Distributions of Aedes albopictus and Aedes aegypti Aedes aegypti was the predominant vector during earlier outbreaks in Africa (Lumsden 1955), and it has been implicated in some recent outbreaks in Africa (Gould et al. 2008) and Indonesia (Laras et al. 2005). However, Aedes albopictus have been described as the main vector implicated in a number of recent outbreaks, between 2005 to 2007 (Leroy et al. 2009, Pagà ¨s et al. 2009, Ratsitorahina et al. 2008, Renault et al. 2007, Sissoko et al. 2008). In the Gabonese outbreak involving both vectors, Vazeille et al. (2008) hypothesised that Aedes albopictus is a more suitable vector for CHIKV than Aedes aegypti, as it has a higher susceptibility for the virus. The two vectors have been recovered from several breeding sites with some overlap (Table 2). Tyres have been the main source of Aedes albopictus larval importation into Italy, in 1992, from Atlanta, USA. Consequently, the trade of these used tyres within Italy had caused large infestations of Aedes albopictus in Linguria, Veneto, Lom bardy and Eimlia-Romagna regions, by the end of 1995 (Knudsen et al. 1996). Aedes aegypti larvae predominate inside home, whereas Aedes albopictus larvae predominate outside home (Preechaporn et al. 2006). Table 2. The natural and artificial breeding sites for Aedes aegypti and Aedes albopictus larvae. Natural and artificial breeding sites Incidence of Aedes aegyptilarvae Incidence of Aedes albopictus larvae References Barrels X Gould et al.2008 Drums X X Gould et al.2008, Ratsitorahina et al.2008 Buckets X Ratsitorahina et al.2008 Flower pots X Gould et al.2008 Discarded cans X X Preechaporn et al.2006, Ratsitorahina et al.2008 Coconut shells X Preechaporn et al.2006, Ratsitorahina et al.2008 Clay water jars X Gould et al.2008 Mango tree holes X Lumsden 1955 Wetlands X X Vazeille et al.2008 Discarded tyres X X Preechaporn et al.2006, Ratsitorahina et al.2008 Plant pots X X Preechaporn et al.2006, Ratsitorahina et al.2008 Gardens X Adhami and Reiter 1998 Discarded plastic bottles X Adhami and Reiter 1998, Preechaporn et al.2006 Wet containers X Ratsitorahina et al.2008 Banana trees X Preechaporn et al.2006 Plant axils X Preechaporn et al.2006 Animal pans X X Preechaporn et al.2006 Plastic containers X X Preechaporn et al.2006 Cement tanks X X Preechaporn et al.2006 Ant guards X Preechaporn et al.2006 Preserved areca jars X Preechaporn et al.2006 Small and large earthen jars X X Preechaporn et al.2006 Key: (X):- present, (-):- absent. Effect of climate change Outbreaks have been associated with climatic conditions such as temperatures and high rainfall. Temperatures influence the developmental rate of Aedes albopictus larvae to adult mosquitoes, with the rate optimising at temperatures between 25 to 30oC (Straetemans 2008). Thus, Tilson et al. (2009) argued that mean monthly temperatures above 20oC are required to initiate an outbreak, as illustrated by the Italian outbreak that was initiated in June and subsided in September when the monthly average temperatures were 22oC and fell below 20oC. Mean annual rainfalls over 500mm is required (Straetemans 2008) to provide suitable breeding environment for the mosquitoes to expand their population (Lumsden 1955); as a result, most outbreaks have been associated with high rainfall (Lumsden 1955, Pastorino et al. 2004, Renault et al. 2007, Sissoko et al. 2008, Yoosuf et al. 2009) as illustrated in Table 3. In 2009, the UK Met office (2010) recorded a mean annual rainfall and temperature of 1201.3 mm and 9.2oC, respectively. The rainfall is sufficient to initiate an outbreak; however, the low temperature is insufficient to support the mosquitoes life cycle. Therefore, the question is what would the impact be to the UK if the climatic condition changes to favour this mosquito? Table 3. Mean temperature and the amount of rainfall that were reported during several outbreaks. Country Duration of the outbreak Mean monthly Temperature (oC) Months mean monthly temperature were collected Amount of Rainfall (mm) Months high rainfall were recorded Reference Tanzania 1952 1953 21.8 28.5 Jun Nov 1203 Jan Dec 1952 Lumsden 1955 Bogor Aug Dec 2001 24 26.2 Jan 2000 Dec 2001 NA Laras et al.2005 Bekasi Jan 2002 26.2 29.6 Jan 2001 Dec 2002 1931 Jan Feb 2002 Laras et al.2005 Maldives 2006 2007 NA NA 970 Nov Dec 2006 Yoosuf et al.2009 Key: NA- not available Distribution of Chikungunya outbreak Mayotte (French Overseas Territory), an island of the Comoros archipelago, encountered its first CHIKV outbreak imported from Grand-Comore in mid-April 2005 (Renault et al. 2007), with 6346 reported cases (in two waves), observed by the surveillance system implemented throughout the island by the local French Health Authority, Dass (Direction des affaires sanitaires et socials) Mayotte. The first (minor) wave commenced in April 2005, it later peaked in week 18 and the infection rate diminished in June, with the virus maintaining low levels thereafter, during the temperate and dry season. However, the second (major) wave began during the first week of May 2006, peaked during the hottest and rainiest months around March/April 2006 and reduced to control levels by July 2006 (Sissoko et al. 2008). In March 2005, a chikungunya infection which started in Grande-Comorre was imported into La Reunion (French Overseas Territory), becoming its first severe reported case involving two waves of outbreak, as observed by the epidemiological surveillance system implemented by the islands local Health Authorities (Renault et al. 2007). Firstly, a (minor) wave commenced in March 2005, peaked in May 2005 and decreased at the beginning of July to approximately 100 cases where the level was maintained during the austral winter. By December 2005 the second (major) wave began; however, the capacity of the surveillance system at the time was insufficient to evaluate the number of cases, as the number of cases was increasing exponentially. This resulted in an underestimation of the number of reported cases with possible misdiagnosis with Dengue fever which circulated the island the previous year (Renault et al. 2007). By April 2006, the Regional Health and Welfare Office reported 203 deaths that w ere directly (due to low immune status) or indirectly (in associations with other underlying conditions) attributed with chikungunya infection, with a low mortality rate of 0.3/1000 people (Renault et al. 2007). The Maldives encountered its first CHIKV outbreak involving 11879 confirmed and suspected cases on 121 of the 197 inhabited islands, observed by the surveillance system implemented by the Epidemiology Unit of the Department of Public Health (DPH), from December 2006 to April 2007 (Yoosuf et al. 2008). The outbreak commenced at the beginning of December 2006, peaked in week 6 and subsided to control levels by week 11 before halting in April 2007. The epidemic was thought to be associated with post-tsunami construction activities which provided breeding sites for mosquitoes. Moreover, approximately five to six elderly patients died as result of co-morbidity and other conditions (Yoosuf et al. 2008). Figure 2: Global Distribution of chikungunya virus, 1952 to 2009. The cases represented on the map are either confirmed cases or suspected cases (Evenor 2010). References: 1 Krastinova et al. 2006, 2 Rezza et al. 2007, 3 Pastorino et al. 2004, 4 Sissoko et al. 2008, 5 Lumsden 1955, 6 Tamburro and Depertat 2009, 7 CDC 2009, 8 WHO 2008, 9 Yoosuf et al. 2009, 10 Leroy et al. 2009. Importation into Europe England In 2006, the United Kingdoms (UK) Health Protection Agencys (HPA) Special Pathogens Reference Unit (SPRU) reported 133 imported cases of chikungunya (Table 4). The majority of these tourists had travelled to the Indian Ocean islands (68), between March and August 2006, where outbreaks were circulating, with Mauritius being the main destination site involving 58 imported cases, followed by 6 in the Seychelles, and 4 in Madagascar. However, when the outbreaks were in decline, only one case was detected in December (HPA 2007). Between August and December, 44 cases were imported from India and 10 cases were imported from Sri Lanka, between November and December; countries with reported recent chikungunya outbreaks. Also imported into the UK, where one case from Nigeria, one from Tanzania, one case from Kenya, and one case from Australia. There had been no mention of chikungunya outbreak in these countries. However, the article did not state whether there had been reported sightings of Ae des mosquitoes in UK (HPA 2007). Table 4. The number of cases was identified by different methods from the 133 imported cases, in the UK. Identification of the imported cases Number of cases Laboratory confirmed case 45 Probable case 30 Suspected case 35 Past exposure 23 France The Pitià ©-Salpà ªtrià ¨re Hospital in Paris, France, reported 80 cases of Chikungunya infection imported by tourists who recently visited the Southwest Indian Ocean region, between March 2005 and August 2006. The majority of cases (52) were imported from La Reunion (Hochedez et al. 2007), a popular destination site for French tourists (HPA 2006). Other destination sites reported were; Mauritius with 18, Comoros with 4, Madagascar with 3, and Mayotte with 2 cases (Hochedez et al. 2007). Within the same period, Metropolitan France reported 766 imported cases, which correlated with the two waves of the La Reunion outbreak (Figure 3). At the peak of the first La Reunion outbreak, an average of 20 cases was imported to France monthly. However, between August and November 2005, during the Southern Hemisphere winter, the cases decreased (Krastinova et al. 2006). A month after the peak of the second outbreak, the number of imported cases drastically increased. It can be argued that Fran ce is at risk of future outbreaks, in view that some of its inhabitants are constantly visiting the Southwest Indian Ocean regions (Hochedez et al. 2007), mainly La Reunion and also due to the inhabitation of Aedes albopictus (Krastinova et al. 2006). Figure 3: Correlation between imported cases of Chikunugunya in metropolitan France to the estimated number of cases in the La Reunion outbreak (Krastinova et al. 2006). Italy Chikungunya was apparently imported into Italy by a male tourist coming from the Kerala province in India, who developed febrile illness two days into his holiday. The region he visited was Castiglonia di Cervia in June 2007. This was recorded by Ravenna provinces local health unit in the Emilia Romagna region, northeastern Italy where 205 people developed CHIKV infection (Rezza et al. 2007). The vector, Aedes albopictus, was implicated in the spread of the virus which was then imported from Castiglione di Cervia into Castiglione de Revenna two villages separated by a river. Mosquito control measures implemented in the area resulted in a reduction in chikungunya infection. However, the control measure was not implemented in other villages and therefore a new wave occurred. The virus isolated from the outbreak contained the same mutational change (Ala226Val) in the membrane fusion E1 glycoprotein as the Indian Ocean variant, thereby suggesting that the Kerala strain could have origina ted from the Indian Ocean outbreak (Rezza et al. 2007). Other European Countries Tourism has been one of the main methods of CHIKV distributions worldwide, including its importation into several European countries. In 2006, the Bernhard-Nocht Institute for Tropical Medicine in Hamburg, Germany examined 720 samples from 680 European patients who became symptomatic upon return to Germany, Belgium, Switzerland, Denmark, and Poland from several destinations (Table 2) (Panning et al. 2008). The majority of patients had recently visited countries in the Indian Oceans; Mauritius, the Seychelles, La Reunion and Madagascar, and other countries; Bali, Indonesia, Sri Lanka, India, Malaysia, Kenya and Thailand. Moreover, most of these countries have been implicated in recent CHIKV outbreaks. No outbreaks were reported in these European countries; however, future outbreaks can be hypothesised (Panning et al. 2008). Table 5. The country of origin and the holiday destinations of patients presented at the Bernhard-Nocht Institute for Tropical Medicine in Hamburg, Germany. Exact destinations were only available for 27.8% of patients, and exact itinerary were not available (Panning et al. 2008). Country of origin Number of patients Germany 515 Belgium 99 Switzerland 42 Denmark 22 Poland 2 Total Nos. of patients 680 Holiday Destinations (Regions with Chikungunya Epidemic) Number of patients Mauritius 92 The Seychelles 23 La Reunion 18 Madagascar 9 Bali 2 Indonesia 6 Sri Lanka 5 India 28 Malaysia 2 Kenya 1 Thailand 3 Concurrence with Dengue Fever and Malaria In 2006 and 2007, Madagascar and Gabon reported co-infections between Chikungunya and DENV-1 or DENV-2 respectively (Ratsitorahina et al. 2008, Leroy et al. 2009). Contrary to CHIKV, dengue virus (DENV) is of Flavirivirus genus from Flaviridae family; consisting of four antigenically distinct but closely related serotypes (DENV1-4). It is transmitted by Aedes aegypti and Aedes albopictus, also CHIKV transmission vectors (Cook and Zumla 2009). DENV and CHIKV have similar clinical features (Yoosuf et al. 2008). However, the only difference is that CHIKV has arthalgia (). The extended incubation period of DENV (5-8 days) differentiated it from CHIKV (2-7 days); however, the difference is insignificant (Cook and Zumla 2009). Thus, serological diagnosis can be used to differentiate DENV to CHIKV (Ratsitorahina et al. 2008). Ratsitorahina et al. (2008) and Leroy et al. (2009) confirmed Aedes albopictus as the predominating transmission vector of both CHIKV and DENV1 or 2. However, neither study stated whether the vector could simultaneously harbour both viruses. Moreover, the study by Vazeille et al. (2008) demonstrated that Aedes aegypti has a higher susceptibility to DENV-2 virus and a lower susceptibility to CHIKV; whereas Aedes albopictus is a more efficient vector for CHIKV than DENV-2 (Vazeille et al. 2008 and Moutailler et al. 2009). Leroy et al. (2009) further demonstrated this theory in the Gabon outbreak, as the majority of the patients had CHIKV compared to DENV-2. In May 1999 and February 2000, the Matete and Kingabwa quarters of Kinshasa in the Democratic Republic of Congo (DRC) reported two Chikungunya outbreaks. CHIKV was the main contributing factor in the first outbreak; however, during the second outbreak, evidence confirmed possibility of co-infections between CHIKV and Plasmodium falciparum (Pastorino et al. 2004). Malaria is a parasitic infection, of the Apicomlexa phylum, that mainly infects hosts red blood cells. It is transmitted by Anopheles species, whereas CHIKV is mainly transmitted by Aedes species. Plasmodium falciparum is one of the four species of Human Malaria (including Plasmodium vivax, Plasmodium malariae, and Plasmodium ovale). However, Plasmodium falciparum is the most severe form of Malaria (Cook and Zumla 2009). Pastorino et al. (2004) hypothesised that co-infections could be due to long term latency of Plasmodium falciparum, the presence of both transmission vectors in the area or the pathogens sharing the same vec tors. An experimental investigation by Yadav et al. (2003 as cited by Pastorino et al. 2004) demonstrated that urban Anopheles stephensi (Plasmodium falciparum vector) could transmit CHIKV. Lack of Research We are still in the preliminary stages of understanding the interaction between CHIKV and host immunity (Kam et al. 2009), despite increasing number of reported outbreaks, there are insufficient evidences of up-to-date quality research (Panning et al. 2008). Therefore, outbreaks should be utilised to implement entomological and epidemiological system in improving our poor knowledge of the virus (Pialoux et al. 2007). Chretien and Linthicum (2007) argued that the Italian outbreak should provide opportunities for developed countries to strengthen the public-health system of developing countries in order to reduce the worldwide spread of outbreaks. These can be done by implementing Entomological and Virological surveillance in Aedes albopictus infested areas (Charell et al. 2008). Renault et al. (2007) utilised Deltamethrin insecticides to eradicate adult mosquitoes, whereas Rezza et al. (2007) utilised synergised pyrethrins. Furthermore, both authors utilised the biological larvicide, Bacillus thuringiensis israelensis, to destroy breeding sites (Renault et al. 2007, Rezza et al. 2007); however, Renault et al. (2007) later utilised Fenitrothion and temephos. Other control measures include educating the community on personal protection (Ratsitorahina et al. 2008). Although, no commercial vaccine has been approved, several candidates have been tested including the Formalin inactivated CHIKV vaccine for the Indian strain, DRDE-06, ECSA genotype (Tiwari et al. 2009). Therefore, the author believes that future outbreaks can be avoided if more research on CHIKV is undertaken, and a worldwide surveillance system is implemented. Conclusion This review has demonstrated that tourism is one of the main methods of CHIKV distributions worldwide, as it was the reason of several outbreaks. CHIKV was transported throughout the Southwestern Indian Ocean islands by viraemic tourists visiting different islands (Figure 2) and Kerala, India, which was then imported into Italy (Renault et al. 2007, Rezza et al. 2007, Sissoko et al. 2008, Yoosuf et al. 2008). However, outbreaks require temperatures above 20oC and annual rainfall over 500mm to maintain Aedes mosquitoes populations (Straetemans 2008, Tilson et al. 2009). Therefore, England is one of the least at risk country, as Aedes albopictus is not present, and the temperature is unfavourable to maintain mosquitoes life cycle (HPA 2007, Met Office 2010). Countries such as France and Italy are at high risk, due to the presence of Aedes albopictus and the introduction of CHIKV; although, Italy is the most at risk due to a recent outbreak (Krastinova et al. 2006, Rezza et al. 2007). T he eminent climatic changes could result in rising temperatures and increased rainfall that would favour the establishment of Aedes albopictus worldwide. All these emphasises the need for Western medicine to plan for future CHIKV outbreaks, by implementing a worldwide surveillance system in order to monitor outbreaks and to perform vector control measures (Charell et al. 2008). Chikungunya have concurrence with Malaria and Dengue Fever (Leroy et al. 2009, Ratsitorahina et al. 2008); furthermore, evidence suggests wrong classification of Chikungunya due to its resemblance to Dengue fever. CHIKV is constantly mutating, thus constant development of a new vaccine is required (Tiwari et al. 2009). Thereby, further researches are needed.

Kanye West :: essays research papers

Singer/Songwriter for this Era He may just seem like another rapper to you but if you actually listen to his lyrics you can see he’s not like any rapper out there. His name is Kanye West and he was born in Chicago Illinois. He grew up in the â€Å"ghetto† and learned to appreciate life. He didn’t learn to really, truly appreciate life until October of 2002. Driving back to his hotel late one night after a recording session, the new-coming rap/hip-hop artist was involved in a devastating, near fatal car accident. The crash left him with a broken jaw in three places and an appreciation for life. Just weeks after being released from the hospital he recorded his first major hit, â€Å"Through the Wire,† with his mouth still wired shut. He records every song like its going to be his last song and that makes every song better than the last. He’s not only a rap artist but also a producer. He has been responsible for being behind songs like Jay-Z’s Izzo, Girls, Girls, Girls, The T akeover, and 03 Bonnie and Clyde. â€Å"Through the Wire† was his first hit and it hit hard. With lyrics like: I must got a angel/ Cuz look like death missed his ass/ Unbreakable/ What you thought they call me Mr. Glass/ I look back on my life like the ghost of Christmas past/ Toys R Us where I used to spend that Christmas cash/ And I still won't grow up/ I'm a grown ass kid/ So I should be like other stupid s**t that I did/ But I'm a champion/ So I turned tragedy to triumph/ Make music that's fire/ Spit my soul through the wires. Read the lyrics and you’ll see why its so universal. If you listen to the â€Å"beats† and the rhythm you’ll really understand. One of his most controversial songs came later in his career, it was titled â€Å"Jesus Walks,† many people didn’t want this song to be played but radios did it any way and so did MTV. There is one verse of the song that makes you appreciate his work: To the hustlers, killers, murderers, drug dealers, even us crippers.../(Jesus walks with them!)/To the victims of welfare feel we living in hell here, hell yea.../(Jesus walks with them!)/Now hear ye hear ye wanna see thee more clearly/I know He hear me when my feet get weary/Cause we're the almost nearly Kanye West :: essays research papers Singer/Songwriter for this Era He may just seem like another rapper to you but if you actually listen to his lyrics you can see he’s not like any rapper out there. His name is Kanye West and he was born in Chicago Illinois. He grew up in the â€Å"ghetto† and learned to appreciate life. He didn’t learn to really, truly appreciate life until October of 2002. Driving back to his hotel late one night after a recording session, the new-coming rap/hip-hop artist was involved in a devastating, near fatal car accident. The crash left him with a broken jaw in three places and an appreciation for life. Just weeks after being released from the hospital he recorded his first major hit, â€Å"Through the Wire,† with his mouth still wired shut. He records every song like its going to be his last song and that makes every song better than the last. He’s not only a rap artist but also a producer. He has been responsible for being behind songs like Jay-Z’s Izzo, Girls, Girls, Girls, The T akeover, and 03 Bonnie and Clyde. â€Å"Through the Wire† was his first hit and it hit hard. With lyrics like: I must got a angel/ Cuz look like death missed his ass/ Unbreakable/ What you thought they call me Mr. Glass/ I look back on my life like the ghost of Christmas past/ Toys R Us where I used to spend that Christmas cash/ And I still won't grow up/ I'm a grown ass kid/ So I should be like other stupid s**t that I did/ But I'm a champion/ So I turned tragedy to triumph/ Make music that's fire/ Spit my soul through the wires. Read the lyrics and you’ll see why its so universal. If you listen to the â€Å"beats† and the rhythm you’ll really understand. One of his most controversial songs came later in his career, it was titled â€Å"Jesus Walks,† many people didn’t want this song to be played but radios did it any way and so did MTV. There is one verse of the song that makes you appreciate his work: To the hustlers, killers, murderers, drug dealers, even us crippers.../(Jesus walks with them!)/To the victims of welfare feel we living in hell here, hell yea.../(Jesus walks with them!)/Now hear ye hear ye wanna see thee more clearly/I know He hear me when my feet get weary/Cause we're the almost nearly

Coca Cola vs Pepsi: Background

Research Proposal |Student Number: | PROVISIONAL TITLE |Coca Cola Vs Pepsi: how a competitive brand proliferation has determined their dominance in the global soft drink industry? | BACKGROUND | | |It is not a foreign notion that both Coca Cola and Pepsi have been competing with one another in the global soft drinks industry for many years.From the | |early stages, of both the drink brands development from 1910, when Pepsi took on Coca Cola in the American carbonated drinks market franchising 24 | |states[1]. Too the current day in which Coca Cola this year celebrated, 84 years of being the official sponsors of the Olympic Games. As well as Pepsi | |wining the bid for sponsorship of the Superbowl halftime show once more; with last year’s show being viewed by an estimated 114 million globally. 2] | | | |Their soda war has been raging for over a century. When Caleb Bradham created Pepsi in 1898, Coca Cola had already been incorporated for 6 years by Asa | |Candler who purchas ed John S Pembertons Coke recipe, and was selling a million gallons a year. By the time Pepsi had franchised 24 states; Coca Cola had | |established bottling plants in Cuba, Canada and Panama and understood the power of advertising. Ploughing large amounts of profits into marketing with | |D’Archy Advertising Company.Over the next 20 years Pepsi suffers two bankruptcies the first in 1923, the start of World War I (WWI). When government | |policies on sugar rationing left the company with no other viable option and Pepsi Cola was sold to Craven Holdings Corp. After two years the trademark | |went bust once again in 1931. Here though good fortune comes in the form of Loft Inc a candy store chain, with its intuitive president Charles G Guth; | |they initiate the first competitive pricing strategy between the two firms. Pepsi Cola introduced the 12 ounce bottle for 5 nickel in 1933.With profits | |rising Pepsi produces their first advertising campaign for radio and jukebox: †˜Pepsi Cola Hits The Spot, Twelve Full Ounces That’s A Lot, Twice As Much For| |A Nickel, Too, Pepsi Cola Is The Drink For You’. During this time Coca Cola has established bottling operations in Bordeaux, Paris, Philippines’ | |establishing a global distribution network of resources. Resulting in a huge group investment of $25 million persuaded by Ernest Woodruff who would become| |President of Coke in 1923. The investment spurs Coke to spread to Australia Norway and South Africa. | | |By 1959 Coke is now a registered trademark under the name of The Coca Cola Company, their first ever television commercial has been advertised and the | |company’s distribution network crosses 100 countries and 1700 plants. From the 1940’s onwards Pepsi have learnt from previous events and at the beginning | |of World War II (WWII) purchase a sugar plantation in Cuba to avoid disruption to business. They have also developed their products container to a can, a | |m ore progressive and modern aversion from the traditional heavy glass bottle.By 1959 Pepsi was now available in a 120 countries; differentiating their | |target market the youth nicknamed the ‘sociables’. At this point, for the first time both Coca Cola and Pepsi Cola are equals. In the sense they have | |established equally strong global distribution networks and have similar levels of assets. | | | |Albeit in 1960 Coca Cola was not complacent with sharing the lime light with Pepsi Cola, and initiates a merger acquiring Minute Maid Corporation in | |response.This causes a domino effect over the next few years with Coca Cola introducing Sprite and Diet Coke. Pepsi Cola merges with Mountain Dew adding | |to their trademark and then merging into the snacks industry with Frito Lay Inc creating PepsiCo Inc, as well as introducing Diet Pepsi. Both brands have | |continued to develop and expand. To this day The Coca Cola Company is consists of over 400 brands[3] and Pepsi con sisting of 22 food and beverage | |brands[4]. | | |Although Coca Cola and PepsiCo are prestige brands, they both remain global market powers in a vigorously competitive soft drinks industry, valued at total| |value US$30. 3bn by 2008[5]. Their success is down too their strategic behaviour in response to changes in the market structure, changes in market demand | |and product development over the last 84 years. Both brands have practiced archetypal methods such as pricing strategies, mergers, product | |differentiation, in order to compete with one another for market dominance.To such an extent the market has developed into an oligopoly, in which they | |hold a large market share stifling other competition. This type of competition is discussed in great detail in the Journal of Economics and Management | |Strategy, where company strategic behavioural responses are explained by using various oligopoly competition theories such as Cournot, Bertrand competition| |and Pure strategy Nash equilibrium games. Some of the articles within the Journal are specific to Coca Cola and Pepsi, proving that my topic is both | |contemporary and relevant. 6] The journal also embarks on the effectiveness of constant research and development to maintain product differentiation in the| |market. [7] The journal contains articles relevant to the soft drinks industry[8] and articles that can explain certain company actions like recipe | |patents[9]. | | | |Coca Cola and Pepsi’s century long soda war can be analysed stage by stage, each brands reaction to the other is a carefully thought out plan in which the | |sole purpose is ultimately to overcome the rival brand last move in a continuingly competitive game. RESEARCH QUESTIONS AND OBJECTIVES |The main objective of this piece of research is to examine the strategically competitive decisions made by both Coca Cola and Pepsi over the last 84 years;| |that have developed both brands into establishing themselves as significant pow ers in the global soft drinks industry. | | | |My aim is to go through both brands commercial history identifying key events and competitive moves, such as the first pricing strategy instigated by Pepsi| |in 1933, and Coca Cola’s merger of Minute Maid in 1960.Using officially endorsed company literature to establish a thorough history since 1986 to the | |present day. Such texts as ‘For God, Country and Coca Cola: The Definitive History of the World’s Most Popular Soft Drink’[10] and ‘Pepsi 100 Years’[11] | |and each corporations global web sites (www. pepsico. com/www. coca-cola. company. com) will be essential to collating a empirical investigation. | | |Once I have compiled a detailed history for both companies, it will be clear that there are certain strategies that have been used to increase either | |brands market power. I will use microeconomic theory with the aid of scholarly papers, journals and market records (some of which I have referenced in my | |background) to explain the reasoning behind instigating the strategies and why they were a success to either Coca Cola or Pepsi brand proliferation.I have| |already outlined briefly a few key implemented strategies in my background; the innovation of the Pepsi can, Nickel for a Nickel decade, Minute Maid | |Corporation merger, but there are other notable tactics. | | | |Each chapter will be based on an individual event or commercial decision which I will have identified after further investigation, with the chapters in a | |chronological order. In each chapter I will analyse the motive for the action, the economic strategy implemented and its direct effectiveness on the soft | |drinks industry.When concluding my research, I hope to have a synopsis of how; when the right strategy is applied in the right climate it can have a | |profound effect on a company’s demand and supply leading to increase in profits and market share too brand proliferation[12]. Alth ough my research is | |focused on coca cola corporation and PepsiCo it may be prudent to research another leading corporation within the global soft drinks industry i. e. Nestle | |Sa or Suntory Holdings Ltd. An investigation may reveal a ype of industrial organisational strategy which has not been used in Coca Cola and Pepsis | |relationship. I could provide this strategy as a suggested forthcoming policy to deal with Coca Cola and Pepsis modern day feud such as the Olympic | |sponsorship dispute[13] | REFERENCES |1. |Mark Pendegrast (2000). For God, Country and Coca Cola: The Definitive History of the World’s Most Popular Soft | | |Drink. 2nd ed. US: TEXERE (Thomson Corporation). ix-621. | |2. |Stoddard (1997). Pepsi: 100 Years.US: General Publishing Group U. S. 1-208. | |3. |Dhar, Tirtha 1 ; Chavas, Jean-Paul 2 ; Cotterill, Ronald W 3 ; Gould, Brian W 4 . (2005). An econometric analysis of | | |brand-level strategic pricing between Coca-Cola Co. and PepsiCo. An econometric analysis of brand-level strategic | | |pricing between Coca-Cola Co. and PepsiCo. 14 (4), 905-932. | |4. |J. C. Louis and Harvey Z. Yazijian. (1980). The Cola Wars: The Story of the Global Corporate Battle Between the | | |Coca-Cola Company and Pepsico, Inc. Business History Review. 5 (04), 386-590. | |5. |Dube, Jean-Pierre. (2005). Product differentiation and mergers in the carbonated soft drink industry. Product | | |differentiation and mergers in the carbonated soft drink industry. Journal of economics and management strategy 14 | | |(4), 879-904. | ———————– [1] Kim Bhasin. (02/11/2011). COKE VS. PEPSI: The Amazing Story Behind The Infamous Cola Wars. Available: http://www. businessinsider. com/soda-wars-coca-cola-pepsi-history-infographic-2011-11? op=1. Last accessed 04/11/2012. [2] Sports Illustrated. (2012). Pepsi