Legal aspect Essay Example | Topics and Well Written Essays - 1250 words

Legal aspect - Essay Example They include autonomy, beneficence, nonmaleficence, veracity, confidentiality, justice, and fidelity. Based on the case before us, the nurses had the ethical responsibility of providing safe, compassionate, and competent care to the patient (Storch, Rodney, and Starzomski, 2004). In this regard, it was the responsibility of nurses to ensure that the patient is provided with the necessary treatments and care to ensure his well-being. In fact, the patient also has the right to receive treatment from nurses regardless of their status or situation. Therefore, it was the obligation of the nursing staff to ensure that the right of the patient is protected. The nurses were also under the ethical responsibility to preserve the dignity of the patient. This included the duty of providing the necessary support to ensure the patient’s dignity and integrity is maintained, according to Storch, Rodney, and Starzomski (2004). In the case before us, the patient had the right to be provided wit h the necessary care such as ensuring his cleanliness and well-being is assured. This includes being cleaned and turned on bed periodically to ensure his dignity is not compromised. The nurses were also under an ethical obligation to promote justice of the patient (American Nurses Association, 2006). ... Further, the nurses had the ethical responsibility of ensuring that the privacy and confidential information pertaining to the patient are maintained, according to the American Nurses Association (2006). In this regard, the nurses were expected to ensure that any confidential information pertaining to the patient is only used for the purpose for which it is meant. Therefore, they should ensure that private and confidential information is not divulged to the public without the consent of the patient. 2. Was there a deviation from the standards of care in this instance? Explain. The case before us showed a deviation from a number of standards of care expected of the nurses in discharge of their duties. Firstly, the case manifests a deviation from the nurses’ ethical duty to provide safe, compassionate, and competent care. This is evident from the fact that the nurses at the hospital failed to ensure that the patient received the quality care. According to Mrs. O’Hara†™s family, their patient died because of the nurses failed to administer the care and treatment expected. The fact that the 86-year old man laid on the bed without assistance from nurses is a clear proof of the deviation of this standard of care. The case also shows a deviation from the ethical responsibility of protecting the dignity of the patient. Every patient has a right to receive the necessary support from the health care providers such as being given the opportunity to bath and the turned on the bed in case the patient is too weak to do so by himself or herself (Burkhardt and Nathaniel, 2002). The case before us, however, shows clearly that the nurse charged with the responsibility of providing such a support failed to do so. As claimed by Mrs. O’Hara’s family, the 86-year old patient

Promote person centred approaches Essay Example for Free

Promote person centred approaches Essay Person centred values must influence all aspects of health and social care. The individual is at the centre of the care and are involved in every aspect of it. This ensures that their support, activities, care plans and support plans are tailored to the individual and meet their needs in a way that is appropriate to them. There are person-centred values which must be used to underpin the above. These are respect, partnership, individuality, rights, choice, privacy, independence and dignity. In following the values, people are then empowered to live their lives and achieve their potential. A care plan details a persons needs and wishes, what is being done to meet them and who is involved in doing so. If a care plan is person-centred it reflects their individuality and will contain their own views and wishes, inform you about what they think is important and how they feel about their circumstances and tell; you how they want to live their life. By knowing this, it means you can support them to live how they want and achieve their dreams, recognising their choices and ideas. Read more: Define person centred values essay There are factors which influence the capacity of an individual to give consent. Having the capacity means having the physical or mental ability to do something, and consent means having the ability to give informed permission for something to happen. It also implies the individual understands what their decision means. The ability to give consent comes from being able to understand complex and abstract ideas or concepts without the need for evidence. You have to be able to weigh up the pros and cons and make a decision. Therefore you need to be able to understand the risks and benefits of a situation, be able to freely express your thoughts, ask questions and have the time to process the situation. Personal values and beliefs, the level of education and a person’s communication skills impact on their ability to make a decision. As does, having their thoughts and opiuons respected, treated with dignity and knowing theywont be judged for the decisions they do make. If consent can not be readily established you need to adapt your approach to  the individual. For example if a person needs time to process information and go over it time and time again, then you do that till they are ready. Some people are unable to consent due to their learning disability or medical condition. In this case, the individual will have a representative will act in their best interests. Any decisions already given consent too would be found in their care plan. Family members are a great point of contact. Active participation is about working in a way which respects the individual’s right to participate in life as independently as possible. They are seen as active participant or partner. To apply active participation to an individuals needs you would make sure you are aware of their likes, dislikes, wishes and also their abilities. You would then use this knowledge to come up with a plan that best suits the individual. This ensures a happy outcome for everyone. It is person-centred and put the individual in control and living an independent life where possible. Sometimes an individual needs support to challenge or question a decision about them which is made by others. You can do this by supporting the individual to decide what they want to do and how they will do it, ensuring they understand the decision that has been made and help them think through why they want to challenge the decision. You can identify who else you might be able to get involved to help out and consider if an advocate would be necessary. Arranging a meeting to address their concerns can also be done. Identity, self-image and self-esteem are all linked. Self-image is all about how we see ourselves, and our opinions of our won worth. Self-esteem is all about being confident in who we are and out sense of value. Identity is knowing who you are, what makes you unique, your personality and characteristics. If you don’t know who you are as an individual then you are more likely to struggle with a low sense of value which creates a negative self-image and low self-esteem. This can manifest in individuals behaviour, ability to make simple decisions, express themselves and make choices. Wellbeing is a feeling that you are feeling well and doing well. There are  many factors that influence this. The practical aspects of life factors are income, employment, quality of living environment, physical and mental health and access to services and amenities. There are also factors in relation to personal and social relationships which are support networks, loving and intimate relationships and relationships with the wider community. Values and attitudes also contribute to wellbeing. These are an individual’s sense of purpose and value, their hopes, dreams and fears, their satisfaction with life, what they think and feel about themselves and any moral or spiritual codes of behaviour. How people are treated by society and their life experiences play a part in how they see themselves and therefore affect their sense of wellbeing. Risk taking and risk assessments relate to rights and responsibilities. The exercise of individual rights goes side by side with the individual taking responsibility for the outcomes of their decision. Therefore, you need to be sure that the individuals have the capacity to make an informed decision and fully understand any potential consequences. Risk assessments need to be regularly reviewed as peoples needs and abilities change, especially if their health deteriorates as they may be expected to do more than they can manage. Also, if an activity was agreed to develop skills and confidence, by not reviewing the risk assessment, your are undermining everything they have achieved and they won’t be able to continue to progress.

Black Militia’s Formation Essay -- American History, The Civil War

In such a controversial period regarding the spread of slavery and state’s rights, the Louisiana black militia’s formation and involvement during the Civil War was not one without strife. The Union and Confederacy were both divergent in issues regarding the black population. It was only innate the black population would assist in the struggle which would determine their future to be free from subrogation. In order to review the history of the Civil War, it is only practical to view the involvement of black men during this struggle. James G. Hollandsworth, Jr. explores the social, political, and military aspects of the first, second, and third regiments of the Louisiana Native Guards during the Civil War. This topic of black militias is a rare narrative due to its lack of precedent over that of the white participants. The author begins with the Louisiana Native Guards representing the Confederacy during the siege of New Orleans and continues through the time of reconstruction. The basic initiative of Hollandsworth is to illustrate the discrimination of black soldiers by their white Union counterparts. By tracing some of the involvement of the Louisiana Native Guards during the Civil War, Hollingsworth is able to address some historical questions regarding the different sentiments towards blacks in the north and south. There are several smaller factors which Hollandsworth explores. One of these factors is the differences in sentiments amongst the white participants of the Union militias. The determination of the participants in the black militias is also exemplified to account for their devotion towards the conflict which surrounded the Civil War. Hollandsworth also explores the continued struggle and determination of the black... ...are that of superior authority, such as officers. Since a militia unit contains different hierarchies of participants, to contain the superior and not the inferior provides insufficient evidence on the topic at hand. In order to fully understand history, it is beneficial to gather information from both perspectives and all participants. A biased tabulation of history is compared to that of a victim and its offender. Historical events contain factual elements which may never be fully discovered, especially during times where documentation was some times scarce. Since history sometimes repeats itself, in order to learn lessons, one must identify all the elements which caused the initial conflict. Hollandsworth revives a portion of history which brings about a new perspective to his readers and with this a possible evolution in black military historical literature.

The Speech the Graduates Didnt Hear

Recent research shows that the last fifty years of college education has been a waste. It didn't provide students with adequate preparation for the real world, so through It all out the window because It was all wrong. An article came across my desk the other day â€Å"The Speech The Graduates Didn't Hear† by Jacob Ensures. It suggests that the last four years of their college career has prepared them for a world which doesn't exist. Not allowing them to fail, and providing an easy way out. Giving things they demented yet didn't deserve.I felt as if it was education that failed not the students. On several notes the writer admits education was what failed not the students: we created an altogether forgiving world, we didn't want to be bothered, and we have accepted failures and k quitters. Ensures went Into details and said â€Å"which ever slight effort you gave was all that was demented† (1). Why should that be enough for a professor who represents an Institution that promotes a higher level of learning? Raise the standards if you think they are not high enough. If his forgiving world you have created Is not realistic. Sake it realistic. As a student myself, I've experienced the lack of care from professors. However when we break appointments or don't meet deadlines make exceptions with consequences. Prepare us of what's to happen in the real world. Doing us a favor that sets us back isn't really a favor. On the other hand, why should we be tolerated or taught things that should be unlearned? According to Carter A Daniel, â€Å"we had to do it, for the sake of education† (CTD. In Ensures 2). To an extent I can agree. Still as leaders, I feel they hocked be held responsible. Why aren't they being held responsible? In life every action has a reaction. As students if we see the lack of care, or respect from a professor it will reflect In our work and attitude towards them. Professors seem not to care as much because to them it's the student' s life and choice. The choices we make don't Impact them directly so why should they care. As Ensures stated â€Å"quitters are no heroes†, that's what we are taught in the real world. (1) However in college it's somehow accepted. Teach me, mold me, show me the right way. How can we learn If I've never been taught?How can we know failure if we've never really failed? The writer clearly states â€Å"With us you could argue about why your errors were not errors, why mediocre work really was excellent, why you could take pride in routine and slipshod presentations† (Ensures 1 Clearly these excuses are being accepted instead of corrected. Professor Carter A Daniel said it best when he wrote â€Å"Education has failed you by being easy, free, forgiving, attentive, comfortable, Interesting, and unchallenged fun† (CTD. Ensures 2). I say It's time for the facilities ND students to come together and make a change.Do it because we have to. Do it for education. By Indian t hrough it all out the window because it was all wrong. An article came across my world which doesn't exist. Not allowing them to fail, and providing an easy way out. Failed not the students. On several notes the writer admits education was what failed bothered, and we have accepted failures and k quitters. Ensures went into details should that be enough for a professor who represents an institution that promotes a this forgiving world you have created is not realistic, make it realistic. As a student should be held responsible.Why aren't they being held responsible? In life every professor it will reflect in our work and attitude towards them. Professors seem not to don't impact them directly so why should they care. As Ensures stated â€Å"quitters are somehow accepted. Teach me, mold me, show me the right way. How can we learn if we've never been taught? How can we know failure if we've never really failed? The slipshod presentations† (Ensures 1). Clearly these excuses are being accepted interesting, and unchallenged fun† (CTD. Ensures 2). I say it's time for the facilities

Canon photo chains Essay

Inroduction The message behind photo chains was to inspire people by spreading from one photograph to another as the next creative experience.   The goal behind photo chains was to build accurate insight, which is the main requirement to assemble strong engagement and a strong background of supporting ideas.   The purpose of Photo chains was to encourage consumers increase their experience with canon camera lens technology.   The campaign was launched to allow people to compete and show their photo experience.   The idea behind this photo chains was to create brand awareness and market their products. This would result in attracting many customers to buy canon products. Which marketing positioning strategy Canon used in this campaign? Why? As marketing positioning strategy, Canon launched an online campaign referred to as imagination.   This campaign was a photo contest which encouraged people to participate by uploading their photos.   This campaign was to create awareness about their quality brand which they had created with purpose of inspiring its consumers. Perreault, Cannon & McCarthy (2012) states that customers tend to have more power in making purchases when they have detailed information of the product or services they are targeting to buy.   Canon used this strategy by creating photo chains of which were advertised through television and social networks.   This advert directed people to their website where they were supposed to upload their picture. Canon had established a unique brand which was different from the other competitors this was as a result of influencing creativity and innovation in its operations.   Targeting consumers though online means was a good strategy to improve their relation with customers and building their brand     awareness.   Canon strategically placed its photo chains campaign online to reach out many consumers and give them chance to upload their photos.   The strategy was able to grow largely in the social media attracting more audience.   The canon EOS was of good quality and low price as compared to other competitors. Moreover, Canon also used the strategy of offering low prices with the aim of attracting many customers to buy their quality products. Evaluate and Explain the effectiveness and benefits of â€Å"Photochains† for Canon in terms of: †¢ Target consumers †¢ Brand position in the market †¢ Profit (Short and Long-term) Canon Photo chains campaign mostly targeted individuals, companies and families.   This was an effective online campaign which involved many people who had passion for photographs.   According to Perreault, Cannon & McCarthy (2012) marketing tends to operate in various different dynamic where one of them is use of digital tools. On this perspective, online marketing ensured that Canon was able to create their brand awareness by reaching out to all global customers. Through Photo chains, Canon was able to reach out many people by mostly targeting wildlife, travel and DSLR videographers.   The quality of their brand was to inspire people with the new level of creativity as way of creating brand awareness.   The outcome results were encouraging as many global consumers opted to buy canon products. Brand position in the market Canon established EOS brand of its own having advantage of being unique and creative. This means that the company positioned its brand to be unique from those of competitors. Introduction of EOS Photo chains which inspired and attracted many customers. This brand was distinctive and quite different from competitors. The purpose of this brand positioning was to improve consumer experience. The company also used value and price positioning in the market. This means that it offered high quality prices at relatively low price. Profit (Short and Long-term) Canon photo chains attracted many consumers who resulted to buy their products.   This increased their total sales due to high demand of their products.   Building a strong brand, Canon   Ã‚  was able to dominate the market ahead of other competitors which made them to increase their growth rate. This implies that the company will remain in market for long time due to quality brand they established. References Perreault, W. D., Cannon, J. P., & McCarthy, E. J. (2012). Basic marketing: A marketing   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   strategy planning approach. http://www.youtube.com/watch?v=wS1dO8ydng      

History Through Movies essays

History Through Movies essays The movie The Last Days focuses on five Shoah survivors, each one of them telling their story to the camera. These five survivors are named Congressmen Tom Lantos, Alice Lok Cahara, Renee Firestone, Bill Basch and Irene Zisblatt. Each one of them came to America after the war creating families, professions and occupations, they narrate there past. The first person viewed is congressmen Tom Lantos, the 10- times elected Congressmen from California and the only holocaust survivor in Congress, he is the only Budapest of the group, the son of Patrician parents, both killed in camps. Tom Lantos came to the United States in 1947 on a Hillel Scholarship. Zisblatt escaped the gas chamber only because the room was so full that the door could not be shut without first removing her, Basch came face to face with a Nazis pistol, forced to leave a friend behind or to be killed himself. The witnesses were all teenagers then who grew up fast now narrating their Holocaust horrors. Many of them beli eve that they were kept alive to tell their story. The film focuses on the last years of the war when the Nazis shifted their emphasis from winning the war to diverting immense resources to the final Solution an attempt to annihilate all of European Jews. The horror began, on March 19,1944, Hitler by now mistrustful of his ally invaded the country. In Hungary the selection and deportation process was carried out in a mere twelve weeks. It is a documentary about the final days of millions of Jews, which is known as the Holocaust. Spielberg put together lots of film file footage about the Holocaust. It is a horrifying, troubling, but ultimately uplifting documentary that tells the story of the Holocaust in the words of Jewish Hungarian survivors. The film begins with the survivors each one of them telling their personal stories. These are five apparently strong and healthy older people, each one of them ...

-59055067894200044577006724650004029075-800735 Essays - Free Essays

-59055067894200044577006724650004029075-800735 Essays - Free Essays -59055067894200044577006724650004029075-800735 27 Sep 191700 27 Sep 1917-923925-791845 19 July 183400 19 July 1834-914400-9067800038957254643755 Degas00 Degas-10191754669155 Edgar00 Edgar Edgar Degas was a French artist well-known for his work in painting, sculpture, printmaking and drawing. He was born on the 19th of july 1983 and died on the 27th of september 1917. Edgar is to be known as one of the founders of Impressionism although he refused the term, and preferred to be called a realist which was an artist or philosopher who believed in showing and discussing realism rather than visionary thoughts. Edgar's paintings and drawings are especially identified with the subject of the dance, and over half of his work portray dancers. His portraits are known to to be amongst the finest in the history of art. In Edgar's early career, his passion was to be a history painter and he was well supported by his rigorous academic training and close study of classic art.

Avoid Run-On Sentences in Your Business Writing

Avoid Run-On Sentences in Your Business Writing This statement contains an error. Find and correct it: The next few weeks will be busy. Both the website update and the app launch have deadlines in December.Huang is our most diligent employee, I would like him on my team. Run-on sentences and sentence fragments are becoming more and more common, and seem to be a tricky area for many people. I certainly have been guilty of all of these before, particularly when I am texting. While I think it is somewhat inconsequential to have a grammatical mistake in a quick text dashed off to a friend, these types of mistakes become problematic when they spill into more formal business contexts such as emails, letters, and memos. In fact, run-on sentence construction (also called fused sentences) is the #1 most common business writing grammar error we see in client writing. Fragmented sentences is the #2 error, and they are very related. Let's back up a step or two (we have to go back to middle school grammar class now) and look at the difference between Independent and Dependent Clauses. The difference between these two is the foundational reason that run-on sentences and sentence fragments are wrong. First of all, what is a clause? A clause is a group of words with a subject and a verb. There are two main types of clauses: Independent and Dependent. An Independent Clause can stand alone as a complete sentence. Ex. John is a highly intelligent business man. Ex. Suzette was recognized for her contributions. A Dependent Clause can't stand alone, and therefore it must be connected to an Independent Clause. A Dependent Clause usually happens when you add a dependent marker word. These words are often conjunctions or adverbs, and leave us with a question. Ex. Because John is a highly intelligent businessman, Ex. When Suzette was recognized for her contributions. You should notice that by adding the dependent marker word to these clauses, they become incomplete sentence fragments, and you are essentially left hanging; what happened when Suzette was recognized? What happened because John was a highly intelligent businessman? To fix this situation, you need to connect those Dependent Clauses to Independent Clauses. Ex. Because John is a highly intelligent businessman, his company is very profitable. Ex. When Suzette was recognized for her contributions, she was given a promotion and a corner office. Connecting a dependent clause to an independent clause helps us to avoid sentence fragments. But what about the more common run-on sentences? Run-on sentences occur when we connect two independent clauses without using proper punctuation. Ex. Huang is the most diligent employee, I would like him on my team. There are many ways to fix the sentence above: Huang is the most diligent employee; I would like him on my team. (You could also add a transition here if you would like: Huang is the most diligent employee; therefore, I would like him on my team.) Huang is the most diligent employee. I would like him on my team. (Like the sentence above, you could also add a transition here: Huang is the most diligent employee. As a result, I would like him on my team.) Huang is the most diligent employee, and I would like him on my team. Because Huang is the most diligent employee, I would like him on my team. Simple clear language is the key to good business writing, soit is typically best to simply split the run-on into two complete sentences, as shown in number 2: Huang is the most diligent employee. I would like him on my team. Run-on sentences and sentence fragments are easy mistakes to make, and are just as easy to fix. Start by asking yourself this question: Does this clause express a complete thought? If not, connect it to another clause that answers the unanswered question. If it does, make sure that it isn't connected to another complete thought with a comma (use a period or a semi-colon instead). This one question should make it easy for you to find the run-on sentences and sentence fragments in your business writing, and fix them on your own. If you want additional support in this area, Instructional Solutions offers business writing courses that include detailed, individualized instructor feedback on your business writing.

Pro-Slavery Speech Essay Example | Topics and Well Written Essays - 500 words

Pro-Slavery Speech - Essay Example My next point deals with the issue of love. I concur that love is the most important human law and I believe that it is love that is responsible for slavery in the first place, otherwise I fail to understand how a person can feed, clothe and house a person without loving them. Historical accounts of past slave owners in 18-19th century US highlights how slaves were housed in suitable sleeping conditions, were guaranteed three meals a day and were provided with adequate health care in the event that they became sick. This was a far cry from the free-men in Britain during the industrial revolution, whose conditions were atrocious, coupled with the lack of adequate meals and deplorable working and living conditions. Slaves were as matter of fact better off than free men. The only other religion that Americans value is the American dream. One is only needed to visit a mall to see how we value consumerism and our way of life. We have even commercialized Christmas to the extent that children view the holiday in terms of presence rather than as a celebration of the birth of Christ. What many fail to understand, is that their ability to enjoy theses privileges was through slavery. It was only through slavery that American plantation owners were able to reap profits from their farms and it is only through slavery that Americans enjoy purchasing cheap clothes made in Asia. Knowingly or unknowingly we all support slavery. I would like to finish my argument by posing the question, aren’t we all slaves in a way?

Assisting Palestine Refugees Essay Example | Topics and Well Written Essays - 2750 words

Assisting Palestine Refugees - Essay Example Thus the Palestinian refugees were scattered through the different locations where their presence is still seen today. In June 2002, US President George W. Bush formally committed US support to the creation of an independent Palestinian state that would be established on the West Bank and Gaza Strip. This was further bolstered by the pronouncement by Israeli Prime Minister Ariel Sharon, in the 2004 Likud convention, that â€Å"If a new Palestinian Authority is established, free of terror, if the incitement stops, the Israeli government led by the Likud will be prepared to carry out its part to make possible the establishment of an independent Palestinian state† 2 In January 2009, Israel ended a three-week military operation in the Gaza Strip that killed 1,200 Gaza residents and 5,000 wounded. During the military assault, civilian housing, public infrastructure, and most importantly medical facilities suffered serious damage, with thousands left homeless. A subsequent UN fact-finding mission recommended that international legal action be taken against Israel and Hamas for alleged war crimes and what may be crimes against humanity; however, as of the end of 2009, the UN Security Council has not yet acted on the recommendation.3 Meanwhile, Israeli pursued a policy of restricting movement of people and goods through the borders of the Gaza Strip, which has stifled economic activity and impeded territorial reconstruction. Restrictions were slightly relaxed in the West Bank; however, economic progress, settlement building, and reconstruction were all the same impeded, while incidences of settler violence against Palestinians still broke out. 4 It is against this backdrop that the case of Palestinian refugees is to be analyzed. The refugee situation shall be described by assessing the rights and obligations of the host state vis-à  -vis the refugee, the capability and nature of short-term and long-term responses, the role of international civic organizations in refugee response, and the prospects for successful repatriation and reconstruction.

Write a summary of each of the following texts and discuss how the Essay

Write a summary of each of the following texts and discuss how the authors address the subject of identity - Essay Example If economics and political figures do not fix the globalization structure, people will not have what they want, which will become a part of their identity. Therefore, each decision that man makes affects his true self and identity. In the twenty-first century, economic changes were threatening the third American middle class because U.S. corporations started to transfer production jobs and service jobs to low-wage workers. Along with that, in many Third World countries of export-oriented development strategies made the global market for both skilled and unskilled labor to grow bigger. Reducing the cost of such imports as toys from China and shoes from Indonesia, it destroyed the jobs. Unfortunately, every sector from foreign competition, an ever growing number of manufacturing and service jobs were eliminated by technological innovations, which is a trend that will probably prove even more important than globalization over time.. Due to technologically driven increases in productivity, advances in manufacturing and automation have slashed the prices of consumer appliances such as televisions and personal computers. However, productivity growth threatens the middle class and other social classes in three ways due to the poor structure of globalization, which could increase economic growth if reconstructed correctly. Within the book, it seems that a cow in a foreign country makes more money than anyone in the world, which most economists cannot realize as a problem. With that fact, the book suggest that globalization needs to be restructured in order to benefit everyone since their actions define their identity. In â€Å"Art of Darkness,† blacks are settled in Britain, however some do not receive the same education and treatment as white students due to the fact that they are viewed as a minority race Furthermore, because of their lack culture acknowledgement from teachers, sometimes British blacks

Animal Behavior (Biology) Essay Example | Topics and Well Written Essays - 1500 words

Animal Behavior (Biology) - Essay Example sneaking behaviors are relevant due to the fact since females are the restraining sex, and females invest more in offspring than males, males tend to be competing for females. (Roche 2006) This proves to be a significant evolutionary requirement and is especially t evolutionary requirement and is especially relevant when taking evolution and sneaking behaviors into account. Given the evolutionary requirements and the success of sneaking behavior in the context of reproducing and the ability to do so it becomes obvious why the Haplochromis burtonii who succeed at this mating form of natural selection will prevail and evolve. In order for evolution to succeed natural selection is first required to be a success. My hypothesis as to why the sneaking strategy is favored in certain circumstances is that it succeeds evolutionary because f a disparity in the population of females. If the population of males is more than can be supported by the population in order to survive they can do so by being a sneaker. This is beneficial to the sneaker male because by impersonating a female he is able to a nest in a manner that does not require fighting and his chances of injury is reduced or eliminated. I also think that inclusive fitness may be beneficial to the survival and imminent evolution of the male. ... This premise means that as a minimum a number of this variation must be heritable. By that it is meant that a genetic basis of behavior must be present. This is because a basis for both successful natural selection and evolution behavior must affect the ability of an animal to survive and reproduce. By making reference to inclusive fitness it is meant that the male may have a better chance to reproduce if favored by the females in this respect. However it is important to observe altruism is not a high priority behavior within Haplochromis burtonii populations. However it can exist in regard to inclusive fitness behaviors and by practicing sneaking behavior the sneaker male has a better chance of benefiting from inclusive fitness from the females. Roche explains that "Inclusive fitness can be estimated using a coefficient of relatedness, which estimates the chances that two related individuals both have a given allele (alternately: the proportion of genes that are identical in two individuals because of relatedness)." (2006) I hypothesize that by participating in sneaker behavior the Haplochromis burtonii literally doubles chances of either reproducing or surviving until they are able to do so. 1) c) How could you test this empirically What predictions do you make if the hypothesis is true To test this hypothesis empirically would prove to be a challenge. The reason for that is the challenge of tracking the specific Haplochromis burtonii would be difficult and specific subjects would be impossible to distinguish during many parts of the observation. There is no way to mark the subjects. However the behavior of the Haplochromis burtonii can be observed. It is during the course of these observations that

Dramatic Literature Analysis Paper Essay Example | Topics and Well Written Essays - 250 words

Dramatic Literature Analysis Paper - Essay Example Each member of the Younger family is driven by the dreams of their own. Mama intends to buy a house of her own while the son, Walter Lee, wants to invest money on a liquor store which, according to him, will solve their financial crisis. Unfortunately, their race and Walters business partners betrayal stand in the path of the fulfillment of their dreams. However, the family sticks together to make their dreams come true. The main characters strive to deal with the tyrannical circumstances inflicted upon them. All the sufferings they endure, fights they indulge in and the frustration that comes out in various ways, including Walters  fights with Ruth, Mama, and Beneatha,   Ruth’s consideration of an abortion and Beneatha dating two very different men, certainly seems to be the result of their intense struggle to attain their dreams. However, the final realization that the dream of a house is most important for it unites the family, exhibits that pride in oneself is the only way to hold on to one’s self-esteem and assert one’s value as a human being. Similarly, Mama’s dedication to the plant is the symbol of her utmost care and dream for her family to move up in the  world. The play A Raisin in the Sun is an intriguing piece of work by Hansberry which describes the importance of family and unity. It is thought provoking as it describes the efforts of a poor black family that, despite the numerous predicaments, choose to stick together to attain a place of its

Animal Behavior (Biology) Essay Example | Topics and Well Written Essays - 1500 words

Animal Behavior (Biology) - Essay Example sneaking behaviors are relevant due to the fact since females are the restraining sex, and females invest more in offspring than males, males tend to be competing for females. (Roche 2006) This proves to be a significant evolutionary requirement and is especially t evolutionary requirement and is especially relevant when taking evolution and sneaking behaviors into account. Given the evolutionary requirements and the success of sneaking behavior in the context of reproducing and the ability to do so it becomes obvious why the Haplochromis burtonii who succeed at this mating form of natural selection will prevail and evolve. In order for evolution to succeed natural selection is first required to be a success. My hypothesis as to why the sneaking strategy is favored in certain circumstances is that it succeeds evolutionary because f a disparity in the population of females. If the population of males is more than can be supported by the population in order to survive they can do so by being a sneaker. This is beneficial to the sneaker male because by impersonating a female he is able to a nest in a manner that does not require fighting and his chances of injury is reduced or eliminated. I also think that inclusive fitness may be beneficial to the survival and imminent evolution of the male. ... This premise means that as a minimum a number of this variation must be heritable. By that it is meant that a genetic basis of behavior must be present. This is because a basis for both successful natural selection and evolution behavior must affect the ability of an animal to survive and reproduce. By making reference to inclusive fitness it is meant that the male may have a better chance to reproduce if favored by the females in this respect. However it is important to observe altruism is not a high priority behavior within Haplochromis burtonii populations. However it can exist in regard to inclusive fitness behaviors and by practicing sneaking behavior the sneaker male has a better chance of benefiting from inclusive fitness from the females. Roche explains that "Inclusive fitness can be estimated using a coefficient of relatedness, which estimates the chances that two related individuals both have a given allele (alternately: the proportion of genes that are identical in two individuals because of relatedness)." (2006) I hypothesize that by participating in sneaker behavior the Haplochromis burtonii literally doubles chances of either reproducing or surviving until they are able to do so. 1) c) How could you test this empirically What predictions do you make if the hypothesis is true To test this hypothesis empirically would prove to be a challenge. The reason for that is the challenge of tracking the specific Haplochromis burtonii would be difficult and specific subjects would be impossible to distinguish during many parts of the observation. There is no way to mark the subjects. However the behavior of the Haplochromis burtonii can be observed. It is during the course of these observations that

Argue that porn has changed sexuality today Research Paper

Argue that porn has changed sexuality today - Research Paper Example Studies concerning the impacts of pornography in the society focus on various outcomes including potential influences on sexual dysfunction, rape, and difficulties with sexual relationships among others. Individuals can easily access sexually explicit materials from the internet and the effect or influence of this is questionable. Today, exposure to pornography has left many sexually active and independent young women to engage in some sexual acts and do things that they do not want to do in bed which they later regret. According to many studies concerning this same topic, men were found to use sexually explicit materials from the internet as opposed to women. Indeed, watching pornography greatly affect individuals’ sexual behaviours which in turn influences their relationships negatively. Following an extensive research, this paper focuses on the relationship between pornography and sexual aggressiveness among individuals. Even though exposure to pornography has been associat ed with sexual violence and failing relationships, its contribution to sexual enhancement for some people should not be ignored. Individuals exposed to extreme pornographic images are more likely to become addicted or tolerant to such films and this in turn will affect their sexual response. Despite the presence of many studies conducted on this issue, there is still no clear evidence confirming that virtual pornographic images and films can make individuals become addicted to such acts. This is because addiction to porn sex or images influences individuals’ sexual experience in general making them to be sexually dysfunctional since the real sexual experiences do not arouse these addicts. In addition, most people using pornographic materials tend to fantasize about or imitate some of the scenes they have watched in these films in order to get aroused during sexual intercourse with their partners. Pornography is one common way through which

Summer Love by Carlisle Naudyn Caroro Essay Example for Free

Summer Love by Carlisle Naudyn Caroro Essay Ice cream on a hot day. Going to the beach. Sleepless nights. Good hair days. Taking a leisure walk along the boulevard. ILC 2013 in Metro Manila. A Hong Kong Disneyland spree. Frolicking under the sun and simply living in that moment—just a few of the things I planned for my summer bucket list. My thoughts were more tangled than the students around me as we gather for our Commencement Exercises. My left eye got badly infected and turned crimson red, the main reason I never had the chance to present with my class. I climbed up the stage, got my award as the standing 1st Honor and got teary-eyed (not because I was in a sentimental condition but because I can barely open my left eye). Having my eye infected made me dislike the start-off of my summer. Well, I won’t say I am lucky. But indeed, I was blessed that the infection nursed back to normal the next day. Now, I can clearly see God’s beautifully engineered creations. And finally! This is SUMMER. We had school finished early. My family spent the Holy Week at home. We had our Lenten Diet and we never planned to go out somewhere until the week’s done. I’ve got nine weeks to enjoy summer and without a doubt, I’ve got all the time. I looked back on my summer bucket list, read it all throughout. Undeniably, my summer didn’t turned out to be the way I wanted it to be. The first of April, I got myself enrolled in a summer voice class in Silliman University College of Performing Visual Arts—which is actually, not a part of my summer bucket list. Classes will be starting on the 10th but my schedule would be starting on the 16th. It’s still a little bit early. I was uncertain to do so since my sister isn’t with me anymore. I started attending summer classes in SU since I was 9 years old. With my sister whose in college right now. I was sort of afraid going there alone. That is why I got doubts in doing so but since music is what my heart screams for, I went for it. My parents both worked in a state college and they will be having a seminar in Bacolod on the 10th. Two by two thoughts conquered my mind if one way or another, I should go or not. Well, Bacolod is still a strange and unfamiliar place for me since I haven’t been there plus it’s in Region VI. Yet my determination to travel pushed me to explore more on some unknown shores and that while I’m still young and my knees are still strong, I have to GO. So that’s it, we traveled to Bacolod with the company of my parents’ officemates. 9th of April, we headed to Dumaguete City and traveled by land (Well, because air flights cause too much expense) My patience lengthened ‘cause I have to sit on a bus for freaking 7 hours which I’m not really used to. We stopped by several bus terminals and a huge one with a food chain to take lunch. Then, went on. A feeling of astonishment showed in my face ‘because a huge mall was standing just in front of the hotel, Gaisano Bacolod Mall. I got myself indulged in a movie house, watched Star Cinema’s two of the recent successful movies—It Takes A Man A Woman and Must Be Love, both actually deserved a standing ovation. I as well got the chance of going to SM Bacolod. It was there my Mama bought me a new-fangled LG phone and beyond doubt, I was happy. Witnessing the dancing lights, the busy crowd in the amazing Panaad Festival was one of a kind. I got myself camera-captured in many of the native booths. I got myself pretty awed too, in Mambukal Resort. The beauty of the falls, the warm sound of the flowing river and the diverse kinds of butterflies in their sanctuary truly caught my eyes. Bacolod, the city of smiles (which is true), gave me a wondrous experience and I really wanted to live there but there are too many alien coasts I have to explore. I bid Adieu to Bacolod and continued my journey. The 16th of April came and my first class started. I went there alone, by the way and I was kind of proud of myself. I still have 2 upcoming classes on the 23rd and on the 30th which means I still have to be more independent. Eating alone at Mc Donald’s, walking to school alone and riding a fast craft to and fro all alone proved it. Within the leisure days, I stayed at home and there were days I met with a couple of friends from my YFC community. I was undoubtedly fortunate that Palarong Pambansa 2013 was held in Dumaguete and the date falls exactly on the week I’m having my second classes. So, I had the chance of witnessing Philippines’ best athletes play around courts and fields. Lucky, indeed. Then came May. The house was a bit of busy since fiesta’s fast approaching. I was actually overwhelmed when the day of the fiesta arrived, just the mere fact of families and friends coming over our house, the food and the moments. A day after the fiesta celebration, I went back to Dumaguete to have my progress recital. My Nanay accompanied me since my mother’s busy taking good care of my father, which is actually in bed for how many days. A feeling of anxiety conquered my whole body that day because I will be rendering a version of Les Miserables ‘On My Own’. I ran into students just like me. They had their stories and I can see it by the way they look and among the many of them, I was caught by a good-looking lad who had a freaking amazing voice. Sincerely I was a little bit boosted and inspired that somehow somewhere there are still good-looking guys who are passionate in music. *wink* I would say I did a great job singing that moment cause I got a feeling of 100% satisfaction. I really had quite a successful day. The next day, my father got confined in Perpetual Succour Hospital for a week in Cebu. I had to be there to accompany my mother. I traveled all alone—another proof of my independence. I was a little bit troubled that my mother won’t allow me to perform in our last summer recital since my family had expenses the past days. It has been my lifelong dream to perform in front a huge crowd and just give happiness and inspiration to young people like me. Yet after we went home, the heavens granted my prayers and my mother gave me the consent. It was May 14 when Papa got confined again in Holy Child Hospital in Dumaguete due to his dialysis sessions. Actually, every time I look at my father’s face, I feel down and I just want to cry but I have to be strong. So, my family stayed in Dumaguete for a week after the elections. While they were busy taking care of my father, I was as well busy going to Silliman COPVA to have rehearsals for our final performance. I wasn’t aware of the costume we had to use for the act and I didn’t bring any back home. My mom was in a full support condition and gave me all the things I needed. We had a 2-day show. We performed a Glee-song medley. The first one was a success. I got teary-eyed singing â€Å"Keep Holding On† since my family was absent on the performance. But the show must go on and by the way, I knew the name of the â€Å"good-looking lad with the freaking amazing voice† and I got the courage to talk to him. 5 points! We became friends and yes, I was happy. The last day, my mother was there and my fighting spirit got braver and I performed like it was the last performance of my life. Moreover, I fished some friends. I spent the following days on my cousin’s home and my grandpa’s since they’re having a fiesta celebration. I’ve had memorable experiences with my family which I haven’t experience a year ago due to some busy days. On the 28th and 29th, the Almighty conquered our province when we had our CFC-YFC ProvCon themed â€Å"iFollow†. The experience was beyond priceless that whenever I raised my hand to sing and worship, I feel saved and redeemed and that’s how powerful God’s grace is. I’m not luck indeed but I’m blessed and highly-favored that the last few days of my summer was spent to exalt the Almighty’s name. So that’s it. I didn’t have chances to go to beaches but I had the chance to be in the city of smiles.

Animal farm essay

Animal farm essay Animal Farm Essay Animal Farm by George Orwell is a compelling book that represents the Russian revolution. Although viewing through the eyes of animals may seem like a childish concept, George does well into making sure that the book carries out the message of revolution. I, t  believe that George showed that Animal Farm was influence of the Russian revolution by the naming of the naming of the three pigshe condition of the farm, and because of the storys plot. Many of the animals in Animal Farm show some sort of connection with the Russian revolution. Most animals either represent a group of people, or an in/famous person. As the story starts to evolve from the rebellion to the Battle for the Windmill, the reader notices how the animals start to change. When Mr. Jones gets expelled for the farm, 3 smart pigs take of the farm: Squealer, Snowball, and Napoleon. These three animals all represent dictators the had a part in the Russian revolution. The most significant part about the names given to the pigs is that they all symbolize the dictators perfectly. Napoleon was a tough, fierce looking boar but was not much of a talker. This would symbolize Vladimir Lenin., the man who took the place as dictator after Tsar Nikolas II stepped down. Squealers name was the identity of Joseph Stalin, the man who kept on stalling the people by giving quick, persuasive speeches on how Lenin was improving the country. Snowball is then given to Trotsky because like Snowball, Trotsky split up with Lenin. In Animal Farm, these three pigs basically reenact what took place during the Russian revolution: betrayal, propaganda, and communism. Perhaps the best device Orwell used here was how he portrayed the three dictators as pigs, which shows how the name and appearance of the characters in this book are significant and related to the revolution. A reason I believe Animal Farm is about the Russian Revolution, was the choice of naming for the pigs During the whole book, Animal Farm was in very poor condition. During the beginning, Manor farm was a horrid place to live: with little food and lots of work everyday, it portrayed what Russia looked like during the time of revolution. Only during the early stages of the revolution was the economy slightly better than once before. Each time that Orwell describes the farm, it is always in a different condition, one which usually matched the condition of Russia. When Napoleon was ruling, the farm was in great economic trouble: the animals were always hungry while the pigs and dogs had enough to eat. This shows that the economy did not actually improve the animals lives, but instead started to benefit the other, higher members of society which is exactly what the Russian revolution resulted in. The condition of the house was a symbol of Russias state which shows how Animal Farm is connected with the Russian revolution. The final way that Orwell connects both Animal Farm and the Russian revolution, was by the plot of the story. During the entire book, all of the events that took place had at least some little significance with the Russian revolution. When Napoleon oppressed the animals by killing them, it was portraying what was known as Bloody Sunday. At the beginning of the novel, when Old Major is giving the speech about rebellion, it was all inspired by the old man known as Karl Marx. Even the event in which Mollie leaves shows the connection between the two. The easiest event to determine the the two, was most likely the scene were Boxer is taking away. If you think back to the revolution and back to Boxers motto ( I will try harder), you can easily see the Boxer is representing Russias working class. Because Russias working class was so loyal to Napoleon, most of them ended up for worse then before, and even worse, is the fact that Napoleon tossed away these people as if they were tools. The e xact same can be said for the Russian revolution. Lenin abused his people and Orwell demonstrates it very clearly and profoundly. I believe that George showed that Animal Farm was influence of the Russian revolution by the naming of the naming of the three pigs, the condition of the farm, and because of the storys plot. By renaming and reassigning of few characters and events, George Orwell has described the revolution into a book that can is comprehensive to both little kids and young adults.

Should Elian Gonzalez Go Back To Cuba Or Stay In The United States? :: essays research papers

Should Elian Gonzalez go back to Cuba or stay in the United States? This seems to be the question drenching the media on a constant bases. Every newspaper, news broadcast, and magazine seem to have a story about Elian. Titles like â€Å"Elian’s Grandmothers are coming to the US†, seems kind of silly if you read the headline literally. I don’t mean to be cold but why do we care if Elian’s grandmother is coming to the US? Thousands of grandmas have come to the US everyday, but we don’t hear about them. The media has turned this dilemma into a circus. All that aside, the question and heated debate of whether or not Elian should stay still plagues us. Everyone seems to have an opinion on this subject. If you ask people casually what they think should happen, you will get very definite answers and plenty of information to back up there opinions. I have asked many colleagues and friends this question. I myself do not have the answer and do not think I am the one to judge. I have spoken to Cubans friends who say the conditions are so terrible over there that there is no way the boy should go back. They speak of old, decrepit, tiny homes with way to many people living in a single dwelling. They speak of a place that has little food and no milk for their children. I have been told of the conditions in the schools and their lack of proper facilities. These acquantenses tell me that Castro his controlling the boy’s father, monitoring his phone calls and making sure he tells everyone that he wants his boy to come home. They say he is not able to say what he really wants for fear of himself and family. For fear that Castro will take away the family’s food and shelter in Cuba. Over all, the general picture that has been painted is not pretty. The only thing not in debate is the fact that children their live a very different life from the majority of the children in the United States.On the other hand, there are the people that believe the child should be with his natural father. That where the child lives does not matter, what matters is whom the child is with. They say he has lost his mother and should not be taken away from his father.

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Tourism Operations In your own words please share with me your understanding on these concepts. I will be grading on depth of knowledge, practical examples and management techniques of each product or service. Please Use Weekly ADAIR, REPAY and Occupancy% PDF – Performance By Industry Segments For the Week of: February 03, 2013 – February 09, 2013 Forecasting Question: #1 – Your hotel is in Phoenix, Arizona.For the Week of: February 03, 2013 – February 9, you're your Occupancy % is down but your ADAIR and Repay are up. Please share with me in a written response the reason for this variance. In other words why if your occupancy % is down would you ADAIR and Repay be up? If you were the General Manager what would you change or keep the same for next weeks rates and why? Tourist Target Markets – Here is the URL for Hotel Simulator, please review the tourist market segment section for next weeks final.Please copy and paste this URL into your browser to access. Http://www. Heterosexuality. Com/document/o. L . 1 . HTML #2 – A market segment is simply a group of customers who have common requirements for a product or a service. Below you will see four tourist market segments that you would like to attempt to attract to your hotel: 1) Business – Name two out of the top three influences that are present in each of the business traveler's decision making process. Why are these so important to the equines traveler? ) Families – Name the three least influential factors in why a family will choose your Hotel over another. 3) International & Affluent Mature.

Pv Trade War Between the Us and China

Introduction International trade and competitive advantages in the costs of production in China have brought numerous opportunities for China’s exports but also generated challenges due to protectionism from its foreign competitors. Consequently, there have been numerous trade cases against China, including anti-dumping, anti-subsidy, in many economic sectors. The very current trade case involving China is the US accusing Chinese manufacturers of dumping photovoltaic (PV) panels in the US market and the Chinese government unfairly subsidizing its own solar industry.In fact, the US’s trade balances in polysilicon products between both the US and China, and the US and the world significantly deficit while China’s polysilicon cells and modules production has increased dramatically (The Kearney Alliance 2012). This essay claims that, the surge in PV exports does not necessarily mean that the Chinese government has subsidized its PV manufacturers illegally, and Chines e solar manufacturers’ low prices do not necessarily imply they are selling their PV products below the cost of production.Importantly, imposing such significant imports tariff is highly likely to undermine not only the bilateral trade between two countries but also long-term benefits of both countries. First, this essay provides an overview of the US-China PV trade case; then explains why China solar industry has been growing dramatically; and finally it analyses what the consequences might be if the US imposes a countervailing and antidumping tariff on China’s PV. BackgroundOn October 2011, seven US-based PV manufacturers headed by SolarWorld Industries America reported China on a double-anti case to US Department of Commerce (DOC) and US International Trade Organization (ITO). The seven manufacturers, which later formed Coalition for American Solar Manufacturing (CASM), accused China for dumping their PV module products to US market and giving a huge amount of expor t subsidy to this industry which in turn causing severe injuries to US PV manufacturers.Several investigations have been carried out by both DOC and ITC for this issue, as the coalition accused China government providing cash grants, heavily discounted resources, huge loans and credits, tax exemption, incentives and rebate and export grant insurance to the industry. In its final determination held on 10 October 2012, DOC proposed 18. 32 per cent to 249. 96 per cent of anti-dumping and 14. 78 per cent to 15. 97 per cent of countervailing duty.Further actions, including issuing or not issuing anti-dumping and countervailing duty orders, will be made after ITC final determination (US DOC 2012). Photovoltaic industry is a new emerging industry as a response to the threat of energy shortage and environmentally-unfriendly fossil fuel-based energy. Governments issued supportive policies, including giving significant account of subsidy considering higher production cost of this new energy i ndustry compared to that of conventional one.In case of China, the country issued a PV market policy in 2007 that included deployment, investment and research and development supports under the scheme of middle and long term program of renewable energy development set by National Development and Reform Commission (NDRC) targeting the energy of 300MWp by 2010 and 1. 8 GWp by 2020 of PV cells installed (Grau et al. 2011). This policy and its comparative advantage on labors result in excessive growth of China PV industries, making China’s world market share skyrocketing from 1 per cent in 2001, 5 per cent in 2005 to 50 per cent in 2010.In 2012, four of the top five PV producers are Chinese overtaking US manufacturers which occupy 27 per cent in 2006, decreased to 5 per cent in 2010 of the total world share (The Kearney Alliance 2012). Why has China’s PV grown so big so fast? There are a number of reasons why the PV industry in China has experienced tremendous growth withi n a short span of time. For instance, China produced about 1 per cent of the world’s solar cells in 2001, and by 2010 it produced nearly almost half (The Kearney Alliance 2012).The same rate of growth was achieved by Japan and Germany during their PV industry expansion; however the key difference is it took them twice as long (The Kearney Alliance 2012). First, such fast paced growth would not be possible without assistance from the government. The Chinese government has been providing many different kinds of assistance to the manufacturers to promote the growth of the PV industry in China. The government’s policy to boost the industry came in the form of loans, tax credits and grants.Additionally, some of the resources required for manufacturing of PV cells were subsidized or discounted to encourage manufacturers to produce more. In 2011, the Chinese government initiated a ‘Five-Year Plan’ to induce further growth of the PV industry well into the year 201 5. Second, it is estimated that help from the government allowed some Chinese manufacturers of PV cells to have somewhere between 18-30 per cent cost advantage over their US counterparts (The Kearney Alliance 2012).The government alone is not responsible for the cost advantage enjoyed by the Chinese manufacturers; scale and vertical integration, and labour costs constitute significant part of the cost advantage. The scale and vertical integration of some of the top tier Chinese manufacturers means that they gain cost advantages due economy of scale; larger factories can produce at a lower cost, and additionally they tend to own or control majority of the companies in the supply chain as well as distributions outlets thus allowing them to maximize profit from supply, production and distributions.Moreover, labour costs are relative cheap compared to the US, especially for unskilled labour, where China has approximately 80 per cent labour cost advantage over the US counterparts (The Ke arney Alliance 2012). Third, besides the assistance and cost advantages, some, if not all, Chinese manufacturers tend to offer trade credit, where solar power customers can purchase the panels without having to pay upfront and are given 60 days payment window to complete the deal.This provides tremendous financial benefit to the customers, as they will have some time for installation of the panels without paying upfront for the panels thus the cost of downtime during the installation is not born by the customers. Finally, growth of China’s PV industry is also due to the extreme projected growth of domestic demand. In 2010, Chinese domestic demand for solar power was only 3 per cent of the world’s demand, and by the end 2014 this is expected to increase to 26 per cent (EPIA 2011). Is Chinese government providing illegal subsidies? Are Chinese manufacturers dumping their products on the U.S. market? The US government accuses the Chinese government of providing the export subsidies, which according to WTO rules is illegal. However, the Chinese government claims that the subsidies, grants, loans and discounts given to the manufacturers are intended to promote the solar power industry and make it cost competitive with conventional power sources. It is worth noting that it’s not just Chinese government that provides subsidies, the US also provides substantial subsidies to its solar power industry albeit to a slightly lesser extent and lower amount in dollar terms.For instance, the US government does not provide land grants or discounts, and the total stimulus loan/loan guarantee is only US$1. 3 billion compared to US$30 billion from the Chinese government (Goodrich et al. 2011). The US Department of Commerce accuses Chinese manufacturers of dumping PV cells on the US market. According to the WTO (WTO, 2012), dumping occurs when a company exports a good to foreign market at a price less than the price it normally charges in its domestic market. T he US considers Chinese economy as non-market economy, thus the Chinese domestic price of PV cells cannot be determined directly from the Chinese market.Therefore, third or surrogate country needs to be chosen in order to determine the fair value of Chinese PV cells. The U. S Department of Commerce has chosen Thailand from a list of 6 countries as the surrogate country. This is unlikely to reflect an appropriate normal price for the Chinese PV since the costs of PV production in China is normally lower than those in Thailand. Possible consequences Both sides are currently still waiting for ITC's final determination. If an affirmative determination is made in late November that imports of PV cells from China, no matter being assembled into modules or not, leads to US omestic industry being or is threatened to be materially injured, Commerce will issue the Anti-Dumping and Countervailing duties order. Back when the preliminary determinations was announced earlier this year, in which t he DOC assessed countervailing duties ranging at a lower rate, most Chinese manufacturers breached a sight of relief and continue their business in U. S. as before. However, DOC's final determination assessed significant higher countervailing duties at 14. 78 per cent -15. 24 per cent, comparing to its 2. 9 per cent-4. 3 per cent in the preliminary (US DOC 2012), undoubtedly it will have a severe impact on China's manufacturers and global solar industry. As the subject of DOC and ITC's investigation is PV cells that are manufactured in China, Chinese firms could shift manufacture or directly purchase PV cells from other countries to avoid tariffs on modules made of Chinese cells. An ideal location is Taiwan, which is already a robust solar cell manufacturing market. Although it is 8 per cent higher than using its domestic produced cells, cells made in Taiwan still have a 10-22 per cent cost advantage than the ones in the US (Wesoff 2012).Not to mention its relative closeness to Chin a. However, using PV cells from other countries other than the US and assembles into PV modules is not a proper long-term strategy. The US could also initiate another investigation into Chinese PV modules assembled, using other countries' cells. Thus, this is only a transitional strategy for Chinese manufacturers before China's domestic demand for PV products picks up to ameliorate industry's excessive supply situation. On the other hand, the imposition of high countervailing and anti-dumping duties might also affect the U.S. solar industry. In 2011, manufacturing only contributed 24000, or 24 per cent of the total employment in the solar industry (The Solar Foundation 2011). Punitive tariffs against Chinese cells will lead to a price jump on PV cells and modules in the US market, it causes the cost of solar projects in the US to increase and the implementation and demand for solar products to decline, which ultimately transits into lower employment in other sectors in the PV indust ry. The Coalition for Affordable Solar Energy commissioned a study showing that a 50 er cent tariff will indeed boost employment in the cell and module manufacturing sector. However, this tariff jump would also result in a huge decrease in employment from slowing-down discretionary spending by solar buyers and an overall demand decrease in other sectors in the whole PV industry. The net impact on total employment would be 15 per cent -40 per cent decline in the US PV industry compared to its 2010 numbers (Berkman et al. 2012). This means the resurrection of the US cells and module manufacturers is at the cost of the rest and the vast majority of the US PV industry.Another potential outcome is that Chinese manufacturers could retaliate against imposed tariffs. The US currently still has a huge positive net export of polysilicon and PV manufacturing equipment to China. In 2011, China attributed to around 30 per cent of the US total net exports of polysilicon and 60 per cent of PV capi tal equipment (GTM 2012). To protest against imposed tariffs and duties, Chinese manufactures could ramp up their own production of polysilicon or turn to other countries to fill the gap, effectively cutting out the US firms in the solar supply chain.Conclusion In sum, Governments in most industrial countries including the US and China have been promoting clean energy technology in recent years. Among the world’s solar producers, China’s booming renewable energy industry, especially solar industry has dominated world solar markets and challenges American leadership. President Obama affirmed the US’s concern about clean energy technology: ‘†¦to make sure that we win the competition. I don’t want the new breakthrough technologies and the new manufacturing taking place in China and India’ (Morris et al. 012, p1). Meanwhile the subsidy to energy, including solar industry, has been successful in China (rapidly increase its market share of wor ld polysilicon production), the US policy subsidy on clean energy has not brought any expected result, even failure (i. e. bankruptcy of Solyndra–the California solar firm) (Robert et al. 2010). Trying to protect the domestic solar industry by preventing other country’s polysilicon exports is highly unlikely to be a wise and fair policy.In particular, countervailing and anti-dumping duties would result in a significant decline in exports of polysilicon and PV manufacturing equipment to China as well as a fall in employment. Indeed, China could have several ways rather than bring the case to the WTO in responding to the trade barriers imposed by the US, but what the US needs to consider its long term benefit. The competitive price of Chinese solar as a cheap source of clean energy which potentially enhances the US economic growth, creates jobs for Americans and tackles with climate change.ReferenceBerkman, M, Cameron, L ; Chang, J 2012, ‘The employment impacts of proposed tariffs on Chinese manufactured photovoltaic cells and modules’, The Brattle Group, Washington, D. C. viewed 16 September 2012, . EPIA see European Photovoltaic Industry Association. European Photovoltaic Industry Association 2011, ‘Global market outlook for Photovoltaics until 2015’, viewed 12 Oct 2012, http://www. epia. org/index. php? eID=tx_nawsecuredl;u=0;file=fileadmin/EPIA_docs/publications/epia/EPIA-Global-Market-Outlook-for-Photovoltaics-until-2015. pdf;t=1351601058;hash=65fb67c830a17dc3384646f83c30e104Goodrich, A, James, T ; Woodhouse, M 2011, Solar PV manufacturing cost analysis: US competitiveness in a global industry, Stanford University, viewed 25 Oct 2012, ;lt; http://www. nrel. gov/docs/fy12osti/53938. pdf;gt;. Grau, T, Huo M ; Neuhoff, K 2011, ‘Survey of photovoltaic industries and policies in Germany and China’, Climate Policy Initiative, Berlin. GTM 2012, ‘U. S. Solar Energy Trade Assessment 2011: Trade Flows and Dom estic Content for Solar Energy-Related Goods and Services in the United States’, Greentech Media, Washington, D.C. Morris, AC, Nivola, PS ; Schultze, CL 2012, ‘Clean energy: revisiting the challenges of industrial policy’, The Brookings Institution, Washington, DC. Roberts, MJ, Lassiter, JB ; Nanda, R 2010, ‘US Department of Energy & Recovery Act Funding: bridging the â€Å"Valley of Death† ‘, Harvard Business School. The Solar Foundation 2011, ‘Nation Solar Jobs Census 2011’, viewed 12 October 2012, . The Kearney Alliance, 2012, ‘China solar industry and the US anti-dumping/anti-subsidy case’, China Global Trade.USDOC 2012, ‘Fact sheet: Commerce finds dumping and subsidization of crystalline silicon photovoltaic cells, whether or not assembled into modules from the People's Republic of China’, Department of Commerce, The United States of America, viewed 15 October 2012, . Wesoff, E 2012, ‘Breaking n ews: Commerce Dept. Chinese solar panel dumping verdict is now in’, Greentech Media, viewed 17 October 2012, . WTO see World Trade Organisation World Trade Organisation 2012, ‘Anti-dumping, subsidies, safeguards: contingencies, etc’, The World Trade Organisation, viewed 10 October 2012, http://www. wto. org/english/thewto_e/whatis_e/tif_e/agrm8_e. htm

Beka lamb by Zee Edgell Essay

The book deals with social insecurity, racial prejudice and the rule of the consecutive church in a small town. Beka’s best friend Toycie Qualo is older than she is, being 17 at the time when Beka was 14, and in her last year of school gets herself expelled when she gets into a situation where she becomes pregnant by her boyfriend Emilio Villanueva, and dies after a miscarriage and a short space of time in the local asylum nicknamed â€Å"Sea Breeze Hotel†. Through flashbacks, points on politics and independence are strongly brought out, since the political struggles for independence in Belize at that time also mirrors Beka’s own need for self-rule and her developing maturity. Beka’s father (Bill Lamb) cuts down Beka’s favorite tree (a bougainvillea) as a sign that the wild ways Beka had picked up must stop at once when she finally tells him that she has failed her exam. Her mother (Lilla Lamb) buys her a special book and pen in which she is told to write any lies or stories that she is tempted to tell, in an effort to curb her tale-telling habit. By the end of the book, Beka has transformed from â€Å"a flat-rate Belize creole† to a girl with â€Å"high mind†, since her troubles have forced her to learn the value of money, education, unity within the community and most of all, some manners and respect Beka Lamb is the debut novel of Belizean author Zee Edgell. It is the story of both Beka and Belize, an adolescent girl and an adolescent country. Set in Belize in the 1950s, fourteen-year-old Beka struggles with growing pains complicated by the society in which she lives while her country struggles to move from colonialism to independence. The novel opens with three seminal events. The young Creole teen, Beka, has just won an essay contest at St. Cecilia’s Catholic school, Beka’s lifelong friend Toycie has died (but the traditional nine-day wake has not been held for her), and two members of the Belizean Peoples’ Independent Party, Pritchard and Gladsen, are imprisoned for disloyalty to the British government. These events symbolize the often painful challenge of coping with growth and change. Narrated by flashbacks, the novel covers a period of seven months. While preparing for bed one night, Beka vows to â€Å"keep a wake† for her deceased friend Toycie â€Å"in the privacy of her own heart.† As she reminisces about the past months â€Å"waking the gone,† her story unfolds. Beka recalls that her life started to change the day she decided to stop lying. Her last lie was a big one. Failing three subjects, Beka had not been promoted to the next grade. Beka’s parents are struggling to pay for her private education. Fearing their reaction to her failure, Beka tells them that she passed, naively believing that they do not already suspect the truth. Beka’s lying habit is the most serious of the many conflicts she has with her parents. She does not clean the attic properly, she throws garbage into the yard, she steals money from her father’s pants pockets and she procrastinates with her chores. Beka’s mother, Lilla Lamb, often complains about Beka’s â€Å"laziness and ingratitude† to her husband, Bill Lamb, who then must discipline Beka. Beka seeks solace from her friend Toycie and her paternal grandmother, Granny Ivy, who shares a bedroom with Beka and usually takes her side. In spite of these parent-teen conflicts, Beka does have a loving relationship with her parents. Her family is one of only two nuclear families in the community, and while her parents do not love all that Beka does, they do love her. Beka begs her father for a second chance at school, promising to pass this time, and Bill Lamb eventually relents. A nun at Beka’s school, Sister Gabriela, takes Beka under†¦

Would you be willing to go on a one way trip for the rest of your Essay

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Grief and Life Essay Example | Topics and Well Written Essays - 1000 words

Grief and Life - Essay Example At first she thought that the feeling of meaninglessness and the feeling of grief are very different from each other. But she realizes, after being a mother and a wife, and after losing someone she dearly loves, that what she felt as a child was very similar from the grief that struck her as an adult. This essay talks about the journey of Didion through grief, particularly how she describes her experience with grief in terms of the feeling of meaninglessness that plagued her throughout her young life. Didion explains how different our notion of ‘grief’ is from what it really is in real life. She explains how our expectations of grief are too ‘simple’ or ‘easy’. We know that we will lose someone we love. We expect to go through definite changes, and ‘heal’ immediately. We expect that we should be strong during this very tough time (Worden, 40). Didion explains such in the following manner: â€Å"In the version of grief we imagine, the model will be ‘healing’. A certain forward movement will prevail† (Didion, 392). We think that the normal course of grief is toward ‘healing’ or ultimate ‘acceptance’ of a loss of a loved one. That we do not have to exert too much effort in moving on because everything will resolve by itself. She adds that â€Å"we imaging that the moment to most severely test us will be the funeral, after which this hypothetical healing will take place† (Didion, 392). She mentions ‘hypothetical’ to emphasize the fact that this belief is somewhat flawed. However, based on her experience with grief, it is an emotion that does not subside easily; it is an emotion that is very difficult, sometimes impossible, to deal with. As Didion says, â€Å"We have no way of knowing†¦Ã¢â‚¬  Grief is something that is uncertain; something that is unimaginable (Didion, 392). Grief is a feeling of

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Humor in the Workplace The Weighing the Pros and Cons Essay Example for Free

Humor in the Workplace The Weighing the Pros and Cons Essay Weighing the Pros Con sSubmitted to:Wilma ThomasonPrinciples of Management InstructorPrepared by:Successful Future ManagementKenya HardenSunday, June 28, 2009Humor in the WorkplaceWeighing the Pros ConsI.IntroductionA.Evaluating the problems in the workplace1.Poor productivity2.Lack of creativityII.Benefits of incorporating humor at workA.Improves healthB.Reduces stressIII.How stress effects companiesA.Increases possibility of mistakesB.Loss of money IV.ConclusionA.Companies encourage humor1.Set ground rules2.Know what is allowed Increase your companys earning potential by paying your employees to watch comedy shows and play games for thirty minutes a day! Reduce employee sick leave by establishing company playtime. These statements may sound asinine, but companies are discovering the benefits of incorporating enjoyment and laughter in the office. People spend at least forty hours a week in the workplace and about five or more of those hours are spent trying to think of a new idea, or trying to complete a project because they cant focus. Some employees are just drained and their minds are bombarded with thoughts of what they need to do at home. As a way to keep their employees focused and boost productivity, many companies are taking heed to the saying: Laughter is the best medicine. It is becoming a fast growing trend in businesses to find ways to allow their employees a period to loosen up and laugh. Laughter has been found to keep a person healthy and has several benefits; it lowers tension, causes one to relax, boosts the immune system and can even temporarily relieve pain (www.HelpGuide.org). Laugh and the world laughs with you, this seems true even in the workplace. It is important that various methods are available to help employees eliminate stress so that their work is not affected. Stress can have a very negative effect on employee performance and causes burn-out. A person that is stressed-out is often distracted and makes mistakes. This can cause a major financial loss to the company, as well as the employee, if injury occurs or a major project is delayed. Some companies consider that having fun or joking around on the job as  goofing off. Management in these types of companies feels that employees do not take their jobs seriously. Some employees are even labeled as adolescent, unprofessional and unproductive. This type of atmosphere creates tension and increases the risks of work related health problems in employees. It also costs the company money due to excessive downtime due to the lack of creativity. However, many companies have been encouraging employees to have fun at work and have even set-up special rooms for their employees to take breaks equipped with televisions and games. By allowing employees to enjoy themselves at work, companies are building better relationships and strengthening communication between management and employees. So why not put the low cost, (if not free) remedy of humor in place? Laughter is contagious. It can make the workplace more pleasurable by easing tension, reduce risk of employee burnout, improve productivity and creativity. The key to the success of implementing humor in the workplace is to make sure that no one oversteps boundaries or cause injury to anyone. It is crucial that no one is offended by joking; steer clear of religious, political, or personal topics. Everyone must be mindful of what is allowed and what is taboo. It is recommended that all business incorporate humor in the daily routines of their employees. The physical and mental health of employees is reflected in his or her performance. Allowing fun and relaxation on the job as a release will only improve productivity. The benefits of humor well out-weigh the risks. Works Cited Emotional Intelligence Central. Laughter is the Best Medicine: The HealthBenefits of Humor HelpGuide.org. 2001-2009. 24 June 2009 Levy. S. Working in Dilberts World. Newsweek 12 Aug 199623 June 2009 McGhee, P. Health, Healing on the Immune System: Humor as Survival Training. 23 June 2009University of Missouri-Columbia. Light Humor in the Workplace is a Good Thing,Review shows. ScienceDaily 1 November 2007. 24 June 2009http://www.sciencedaily.com/releases/2007/10/071031130917.htmWood, Robert E., Beckmann, Nadin and Pavlakis, Fiona. Humor in Organizations: NoLaughing Matter Research Companion to the Dysfunctional Workplace. Ed. Langan-Fox, Janice, Cooper, Cary L. and Klimoski, Richaard J. Cheltenham,Glos, UK: Northhampton, MA: Edward Elgar, 2007 216-231

Case Study On A Patient With Oesophagitis Nursing Essay

Case Study On A Patient With Oesophagitis Nursing Essay The patient was a female, age 89, with a BMI of 15.4 kg/m2 (underweight). Her presenting complaint was nausea and vomiting, bringing up coffee ground vomit, fatigue and loss of appetite since two days ago. Her past medical history included atrial fibrillation, paranoid psychosis and iron deficiency anaemia. She also had a cholestectomy done in year 2000. She was single and lived alone; she neither smoked nor drank. There was no relevant family history recorded for her case. On admission she was taking medication stated in Table 1 below. She was known to be allergic to ciprofloxacin. Table 1 Repeat medication taken on admission Drug Dose Digoxin 125 Â µg once daily Lisinopril 2.5 mg once in the morning Furosemide 40 mg once daily Clopidrogel 75 mg once daily Quetiapine fumarate 125 mg twice daily Tramadol hydrochloride 100 mg twice daily Codeine phosphate 60 mg one to be taken as required Paracetamol 500 mg four times daily Folic acid 5 mg once daily Ferrous fumarate 322 mg twice daily (Last prescription dated three months ago) Clinical data and diagnosis On admission, her temperature was 36.4Â °C, pulse was 83 beats per minute, and her blood pressure was 124/46 mmHg. Her Abbreviated Mental Test (AMT) score was 7 out of 10, indicating mild confusion. A full blood count, renal function test, liver function test, and an electrocardiogram (ECG) were carried out. Her liver function test came back normal. The ECG showed some ST depression, but the patient denied any chest discomfort. Her haemoglobin levels were low at 9 g/dl (11.5-16.5 g/dl), while platelets were low at 108109/l 150-400109/l). her plasma urea was elevated at 38.2 mmol/l (2.5-7.5 mmol/l), and her creatinine was 273 Â µmol/l (50-80 Â µmol/l for female). Her creatinine clearance was calculated to be 8.1 ml/min, which indicated severe renal impairment. The diagnosis was acute renal failure, and gastritis or peptic ulcer disease. Clinical progress On day 1, patient was dehydrated and had some upper abdominal discomfort (Dyspepsia). The plan was to stop tramadol, clopidogrel, lisinopril and furosemide, due to the coffee ground vomit and acute renal failure. Two units of RCC (Red cell concentrate) and IV fluids were given. A urinary catheter was used to monitor urine output. Patient was continued on ferrous fumarate and given gaviscon 10mls. Quetiapine fumarate was not given as it was not available. On day 3, patient was paranoid; as quetiapine fumarate was still not available, haloperidol 1 mg was given as an intramuscular injection according to the hospital guidelines. Her haemoglobin levels were back to normal (12 g/dl) and her creatinine clearance improved to 33.3 ml/min; measurements were taken again because the values were so different. The catheter was taken out, but she was to receive subcutaneous fluids hourly. Patient was passing black stools. She was given Peptac 10mls for abdominal discomfort and was scheduled for an endoscopy the next day. Quetiapine fumarate was given on day 4 and patient was taken off haloperidol. On day 6, the patients confusion was thought to be influenced by digoxin; levels were checked and found to be 1.1 Â µg/l (0.5-2.0 Â µg/l); however dose of digoxin was decreased to 62.5 Â µg. a rectum examination was conducted to make sure patient was not bleeding from the lower gastrointestinal tract. The gastroscopy report came back stating patient had grade D oesophagitis (Reflux oesophagitis), that is an extenxive mucosal breaks engaging at least 75% of oesophageal circumference. She was also found to have a large chronic duodenal ulcer, non-bleeding with visible vessels. The plan was to start the patient on IV proton-pump inhibitor (PPI, pantoprazole 8 mg/hr) for 72 hours, oral omeprazole 20 mg daily, and eradicate H. pylori if infection was present (CLO test). On day 9, the CLO test came back negative. Patient was taken off IV PPI and put onto oral PPI (Omeprazole 40 mg daily). A repeat endoscopy was scheduled for the week after. Disease Overview Prevalence Oesophagitis is the inflammation of the lining of the oesophagus, usually caused by irritation due to stomach acid reflux.1,2 It is included under the boarder term of gastro-oesophageal reflux disease (GORD), which also includes endoscopy-negative reflux disease.3 In the UK, there is a 28.7% prevalence of GORD, and the risk is found to increase with age, especially for those over 40 years of age. There is an estimated of over 50% of GORD patients between 45 and 60 years of age.4 About 25 to 40% of people with GORD are found to have oesophagitis on endoscopy.5 Pathophysiology, risk and diagnosis Acid reflux can occur because of incompetence of the lower oesophageal sphincter, a transient complete relaxation resulting from a failed swallow, that is, a swallow without the usual peristalsis wave (Found in 65% of patients). It can also be caused by a transient increase in intra-abdominal pressure (17% of patients), or a spontaneous free reflux due to the lower oesophageal sphincter having a low resting pressure (18% of patients).6 Possible risk factors for GORD are pregnancy, excess alcohol consumption, smoking and hiatus hernia. Obesity is thought to be a risk factor, as well as certain foods like onions, citrus fruits and coffee. Drugs that are thought to relax the lower oesophageal sphincter like calcium channel blockers are thought to play a role in promoting GORD. There is however very limited evidence to support these claims.4,5 It is now thought that more than 50% of GORD risk is genetic, as it is found that a first degree relative of a person with GORD is four times more at risk of getting the disease.4 Diagnosis of GORD is based mainly on the patients symptoms, predominantly acid regurgitation or heartburn.7 An endoscopy is usually the main diagnostic procedure done to confirm GORD. Pharmacological treatments and mechanisms of action The main drug used for this disease is a proton-pump inhibitor (PPI). PPIs are one of the most prescribed drugs for the treatment of acid-peptic diseases, including GORD and peptic ulcer disease.8,9 They are substituted 2-pyridyl methysulfinyl benzimidazoles, with pKa around 4, and have a very short plasma half life of one to two hours. They are weak bases that are lipophilic, which allows them to cross the membranes of the parietal cells easily. Once inside the parietal cells, where the pH value is less than 4, they protonate into the activated tetracyclic sulphenamide form of the drug and accumulate inside the cells. Here they form covalent bonds with the cysteine residues in the hydrogen/potassium adenosine triphosphatase (H+/K+ ATPase) enzymes, forming disulphide bonds, inhibiting the acid secretion activity of the pump irreversibly. Due to the covalent bonds, their duration of action exceeds their plasma half life. To resume acid production, the parietal cells must then generate , or activate, new proton pumps.8,9 Examples of PPIs are omeprazole, lansoprazole, pantoprazole, and rabeprazole, the last of which has a pKa of 5, and is activated at a broader range of pH compared to the other three, leading to a higher acid-suppression activity. The common side-effects of PPIs are nausea, diarrhoea, abdominal pain and headache. Diarrhea seems to occur because of a change in the gut flora brought about by the PPI, and appears to be age-related.8 PPIs, especially omeprazole, are known to alter the activity of cytochrome P in the liver, an important consideration for patients taking drugs with narrow therapeutic windows like warfarin and phenytoin. They also cause a prominent gastric pH increase, and are able to inhibit or decrease the absorption of weak bases that require acid for absorption, like iron salts, griseofulvin, and vitamin B12.8 Other drugs that may be used in this case are H2 receptor antagonists, which inhibit the secretion of acid by stopping histamine from binding to the H2 receptors on the parietal cells; and prokinetic drugs, usual examples like cisapride, metoclopramide and domperidone, which work by increasing the pressure of the lower oesophageal sphincter, and accelerating gastric emptying.10 Evidence for treatment of the condition The National Institute for Health and Clinical Excellence (NICE) guidelines state that, for the management of oesophagitis on endoscopy, patients are to be given full dose PPI for one to two months. If there is a response to the treatment, low dose PPI is given, probably on an as required basis. If there is no response, the dose of PPI is doubled for another month, before switching to low dose PPI. If there is no response to the doubled dose of PPI, treatment is then switched to a histamine H2 receptor antagonist or a prokinetic.11 Klinkenberg-Knol EC et al1 compared the effects of omeprazole and ranitidine in a randomised, double-blind, endoscopically-controlled trial done on patients with reflux oesophagitis. Omeprazole was given at a dose of 60 mg daily while ranitidine was given at 150 mg twice daily. The symptoms were evaluated before starting the trial, and at the second, fourth and eighth week. Endoscopy was done at the start of the trial, and repeated during week 4, with another after 8 weeks if there was an absence of healing at week 4. For patients taking omeprazole, 19 out of 25 patients improved from Grade 2 or 3 (erosions or ulcerations) to Grade 0 or 1 (erythema and friability)12 after 4 weeks; while for patients taking ranitidine 7 out of 26 showed similar improvement (P = 0.002). At week 8, corresponding improvement was shown in 22 out of 25 for the omeprazole group, and 10 out of 26 for the ranitidine group (P = 0.001). Omeprazole showed a significantly higher healing rate, which was reflected in a better improvement of reflux symptoms as well. Patients receiving omeprazole experienced a more profound and faster relief of heartburn, which was the most common symptom complained by the patients (P = 0.0001). After 2 weeks, 92% (23 out of 25 patients) of patients receiving omeprazole reported that their reflux symptoms were either gone or had improved, while only 65 % (17 out of 26) of the ranitidine group reported the same (P = 0.01). This study however, only showed the superiority of omeprazole over ranitidine in the short term treatment of reflux oesophagitis. Further studies were needed to evaluate the effects of omeprazole in long term management and at a lower dose. Havelund T et al12 performed a double blind study on patients with Grade 1, 2 and 3 reflux oesophagitis. Patients were allocated randomly in this study to a treatment with omeprazole (40 mg once daily), and ranitidine (150 twice daily), for a period of 12 weeks. It was found that patients treated with omeprazole had a faster response to the treatment than those taking ranitidine (P < 0.0001). For the omeprazole group, healing rates were reported at 4, 8 and 12 weeks to be 90%, 100% and 100% respectively for those with Grade 1 reflux oesophagitis. For Grade 2 and 3, corresponding healing rates were 70%, 85% amd 91%. While for the ranitidine group, healing rates were 55%, 79% and 88% for Grade 1, and 26%, 44% and 54% for Grade 2 and 3. This pointed to a superiority of omeprazole at a lower dose (40 mg) over ranitidine. Sandmark S et al13 did a similar study, but with an omeprazole dose of 20 mg daily. Healing of oesophagitis was targeted in this study to be a complete healing of all ul cerative and erosive lesions in the oesophagus. At 4 weeks, healing rates were shown to be 67% in the patients taking omeprazole and 31% in those taking ranitidine (P < 0.0001). Corresponding healing rates were 85% (Omeprazole group) and 50% (Ranitidine group) after 8 weeks (P < 0.0001). This was also reflected in a more profound and faster- improvement in reflux symptoms in the patients taking omeprazole (51% by the end of the first week compared to 27% for patients taking ranitidine). Robinson M et al14 conducted a study to compare, in patients with erosive oesophagitis the efficacy and tolerability of omeprazole at a dose of 20 mg daily to ranitidine at a dose of 150 mg twice daily together with a prokinetic drug metoclopramide at a dose of 10 mg four times daily. It was found that healing rates for omeprazole were significantly greater than that for ranitidine in combination with metoclopramide. Omeprazole also provided a more profound relief for patients with reflux symptoms. More side effects and treatment-related withdrawals were found among the patients allocated the ranitidine-metoclopramide combination. Omeprazole was thus found to be more effective and better tolerated. Iskedjian M and Einarson TR conducted a meta-analysis15 of the three drugs cisapride, omeprazole and ranitidine for GORD treatment. At 12 weeks, 95% of patients were cured in the omeprazole group (40 mg daily), 81% in the ranitidine group (600 mg daily), and approximately 60% in the cisapr ide group (40 mg daily). In mild GORD, healing rate was 56% for cisapride versus 38% for ranitidine, while healing rates for cisapride and omeprazole showed no significant difference. In severe GORD, the healing rate for cisapride was only a half of that of omeprazole (43% versus 87%), while showing no significant difference when compared to that of ranitidine (50%). Thus it was concluded that omeprazole is favoured for treating severe GORD, while cisapride may be that of mild GORD. Vigneri S et al16 compared 5 maintenance therapies after an initial treatment of omeprazole 40 mg daily for 1 to 2 months, and healing was confirmed by endoscopy. Patients were then randomly assigned 12 months of treatment in the 5 following groups: cisapride (10 mg three times daily), ranitidine (150 mg three times daily), omeprazole (20 mg daily), ranitidine and cisapride, or omeprazole and cisapride. At 12 months 54% of the cisapride group, 49% of the ranitidine group, 80% of the omeprazole group, 66% of the ranitidine-cisapride group, and 89% of the omeprazole-cisapride group were found to be in remission at 12 months of maintenance therapy. Omeprazole showed a significantly better efficacy than cisapride (P = 0.02), and ranitidine (P = 0.003). Ranitidine-cisapride combination therapy was found to show a more profound improvement than ranitidine alone (P = 0.05). Omeprazole-cisapride combination therapy showed better efficacy than cisapride (P = 0.003), ranitidine (P < 0.001), an d also ranitidine and cisapride combination therapy (P = 0.03). Omeprazole as monotherapy or in combination with cisapride is found to be more effective for maintenance therapy of reflux oesophagitis, compared to ranitidine or cisapride alone. Omeprazole in combination with cisapride shows more efficacy than ranitidine and cisapride. The effects of newer PPIs lansoprazole (30 mg daily), rabeprazole (20 mg daily) and pantoprazole (40 mg daily) were compared with that of omeprazole (20 mg daily), ranitidine (300mg daily) and placebo in randomised clinical trials brought together by Caro JJ et al.17 The healing rate ratios noted for the newer PPIs as well as omeprazole were as follow: lansoprazole 1.62; rabeprazole 1.36; pantoprazole 1.60; and omeprazole 1.58. There was a greater decrease in the heartburn symptoms in patients taking PPIs than those taking ranitidine (P < 0.002), as well as in the healing of ulcers (P < 0.05), and relapse (P < 0,01). Compared to placebo, the PPIs obtained a much more profound relief of reflux symptoms (P < 0.01), healing of ulcers (P < 0.001) and relapse (P < 0.006). From this study, it was found that there is not much difference between the newer PPIs and omeprazole when it comes to relief of reflux symptoms, ulcer healing and rate of relapse, while all PPIs are better than ranitidi ne and of course, placebo in terms of treatment for erosive oesophagitis. Kahrilas PJ et al18 compared esomeprazole and omeprazole efficacies in reflux oesophagitis patients. It was found that more patients (P < 0.05) on esomeprazole 40 mg and esmoprazole 20 mg were healed after 8 weeks of treatment compared to omeprazole (94.1% and 89.9% compared to 86.9%). Adverse effects were common in both treatments. Esomeprazole was found to have a greater efficacy compared to omeprazole in reflux oesophagitis and both have a similar tolerability profile. Rohss K et al19 showed that esomeprazole at 40 mg daily had better acid control than omeprazole 40 mg daily. Since maintenance of intragastric pH > 4 is important for the effective management of GORD, the mean percentage of a 24 hour period with intragastric pH > 4 was taken as an indication of the efficacy of the treatments. Measurements were taken on day 1 and day 5, and on both days esomeprazole showed a greater mean percentage (P < 0.001) at 48.6% and 68.4% versus 40.6% and 62.0% for omeprazole. Wahlqvist P et al20 compared,from the perspective of the National Health Service (NHS),the cost effectiveness of the actue treatment of esomeprazole (40 mg daily) with omeprazole (20 mg daily) in reflux oesophagitis patients.It was estimated that, taking into consideration of the healing probabilities over 8 weeks, treatment with esomeprazole saves up toa total of 1290 pounds compared to treatment with omeprazole. Esomeprazole was found to provide a greater effectiveness at a lower cost. This is reflected in another study conducted by Plumb JM and Edwards SJ,21 which found that esomeprazole is cost effective in comparison to all other PPIs for the treatment of reflux oesophagitis. Conclusion The treatment given to this patient was appropriate in terms of the algorithms stated in the NICE guidelines; she was started on a full dose PPI after eosophagitis was confirmed on the endoscopy. As stated above, PPIs are proven to have superior effects in comparison with histamine H2 receptor antagonists and prokinetic drugs, both providing relief of reflux symptoms but not healing the oesophagitis itself.10 Among all the PPIs currently available, esomeprazole, the S-isomer of omeprazole, has been found to show more improvement than all other PPIs. Current studies have shown that the treatment of reflux oesophagitis with esomeprazole is more cost effective than treatments using any other PPI, providing a greater healing rate at a lower cost. Thus it might be in the interest of the NHS to treat this patient with esomeprazole than omeprazole. (2271 words)