How desirable is censorship Essay Example

How desirable is censorship? Essay Most people think that censoring materials is going against peoples right to information and press but in some cases censorship is unavoidable. Censorship is the suppression or deletion of material which may be considered objectionable, harmful or sensitive, as determined by a censor. But it is an arguable topic on who gets to censor materials and the criteria for a material not to be censored. Mainly censorship is done on three bases: materials regarding national security, liable materials which can damage an individuals or a firms dignity and reputation and finally material that is obscene materials such as pornography. When it comes down to the security of a nation from attacks by terrorist and other countries, it is obvious that the material which put it in jeopardy is bound to be censored. Materials like maps of secret location like the Whitehouse and other government areas of most of the countries are censored on Google earth and out of reach of the local population because it provides an easy access for the terrorists as they will be able to view those places and plan their attacks. Other official papers also like of those of research done by a country and military tactics is censored because the linkage of the information may turn out to be a huge problem for a country. So these types of censoring are justified and are reasonable. But when the government holds back secret information which they think will start a revolution and the people will rebel against the government isnt the correct use of censorship as the citizens of the country have the right to know what is happening and show their feeling and thoughts towards what the government of doing with the country. We will write a custom essay sample on How desirable is censorship? specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on How desirable is censorship? specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on How desirable is censorship? specifically for you FOR ONLY $16.38 $13.9/page Hire Writer This type of censorship is usually seen in Middle Eastern countries like Iran and Saudi Arabia. Another material which is usually censored is obscene or vulgar materials like pornography, or usage of foul languages. In most of the countries pornography is legal for adults and is only banned for children under the age of 18. So this type of censoring is expectable as exposure to such material can affect the growth of the child and put negative images in their minds. Censoring foul languages from songs is also a good thing as the songs are played on radio and the child may learn the language trying to imitate their idols and singers which isnt a good thing. A song of a famous hip-hop artist Akon had to be re-sung to have a permission to be broadcasted on radio and television as it contained swearing words. On the other hand, another song which was banned was of the black eyed peas. The song lets get retarded had to be changed on to lets get it started to be broadcasted as the censor thought that it would offend the physically challenged people. I dont think this type of censoring in music is justified as the whole concept of the song and the meaning behind it has to be changed. There are many other songs which offend a lot of people but they arent banned like those of Slim shady. Why is it so? So the criteria for a song to be banned should be made clear and shouldnt be bias. There is a lot of censoring done by certain schools, colleges, universities and other educational institutions itself because they dont want some things to be known by the students or it goes against the morals of the school. As an example of a just banned book, David Gutersons acclaimed book Snow Falling on Cedars has been banned by the South Kitsap School District in Washington State as an inappropriate and obscene book. Why it was banned is much deeper, as the book is written about the racism and anti-Japanese persecution during and after World War II on the Kitsap Peninsula. The book was banned because Kitsap is still a right wing, racist stronghold and they wish to block any recognition of their bigoted past and present. This is known as white washing where they try to hide their past which they are ashamed of. Many books in the past have been banned for reasons varying from offending religious beliefs to portraying women as liberated because of this reason many Canadian childrens books are censored as well, not at the government level, but at the level of local schools and libraries. Restricting childrens literature puts a severe limitation on a childs right to read. This type of censorship shouldnt be done as it goes against many of the rights of the people like the freedom of expression and press. The people have the right to read such books and know about the truth and get these types of ideas. Censoring is done in every field these days. There are many other types of censoring done: like corporate censoring where they hide the materials of a project or tender from their adversary; commercial censoring where certain advertisements cannot be played during a certain period of time; parental locking where the parents are able to lock channels and web pages which they dont want their children looking at; political censoring which keeps certain information from the public for certain reasons; personal censoring where an individual decides not to say anything about a subject matter even after knowing the truth for money or some other reason. Censorship is a controversial issue as we know and there will always be two sides of the story to tell. But some materials even though people dont want it to be censor have to be cause if there is no censoring done than a big problem would arise socially, economically as well as politically. So drawing the line between censoring materials and non censoring materials should be the highlight of the agenda rather than try to completely censor materials or completely removing censorship.

Comparing Araby and Going to the Moon

Comparing Araby and Going to the Moon Free Online Research Papers When one talks about the allure of the other, many different meanings can rise up into the conversation. Allure is defined as an attractive or tempting quality possessed by somebody or something, often glamorous and sometimes risky. In both short stories, Araby and Going to the Moon, the allure of the other, love or acceptance, shared a similar yet different pattern as it happens throughout the two stories. For the stories, the protagonists were attracted to a female character because both of them seemed capable of providing an imaginary satisfaction, either for love or recognition that would fill up the void of loneliness and isolation. Due to the appeal of the unknown, both of the protagonists were allured to a location that they believed to be secure and harmonious. Then at the end, both protagonists realized that what they desired, love or acceptance, can not be fulfilled because their deep emotions and feelings blindly misled them. The main similarity between the two stories is that both protagonists were drawn towards a female character because they portrayed the superficial appeal of love and acceptance. In Araby, the boy was attracted to the girl because he is a senior teenager who as all other teenagers is interested in the matter of sexuality. The author illustrated that boy has no way of escaping the allure of the female character in the story, Mangan’s sister, because she composed of an attractive appearance and body figure. As a result, her body figure and movements became the main focus on his mind. â€Å"Her dress swung as she moved her body and the soft rope of her hair tossed from side to side† (288, James Joyce). Instead of realizing that he was really interested in sexuality, he blindly led himself to believe this is a high ordered romance. Due to the appeal revealed from Mangan’s sister, the boy was blindly infatuated with her. Evidence supporting this is that the author use d a metaphor to imply that the narrator felt like a harp controlled by Mangan’s sister. In the other story, Going to the Moon, the young protagonist was drawn to a female character who he believes can connect him with the outside world and provides him with protection and acceptance. She is so exceptionally different from the others that she â€Å"stood out from the stiff formality of the priests and nuns like a burst of colour in a grey landscape† (213, Nino Ricci). The reasons for her difference are her striking beauty, rich and colourful apparel, and unique ways of teaching. Therefore, including the protagonist, all the kids admire her to a great extend. The moon in the unique moon game started by her symbolizes an ideal world where the boy believes he can be accepted and welcomed. Since the game was organized by her, she then became the connection to his hopes of acceptances. So in both stories, the young and innocence of the story led them to succumb to the superf icial appeal of love and acceptance because they seemed so interesting and comforting. Due to the appeal of love and acceptance, both protagonists had a location in mind that reflects their hopes and dreams. In the story Araby, the magical place in the mind of the boy was the bazaar Araby. This place is implied with significance and heavenly decoration because it is where the protagonist can start his plan of consummating his love. Since the boy promised the girl that he will retrieve something back for her from the bazaar, the mission to the bazaar then represents a mission of winning the girl’s love. The bazaar then was constantly on his mind, â€Å"†¦the word Araby were called to me through the silence in which my soul luxuriated and cast an Eastern enchantment over me† (Joyce 289). In the story, Going to the Moon, the desirable location the protagonist dreams of was U.S.A. His family and he were originally planning to go to U.S.A, and they see it with a greater importance and significance in comparison to Canada. This was illustrated at the begi nning where Windsor, Canada, was like a purgatory. An allusion was also used to show the protagonist’s desire to go to U.S.A by comparing their family to Dorothy which â€Å"falling asleep on the road to Emerald city†, or U.S.A. Not only so, the protagonist view the building structure in U.S.A with high respect and admiration, â€Å"†¦that skylines tall buildings stood unnaturally still and crisp in the cold air†¦they had a strange, unreal quality†¦.my eyes could not believe their own power to hold so much in a glance† (Ricci 210). So for both of the stories, the appeal of the unknown caused the allure to a location, changing from feeling or emotion to a materialized desire for a place. High expectations usually conclude with a note that disappoints the person with the hope. Just as in the story, Araby, where the protagonist came into a realization that the girl does not love him as she treated him out of duty, and in some way, she seemed to be using him to buy things for her. The author prelude the realization by showing a flat, meaningless conversation between the protagonist and a saleswoman in comparison to the flirtation shared between the same women and two other men. Mangan’s sister is just like the saleswoman, treat the boy out of duty rather than the passion he desired. At the end, the reality was learnt by the boy in the harshest way possible, as he saw himself â€Å"as a creature driven and derided by vanity; and my eyes burned with anguish and anger† (292, James Joyce). The realization in the story Going to the Moon is that U.S.A was not a utopia as imagined. Due to the death of the astronauts and riots in Detroit, the boy can no longer mislead himself to believe that U.S.A is a safe and secure country. Not only that, the death of the astronauts had changed Miss Johnson, as she changed and acted in the same way as all other teachers in the school. The change in her, the termination of the moon game had completed destroyed the boy’s hope and faith of the easy acceptance into a welcoming world. However, though, the boy had began to accept his life, his position in Canada, because it seems Windsor can be a peaceful place to be in comparison to U.S.A, because at the end he called Windsor â€Å"home†. Overall, the tough realizations caused pains and sufferings to both protagonists as they cannot be satisfied with their hopes and desire. However, the same time they learn from these harsh lessons, they advance in life significantly. The allure of the other plays a major role in both Araby and Going to the Moon. In both short stories, the main characters were attracted to a certain character for a variation of reasons. It could be to fill a void in their life, or to fulfill an imagination or dream they have had in the past. Either way, the allure controlled them to the point where they discovered that is wasn’t safe or pleasant like the main characters thought it would be. The disappointment of the allure not being what was expected hit the protagonists hard and in a deep manner. The results changed their way of life and way of thinking, which made them see the world in a different way. In conclusion, one cannot always go with the allure of the other and expect perfect results, but one can always try and accept the results regardless. 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World War II Essay Example | Topics and Well Written Essays - 500 words

World War II - Essay Example 6, 600 million towards damages that were caused by the war, Germany would not build their army and the Rhineland area was to be de-militarized, and finally some parts of Germany was to be allocated to other countries. Despite the harsh conditions imposed by the treaty, Germany went ahead and signed the treaty which resulted in acute poverty in the 1920s as the country suffered serious setbacks and could not pay the money. It was at this juncture that the German people voted Adolf Hitler to power as he promised them that he would put an end to all their sufferings. Once in power, Hitler began to build the German army and also stationed troops in the Rhineland area. Though France and Britain kept track of Hitler’s moves they were unwilling to begin another war and instead believed that a stronger Germany would prevent the spread of Communism to the west. Hitler also entered into an alliance with Italy and Japan in 1936. Hitler wanted to expand his territory by acquiring Austria and with about 99% of the Austrian people favoring a union with Germany; Hitler acquired Austria but promised that this would be the end of his expansion plans.

Spring awakening Essay Example | Topics and Well Written Essays - 500 words

Spring awakening - Essay Example This writing compares modern America and the issues faced by the teenagers in Spring Awakening. In Spring awakening the parents and the society at large are not ready to inform their children about the sexual exploration. Parents consider it unethical to discuss issues of sexual relationship with their children. This is really unfortunate since most of the children in the play are starting to experience changes in their bodies. No one is out there to explain to them about these changes. Even the very parents with the responsibility of caring are not giving their children any explanation to the biological changes they experience. The big issue of the play was the challenges the teenagers had due to the societal suppression and fear of discussing sexuality and reproduction. For instance, Wendla who is a teenage school girl is in a big trouble because her mother Bergmann is not comfortable with her daughter’s quick growth. Wendla’s mother is not ready to discuss with Wendla the facts about reproduction and sexuality despite her daughter’s growing curiosity. Martha is also emotionally disturbed by her parents’ continual physical abuse. It is surprising to note that 17-year old Lammermeier does not even have sexual thoughts and even the expulsion of Melchior from school simply because he has knowledge about sex and he is able to express himself in writing. Failure by the society and the parents to discuss sexuality and reproduction in the play makes Wendla conceive Melchior’s child unknowingly and finally dies after unsafe abortion. It is quite sarcastic to find that the same parents who do not want to talk about sex decide to send Melchior to a reformatory because they discover that he got Wendla pregnant. I feel that modern America has actually changed especially the perception of the topic of sexuality and reproduction. By the time I was an adolescent, I had known a lot about this topic. I got the knowledge from the school, media and very many

Bipolar Disorder as a Mental Illness Research Paper

Bipolar Disorder as a Mental Illness - Research Paper Example There are specific medical events that take place that chemically represent the nature of the disease. Despite the fact that there are some people who believe that bipolar disorder is not a physical manifestation, the truth is that it is a disease that can be treated with pharmaceutical methods of treatment. The nature of bipolar disorder is that it is a mental disease with specific treatments that can assist a person who is suffering from its affects to have a vital and meaningful life. Mood Swings The nature of bipolar disorder is that it is defined by mood swings. This type of definition lends itself to interpretations that suggest that perhaps it should be more easily controlled by the individual and is a matter of choice over a matter of disease. As well, there are times when the disease is attributed to normal hormonal mood swings and is discounted as the unreasonable nature of the individual, rather than being understood as outside of their control. There are those who do not have an understanding, nor wish to believe, that a mental disorder can be accountable for the actions of a person, rather than the mental issues that are based upon a biological factor. Mood swings have been attributed to an unreasonable mind, rather than to the chemical state of an illness that can be treated. ... ves in a position where instead of their loved ones recognizing that they are experiencing a disorder, they are blamed for their symptoms without there being an understanding of how they can possibly not be in control of themselves. Women with bipolar disorder are more susceptible to larger mood swings in association with their periods, their symptoms of PMS lasting for weeks rather than days and their anger and irritability being beyond their ability to conduct themselves as they normally would (Burgess, 2006, p. 186). The problem that comes with this is that a blame is set up that creates stress, shame, and guilt, as the actions and behaviors manifest outside of the control or the actual responses that a person would have to any given situation. In this situation, the problem will begat the problem, perpetuating a cycle of episodes from the stress that is created from not addressing the problem sufficiently and from blaming a person for not having control, when they suffer from a d isease that takes control from them. Bipolar Illness Sartorius (2005) describes bipolar disorder as â€Å"a chronic remitting and relapsing illness that causes significant burden to patients, families and society† (p. 69). Hudson and Rapee (2005) through saying â€Å"Although patients with bipolar disorder may also experience many †¦psychotic symptoms, their major problem is mood instability. Periods of abnormally elevated mood, increased energy and decreased need for sleep, alternate with episodes of depressed mood, decreased interest, and low energyâ€Å" (p. 205). â€Å"It exists within the patience as an active illness for about 1% of the lifetime. Per year, 9-15 per 100,000 men contract the illness and 7-30 per 100,000 women. Most people who have the illnesses will seek some sort of help for

Acute Exacerbation of Bronchial Asthma (AEBA) Case Study

Acute Exacerbation of Bronchial Asthma (AEBA) Case Study 1.0 CASE SUMMARY 1.1 Patient information and presenting complaints SAR, a 54-year-old female with weight of 54kg and height of 160cm was referred to the hospital by her GP due to shortness of breath which was not relieved by taking inhaler, minimum cough with yellowish sputum, abdominal pain and mild diarrhoea. Her shortness of breath had been on and off for the past 1 week and the condition was deteriorating on the day of admission. 1.2 Relevant history SAR is a non-smoker and a non-alcoholic housewife. She has had bronchial asthma since childhood. Her siblings and children were found to have family history of bronchial asthma as well. The patient has been taking inhaled salbutamol 200 µg 1 puff when required as reliever and inhaled budesonide 200 µg 2puffs bd as preventer for umpteen years. Besides that, SAR also has medical history of hypertension, diabetes mellitus and ischaemic heart disease (IHD) for 10 years. She has no relevant family history for these illnesses. For the past few years, SAR has been taking rosuvastatin 20mg at night, fenofibrate 160mg OD and ezetimibe 10mg OD for dyslipidaemia, gliclazide 60mg BD and rosiglitazone 4mg OD for diabetes mellitus, losartan 50mg OD for hypertension, ticlopidine hydrochloride 250mg OD for prophylaxis against major ischaemic events and famotidine 20mg OD to prevent gastrointestinal ulceration due to the use of anti-platelet agent. 1.3 Clinical data On examination upon admission, SARs blood pressure and pulse rate were recorded as 111/80 mmHg and 111bpm respectively. Her respiratory rate was normal (16 breaths/min). Her SpO2 measurement was 98% and it showed decreased high flow mask. Her DXT blood glucose test revealed that her random blood glucose level was abnormally high (21.6mmol/L). From the doctors systemic enquiry, SARs ankles were slightly swollen and her respiratory system showed prolonged minimal bibasal crept and rhonchi. Also, SARs chest X-ray showed shadowing in the lower zone of her right lung. The renal function tests gave results of high urea and elevated creatinine levels of 16.3mmol/L and 270 µmol/L respectively. Creatinine clearance derived from Cockcroft and Gault formula is 17ml/min which indicates that the patient has severe renal impairment. The liver function tests revealed a mild decrease in albumin concentration and an increase in the plasma globulin. On the other hand, the haematological tests showed low red blood cell count (3.41012/L), low haemoglobin count (9.4g/dL), high platelet count (410109/L), high white blood cell count (17.1109/L), high neutrophil count (16.4109/L) and low lymphocyte count (0.5109/L), whereas cardiac marker tests showed abnormally high counts in creatine kinase (156IU/L) and lactate dehydrogenase (627IU/L). 1.4 Diagnosis and Management Plan Based on the patients symptoms, medical history, physical examinations, and laboratory tests, SAR was diagnosed with chronic heart failure (CHF), acute exacerbation of bronchial asthma (AEBA) secondary to pneumonia and uncontrolled diabetes mellitus. Her doctor developed therapeutic plans which included anti-asthmatic drugs and antibiotics, and ordered further investigations such as SpO2 and PEFR. Besides that, her doctor also added diuretic to her ACEI therapy and restrict her fluid intake to not more than 800cc/day. Her uncontrolled diabetes mellitus was under monitoring of DXT blood glucose test 4 hourly and she was referred to dietician for diabetic diet counselling. 1.5 Ward medication Throughout the 3days in hospital, Sarah was being prescribed with medications as listed below: 1.6 Clinical Progress and Pharmaceutical Care Issues On the first day of admission, the patients past medication history was confirmed by appropriate patient interview and her family members were being advised to bring SARs home medication to ensure that the appropriate medications were continued and prescribed. From the interview, dust was found to be the chief precipitating factor. The patient was on appropriate drugs (nebulised ipratropium bromide 0.5mg and nebulised salbutamol 5mg in normal saline 4 hourly, IV hydrocortisone 100mg stat) for acute management of severe asthma as according to guidelines and eventually her SOB was relieved.2-3 However, she was prescribed with oral prednisolone at dose as low as 30mg od for acute asthma, it should be suggested to increase prednisolone dose to 40-50mg daily as according to evidence-based guidelines to achieve maximal effects.2-3 Another pharmaceutical care issue is regarding the patients poor inhaler technique. Thus, the pharmacist educated and assessed SAR on her inhaler technique since day 1. Appropriate antibiotics indicated for pneumonia which included IV ceftriaxone 2g stat and oral azitromycin 500mg od were initiated upon admission. Oral cefuroxime 250mg bd was added to the drug regimen on day 2 after stopping IV ceftriaxone 2g on the first day. Therefore, signs of recovery and WBC count were monitored regularly and completion of antibiotic course was ensured. In addition to that, vaccinations against pneumococcal infection and influenza should be strongly recommended in this asthmatic patient.2-3,5-8 Co-administration of high dose IV furosemide (40mg bd) and corticosteroids can increase the risk of hypokalaemia, therefore SAR should be started on potassium chloride 600mg bd which is an appropriate dose for renal insufficiency patient to avoid the potential risk.1 Besides that, potassium level of SAR should also be closely monitored during the administration of potassium chloride. The doctor added lovastatin 20mg at night to her existing triple therapy of dyslipidaemia (rosuvastatin, ezetimibe, fenofibrate). Rosuvastatin should be avoided if patients creatinine clearance is less than 30ml/min.1 Due to its same mechanism of action as lovastatin and its contraindication in patient with severe renal impairment, rosuvastatin should be withdrawn from the drug regimen. Practically, a comprehensive lipid profile of SAR should be established and monitored in order to choose the best combination of lipid lowering agents to improve the individual components of lipid profile. Combination therapy of ezetimibe and lovastatin is considered more appropriate as concurrent use of fenofibrate and statin may potentiate myopathy. Therefore, fenofibrate and rosuvastatin should not be continued. Liver function should be monitored to avoid the risk of hepatotoxicity. SAR was diagnosed with uncontrolled diabetes mellitus which means her blood glucose level was not adequately controlled with concurrent therapy of gliclazide and rosiglitazone. Her random blood glucose level was fluctuating throughout day 1 (24.9mmol/L, 14.2mmol/L, 7.3mmol/L and 14.7mmol/L). Targets for blood glucose levels should be ideally maintained between 4 and 7mmol/L pre-meal and On day 2, SAR was feeling much more comfortable and had not complaint of SOB. However, SARs maintenance management of asthma was found to be not conformed to the asthma guidelines.2-3 She was prescribed with unacceptable high dose of corticosteroids (MDI beclomethasone 200 µg 2 puffs tds) in addition to her current steroid regimen (MDI budesonide 200 µg 2 puffs bd and oral prednisolone 30mg od). SAR was at potential high risk of experiencing considerable side effects such as diabetes, oesteoporosis, Cushing syndrome with moon face, striae, acne, abdominal distension and other profound effects on musculoskeletal, neuropsychiatric and ophthalmic systems as a result of overdosage of corticosteroids.1 Oropharyngeal side effects such as candidiasis are also more common at high dose of inhaled steroids, but can be minimized if the patient rinse the mouth with water after inhalation. It should be recommended to add the long acting beta agonist (LABA) to the inhaled corticosteroids (ICS) treatment instead of initiating SAR on high dose steroid (2000 µg). Combination inhaler of formoterol and budesonide (Symbicort 200/6 Turbohaler ® 2 puffs bd) should be given and control of asthma need to be continuing assessed.2-3 If LABA is proved to be not effective, addition of 4th agent (leukotriene receptor antagonist, theophylline or oral beta agonist) can be considered.2 When SAR showed recovery of leg swelling, furosemide was given orally instead of intravenously with reduced frequency and total daily dose. On day 3, SAR was arranged to be discharged. The pharmacist should review the appropriateness of discharged medication by checking discharged prescriptions against ward medication chart and ensure all information relevant to primary care referrals are included. In addition to that, the pharmacist should also reiterate and reinforce the importance of patient compliance and follow-up reviews, counsel on indications, doses and possible adverse effects of each discharged medication, and rechecked SARs inhaler and insulin injection techniques prior discharged. Asthma education includes advice to avoid trigger factors, including caution with NSAIDs and avoidance of dust exposure. Greater attention should be paid to inhaler technique as poor technique leading to failure of treatment. SAR should be educated on the use of peak flow meters and advised to monitor and record her own PEFR at home. A written personalised asthma action plans should be designed for SAR prior discharged. Diabetic cou nselling should emphasize on proper insulin injection techniques and healthy lifestyle modifications. SAR needs to be made aware of the signs of hypoglycaemia and hyperglycaemia and how to response to them. Polypharmacy may adversely affect compliance with prescribed drug therapy, therefore SAR should be taught not to mix up her medicines by using daily pill box and her family member should also be advised to supervise her on medicine taking. 2.0 PHARMACOLOGICAL BASIS OF DRUG THERAPY 2.1 Disease background 2.1.1 Asthma Asthma is a common chronic inflammatory condition of the lung airways affecting 5-10% of the population and appears to be on the increase.5 It is especially prevalent in children, but also has a high incidence in more elderly patient. Asthma mortality is approximately 1500 per annum in the UK and costs in the region of  £2000 million per year in health and other costs.2-3,6 Symptoms of asthma are recurrent episodes of dyspnoea, chest tightness, cough and wheeze (particularly at night or early in the morning) caused by reversible airway obstruction. Three factors contribute to airway narrowing: bronchoconstriction triggered by airway hyperresponsiveness to a wide range of stimuli; mucosal swelling/inflammation caused by mast cell, activated T lymphocytes, macrophages, eosinophils degranulation resulting in the release of inflammatory mediators; smooth muscle hypertrophy, excessive mucus production and airway plugging.7 There is no single satisfactory diagnostic test for all asthmati c patients. The useful tests for airway function abnormalities include the force expiratory volume (FEV1), force vital capacity (FVC) and peak expiratory flow rate (PEFR). The diagnosis is based on demonstration of a greater than 15% improvement in FEV1 or PEFR following the inhalation of a bronchodilator.2,3,6 Repeated pre and post-bronchodilator readings taken at various times of the day is necessary. The FEV1 is usually expressed as the percentage of total volume of air exhaled and is reported as the FEV1/FVC ratio. The ratio is a useful and highly reproducible measure of lungs capabilities. Normal individuals can exhale at least 75% of their total capacity in 1 second. A decrease in FEV1/FVC indicates airway obstruction. 2.1.2 Community-acquired pneumonia Pneumonia is defined as inflammation of the alveoli as opposed to the bronchi and of infective origin. It presents as an acute illness clinically characterized by the presence of cough, purulent sputum, breathlessness, fever and pleuritic chest pains together with physical signs or radiological changes compatible with consolidation of the lung, a pathological process in which the alveoli are filled with bacteria, white blood cells and inflammatory exudates. The incidence of community acquired pneumonia (CAP) reported annum in UK is 5-11 per 1000 adult population, with mortality rate varies between 5.7% and 14% (patients hospitalised with CAP).8 Streptococcus pneumonia is the commonest cause, followed by Haemophilus influenzae and Mycoplasma penumoniae.7 2.1.3 Congestive cardiac failure Congestive cardiac failure occurs when the heart fails to pump an adequate cardiac output to meet the metabolic demands of the body. It is a common condition with poor prognosis (82% of patients dying within 6 years of diagnosis) and affects quality of life in the form of breathlessness, fatigue and oedema.6,7 The common underlying causes of cardiac failure are coronary artery disease and hypertension. Defects in left ventricular filling and/or emptying causes inadequate perfusion, venous congestion and disturbed water and electrolyte balance. In chronic cardiac failure, the maladaptive body compensatory mechanism secondary physiological effects contribute to the progressive nature of the disease.6 2.1.4 Diabetes mellitus Diabetes mellitus is a heterogenous group of disorders characterised by chronic hyperglycaemia due to relative insulin deficiency and/or resistance. It can be classified as either Type 1 or Type 2. In Type 1, there is an inability to produce insulin and is generally associated with early age onset. Decreased insulin production and/or reduced insulin sensitivity, maturity onset and strong correlation with obesity are characteristics of Type 2 diabetes. Diabetes affects 1.4 million people in the UK, over 75% of them have Type 2 diabetes.6 It is usually irreversible and if not adequately managed, its late complications can result in reduced life expectancy and considerable uptake of health resources. 2.2 Drug pharmacology 2.2.1 Treatment for asthma 2.2.1.1Beta-adrenoceptor agonists (e.g. salbutamol, terbutaline) These short-acting selective ÃŽ ²2 agonists (SABA) are the first line agents in the management of asthma and are also known as relievers. The selective ÃŽ ²2 agonists act on ÃŽ ²2 aderenoceptors on the bronchial smooth muscle to increase cyclic adenosine monophosphate (cAMP) leading to rapid bronchodilation and reversal of the bronchospasm associated with the early phase of asthmatic attack.5 Such treatment is very effective in relieving symptoms but does little for the underlying inflammatory nature of the disease. ÃŽ ²2 agonists should be initiated ‘when required as prolonged use may lead to receptor down regulation renders them less effective.5-6 Compared to SABA, long-acting beta-adrenoceptor agonists (e.g. salmeterol, formoterol) have slower rate of onset and their intrinsic lipophilic properties render them to be retained near the receptor for a prolonged period (12hours), which means that they cause prolonged bronchodilation. 2.2.1.2 Muscarinic receptor antagonists (e.g. ipratropium) Ipratropium blocks parasympathetic-mediated bronchoconstriction by competitively inhibiting muscarinic M3 receptors in bronchial smooth muscle.1,5-6 It has slower onset of action than ÃŽ ²2 agonists but last longer. 2.2.1.3 Inhaled corticosteroids (ICS; e.g. beclomethasone, budesonide) and oral prednisolone These agents are used to prevent asthmatic attacks by reducing airway inflmmation. They exert their anti-inflammatory actions via activation of intracellular receptors, leading to altered gene transcription. This results in decreased cytokine production and the synthesis of lipocortin leading to phospholipase A2 inhibition, and the inhibition of leukotriene and prostaglandins.5 Candidiasis occurs as common side effects with inhalation and systemic steroid effects such as adrenal suppression and osteoporosis, occur with high dose inhalation or oral dosing. 2.2.2 Treatment for pneumonia Antiobiotic treatment is appropriate with amoxicillin being used as first choice agent for mild, community-acquired infections. Depending on response and the strain of bacteria, other antibiotic agents can be used. Two groups of antibiotics which were given to the patient in this case scenario will be discussed here. 2.2.2.1 Cephalosporins (e.g. cefuroxime, ceftriaxone) Both ceftriaxone and cefuroxime are broad spectrum bactericidal antibiotics belong to cephalosporins group. They inhibit the synthesis of bacterial cell wall by binding to specific penicillin-binding proteins and ultimately leading to cell lysis. Second generation cefuroxime is beta-lactamase resistant and active against Gram-negative bacteria such as Haemophilus influenzae and Klebsiella pneumoniae. Being third generation cephalosporin, ceftriaxone display high beta–lactamase resistance and enhanced activity against Gram-negative pathogens (including Pseudomonas Aeruginosa), but it has relatively poor activity against Gram-positive organisms and anaerobes.1,5-6 2.2.2.2 Maclolides (e.g. azithromycin, erythromycin, clarithromycin) Maclolides prevent protein synthesis by inhibiting the translocation movement of the bacterial ribosome along the mRNA, resulting in bacteriostatic actions. Azithromycin has slightly less activity than erythromycin against Gram-positive organisms but possesses enhanced activity against Gram-negative bacteria including Haemophilus influenza. 2.2.3 Treatment for chronic cardiac failure 2.2.3.1 Loop diuretics (e.g. furosemide) Diuretics are the mainstay of the management of heart failure and provide rapid symptomatic relief of pulmonary and peripheral oedemia.5,6,9 Loop diuretics are indicated in majority of symptomatic patients and they work by inhibiting Na+/K+/2Cl- transporter in the ascending limb of the loop of Henle, inhibiting the establishment of a hyperosmotic interstitium and thus reducing the production of concentrated urine in kidney, leading to profuse dieresis.5-6 2.2.3.2 Angiotensin II receptor antagonists (e.g. losartan, candesartan, valsartan) These agents block the action of angiotensin II at the AT1 receptor, which will also reduce the stimulation of aldosterone release. Therefore AT1 receptor antagonists can be used as an alternative in patients suffering from a cough secondary to ACE inhibitors. 2.2.4 Treatment for Type II diabetes mellitus 2.2.4.1 Sulphonylureas (e.g. Gliclazide, glibenclamide, glipizide) The sulphonylureas have two main actions: increase basal and stimulated insulin secretion and reduce peripheral resistance to insulin action. They bind to receptors associated with voltage dependent KATP channels on the surface of pancreatic beta cell, causing channel closure which facilitates calcium entry into the cell and leads to insulin release. Sulphonylureas are considered in Type II diabetes patients who are intolerant to metformin, not contraindicated and not overweight. 2.2.4.2 Thiazolidinediones (e.g. rosiglitazone, pioglitazone) These new agents are ‘insulin sensitisers which act as nuclear peroxisome proliferator-activated receptor-gamma (PPAR-ÃŽ ³) agonist. They work by enhancing insulin action and promoting glucose utilization in peripheral tissue, and so reduce insulin resistance. Thiazolidinediones is known to be associated with oedema and increased cardiovascular risks, therefore these agents should be avoided in patients with heart failure.1,4,6 3.0 EVIDENCE FORTREATMENT OF CONDITIONS 3.1 Asthma 3.1.1 Evidence for the use of oral prednisolone and IV hydrocortisone in the management of AEBA There are mounting evidences suggesting that systemic corticosteroids effectively influence the airway oedema and mucus plugging associated with acute asthma by suppressing the components of inflammation, including the release of adhesion molecules, airway permeability and production of cytokines.10-12 A randomised trial involving 88 patients (aged 15-70years) with AEBA reported the significant efficacy of oral prednisolone (40mg daily for 7 days) in improving FEV1 and FVC at values of 68 ±45.3% and 53.4 ±46.5% respectively (P=0.04) in prednisolone-treated group.13 A Cochrane meta-analysis involving six trials recruiting 374 acute asthmatic exacerbation patients determined the early use of systemic corticosteroids significantly reduced the number of relapses to additional care, hospitalisation and use of short-acting ÃŽ ²2-agonist without increasing side effects, regardless of the routes of administration studied (oral/intramuscular/intravenous) and choice of agents.14 3.1.2 Evidence for the use of inhaled ipratropium bromide in the management of AEBA A double-blind, randomised controlled trials recruiting 180 patients with AEBA admitted to emergency department showed that ipratropium had beneficial effects in improving pulmonary function, with a 20.5% increment in PEF (p=0.02) and a 48.1% greater improvements in FEV1 (p=0.0001) compared to those given ÃŽ ²2-agonists alone. Ipratropium also demonstrated a 49% reduction in the risk of hospital admission.15 A more recent meta-analysis incorporating thirty-two double-blind, randomised controlled trials including 3611 patients with moderate to severe exacerbations of asthma also showed the benefits of combination treatment of nebuliser ÃŽ ²2-agonists and anti-muscarinic in reducing hospital admissions (relative risk 0.68,p=0.002) and in producing a significant increase in lung function parameters in AEBA patients (standard mean difference -0.36, p=0.00001).16 Another pooled analysis of three multicenter, double-blind, randomised controlled studies also showed that combination therapy of ipratropium bromide and salbutamol for the treatment of AEBA had decreased risk of the need for additional treatment (relative risk=0.92), asthma exacerbation (relative risk=0.84) and hospitalisation (relative risk=0.80).17 3.1.3 Evidence for addition of LABA to ICS in the management of asthma Symbicort Maintenance and Reliever Therapy (SMART) studies demonstrated the combined use of formoterol/budesonide contributes to a greater reduction in risks of exacerbations, improved lungs performance and better control of asthma than high dose of ICS with SABA.18-22 These studies also reported the advantage of this approach in terms of patient compliance as it allows the use of single inhaler for both rescue and controller therapy, and reductions in healthcare costs.18-22 A large double-blind, randomised trial reported that there was a significant 21-39% reduction of severe exacerbations in asthmatic patients treated with SMART therapy compared with high dose budesonide plus SABA.23 A meta-analysis involving 30 trials with 9509 patients showed that the use of combination inhaler (formoterol/beclomethasone 400mcg) resulted in greater improvement in FEV1, in the use of rescue SABA and in the symptom-free days compared to a higher dose of ICS (800-1000mcg/day).24 Another double-blind randomised trial investigating the effect of combination budesonide and formoterol as reliever therapy for 3394 patients who were assigned budesonide plus formoterol for maintenance therapy showed that the time to first severe exacerbation was significantly longer in as needed budesonide/formoterol group compared to as needed terbutaline group (p=0.0051). The other finding of the study is the significant lower rate of severe exacerbation for as needed budesonide/formoterol versus as needed terbutaline group (0.19 vs 0.37, p 3.2 Community-acquired pneumonia 3.2.1 Evidence use of combination therapy of second and/or third generation cephalosporins and macrolide in the management of pneumonia A multicenter, randomised trial investigated the efficacy of IV ceftriaxone 2g for 1 day followed by oral cefuroxime 500mg bd in the adult pneumonia treatment. The sequential therapy in combination with a macrolide achieved 90% of clinical success, 85% of overall bacteriologic clearance with 100% eradication of S.pneumoniae after 5-7days of treatment.27 An open label, prospective study involving 603 patients demonstrated that adding azithromycin (500mg od for 3days) to IV ceftriaxone 1g/day in the treatment of community-acquired pneumonia resulted in shorter hospital stay (7.3days vs 9.4days) and a significant lower mortality rate (3.7% vs 7.3%) than adding clarithromycin.28 Lack of randomisation and no blinding of evaluators may become the major limitations of this study; however the effectiveness of macrolide in addition to cephalosporins empirical therapy in treating pneumonia is unquestionable. 3.3 Chronic heart failure 3.3.1 Evidence use of loop diuretic in the management of chronic heart failure (CHF) A meta-analysis of 18 randomised controlled trials concluded that diuretics significantly lowered the mortality rate (odds ratio (OR) 0.25, P=0.03) and reduced hospital admissions for worsening heart failure (OR 0.31, P=0.001) in patients with CHF compared to placebo.29 Compared to active control, diuretics significantly improved exercise capacity in CHF patients. (OR 0.37, P=0.007).29 A recent review reappraisaled the role of loop diuretics as first line treatment for CHF concluded that existing evidence of association of loop diuretics with rapid symptomatic relief and decreased mortality supporting the essential role of diuretics in the management of CHF.30 3.3.2 Evidence use of angiotensin II receptor antagonists in the management of CHF The Losartan Heart Failure Survival Study ELITE II, a double-blind, randomised controlled trial involved 3152 patients with NYHA class II-IV heart failure and ejection fraction ≠¤40% reported that there were no significant differences between losartan and enalapril groups in all cause mortality (11.7 vs 10.4% mean mortality rate). However, losartan Acute Exacerbation of Bronchial Asthma (AEBA) Case Study Acute Exacerbation of Bronchial Asthma (AEBA) Case Study 1.0 CASE SUMMARY 1.1 Patient information and presenting complaints SAR, a 54-year-old female with weight of 54kg and height of 160cm was referred to the hospital by her GP due to shortness of breath which was not relieved by taking inhaler, minimum cough with yellowish sputum, abdominal pain and mild diarrhoea. Her shortness of breath had been on and off for the past 1 week and the condition was deteriorating on the day of admission. 1.2 Relevant history SAR is a non-smoker and a non-alcoholic housewife. She has had bronchial asthma since childhood. Her siblings and children were found to have family history of bronchial asthma as well. The patient has been taking inhaled salbutamol 200 µg 1 puff when required as reliever and inhaled budesonide 200 µg 2puffs bd as preventer for umpteen years. Besides that, SAR also has medical history of hypertension, diabetes mellitus and ischaemic heart disease (IHD) for 10 years. She has no relevant family history for these illnesses. For the past few years, SAR has been taking rosuvastatin 20mg at night, fenofibrate 160mg OD and ezetimibe 10mg OD for dyslipidaemia, gliclazide 60mg BD and rosiglitazone 4mg OD for diabetes mellitus, losartan 50mg OD for hypertension, ticlopidine hydrochloride 250mg OD for prophylaxis against major ischaemic events and famotidine 20mg OD to prevent gastrointestinal ulceration due to the use of anti-platelet agent. 1.3 Clinical data On examination upon admission, SARs blood pressure and pulse rate were recorded as 111/80 mmHg and 111bpm respectively. Her respiratory rate was normal (16 breaths/min). Her SpO2 measurement was 98% and it showed decreased high flow mask. Her DXT blood glucose test revealed that her random blood glucose level was abnormally high (21.6mmol/L). From the doctors systemic enquiry, SARs ankles were slightly swollen and her respiratory system showed prolonged minimal bibasal crept and rhonchi. Also, SARs chest X-ray showed shadowing in the lower zone of her right lung. The renal function tests gave results of high urea and elevated creatinine levels of 16.3mmol/L and 270 µmol/L respectively. Creatinine clearance derived from Cockcroft and Gault formula is 17ml/min which indicates that the patient has severe renal impairment. The liver function tests revealed a mild decrease in albumin concentration and an increase in the plasma globulin. On the other hand, the haematological tests showed low red blood cell count (3.41012/L), low haemoglobin count (9.4g/dL), high platelet count (410109/L), high white blood cell count (17.1109/L), high neutrophil count (16.4109/L) and low lymphocyte count (0.5109/L), whereas cardiac marker tests showed abnormally high counts in creatine kinase (156IU/L) and lactate dehydrogenase (627IU/L). 1.4 Diagnosis and Management Plan Based on the patients symptoms, medical history, physical examinations, and laboratory tests, SAR was diagnosed with chronic heart failure (CHF), acute exacerbation of bronchial asthma (AEBA) secondary to pneumonia and uncontrolled diabetes mellitus. Her doctor developed therapeutic plans which included anti-asthmatic drugs and antibiotics, and ordered further investigations such as SpO2 and PEFR. Besides that, her doctor also added diuretic to her ACEI therapy and restrict her fluid intake to not more than 800cc/day. Her uncontrolled diabetes mellitus was under monitoring of DXT blood glucose test 4 hourly and she was referred to dietician for diabetic diet counselling. 1.5 Ward medication Throughout the 3days in hospital, Sarah was being prescribed with medications as listed below: 1.6 Clinical Progress and Pharmaceutical Care Issues On the first day of admission, the patients past medication history was confirmed by appropriate patient interview and her family members were being advised to bring SARs home medication to ensure that the appropriate medications were continued and prescribed. From the interview, dust was found to be the chief precipitating factor. The patient was on appropriate drugs (nebulised ipratropium bromide 0.5mg and nebulised salbutamol 5mg in normal saline 4 hourly, IV hydrocortisone 100mg stat) for acute management of severe asthma as according to guidelines and eventually her SOB was relieved.2-3 However, she was prescribed with oral prednisolone at dose as low as 30mg od for acute asthma, it should be suggested to increase prednisolone dose to 40-50mg daily as according to evidence-based guidelines to achieve maximal effects.2-3 Another pharmaceutical care issue is regarding the patients poor inhaler technique. Thus, the pharmacist educated and assessed SAR on her inhaler technique since day 1. Appropriate antibiotics indicated for pneumonia which included IV ceftriaxone 2g stat and oral azitromycin 500mg od were initiated upon admission. Oral cefuroxime 250mg bd was added to the drug regimen on day 2 after stopping IV ceftriaxone 2g on the first day. Therefore, signs of recovery and WBC count were monitored regularly and completion of antibiotic course was ensured. In addition to that, vaccinations against pneumococcal infection and influenza should be strongly recommended in this asthmatic patient.2-3,5-8 Co-administration of high dose IV furosemide (40mg bd) and corticosteroids can increase the risk of hypokalaemia, therefore SAR should be started on potassium chloride 600mg bd which is an appropriate dose for renal insufficiency patient to avoid the potential risk.1 Besides that, potassium level of SAR should also be closely monitored during the administration of potassium chloride. The doctor added lovastatin 20mg at night to her existing triple therapy of dyslipidaemia (rosuvastatin, ezetimibe, fenofibrate). Rosuvastatin should be avoided if patients creatinine clearance is less than 30ml/min.1 Due to its same mechanism of action as lovastatin and its contraindication in patient with severe renal impairment, rosuvastatin should be withdrawn from the drug regimen. Practically, a comprehensive lipid profile of SAR should be established and monitored in order to choose the best combination of lipid lowering agents to improve the individual components of lipid profile. Combination therapy of ezetimibe and lovastatin is considered more appropriate as concurrent use of fenofibrate and statin may potentiate myopathy. Therefore, fenofibrate and rosuvastatin should not be continued. Liver function should be monitored to avoid the risk of hepatotoxicity. SAR was diagnosed with uncontrolled diabetes mellitus which means her blood glucose level was not adequately controlled with concurrent therapy of gliclazide and rosiglitazone. Her random blood glucose level was fluctuating throughout day 1 (24.9mmol/L, 14.2mmol/L, 7.3mmol/L and 14.7mmol/L). Targets for blood glucose levels should be ideally maintained between 4 and 7mmol/L pre-meal and On day 2, SAR was feeling much more comfortable and had not complaint of SOB. However, SARs maintenance management of asthma was found to be not conformed to the asthma guidelines.2-3 She was prescribed with unacceptable high dose of corticosteroids (MDI beclomethasone 200 µg 2 puffs tds) in addition to her current steroid regimen (MDI budesonide 200 µg 2 puffs bd and oral prednisolone 30mg od). SAR was at potential high risk of experiencing considerable side effects such as diabetes, oesteoporosis, Cushing syndrome with moon face, striae, acne, abdominal distension and other profound effects on musculoskeletal, neuropsychiatric and ophthalmic systems as a result of overdosage of corticosteroids.1 Oropharyngeal side effects such as candidiasis are also more common at high dose of inhaled steroids, but can be minimized if the patient rinse the mouth with water after inhalation. It should be recommended to add the long acting beta agonist (LABA) to the inhaled corticosteroids (ICS) treatment instead of initiating SAR on high dose steroid (2000 µg). Combination inhaler of formoterol and budesonide (Symbicort 200/6 Turbohaler ® 2 puffs bd) should be given and control of asthma need to be continuing assessed.2-3 If LABA is proved to be not effective, addition of 4th agent (leukotriene receptor antagonist, theophylline or oral beta agonist) can be considered.2 When SAR showed recovery of leg swelling, furosemide was given orally instead of intravenously with reduced frequency and total daily dose. On day 3, SAR was arranged to be discharged. The pharmacist should review the appropriateness of discharged medication by checking discharged prescriptions against ward medication chart and ensure all information relevant to primary care referrals are included. In addition to that, the pharmacist should also reiterate and reinforce the importance of patient compliance and follow-up reviews, counsel on indications, doses and possible adverse effects of each discharged medication, and rechecked SARs inhaler and insulin injection techniques prior discharged. Asthma education includes advice to avoid trigger factors, including caution with NSAIDs and avoidance of dust exposure. Greater attention should be paid to inhaler technique as poor technique leading to failure of treatment. SAR should be educated on the use of peak flow meters and advised to monitor and record her own PEFR at home. A written personalised asthma action plans should be designed for SAR prior discharged. Diabetic cou nselling should emphasize on proper insulin injection techniques and healthy lifestyle modifications. SAR needs to be made aware of the signs of hypoglycaemia and hyperglycaemia and how to response to them. Polypharmacy may adversely affect compliance with prescribed drug therapy, therefore SAR should be taught not to mix up her medicines by using daily pill box and her family member should also be advised to supervise her on medicine taking. 2.0 PHARMACOLOGICAL BASIS OF DRUG THERAPY 2.1 Disease background 2.1.1 Asthma Asthma is a common chronic inflammatory condition of the lung airways affecting 5-10% of the population and appears to be on the increase.5 It is especially prevalent in children, but also has a high incidence in more elderly patient. Asthma mortality is approximately 1500 per annum in the UK and costs in the region of  £2000 million per year in health and other costs.2-3,6 Symptoms of asthma are recurrent episodes of dyspnoea, chest tightness, cough and wheeze (particularly at night or early in the morning) caused by reversible airway obstruction. Three factors contribute to airway narrowing: bronchoconstriction triggered by airway hyperresponsiveness to a wide range of stimuli; mucosal swelling/inflammation caused by mast cell, activated T lymphocytes, macrophages, eosinophils degranulation resulting in the release of inflammatory mediators; smooth muscle hypertrophy, excessive mucus production and airway plugging.7 There is no single satisfactory diagnostic test for all asthmati c patients. The useful tests for airway function abnormalities include the force expiratory volume (FEV1), force vital capacity (FVC) and peak expiratory flow rate (PEFR). The diagnosis is based on demonstration of a greater than 15% improvement in FEV1 or PEFR following the inhalation of a bronchodilator.2,3,6 Repeated pre and post-bronchodilator readings taken at various times of the day is necessary. The FEV1 is usually expressed as the percentage of total volume of air exhaled and is reported as the FEV1/FVC ratio. The ratio is a useful and highly reproducible measure of lungs capabilities. Normal individuals can exhale at least 75% of their total capacity in 1 second. A decrease in FEV1/FVC indicates airway obstruction. 2.1.2 Community-acquired pneumonia Pneumonia is defined as inflammation of the alveoli as opposed to the bronchi and of infective origin. It presents as an acute illness clinically characterized by the presence of cough, purulent sputum, breathlessness, fever and pleuritic chest pains together with physical signs or radiological changes compatible with consolidation of the lung, a pathological process in which the alveoli are filled with bacteria, white blood cells and inflammatory exudates. The incidence of community acquired pneumonia (CAP) reported annum in UK is 5-11 per 1000 adult population, with mortality rate varies between 5.7% and 14% (patients hospitalised with CAP).8 Streptococcus pneumonia is the commonest cause, followed by Haemophilus influenzae and Mycoplasma penumoniae.7 2.1.3 Congestive cardiac failure Congestive cardiac failure occurs when the heart fails to pump an adequate cardiac output to meet the metabolic demands of the body. It is a common condition with poor prognosis (82% of patients dying within 6 years of diagnosis) and affects quality of life in the form of breathlessness, fatigue and oedema.6,7 The common underlying causes of cardiac failure are coronary artery disease and hypertension. Defects in left ventricular filling and/or emptying causes inadequate perfusion, venous congestion and disturbed water and electrolyte balance. In chronic cardiac failure, the maladaptive body compensatory mechanism secondary physiological effects contribute to the progressive nature of the disease.6 2.1.4 Diabetes mellitus Diabetes mellitus is a heterogenous group of disorders characterised by chronic hyperglycaemia due to relative insulin deficiency and/or resistance. It can be classified as either Type 1 or Type 2. In Type 1, there is an inability to produce insulin and is generally associated with early age onset. Decreased insulin production and/or reduced insulin sensitivity, maturity onset and strong correlation with obesity are characteristics of Type 2 diabetes. Diabetes affects 1.4 million people in the UK, over 75% of them have Type 2 diabetes.6 It is usually irreversible and if not adequately managed, its late complications can result in reduced life expectancy and considerable uptake of health resources. 2.2 Drug pharmacology 2.2.1 Treatment for asthma 2.2.1.1Beta-adrenoceptor agonists (e.g. salbutamol, terbutaline) These short-acting selective ÃŽ ²2 agonists (SABA) are the first line agents in the management of asthma and are also known as relievers. The selective ÃŽ ²2 agonists act on ÃŽ ²2 aderenoceptors on the bronchial smooth muscle to increase cyclic adenosine monophosphate (cAMP) leading to rapid bronchodilation and reversal of the bronchospasm associated with the early phase of asthmatic attack.5 Such treatment is very effective in relieving symptoms but does little for the underlying inflammatory nature of the disease. ÃŽ ²2 agonists should be initiated ‘when required as prolonged use may lead to receptor down regulation renders them less effective.5-6 Compared to SABA, long-acting beta-adrenoceptor agonists (e.g. salmeterol, formoterol) have slower rate of onset and their intrinsic lipophilic properties render them to be retained near the receptor for a prolonged period (12hours), which means that they cause prolonged bronchodilation. 2.2.1.2 Muscarinic receptor antagonists (e.g. ipratropium) Ipratropium blocks parasympathetic-mediated bronchoconstriction by competitively inhibiting muscarinic M3 receptors in bronchial smooth muscle.1,5-6 It has slower onset of action than ÃŽ ²2 agonists but last longer. 2.2.1.3 Inhaled corticosteroids (ICS; e.g. beclomethasone, budesonide) and oral prednisolone These agents are used to prevent asthmatic attacks by reducing airway inflmmation. They exert their anti-inflammatory actions via activation of intracellular receptors, leading to altered gene transcription. This results in decreased cytokine production and the synthesis of lipocortin leading to phospholipase A2 inhibition, and the inhibition of leukotriene and prostaglandins.5 Candidiasis occurs as common side effects with inhalation and systemic steroid effects such as adrenal suppression and osteoporosis, occur with high dose inhalation or oral dosing. 2.2.2 Treatment for pneumonia Antiobiotic treatment is appropriate with amoxicillin being used as first choice agent for mild, community-acquired infections. Depending on response and the strain of bacteria, other antibiotic agents can be used. Two groups of antibiotics which were given to the patient in this case scenario will be discussed here. 2.2.2.1 Cephalosporins (e.g. cefuroxime, ceftriaxone) Both ceftriaxone and cefuroxime are broad spectrum bactericidal antibiotics belong to cephalosporins group. They inhibit the synthesis of bacterial cell wall by binding to specific penicillin-binding proteins and ultimately leading to cell lysis. Second generation cefuroxime is beta-lactamase resistant and active against Gram-negative bacteria such as Haemophilus influenzae and Klebsiella pneumoniae. Being third generation cephalosporin, ceftriaxone display high beta–lactamase resistance and enhanced activity against Gram-negative pathogens (including Pseudomonas Aeruginosa), but it has relatively poor activity against Gram-positive organisms and anaerobes.1,5-6 2.2.2.2 Maclolides (e.g. azithromycin, erythromycin, clarithromycin) Maclolides prevent protein synthesis by inhibiting the translocation movement of the bacterial ribosome along the mRNA, resulting in bacteriostatic actions. Azithromycin has slightly less activity than erythromycin against Gram-positive organisms but possesses enhanced activity against Gram-negative bacteria including Haemophilus influenza. 2.2.3 Treatment for chronic cardiac failure 2.2.3.1 Loop diuretics (e.g. furosemide) Diuretics are the mainstay of the management of heart failure and provide rapid symptomatic relief of pulmonary and peripheral oedemia.5,6,9 Loop diuretics are indicated in majority of symptomatic patients and they work by inhibiting Na+/K+/2Cl- transporter in the ascending limb of the loop of Henle, inhibiting the establishment of a hyperosmotic interstitium and thus reducing the production of concentrated urine in kidney, leading to profuse dieresis.5-6 2.2.3.2 Angiotensin II receptor antagonists (e.g. losartan, candesartan, valsartan) These agents block the action of angiotensin II at the AT1 receptor, which will also reduce the stimulation of aldosterone release. Therefore AT1 receptor antagonists can be used as an alternative in patients suffering from a cough secondary to ACE inhibitors. 2.2.4 Treatment for Type II diabetes mellitus 2.2.4.1 Sulphonylureas (e.g. Gliclazide, glibenclamide, glipizide) The sulphonylureas have two main actions: increase basal and stimulated insulin secretion and reduce peripheral resistance to insulin action. They bind to receptors associated with voltage dependent KATP channels on the surface of pancreatic beta cell, causing channel closure which facilitates calcium entry into the cell and leads to insulin release. Sulphonylureas are considered in Type II diabetes patients who are intolerant to metformin, not contraindicated and not overweight. 2.2.4.2 Thiazolidinediones (e.g. rosiglitazone, pioglitazone) These new agents are ‘insulin sensitisers which act as nuclear peroxisome proliferator-activated receptor-gamma (PPAR-ÃŽ ³) agonist. They work by enhancing insulin action and promoting glucose utilization in peripheral tissue, and so reduce insulin resistance. Thiazolidinediones is known to be associated with oedema and increased cardiovascular risks, therefore these agents should be avoided in patients with heart failure.1,4,6 3.0 EVIDENCE FORTREATMENT OF CONDITIONS 3.1 Asthma 3.1.1 Evidence for the use of oral prednisolone and IV hydrocortisone in the management of AEBA There are mounting evidences suggesting that systemic corticosteroids effectively influence the airway oedema and mucus plugging associated with acute asthma by suppressing the components of inflammation, including the release of adhesion molecules, airway permeability and production of cytokines.10-12 A randomised trial involving 88 patients (aged 15-70years) with AEBA reported the significant efficacy of oral prednisolone (40mg daily for 7 days) in improving FEV1 and FVC at values of 68 ±45.3% and 53.4 ±46.5% respectively (P=0.04) in prednisolone-treated group.13 A Cochrane meta-analysis involving six trials recruiting 374 acute asthmatic exacerbation patients determined the early use of systemic corticosteroids significantly reduced the number of relapses to additional care, hospitalisation and use of short-acting ÃŽ ²2-agonist without increasing side effects, regardless of the routes of administration studied (oral/intramuscular/intravenous) and choice of agents.14 3.1.2 Evidence for the use of inhaled ipratropium bromide in the management of AEBA A double-blind, randomised controlled trials recruiting 180 patients with AEBA admitted to emergency department showed that ipratropium had beneficial effects in improving pulmonary function, with a 20.5% increment in PEF (p=0.02) and a 48.1% greater improvements in FEV1 (p=0.0001) compared to those given ÃŽ ²2-agonists alone. Ipratropium also demonstrated a 49% reduction in the risk of hospital admission.15 A more recent meta-analysis incorporating thirty-two double-blind, randomised controlled trials including 3611 patients with moderate to severe exacerbations of asthma also showed the benefits of combination treatment of nebuliser ÃŽ ²2-agonists and anti-muscarinic in reducing hospital admissions (relative risk 0.68,p=0.002) and in producing a significant increase in lung function parameters in AEBA patients (standard mean difference -0.36, p=0.00001).16 Another pooled analysis of three multicenter, double-blind, randomised controlled studies also showed that combination therapy of ipratropium bromide and salbutamol for the treatment of AEBA had decreased risk of the need for additional treatment (relative risk=0.92), asthma exacerbation (relative risk=0.84) and hospitalisation (relative risk=0.80).17 3.1.3 Evidence for addition of LABA to ICS in the management of asthma Symbicort Maintenance and Reliever Therapy (SMART) studies demonstrated the combined use of formoterol/budesonide contributes to a greater reduction in risks of exacerbations, improved lungs performance and better control of asthma than high dose of ICS with SABA.18-22 These studies also reported the advantage of this approach in terms of patient compliance as it allows the use of single inhaler for both rescue and controller therapy, and reductions in healthcare costs.18-22 A large double-blind, randomised trial reported that there was a significant 21-39% reduction of severe exacerbations in asthmatic patients treated with SMART therapy compared with high dose budesonide plus SABA.23 A meta-analysis involving 30 trials with 9509 patients showed that the use of combination inhaler (formoterol/beclomethasone 400mcg) resulted in greater improvement in FEV1, in the use of rescue SABA and in the symptom-free days compared to a higher dose of ICS (800-1000mcg/day).24 Another double-blind randomised trial investigating the effect of combination budesonide and formoterol as reliever therapy for 3394 patients who were assigned budesonide plus formoterol for maintenance therapy showed that the time to first severe exacerbation was significantly longer in as needed budesonide/formoterol group compared to as needed terbutaline group (p=0.0051). The other finding of the study is the significant lower rate of severe exacerbation for as needed budesonide/formoterol versus as needed terbutaline group (0.19 vs 0.37, p 3.2 Community-acquired pneumonia 3.2.1 Evidence use of combination therapy of second and/or third generation cephalosporins and macrolide in the management of pneumonia A multicenter, randomised trial investigated the efficacy of IV ceftriaxone 2g for 1 day followed by oral cefuroxime 500mg bd in the adult pneumonia treatment. The sequential therapy in combination with a macrolide achieved 90% of clinical success, 85% of overall bacteriologic clearance with 100% eradication of S.pneumoniae after 5-7days of treatment.27 An open label, prospective study involving 603 patients demonstrated that adding azithromycin (500mg od for 3days) to IV ceftriaxone 1g/day in the treatment of community-acquired pneumonia resulted in shorter hospital stay (7.3days vs 9.4days) and a significant lower mortality rate (3.7% vs 7.3%) than adding clarithromycin.28 Lack of randomisation and no blinding of evaluators may become the major limitations of this study; however the effectiveness of macrolide in addition to cephalosporins empirical therapy in treating pneumonia is unquestionable. 3.3 Chronic heart failure 3.3.1 Evidence use of loop diuretic in the management of chronic heart failure (CHF) A meta-analysis of 18 randomised controlled trials concluded that diuretics significantly lowered the mortality rate (odds ratio (OR) 0.25, P=0.03) and reduced hospital admissions for worsening heart failure (OR 0.31, P=0.001) in patients with CHF compared to placebo.29 Compared to active control, diuretics significantly improved exercise capacity in CHF patients. (OR 0.37, P=0.007).29 A recent review reappraisaled the role of loop diuretics as first line treatment for CHF concluded that existing evidence of association of loop diuretics with rapid symptomatic relief and decreased mortality supporting the essential role of diuretics in the management of CHF.30 3.3.2 Evidence use of angiotensin II receptor antagonists in the management of CHF The Losartan Heart Failure Survival Study ELITE II, a double-blind, randomised controlled trial involved 3152 patients with NYHA class II-IV heart failure and ejection fraction ≠¤40% reported that there were no significant differences between losartan and enalapril groups in all cause mortality (11.7 vs 10.4% mean mortality rate). However, losartan

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Relative Strength and weaknesses of modeling, simulation and prototyping. Strengths: †¢ It helps to get an overall structure for a complex system. Creating a model involves the system designer and the clients. Therefore it is suitable to have an idea of what the end product will turn out to be. †¢ Modeling and simulation allows the designers to compute values for different inputs which is difficult to achieve in the real world. †¢ It is cost effective. If the model and simulations are reliable it cuts down on the money required for testing. Weaknesses: †¢ In making a model the requirements of the client or the main problem to be addressed may be misplaced. †¢ The models and simulations may not be accurate in all conditions in reality. †¢ The models can be too simplistic to solve problems involving complex problems †¢ Designers may over rely on models on simulations than actual testing. Problematic assumptions in modelling, simulation and prototyping: One the examples I would like to point out is the flight which crashed on August 16th 1987, the plane was a Mc Donnell Douglous MD-80 operated by the Northwest Airlines. The reason for the crash according to the NTSB was that the aircraft was not set up for take-off properly by the crew due to failure in adhering to the pre-flight checklist. [1] Another factor which contributed to the mishap was the failure of the flight takeoff warning system which did not indicate to the flight crew that the flight was improperly set up for takeoff. This failure of the takeoff system was due to the loss in power to the warning system due to circuit failure. Why is this a simulation error? It is because in the flight simulator this warning system flashed a light when the system was down but in the actual ... ...ight budget and timeframe, this led to engineers relying more on models and simulations than actual testing. Models like the Radar-terrain interaction and Dynamical control effects of pulse-mode propulsion were not properly validated due budget constraints. This reliance on software models and simulations may have caused the MPL to be destroyed. These tools can be used but their limitations should also be known. In order to minimize these failures a decisive decision should be taken early in the development stages by experts and experienced system architects and engineers this will minimize the errors made in the finishing stages. Risk assessment should be carried out whenever analysis are based on models and simulations without being validated by actual testing. This will help reduce the over reliance on models and simulations by the engineers. [4] References: 1.

Racism Essay

Today Racism is so common that it has finally been recognized as an issue, however it hasn’t always been like this. In the past there has been count less acts of racism. Racism can be defined as racial discrimination over skin color, ethnic background and race, or a belief that some races are by nature superior. History is like a giant mirror, it made up of thousands of pieces that creates the whole. It reflects what we do, When the European settlers came to North America, they came with a promise of peace, yet time soon revealed differently. They took the children of the inhabitants (like the Indians and natives) and separated them from their family and people. They were beaten and punished like dogs when they showed signs of their culture (language) and were harassed (raped). They were looked down for their ethnic backgrounds, skin color, language and traditions. We can write a Custom Research Paper on Racism for you! Its hard to believe that things could get any worse as time went by, but it did. In the 1900’ African Americans were looked as servants maids factory workers and other low class jobs. This continued for awhile and became o big that it was finally recognized. This was when the African Americans were separated from the whites, in school, work places and society. They did not have the same rights as the whites did. In Canada natives weren’t given any rights to vote until not long ago. However this act was not the worse image reflected upon by history. The holocaust was an event that began with a single persons hatred for the Jews that erupted into a conflict, which involved the world. This person of course was Adolf Hitler, and the conflict, which involved the world, was World War II. Hitler was a man who took the word racism to the ultimate level both metaphorically and literally. He believed that the Arians were superior to not only the Jews but also the rest of the world. He even consider those with the same skin colour and similar cultured background to be less superior, so this means that he is racist to even those that are similar to him. This wasn’t the worse part however; Hitler soon turned his attention to the literal meaning of racism and dealt with it in a dreadful way. He killed the Jews, thousands upon thousands in concentration camps, or even in their homes. They didn’t kill for money or land, but for reasons based on racism. This was the Holocaust and throughout history this act of racism killed the most and is looked at even today, with terror. To me Racism is something I was not exposed to much because it has gotten a little better today, but it is still out there all around us, this urge which makes us feel higher when compared to others just because of the simple differences. Racism is something that can never end, its like a cycle when one act is finished (African Americans is looked at as equals with the whites) another will start, but we have to try. Racism is not needed, therefore it must stop.

Dangers of Online Predators

The Dangers of Online Predators and What Can be done to Protect Our Youth Marcos Williams CM 107: College Composition 1 Unit 9: Final Abstract This paper is to educate parents and children about the dangers of online predators. Predators are going to great links to prey on children and they are going to great links to hide their identity. Predators are hiding in cyberspace and they are lying in wait for children to go online so they can make their move on unsuspecting children. Law enforcement agencies and parents have to do whatever it takes to protect children and they should make sure that the necessary steps are taken.Law enforcement agencies are using the media and they are hiding online to help capture these offenders. Parents should make sure that their home computers have the proper software, know who kids are friends with online, gain access to all emails kids use, make sure computers are visible at all times, and never turn a blind eye and think that this will never happen to their children. Kid’s safety is always a priority and they should be guarded at all times. I have chosen a degree in Criminal Justice with an emphasis in Cyber-crimes to protect kids against online predators.Educating parents and children about the dangers of online predators and discussing how law enforcement agencies and parents can protect our children is the first step. This paper will discuss what kids don’t know about online predators, how these online predators are hiding their identities from law enforcement, how law enforcement is cracking down on online predators, and most importantly, how parents can protect their kids against online predators. Kids do not realize that predators look for kids with a lack of self-esteem, kids that are vulnerable, and kids that are having problems at home.These offenders meet children in public chat rooms geared towards teens and teens engaging in sexual subjects (Wolak, 2004). They will soon lure kids into private chat roo ms or instant messaging. Some offenders lie about age and or sex to gain trust of children. Once trust is built, the predator introduces the child to pornography. This lowers the child’s inhibitions and desensitizes the child to nudity, and validates adult-child sexual relations (Berson, 2003). After all these things occurs, a face to face meet between the child and predator often follows, and the child is usually sexually abused or worse (killed).Some offenders create child-like avatars, go online and pose as teenagers. Predators use free Wi-Fi at public access points or connect to unsecure wireless routers installed in private residents rather than using their own personal accounts. They hide IP addresses by using proxy servers. Predators use â€Å"throw- away,† free e-mail accounts such as hush mails (private emails that children set up and hide from their parents) and counter surveillance methods. Offenders use pre-paid credit cards to hide any online transactions. They also steal IP addresses of business to avoid detection.These measures that offenders are taking, is making it hard for law enforcement to track them down (NSCEPI, 2010). Law enforcement officers are posing as minors online and assuming different gender to catch online predators (Mitchell, 2005). There is also the media, like the television show â€Å"To Catch a Predator,† to catch and arrest some of these predators. Cyber Tip-lines have been formed so that if parents see anything that is inappropriate they can report it to law enforcement. The FBI, Homeland Security, and other agencies have put together different types of operations to protect kids from online predators (NSCEPI, 2010).Law enforcement officers are collecting and preserving all evidence of grooming, such as pornography, Web cameras, and other electronic equipment to bring down these predators (Brown, 2001). Law enforcement agencies across the nation are taking the necessary steps so that evidence can be g iven to the prosecutor and use at trial to show the perpetrator’s motivation (Brown, 2001). Parents should talk to their kids about the dangers of online predators. They should become computer literate and learn the lingo that children use online, PLS (parents looking over my shoulder), FTF (lets meet face to face), and other abbreviations.Parents should put parental software on computer to monitor sites and keep kids off unsafe sites (Dombrowski, 2007). Home computers should be kept in a family room or kitchen so that parents can monitor and see exactly what sites the children are on. Parents should also discourage their kids from going into chat rooms, especially, private chat rooms with strangers. They should always make sure they know who all of their children’s friends are on the internet (Dombrowski, 2007). When a parent notices inappropriate material on their computer they should notify law enforcement immediately.Parents should use all these measures plus becom e familiar with the internet and the language their kids use on the computer to protect them from online predators. I have chosen to get my Bachelor’s degree in Criminal Justice with an emphasis in Cyber-crimes to protect kids from online predators. In the Cyber-crime field I will be able to protect kids from online predators and educate parents and kids of the online dangers that lurk in cyberspace. Online predators are trying to manipulate and prey on children that are going through something in their home life.Predators are getting smarter and wiser when it comes to lurking and preying on children through the internet. They are taking many precautionary measures to protect their identity from our kids and law enforcement. The FBI, Homeland Security, and other agencies have put together task forces to stop online predators. Law enforcement have partnered with the television show â€Å"To Catch a Predator† to stop online predators. Most of the predators that are arres ted on this show are men between the ages of 20 to 55 years of age. Law enforcement and prosecutors are doing everything they can to put these criminals behind bars.Parents should take the necessary steps to protect their children from these types of predators. Parents need not turn a blind eye and think that their child will not become prey to predators while online. They need to get computer literate and learn the lingo that their children are using while they are on the internet. Parents need to educate their kids about online dangers and keep their computers in areas where traffic is heavy flowing. They also need to get the proper software on their computers to cut down the risk of predators getting to their children.In summary, parents and law enforcement officials need to work together to educate themselves and kids about the dangers of online predators because online predators are doing whatever it takes to manipulate and prey on children. They are also doing whatever it take s to protect them from being identified and prosecuted. References Berson, I. (2003). Grooming Cyber victims: â€Å"The Psychological Effects of Online Exploitation for Youth† Journal of School Violence 2, no. 1(2003): 9-18 retrieved from: http://www. cs. auckland. ac. nzl~john/NetSafe/IBerson. df Brown, Duncan. â€Å"Developing Strategies for Collecting and Presenting Grooming Evidence in a High Tech World† Update (National Center for Prosecution of Child Abuse), 2001, 1. http://www. ndaa. org/publications/newsletters/update_volume_14_number11_2001html Dombrowski, S. C. , Gischlar, K. L. , and Durst, T. â€Å"Safeguarding Young People from Cyber Pornography and Cyber Sexual Predation: A Major Dilemma of the Internet† Child Abuse Review 16, no. 3 (2007): 153-70 https://www. ncjrs. gov/App/Publications/abstract. aspx? ID=240947 Mitchell, K. J. , Wolak, J. , and Finkelhor, D. Police Posing as Juveniles Online to Catch Sex Offenders: Is It Working? † Sexual A buse: A Journal Research and Treatment 17, no. 3 (July 2005): 241-67 retrieved from: http://www. unh. edu/ccrc/pdf/CV82. pdf. National Strategy for Child Exploitation Prevention and Interdiction: A Report to Congress August 2010 http://www. justice. gov/psc/docs/natstrategyreport. pdf Wolak, J. , Finkelhor, D. , and Mitchell, K. J. â€Å"Internet-Initiate Sex Crimes against Minors: Implications for Prevention Based on Findings from a National Study. † Journal of Adolescent Health 35, no. 5 (2004):11-20

Disscuss the advantages adn disadvantages of different methods of solid waste disposal Essays

Disscuss the advantages adn disadvantages of different methods of solid waste disposal Essays Disscuss the advantages adn disadvantages of different methods of solid waste disposal Essay Disscuss the advantages adn disadvantages of different methods of solid waste disposal Essay Waste is something that has no value and as a result requires disposal. Sources can include mining, industry and domestic waste and if left untreated or poorly treated can cause pollution, being both hazardous and toxic.Under the 1990 environmental protection act, the underlying principle is that the polluter pays. Industries causing pollution must get a licence for disposal and must have a duty of care. If they cause excessive pollution then the industry in question must pay the costs to remove the pollutants and clean the area back to its former state. They will also have to pay a landfill tax however grants and subsides to develop anti-pollution equipment are in place.There are 4 main methods of solid waste disposal and these include landfill and land raising, incineration and pyrolysis, chemical treatment and encapsulation/vitrification.Land raising is where pre-dug holes in the ground are filled with rubbish. Landfill on the other hand has the bottom of the pit lined with layers of compacted clay or high density plastic, which is a major advantage in reducing leachates. The waste is then compacted by soil to prevent vermin, stop odours and is capped by clay to seal the landfill. The waste is also compacted to stop air pockets and methane build up, and to decrease subsidence. A further advantage is that rainfall is diverted in pipes around the perimeter of the pit so that rainfall does not cause leachates. Also methane is collected as this causes air pollution and the possibility of explosions but can be used as a fuel for heat and power. However large amounts of carbon dioxide and toxic gases are produced and released into the atmosphere. This could be limited by reducing the amount of organic matter in landfill (composting) but at the present time this is not the case.The main limitations of landfill are the outbreaks of fires due to gases building up, subsidence and the smell. Furthermore, the amount of lorries to and from the site causing large volumes of noise, congestion and the burning of fossil fuels and taking up space that could be used for agriculture. Conversely there are possible uses of a landfill after use such as recreational uses like golf courses and areas of wildlife refuge as these will not be heavily used and will not cause subsidence.Ultimately, landfill does provide a cheap way to dispose of large amounts of waste however sites are visually obtrusive and can cause pollution issues if not maintained and managed correctly.Incineration is a waste treatment technology that involves the combustion of organic materials and/or substances. Incineration and other high temperature waste treatment systems are described as thermal treatment. Incineration of waste materials converts the waste into incinerator bottom ash, flue gases, particulates, and heat, which can in turn be used to generate electric power. The flue gases are cleaned for pollutants before they are dispersed in the atmosphere.Advantages of this form of soli d waste disposal include the generation of electricity and heat that can substitute power plants powered by other fuels. Also, the ash produced can be used in the building industry as breeze blocks.In densly populated areas, finding space for additional landfills is becoming increasingly difficult, which therefore avoids the release of methane. By incinerating municipal solid waste, a tonne of carbon dioxide is prevented from being released compared to other solid waste treatments such as landfill.On the other hand, incineration does pose significant disadvantages. The highly toxic fly ash, for example, must be safely disposed of which usually involves additional waste miles and the need for specialist toxic waste landfill elsewhere. Also incinerators emit varying levels of heavy metals such as mercury which can be toxic at very minute levels.Furthermore, the start up cost of incinerators is high, and requires long contract periods to recover initial investment costs, causing a long -term lock-in. Also, some of the flue gases are not fully filtered casuing dioxines and carbon dioxide to be released into the atmosphere.All types of waste treatment will have their strengths and weaknesses, however often local communities are opposed to the idea of locating waste disposal systems in their vicinity not in my back yard. But to be sustainable and to reduce pollution, ultimately we should aim to reduce waste, be it by improving waste loops, recycling schemes or awareness to the problems of waste. The waste hierarchy; prevention, waste minimisation, reuse and recycling should always come before treatment of waste in any of its guises.

Hershy chocolate bar Research Paper Example | Topics and Well Written Essays - 2250 words

Hershy chocolate bar - Research Paper Example ire of humans to find something sweet to consume dates back to primitive times.Chocolate traces its history to the ancient Romans, Egyptians, Greeks and the Chinese. However, during that period, it was considered a luxurious treat that only few could afford. It evolved from ancient forms to the modern industry centered in Europe. It evolved because of the increased availability of sugar. The increased availability transformed it from an ancient delight into a main modern confectionery industry. The modern industry produces a relatively cheaper food that many people enjoy. This paper will, therefore, analyze the strengths and weaknesses, marketing strategies, consumer behaviors, as well as, the branding strategies that may be associated with Hershey Foods Corporation. The first confectioners in United States were the Dutch bakers of New Amsterdam which were later named New York. There were about 1000 manufacturers in the US at the beginning of the twentieth century. They offered employment to about 27000 workers through which they managed to register total sales of about $60million annually. Until the 1900s, the common equipments that would be used in these enterprises were mainly of kettles, shallow trays, hand cutters, starch boards and hand printers. Compared to the current equipment most of these equipment could be termed inefficient. Efficiency increased with the introduction of European candy manufacturing inventions. They enabled production of candy in large quantities at a more pocket friendly price (Schiffman et al, 2006). This greatly improved sanitary conditions in the manufacturing industries, especially, to the candy manufactures. Besides, the increase in production played a significant role in meet the growing demand for chocolate. The First and the Second World War also contributed to the mass production of candy considering candy was consumed by the armies in the war fields. In addition, the many improvements in the candy industry making led to it

Theories Coursework Example | Topics and Well Written Essays - 1000 words

Theories - Coursework Example Some other areas of production include the production of compact discs, television sets and fridges. As until 2002, Royal Philps Electronic was not one organization that could be said to have been on an upsurge rise in terms of growth or downward decline in terms of growth (Gardener, 2001. This because the growth pattern of the company kept fluctuating by the years. Due to the need to arrest the growth rate of the company and ensure that there was stability in terms of growth, a number of organizational changes were recommended in the company. Most of these organizational changes were given birth to by the coming of Gerard Kleisterlee, who took over as the company’s president in the year 2001. The summary of the organizational change could be given as that, Gerard Kleisterlee saw the need for there to be integration in the operations and functioning of the organization (Koduah, 2001). This is because prior to his coming, â€Å"he found a company that was rigidly divided into six business divisions, with little or no communication among them† (Wyle, 2012). The result of this was that the organization could not have a common focus and so its programs and policies could not be closely monitored and evaluated under the same model. Much of the organizational change that took place at Royal Philips Electronics could be attributed to the personal background and personality of Gerard Kleisterlee, who took over as the president of the company and thus the global leader, responsible for controlling the fortunes and visions orientation of the company (Moynihan and Henry, 2006). This is because the leader was born in the very country of origin of the company and so had very insightful idea about the formal and informal operations of the company. Moreover, the leader received university education in electronics, which gave him an excellent understanding of the core duties and operations of Royal Philips, which was of course, an electronic company.