Expressionism & art Essay

Expressionism is a complex and often contradictory movement. It encompasses the excavation of the psyche while liberating the body. Expressionism generally refers to anything that was not impressionism; it could even include anti-impressionistic work. Up to the outbreak of World War I, the term â€Å"expressionism† was used to describe any art work that was fauviste, futurist, modern, or cubist. Expressionism has qualities that are a more sensitive perception of the world. It attempts to portray the mind of the artist, shaping the figures which an artist paints or writes about. (â€Å"Expressionism (literature)†) Subjective human experience plays a large role in expressionist art. Because of this, expressionism has potential for despair and anguish, which is quite unlike any artistic movement that came before it. (Bassie, 7-10) Expressionism was not a strict movement; unlike surrealism or naturalism in literature or impressionism in painting, expressionism was the offering of ideas, not techniques. (â€Å"Expressionism in Literature†) For example, after World War I, people were anxious and aware that they were vulnerable. Expressionists worked through these emotions, through the fears of atomic war, creating art that was based on their own experiences and feelings. They refused to set limits on the emotional content of their work. (Sandler, 29-30) Franz Kafka’s The Metamorphosis and Max Beckmann’s Departure are both expressionistic, however, Kafka’s story is the more powerful example of the qualities of expressionism. In Franz Kafka’s The Metamorphosis, there is a passage where Gregor describes the horrors of his daily, a job he never wanted. Gregor mentions that he travels for a living, that that it is â€Å"much more than working in the home office. † He goes on to describe what he experiences and wishes that â€Å"the devil take it all! † (Kafka, 688) This passage from Kafka’s The Metamorphosis exhibits expressionism because it expresses Gregor’s human feelings, even though he has been transformed into an insect. It shows how he really feels, including anxiety and despair. For example, he speaks of his job, even the smallest detail. He detests his job, only working at it because his father owed Gregor’s boss money. He details the commute, the sub par room-and-board, and the fact that he does not have any intimate friends, only acquaintances. However, later in the story, Gregor does begin to lose all of these feelings in favor of his feelings of being an insect. He begins to enjoy rotten cheese and climbing the walls of his bedroom. When his family forgets, or rather begins to not care, about him, transforming his bedroom into a storage area that he has to live with, Gregor realizes his feelings as an insect. According to Gustav Janouch, Kafka himself described The Metamorphosis as his own idea of horror. (1477) This transformation, like that of his physical being, is the embodiment of expressionism. This passage, as well as the entire story, is a telling of change, from one state of being to another, from one process of thinking to another. It shows the human experience not because it deals with changing into an insect, but because each individual questions the nature of their existence; their job, their family life, and their inner purpose. Max Beckmann’s Departure exhibits expressionism because it shows human suffering and peace. In the first panel, people are tied up, perhaps being tortured, but clearly in agony. In the second panel, there are three individuals on a boat, seemingly at ease, catching fish. In the third panel, two individuals are tied together, bodies flush against each other, one upside down, the other right side up. It also looks as though a bird is pecking at one of the individuals. Some believe that Beckmann’s work is obscure, dense, and beyond understanding (Finch), however, that is not true of any work of art. Two out of the three panels show human suffering, which holds the majority in the world. Human suffering is experienced by more individuals at more points during their lives than any other feeling. That is the nature of life, the nature of the world. However, peace is also experienced, although not as frequently. For the individuals in the second panel, they seem content with where they are. Everyone experiences contentment in their lives, but for some it occurs so infrequently that those peaceful moments are overshadowed by suffering. This painting could also express Beckmann’s move from Frankfurt to Berlin when the Nazis came to power in the 1930s. (â€Å"Departure†) For example, the individuals in the second panel could be traveling. The first and third panels could represent where they came from and where they were going. Beckmann did not want to leave Frankfurt, but he was forced to leave, and Berlin held nothing for him. In both the first and third panels, individuals are shown as suffering. Perhaps this is what Beckmann was feeling due to his forced move. Expressionism manifests itself in different ways between literary and visual art works. In literary works, feelings are told as well as shown. One can show despair through description of detail and character development. The reader knows somewhat of a character’s past, and perhaps how they got to where they are in a story. One does not experience this is visual art. One can only look at a painting and contemplate and interpret what happened before and what would happen after, but there is no definite answer. The feeling interpreted from a painting are perhaps those that the viewer has imposed on it, not the feelings that the artist wanted to convey. Everyone has their own vision and opinion; with writing, feelings and experiences are laid out clearly, with paintings, feelings and experiences are more the viewer’s than the artist’s. Because of these reasons, the literary arts can be more expressionistic than the visual arts. For example, Kafka’s The Metamorphosis is more expressionistic than Beckmann’s Departure because Kafka’s story is straightforward about the characters’ feelings, while Beckmann’s painting is left too much up to viewer interpretation. Feelings expressed through art, if any, should be those of the artist who created it, not of the patron. – Bassie, Ashley. Expressionism. New York: Artists Rights Society, 2005. – Bloom, Harold. Franz Kafka. Broomall, PA: Chelsea House Publishers, 2003. – â€Å"Departure. † Online Design Museum. 21 May 2009. http://www. cs. wayne. edu/~zhw/csc691/tour1pic1detail. html – â€Å"Expressionism. † Abstract Art. 21 May 2009. http://abstractart. 20m. com/expressionism. html – â€Å"Expressionism in Literature. † Dictionary of the History of Ideas. 1 May 2003. 21 May 2009. http://etext. virginia. edu/cgi-local/DHI/dhi. cgi? id=dv2-24 – â€Å"Expressionism (literature). † Tiscali. 2009. 21 May 2009. http://www. tiscali. co. uk/reference/encyclopaedia/hutchinson/m0097410. html – Finch, Charlie. â€Å"Deciphering Beckmann. † Artnet. 2004. 21 May 2009. http://www. artnet. com/magazine/features/finch/finch7-17-03. asp – Janouch, Gustav. â€Å"Kafka’s View of ‘The Metamorphosis’. † The Story and Its Writer. 7th ed. Ed. Ann Charters. New York: Bedford/St. Martin’s, 2007. – Kafka, Franz. â€Å"The Metamorphosis. † The Story and Its Writer. 7th ed. Ed. Ann Charters. New York: Bedford/St. Martin’s, 2007. – Sandler, Irving. The Triumph of American Painting: A History of Abstract Expressionism. New York: Praeger Publishers, Inc. , 1970.

Christianity in the Land of Santhals

There is considerable difference of opinion among Christians over the story of Creation. From the Catholic perspective God is ever present in some aspect. There are significant themes in the Bible, Moral Therapeutic Deism and â€Å"NOAH† that explicitly express distinct views of creation. The central idea in all three expressions is that God is in existence and created the world. However, the creation stories differ significantly regarding the purpose and reason of the world, more specifically human beings. The story of creation differs greatly throughout the Bible. The amount of altering views in the book of Genesis alone is astounding. Genesis is the study of beginning; the record of all creation along with sin. It is â€Å"mythic† in the way that it tries to make sense of the world. Genesis contains two creation stories. In chapter one and the beginning of chapter two, the first story expresses the stages of creation in six days, with each day expanding from the day before, until creation achieves its peak when God makes human beings in His image. In Genesis I, the world begins â€Å"in the beginning† of everything. From a void, God creates everything out of nothing. â€Å"1 In the beginning God created the heavens and the earth. 2 Now the earth was formless and empty, darkness was over the surface of the deep, and the Spirit of God was hovering over the waters.† (Genesis 1:1-2) God created light and darkness on day one, the next day He created the atmosphere and divided it from the oceans, on day three God created land, water and vegetation, the next day He created the sun, moon and stars, on day five God created creatures to fill the sky and water, on day six He created creatures to fill the land, and on the last day of creation God rested from all His work. The second story of creation centers around the creation of a human being. God took dirt and breathed life to create the world and humanity. In this Genesis story, creation was more experimental. This can be seen through His creation of Adam and eventually Eve. God seems to be enthusiastic about the world. Similar to Genesis I, God created humanity out of His love and kindness. â€Å"And God saw that it was good.† (Genesis 1:4) He plants a garden and creates animals to entertain Adam and Eve demonstrating how deeply He cares for them and all future humanity. Furthermore, when God created man and woman in His own image, the Bible says, â€Å"And God saw everything that He made, and behold, it was very good.† (Genesis 1:31) God was fulfilled with His creation and looking at it gave Him a kind of bliss. The Genesis creation accounts set up a specific problem by stressing the goodness of everything that God has made and continuously deny that the world is broken from the start by a battle involving the forces of good and evil. Although Genesis does not precisely state how evil enters the supposed to be good world, it describes how Adam and Eve introduce the idea of disobedience to God into creation. God in turn created unnatural curses on the future of humanity. These curses, including men to toil in the field, women to be ruled by their husband and experience excruciating pain during child birth, and the inevitable death of all creation, were meant to punish Adam and Eve for their sinful actions. As time advanced and sin expanded, humans eventually deviated so far from good that they started trusting in and worshipping other so-called divine beings. The record of the beginning of humans gradually developed to correspond with the life of transgression, violence and these new convictions. This can be seen explicitly in the movie â€Å"NOAH†. In this movie, the opening scenes make it apparent that God created humans to be good. Because mankind was becoming too sinful, God called upon Noah to build an ark that can sustain the flood that He would create to wipe out the human race. â€Å"NOAH† is a cinematic train wreck that expresses the de-creation story put in action by God. Certain scenes in this movie express how the human race has become nothing but violent. The main character, Noah, even states that he, along with his family, has the darkness inside him. This can be seen through the savagery toward animals and the treatment of women and children throughout the movie. In Genesis, God set a moral standard by which the human beings must live. Although, in the Bible, we know that both humans and animals have become violent, â€Å"I have decided to put an end to all flesh, for the earth is filled with violence because of them.† (Genesis 6:13), ‘Morality' in other animals is simply their instincts. This can add to the claim in the movie that animals are entirely innocent and require protection from the immoral actions of humanity. Genesis places human life in accordance with the life of animals. The first story places the creation of mankind on the same day, day six, as the creation of animals. In â€Å"NOAH† there is an essential division between humans and animals. Instead of saving the human race, God orders Noah to bring two of each species on earth onto the arc to save the animal species. He does this because there is the idea that animals acquire an innocence that human beings clearly do not. This stresses that God saw animal kind as innocent and, in a way, above humans. In the first Genesis story, God created human beings to fill the Earth and order it. â€Å"God blessed them and said to them, ‘Be fruitful and increase in number; fill the earth and subdue it. Rule over the fish in the sea and the birds in the sky and over every living creature that moves on the ground.'† (Genesis 1:28) This verse describes God's purpose for the human race as being fruitful while subduing the Earth. Moral Therapeutic Deism proposes an elevated view of self. It is a very individualistic deism that has the idea that God wants humans to have â€Å"good† morals. The five beliefs of Moral Therapeutic Deism are that God exists and created the world, God wants people to be good, nice and fair to each other, the central goal of life is to be happy and feel good about oneself, God does not need to be particularly involved in one's life except when He is needed to resolve a problem, and good people go to heaven when they die. The first belief is a direct contradiction to the Incarnation in Scripture. It holds the conviction that God made the world then pulled back from it turning away from human beings. The second belief also contradicts Scripture. Christ did not come to Earth to make unmoral men â€Å"good†. He did not come to us to reform us but to reclaim creation from the scourge of sin. Having a behaved people was not His objective. The third belief is a very self-interested idea because happiness means something different to every person. This claim that the end goal of a person's life should be to find happiness completely redefines the idea that God wants people to be nice, fair and kind considering that people can define these traits differently. In Scripture, God yearns for more than merely good behavior and occasional happiness. â€Å"Therefore, anyone who sets aside one of the least of these commands and teaches others accordingly will be called least in the Kingdom of Heaven, but whoever practices and teaches these commands will be called great in the Kingdom of Heaven.† (Matthew 5:19) The fourth belief also contradicts the Incarnation. God is involved in every aspect of our lives. The Kingdom of Heaven, along with God, is current and present. He is exceptionally active in the life and well-being of His creation. â€Å"Behold, I am with you and will keep you wherever you go and will bring you back to this land; for I will not leave you until I have done what I have promised you.† (Genesis 28:15) This idea that God created the world and humanity just to leave it alone can also be seen in the movie â€Å"NOAH†. Repeatedly throughout the movie, Tubal-Cain curses God and is angered by the lack of communication between God and humanity. Except for Noah, who regularly claims to see and hear signs from God, human beings felt that they were, in a way, left in the dark. This caused them to act out and eventually believe that they could do anything they wanted including savagery. The fifth belief is also considered false by Scripture. Heaven is about being present and in constant communication with God. People do not go to Heaven, Heaven comes down to us. â€Å"No one has ascended to heaven but He who came down from heaven.† (John 3:13)

Absorption Costing vs. Variable (Direct) Costing

Absorption Costing vs. Variable (Direct) Costing Absorption cost systems are widely used to prepare financial accounts. These systems are designed to absorb all production costs (variable or fixed) into costs of units produced. Absorption costs techniques allow manufacturing costs to be traced and allocated into product costs. There are different types of absorption costing systems: job order costing, process costing, and ABC costing. In job order costing, costs are assigned to products in batches or lots, and the costs of each specific batch are traced separately using job order cost’ sheets. In process costing, products are produced in a continuous process and costs are systematically assigned to the product. In ABC costing, costs are assigned from cost centers to products. Because a unit’s cost in the absorption cost systems are made of variable and fixed costs, they can be very misleading. Absorption cost systems can incentive overproduction when the overhead rate is calculated based on units produced, and units produced is higher than units sold. In order to calculate this overhead cost, one should divide the total fixed cost by units produced and multiply the result by units sold. This overhead rate will be lower when more units are produced and when variable and fixed costs remain constant. In this process, fixed costs are being spread over more units, thus lowering unit’s cost. This technique allows profit to increase when production increases, and quantity of units produced is higher than quantity of units sold. In this case some of the fixed costs are divided by units and part of the total production (including its costs) is inventoried. The costs inventoried are not transferred to the income statement, thus increasing profits for that period, and misleading managers to overproduce. In some cases, managers do not understand how this costing process works. In the majority of the cases, they are only worried about increasing production and lowering units’ cost. Other managers that have their compensation linked to the period’s profit also feel motivated to overproduce, once profit increases as quantity produced increases. There are many ways to decrease the incentive of overproduction. The first one charges inventory holding costs against profits. In this process, inventory values are increased by the costs of capital plus warehousing costs. Managers that are evaluated based on residual income, tend to dislike this system; first, because it increases data processing complexity, and second, because it decreases residual income when there is an overproduction and an increase in inventory. This system does not eliminate completely the incentive to overproduce, but it makes overproduction less profitable to managers. The second technique that aims to reduce the incentive of overproduction is based on a strict policy against building inventories. This can be done through contracts stating that bonuses tied to net income will not be paid if inventories exceed a certain amount. A third method would be to base managers’ compensation on stock prices instead of accounting earnings. This method will inhibit managers’ actions that could damage the company’s profit maximization plan. However, in cases where the company has more than one plant, overproduction has a small effect on the value of the firm. This factor decreases the efficiency of stock-based compensation to eliminate or reduce overproduction incentive. The forth method consists of the implementation of just-in-time production systems. Because this process does not begin until a part or a total order is made by customers, it reduces inventory levels. In this system, the decision rights are made by demand-driven market orders. Here the production levels are determined by demand, not by managers. Just-in-time systems reduce inventories, thus reducing the incentive to overproduce. Companies can control managers’ incentive to overproduce by adopting variable costing systems. These systems write off all fixed manufacturing costs as a period cost, which will not allow profit increases with overproduction. In variable costing, product costs are made up only of variable costs. Fixed manufacturing costs are considered period costs and are written off. Variable costing and absorption costing differ from each other in the way that they treat fixed costs. Under variable costing, fixed manufacturing costs are written off as a period expense. As for absorption costing, fixed manufacturing costs are included as part of product costs. The advantages of variable costing are that the product’s cost does not change depending on volume change, and it reduces the incentive for overproduction. It is important to notice that when production and sales are equal, absorption costing and variable costing will have the same profit amount. Variable costing systems’ benefits might not exceed its total costs, a fact that contributes to the systems unpopularity.

Marketing Myopia Essay Example | Topics and Well Written Essays - 750 words

Marketing Myopia - Essay Example Marketing Myopia, written by Theodore Levitt, was published in the Harvard Business Review. It won the McKinsey award in 1960. This is a business article that asks the question, â€Å"What business are you really in?† It talks about the strategy of doing business and marketing. Levitt argues that for a business to do better, focus should not be on selling products to customers. Rather focus should be on the customer needs and meeting those needs. According to the writer, most businesses that do not grow, or whose growth keeps declining have a management problem. This management is of the top executives of a company since they are the policy makers and implementers. For a long time, companies have been focusing on the kind of products they think suits the customers. This has led to failures of this company or stagnating growth, to say the least. Theodore Levitt is remarkably insightful in arguments about the failure of management. It is argued that the failure is with the top e xecutives whose work is to make policies. An example is given of the transportation industry, where railroad has been replaced by other means of transport that meet the needs of the customers. The railroad failed to meet the needs of the customer. This is because they had a wrong definition for their business, which is product oriented. They instead should have defined it as customer oriented. The second example is Hollywood, whose focus was in production of movies and not providing entertainment. They have since been overtaken by TV, which meets the needs of the customer by providing entertainment. Levitt’s other examples are of companies whose orientation is customer based. They are nylon and glass-based companies respectively. They have both customer and product advantages that emanate from their excellent technical competence. They apply this technical competence to make sure the products produced are of quality. The focus is on the customers’ needs but not on the product. They apply excellent technical competence to fulfill those needs. In his examples, Theodore Levitt compares different companies that are in different sectors of an economy. The writer is critical in arguing that there is an error of analysis in judging companies according to their products. Success of a company is not on the product, which is a narrow way of classification. Companies die because of a lack of imaginativeness in the management and a lack of will to fulfill the needs of the customer. A railroad industry lacks the imaginativeness to fulfill the needs of the customer, which in this case is transportation. This point is made clearly and shows that companies that have narrowed down their product line are doomed to fail for having a wrong business definition. This gives a serious point for management to think, evaluate their business strategy, applicability, survival, and plan appropriately. The writer argues intuitively that the success of a company is sometimes a ttributed to lack of competition. These companies have since gone under a shadow. Why is that? The dry cleaning companies have been replaced with other customer-friendly companies that discovered how to reduce the amount of dry cleaning required for clothes. The use of chemical additives and synthetic fibers is about to make dry cleaning obsolete. Another company that the writer examined is in the electric utilities. They have no competition, yet, they are not growing. This is because other companies are replacing electricity lines with a small cell electricity transmitter. Grocery stores, on the other hand, have been replaced with large chains of supermarkets. It is argued that the growth industry is non-existent. Arguably, there exist companies that create and capitalize on growth opportunities. The self-deceiving cycle thrives on the ever-expanding population, lack of competition, mass production, and product focus. A company can focus on mass production of goods to meet an expan ding populatio

Professional Issuses in Advanced Nursing Practice Essay

Professional Issuses in Advanced Nursing Practice - Essay Example However, if schizophrenia is diagnosed at an early age, it can reduce adverse effects on the patient (Anderson & Mukherjee, 2007). This happens Schizophrenia is a serious medical illness that affects one out of every one hundred people worldwide. It involves both intellectual and bio-chemical changes in mind though it is treatable. Some of the symptoms of schizophrenia include hallucinations, impaired speech as well as delusion. Flat effect, apathy, and impaired thoughts are included in the model as opposed symptoms. Impaired thinking involves poor memory, inability to make decisions as well as false cognitive functions in the affected person. However, if schizophrenia is diagnosed at an early age, it can reduce adverse effects on the patient (Anderson & Mukherjee, 2007). This happens by showing less negative symptoms as well as, less impaired learning him by the patient. It may also reduce the impact of organized thoughts in the affected patient; hence the patient may take well. The re are various drugs that can be used to control schizophrenia, referred to as Antipsychotic drugs. They exist into two categories including Typical and Atypical Antipsychotic drugs. Typical Antipsychotic drugs include Chlorpromazine (Thorazine), Haloperidol (Haldol), Perphenazine (Trilafon), Fluphenazine (Permitil). The rest are types of Atypical Antipsychotic drugs include Risperidone (Risperdal) Olanzapine (Zyprexa) Quetiapine (Seroquel) Ziprasidone (Geodon) Aripiprazole (Abilify) Paliperidone (Invega) Clozapine (Clozaril). All these drugs could heal and reduce the effects of the serious illness that distorts the brain activities of human beings. However, these drugs have their adverse effects when taken by individuals’ like dizziness when changing positions blurred vision skin rashes constipation dry mouth tremors. Drowsiness or sedation is a common side effect with all drugs used to treat psychosis. Drowsiness often fades with time as patients modify or start immunity to the drug. There are several options to aid the patient from this side effect (British Columbia Schizophrenia Society, 2004). These include adjusting the dose, instructing the patient to take the drug before bed, or changing the medication. The medical condition the patient was diagnosed with was obstructive jaundice. The determiner of the illness uses a distinctive technique known as ERCP that studies bile ducts that indicated the presence of jaundice, the presence of hepatitis, also referred to as liver cancer. The procedure which begins with the patient’s consent, involves passing an endoscope into the mouth, oesophagus and stomach into the duodenum (Douglas, 2005). A thin plastic tube catheter is passed through the endoscope until the common opening to the ducts from the liver and pancreas can be seen. The fluoroscopy is used later to look for blockages and lesions such as stones, which may indicate the obstruction of the biliary tract for example the gallstones also the swelling of the bile duct. There may be traces of raised level of bilirubin, a waste product removed by bile. The reduction in flow of bile causes abdominal pain and fever to the patient, thus needs earlier treatment. It is ideal for the patient or even his/her family members to agree to the selection of undergoing surgery. This is a crucial decision that should not be made by the doctor and carry out the surgery on his own. There are several

Teachers Strategy in a Class Management Essay Example | Topics and Well Written Essays - 2250 words

Teachers Strategy in a Class Management - Essay Example Remaining in control in the classroom is essential for a teacher. If one is not calm and firm then the students will get the signal that the teacher is not able to handle the pressure and they will always try to get away of it or enjoy the teacher’s weakness. When a stern look is sufficient one should avoid yelling. Students won’t get afraid instead will make fun at one’s back. A teacher can also follow the following guideline to manage the class. According to Leaman (2005), â€Å"positive encouragement and praise is the easiest and most powerful way to reward an individual: notice your students working quietly/being helpful/listening well/sitting still, as much as you notice them misbehaving. Draw attention to this and make them feel good about themselves.† (p. 17-18) The students will undergo a positive change and look forward to the teacher’s class to gain the opportunity to be praised in front of the entire class. Keeping the pupil in control do es not mean pin drop silence always. During any group activity, the pupil should be able to participate actively. If it’s not the case then the teacher should work upon this aspect too. It has been rightly pointed out in NASUWT website â€Å"class control is not an end in itself. It is the creation of a learning environment that is important. In different circumstances, the learning environment may be a totally silent classroom or the busy, bustling group activity session.†(para.3) During a lecture, it is often found that the backbenchers are busy exchanging glances or whispering to each other. This is quite disturbing for the teacher.

INFORMING PUBLIC POLICY Essay Example | Topics and Well Written Essays - 500 words

INFORMING PUBLIC POLICY - Essay Example At first, the authors give us a ‘brief history’ of the journal and examine the role eminent personalities such as Jeremy Travis in conceiving a journal for breaching the gap between policy research and criminal justice policy. According to Clear and Frost (2007), the best thing about the journal was that it sought to â€Å"simultaneously maintain a high degree of academic credibility and inform public policy† (p.633). The journal upheld a dissemination strategy to avoid the confinement of policy-relevant research to the academic world. The American Society of Criminology (ASC), under the presidency of Lawrence Sherman, made the journal its official publication. From 2004 onwards, the journal was fully supported by the ASC. Because of this collaboration, CPP reached out to many policy framers through the organizational network of ASC. Importantly, the journal had a pan-American reach. Certainly, its widespread distribution was the result of an excellent media disse mination strategy involving U.S. Newswire and Rubenstein Associates. Criminology & Public Policy was a notable success in terms both circulation and quality. Among the newcomer journals, CPP holds its head high. The genre of ‘reaction essays’ was the major attraction of the journal, which was solicited from the writers by the editors themselves. The authors are of the view that engaging with the media is a difficult task and put forward the rather interesting statement about criminologists that they are â€Å"very reluctant to offer definitive policy recommendations and frequently include a host of caveats to any of the implications that they do raise† (p.636). They also give account of the difficulties pertaining to drawing concrete policy formulations from empirical researches. This problem arises out of the very nature of criminological empirical research, i.e. empirical

How should other areas of DE Mar(marketing, finance, personnel) Essay

How should other areas of DE Mar(marketing, finance, personnel) support its product strategy.. And how should each of the 10 OM decisions be managed to ensure - Essay Example There are many examples f good promotional techniques, and I will go over some f them in this article. A good time to offer special sales is before and during the busy time f your business year. In De Mar, we see this in retail all the time. There are spring sales, summer sales, fall sales, winter sales, white sales, close out sales, inventory sales and on and on. What's really happening here is that companies want to excite you about coming in and taking advantage f price reductions they are offering. Also, if they are heavy on inventory or out-of-style garments, they want to get rid f them and will do so at a reduced rate. You can have sales too. Let's use the example f an air conditioning contractor. Prior to summer, you can offer reduced rates on cooling systems for homeowners. By doing so, you cause people to think about those systems ahead f time. We all know that you are not going to reduce the prices very much in the dead f summer. Also, people know they may have to wait during the summer because it's a busy time, and this way they can be ready for summer and save money as we ll. Efficient customers' caring policy and service department, De Mar can offer to check systems. Tell homeowners you will come out, check their heating and cooling systems, provide general service and repair any needed components. Your price to come out and perform this service should be purposely reduced from your normal rate to attract attention. This also helps to increase business during slower times and even out your business cycle. If you offer service contracts, you can sign up homeowners at certain times f the year and at a special rate. You'll notice that when you purchase an appliance these days, they offer service or extended warranty contracts at very low rates. You would be amazed at the number f people that take those contracts, and the amount f money it generates for the business. The customer just purchased something at a reduced or sale price and for just a few more dollars the customer can have an extended warranty. Most f us accept the offer, and those extra dollars help to bring the profitability f the sale up. You are probably asking yourself, what about the warranty If something happens, a company could spend all kinds f money fixing the problems under the warranty. This is where quality products, construction or services play an important role. Having an open house, mini trade show, buffet lunch or other events at your location is also very effective. Asking contractors to attend and see the products demonstrated or explained by manufacturers' representatives while they have lunch really works. They get a chance to see your company and services in action. Additionally, most manufacturers will help sponsor the lunch in order to be invited. Done correctly, it is possible to stage such an event and have it totally paid for by others. Companies have invited homeowners to "How To" sessions conducted after working hours, and they have been very

Company report Essay Example | Topics and Well Written Essays - 750 words

Company report - Essay Example In the wake of new era of the then company`s CEO, John F. Welch, General Electrics was at its worst financial and economic doldrums (Slater). During his tenure as the CEO of the company, General Electrics underwent a series of radical financial changes. In 1988, the CEO had managed to salvage the economic performance of the company by acquiring about 338 product lines and business at a cost of $11.1 billion. In the year 2009, the company registered a financial success setting its net income at $0.5 billion with consolidated revenue of $3.4 billion. Similarly, the industrial cash flow arising from the company’s operating activities was at $16.6 billion, a financial figure that remained superior as at that time. The table below shows the financial performance of the General Company from 2009 to 2013. General Electrics has a several competitors in the industry. Some of its active competitors include Citigroup Inc and Koninklijke Philips N.V. The table above shows the direct comparison of General Electric with other companies In the beginning of the week, the GE tries to pursue the Alstom assets to possible purchase of the same. This move seems interesting to the investors and it explains the high opening prices. However, in the course of the week, another setback seems to derail the acquisition of the Alstom; French government signs into law a bill that that bars foreign companies from acquiring local companies. Towards the end of the week, General Electric Company makes a payment of $59 billion as pension but it also introduces benefits to workers who are not productive. These further explain the slight drop in the closing price. The stock prices’ marking the beginning of this week was pegged at 26.55. However, at the end of the week, there was a significant change in stock prices of General Electric. Different news outlets reported that Jeff Immelt, company’s CEO reviewed

Rhetorical analysis Essay Example | Topics and Well Written Essays - 500 words - 4

Rhetorical analysis - Essay Example The executive summary provides a brief summary of the content of the report. According to the authors, the aim of the report was to support changes in the nature or state of on-campus restrooms. The report also sought to outline the unsanitary and unkempt nature of the restrooms, and gauge the opinions of the community on the condition of the rooms. The target audience of the business report included faculty heads, students and student leaders, parents, health officials and custodians of the restrooms. Students and student leaders were targeted because they are the main users and beneficiaries of the restroom. They have a responsibility of ensuring that the restrooms are in the best state for accommodation. Parents were targeted because they pay for the restrooms, and their children use the rooms. Therefore, it is important to provide them with information about the nature of the rooms (Kennedy 31). Teachers and custodians were targeted because they have a responsibility of ensuring that the on-campus restrooms are safe and clean for accommodation. The report targeted healthcare officials because of their role in providing safety and health standards. In order to ensure that the report provided the right information, the researchers used online surveys and questionnaires to collect information from faculty heads and students. The aim of the questionnaires was to understand the state of the restrooms, and the opinions of the respondents about the cleanliness of the rooms. The business report used formal and official language to pass information about the state of the restrooms. According to the report, the conditions of the facilities are below standards. In some of the instances, the authors use inflammatory language in order to invoke physical and emotional reactions. For instance, the authors state that the restrooms are â€Å"disgusting† in order to pass emotional messages that people should not be allowed to occupy the rooms. The main strength

Theme 3 Essay Example | Topics and Well Written Essays - 750 words

Theme 3 - Essay Example change process within an organization, and thus there is a lot that the management can do to enhance the success of the change process (MartinÄ iÄ , 2010:82). In arguing for the assertion by (Mullins 2010: 753), that the management has little it can do about resistance to change, it is apparent that the management cannot force change on the organizational stakeholders such as the employees, considering that change has to emanate from within (Shao-His, Ying-Fang & Shao-Wen, 2012:747). Whenever change is externally driven, it will result to resistance and where resistance is not apparent, the change process will be sabotaged by those opposed to it, or they may quit where it is apparent that change must occur. The problem with this is that, the organization may lose its valuable assets in the quitting employees (Phillips, 1983:191). Nevertheless, to argue against the assertion by (Mullins 2010: 753), it is apparent that the management can do a lot about resistance to change within an organization. This principle can be demonstrated well by the case â€Å"Remaking JC Penney’s Organizational Culture†, where Myron E. Ullman, who was appointed to the position of the chairman and CEO of JC Penney Corporation in 2004, had an elaborate plan on how he could introduce change to the organization, through making the organization a great work place for the employees (ICMR, 2007:2). However, he was faced with a lot of resistance, considering that the organization had a culture of rigidity and formal employee relationship spanning over the past 100 years (ICMR, 2007:2). The rigid rules of addressing the managers formally and dressing strictly in accordance with the organizational dress code had made the environment in the organization tense. This resulted to the inability of the organization to attract new talent or retain new recruits, while the employee turnover increased (ICMR, 2007:3). Nevertheless, after Ullman and the newly hired human resource manager, Michael Theilmann

Human Sexuality Essay Example for Free

Human Sexuality Essay William and Jessie both 23 years old have been dating for 3 years. They plan to get married in 2 years when they finish with graduate school. About three months ago William had an unplanned and alcohol induced intercourse with a colleague from work. The couple are in counseling and working on issues of trust and communication. Recently, they have started having sexual intercourse. Jessie says she is unable to climax like in the past. William says he is doing everything the same and thinks she still blames him. Looking at William and Jessie’s case, I believe that the possible societal and gender influences related to William’s and Jessie’s concerns are the male and female sexual scripts. According to Strong, DeVault, Sayad and Yarber (2008), â€Å"Sexual Scripts refers to the acts, rules, and expectations associated with a particular role† (p. 143). All humans are sexual beings; however we all are diverse in terms of our sexual definitions and script expectations. Sexual scripts are not innate, yet they are learned through culture and socialization (Strong et al. 2008). There are as many distinctive sexual scripts as there are people, nonetheless some of these scripts have common themes and can be recognized as a shared blueprint or trend in the larger society. Some male scripts that are relatable to Williams’s concerns are: Performance is a thing that counts. A man always wants sex and is ready for it and, sexual intercourse leads to orgasm. Society has this idea that is embedded in many people that sex to men is something to be accomplished (Strong et al. 2008). It is important for us to notice that in Williams situation, he is feeling like â€Å"less of a man†, in other words, his ego is bruised, because he cannot make Jessie climax. Additionally, there are sexual scripts allotted to women as well. Some female scripts relatable to Jessie’s concerns are: â€Å"The traditional male sexual scripts focuses on sex over feelings, the traditional female sexual script focuses on feelings over sex, on love over passion† (p. 41). Jessie apparently has issues during sex because she can’t get over the thought of Williams having sexual contact with another woman, especially when William is supposed become Jessie’s future husband. The sexual script that relates to this issue is that the woman does not want to have sex, sex is uncomfortable for her or not pleasurable for her. However due to female sexual scripts, women should not talk about sex (Strong et al. , 2008). Sexual scripts are similar to traditional gender roles; society holds men and women accountable for the roles and expectations that have been set for them and if we fail to live up to them, then we are failures at our gender. Moreover, there are indeed biological and psychological components of William and Jessie’s case. Starting with William, he can’t achieve to make Jessie Climax. Psychological causes include trust and communication related stress and anxiety, because he too busy trying to gain Jesse’s trust. Because of this William is most likely concerned about his sexual performance, trust issues and the guilt of having sexual intoxicate intercourse with his work colleague. For women in particular, emotional closeness is a main component in sexual desire (Strong et al. , 2008) and because William cheated with a colleague, she perhaps could have grown psychologically distant. As stated by Strong et al. (2008), â€Å"Desire is the psychological component of sexual arousal† (p. 92). According to the Masters and Johnson’s four-phrase model of sexual response, Kaplan’s tri-phasic model of sexual response and Loulan’s sexual response model, they all include desire and excitement as key elements to sexual response and pleasure and without these two elements, a person cannot truly experience the true satisfaction of sexual intercourse and an orgasm (Strong et al. , 2008). In relation to this case the developmental concerns related to the early adulthood stage according to Strong et al. 2008) are the following: Integrating love and sex, forging intimacy and making commitments. Integrating love and sex was not integrated when it comes to Williams’s infidelity. William was more so thinking with his penis rather than thinking about the love of his life Jessie. As the female, Jessie thinks more with her heart and values the love for William. The thought of betrayal from William, may possibly be disheartening and could hinder Jessie from climaxi ng during intimacy. In Jessie’s mind, loving William and having that solid connection with him was important to her. Furthermore this developmental concern strongly compares to the male sexual script with thoughts of sex over feelings, while the woman’s thoughts consist of feelings over sex. The key to integrating love and sex was missing because of Williams’s infidelity. Therefore uniting the two will take a longer process to connect. Forging intimacy and making commitments plays an integral part in the developmental concerns in this case as well. According to Strong et al. (2008) as a relationship become more meaningful, the degree of intimacy and interdependence increases. As adults become more intimate, most desire to develop their ability to make commitments. In relation to William and Jesse they are in a meaningful relationship, they were planning to get married and spend the rest of their lives with one another, before the infidelity occurred. It is my assumption the intimacy was on a higher level but after the infidelity occurred the intimacy decreased and the trust and communication issues began to form. During the early adulthood stage young adults begin to attend college and students began to meet lots of people in their age bracket. There will be opportunities during college where students attend plenty of social gatherings (frat/sororities houses and parties) and majority of the time alcohol and drugs are involved as well as risky sexual activities. Strong et al (2008) strongly believes that among college students, the use of alcohol is associated with an increased risk of unwanted intercourse, sexual violence and STDS. Since Jesse and William are in the early adulthood stage, it is a strong possibility William wants to venture out in a since before he gets married. Maybe he feels pressured and tied down to Jessie. Lastly, infidelity is common amongst the early adulthood population. Research by McAnaulty and Brineman (2007), states that 41% of the students identified having sexual intercourse with a person other than ones primary partner as constituting being unfaithful. More students (57%) identified dating/spending time with another as unfaithfulness. Infidelity can greatly affect committed relationships, because it could cause a lack of communication and trust worthiness. When relationships are broken, a lot of emotions occur such as lack of sleep, a decrease in appetite, anxiety and constant crying in some cases.

Differences Between Jealousy Of Men Than For Women

Differences Between Jealousy Of Men Than For Women Research is growing to find if there is a difference among men and women when perceiving jealousy. Specifically emotional reactions to a romantic partners infidelity, with men being more upset by a partners sexual infidelity and women being more upset by a partners emotional infidelity (Bailey, Gaulin, Agyei, and Gladue, 1994; Buss, Larsen, Weston, and Semmekoth, 1992; Buunk, Angleitner, Oubaid, and Buss, 1996). However, there is an ongoing discussion as how best to interpret these gender differences, with theorists falling largely into one of the groups: 1) those that view jealousy as an evolved sexual adaptive solution of paternal uncertainty and 2) those who view jealousy as a general social cognition emotion. The main difference in the groups is that those in the first groups focus is on distal explanations of jealousy while those in the second groups focus on proximal explanations of jealousy. In addition, the groups differ in their apprehension of how the mind works, with those in the first group adopting a modular view (Toobey and Cosmides,1992) and those in the second group adopting a general processor view. Theorists in the first group share the conjecture that jealousy is an entity that evolved to explain the specific problem of mate preservation (Daly, Wilson, and Weghorst, 1982). They proclaim that different jealousy responses evolved as a consequence of the fact that ancestral men and women faced unique reproductive challenges. Due to concealed fertilization, men could never be certain that they were genetically related to any children born to their mate. This paternity uncertainty was the greatest reproductive challenge faced by ancestral men. Consequently, selection pressures favored ancestral men who responded with jealousy to signals of a partners sexual infidelity because by doing so they decreased their likelihood of being cuckolded. Women should be less upset than men to signals of a partners sexual infidelity because ancestral women did not face the problem of cuckoldry. However, ancestral women faced a unique reproductive challenge not shared by ancestral men, in that they had to eat a very high calorie diet to meet the energy demands associated with pregnancy and lactation. Consequently, selection pressures favored ancestral women who responded with jealousy to signals of a mates diversion of resources because by doing so they increased the likelihood that they would have the caloric intake sufficient to maintain a healthy pregnancy and an adequate production of breast milk. Buss et al. (1992) argue that the single most consistent indicator to ancestral women that they were in danger of losing a partners resources was if their partner was developing an emotional attachment to another woman, because this emotional attachment signaled his willingness to invest resources in this other woman and her offspring. This theory uses the support from the study that found the sex difference in jealousy evolved through anger or acts of aggressive displayed by men who were evoked by jealous tendencies (Daly and Wilson, 1988), men also use violence to control the sexual behavior of their partner (Daly and Wilson, 1988). In a critical report the findings showed that, when forced to decide if a romantic partners sexual infidelity or emotional infidelity upset them more, women were found to choose emotional infidelity over sexual infidelity, in contrast men found sexual infidelity to be more upsetting (Buss, Larsen, Weston, and Semmelroth, 1992). The results found by this study have been replicated and used the same forced choice method. Although the studies have been supported, there have been studies have reported the opposite results. Theorists in the second group direct their focus on the social cognition and are not limited to romantic partners. Such as, one could feel jealousy over a sibling receiving more affection from the parent or a coworker receiving more praise from a boss. Harris (2003) disputes that jealousy is trigged by the initial feeling a threat to a relationship but that the exact nature and extent of the emotional reaction is determined by the cognitive assessment of the threat. Using this perspective, sex differences can be determined by the cognitive assessments about threats to a romantic relationship. According to Salovey and Rodin, their domain hypothesis suggests that people will have greater feeling of jealousy of individuals that they see to be more superior to them in domains that are highly relevant (1984). A partners attraction to a rival not only points towards a potential of a relationship but also represents a threat to self-esteem, because a partners choice of a rival suggests his/ her superiority. Further research of social cognitive perspective suggests sex differences in jealousy are consequences of differences in logical inferences men and women conclude about the extent sexual infidelity implies the emotional infidelity or how emotional infidelity implies sexual infidelity. This idea is supported by research conduct by Harris and Christenfeld (1996) and DeSteno and Salovey (1996) that people perceive men are more likely than women to have sexual infidelity when there is a lack of an emotional attachment but think that men are less likely than women to form an emotional attachment in a nonsexual relationship. The research includes that these assumptions are what contribute people to believe that a womans sexual infidelity signifies her emotional infidelity while a mans emotional infidelity signifies his sexual infidelity. Consequently, the gender difference as to which type of infidelity is worse is based on a gender difference as to which type of infideli ty implies the occurrence of the other. The purpose of this study is to examine further the role of those who view jealousy as a general social cognition emotion as a proximal explanation for gender differences in jealousy. This study will combine both approaches presented above, but will change the person that the partners imagined infidelity occurs. If jealousy is a domain specific response designed to prevent cuckoldry for men and prevent resource diversion for women, then the person who the partner commits the infidelity should have no impact on jealousy. In contrast, if jealousy is a general emotional reaction to threatened relations based on social cognition then the person the partner commits infidelity should have an impact on jealousy. Methods Participants Participants will be roughly 200 women and 200 men enrolled at Central Washington University. The selection will be random. The demographics of Central Washington University include 10,282 first-time degree seeking students. 7556 White, non-Hispanic, 805 Hispanic, 642 Asian or Pacific Islander, 416 Race/ethnicity unknown, 349 Black, non-Hispanic, 286 American Indian or Alaska Native, and 228 Nonresident aliens. 4,555 men and 4,650 women. All these students are enrolled full-time. This information was gathered from the Central Washington University site for academic year 2009. Materials Following a method described by DeSteno, Bartlett, Braverman, Salovey (2003), participants rated on a 7-point Likert-type scale how much they felt each of six emotions (angry, jealous, calm, threatened, relieved, and hurt) in response to each scenario in the first test procedure. For the second test the forced-choice measure will be used and is similar to those used in previous research investigating sex differences in jealousy resulting from sexual and emotional infidelity (Buss et al., 1992; Buunk et al., 1996; DeSteno Salovey, 1996). Individuals were asked to indicate which of the following two events would cause them more distress: (a) finding out that ones partner had passionate sexual intercourse with another person or (b) finding out that ones partner had formed a deep emotional attachment to another person. Participants will also complete two versions of this scale that will ask for their responses to the same instances of sexual and emotional infidelity, respectively. On this measure, participants were presented with specific statements to which they responded using a 7-point scale ranging from 1 (strongly disagree) to 7 (strongly agree), with the middle point indicating neither agreement nor disagreement. Procedure Participants will report in small groups of no more than twenty to an assigned room, once groups are in their assigned room, they will be informed that the study of the relation between personal character and habits that occur in the context of a romantic relationship. Similar to the procedure used by Buss, Larsen, Westen, and Semmelroth (1992), participants will be instructed to, Please think of a serious committed romantic relationship that you currently have, have had in the past, or would like to have in the future. Next the participants will be asked to imagine four separate scenarios in which this partner is unfaithful. The scenarios will describe either sexual infidelity, Imagine your partner enjoying sexual intercourse with someone else, or emotional infidelity, Imagine you partner falling in love with someone else. The wording in the scenarios will be modeled after items used by Pietrzak Laird, Stevens, and Thompson (2002). To measure more than the type of infidelity the per son with whom the partner committing an infidelity will be manipulated. Participants will be asked to imagine their partner falling in love with a close friend or falling in love with your boss. Equally, participants will be asked to imagine their partner enjoying sexual intercourse with a close friend or enjoying sexual intercourse with their boss. The next test will be presented to participants with two forced choice problem in which they will have to select one of two infidelity scenarios as more upsetting. In one problem, participants will have to choose between their partners emotional infidelity with an unknown person and their partners sexual infidelity with an unknown person. In the next present problem, participants will have to choose between their partners emotional infidelity with someone that is known (such as, friend, coworker, etc.) and their partners sexual infidelity with someone that is known.

E-Commerce in India

E-Commerce in India Marketing environment in India is changing. The trend of marketing by the consumers has changed drastically from past 10 years till date. The local environment has changed in both infrastructural ,social,economic terms in india. This paper shows the increase of the e-commerce market and internet marketing in india. Our findings show that the trend of internet marketing is on the rise among the various section of people of different age groups. This paper also refers to the various causes of the emergence of these markets along with the steps that can be used to enhance its development in Indian market. E-commerce is emerging as a new market which can help in the economic growth. This paper also shows the types on material available on the internet and how it is used as an medium for marketing. INTRODUCTION E commerce or electronic commerce is defined as the sale and purchase of goods and services through internet as the medium through the different sites on the internet. Electronic commerce refers to expansion of the buisness market and maintaining the relationship with the customers by using telecommunication networks . E commerce has led to a shift in the buisness environment in the world including india.india ia still a developing nation. The growth and development of e commerce will be vital for the growth and develpment of nation. In india the users of computers and internet have increased drastically from 1995 to 2013. Now the entire buisness scenario has changed as everything has become online now. Most of the buisness activities are related to internet e.g. internet commerce,virtual commerce,cyber commerce. All these have been possible due to the use of internet. As we say that the world is a global village has been possible due to advancement in the communication services Internet growth has been regarded as the main cause of the new developments, such as decreased margins for companies as consumers turn more and more to the internet to buy goods and demand the best prices. E-commerce provides various benefits to the consumers as goods are available at lower cost, variety of choices are available and the tie of buyer is also saved. People can buy goods and services at a mere click of the mouse button without moving out of their houses or offices. Similarly online services such as banking, ticketing (including airlines, bus, railways), bill payments, hotel booking etc. have been proved a boon for the customers. Online businesses like financial services, travel, entertainment, and groceries are all on the verge of expansion. In the e commerce process the customer browses through internet to get the information about the desired product/services.when the customer is completely satisfied by products features,its advantages after comparing it with other products then the order is placed for the desired product/services. Online transaction is done and then the selling company informs the customer about the payment and the delivery date is given. Some of the features of e commerce process are: E commerce enables the companies to expand them globally. Everything can be sold on internet even if the product is for smaller markets. It is time saving, delivery is done at a faster rate,reduces the cost of transportation. There is no time constraint. Consumer can easily compare pice and product effectively and efficiently. Consumer interaction with the company directly is also improved by quick feedback and comment forms. E commerce refers to better and quick customer services. Due to the absence of intermediaries, buying procedure is generally quicker. E commerce is also boosted by electronic fund transfer throughout the world. Because of all these features the e commerce industry in india has flourished at a high rate, INTERNET USERS IN INDIA During the past decade the no. of internet users has increased at a explosive rate. According to times of india, India had about 121 million internet users by December 2011,. Out of 121 million, 97 million are expected to be active Internet users, who access Internet at least once in a month. a study by internet and Mobile Association of India (IAMAI) and IMRB said A 100 million internet users is considered a critical landmark for the country. With this internet use in India is expected to enter a critical period of growth with the possibility of becoming the largest internet using country in the world in this decade, . The economic times also stated that according to the Internet World Stats, India has achieved a 10.2% internet penetration at about 12.1 crore users as of December 2011. E:SSS.jpg E:internet-usage-statistics-india-500-809.jpg According to the data given in this chart, the internet users in india is increasing year by year and in 2012 the number of internet users were 150 million. These show that the use of internet in on a high among Indian masses.India has 13% of internet users in Asia and 7.36% that of the world. 70% of people who know computer have used internet which is a healthy sign. According to the surveys of india in 2011, the following facts were the main findings : According Census 2011 of India there are 15.54 Million households (6.3% of total population) in India who have computer/laptops in their homes.ÂÂ   However Only 7.6 Million householdsÂÂ   (3.1% of total population)ÂÂ  have laptops/ computers with internet. Maharashtra is the biggest Indian Internet market with 18% of Total Internet households followed by Tamil Nadu with 10%,ÂÂ  KarnatakaÂÂ  8.27% , U.P (Noida inclusive) 8.18%, Delhi 7.68% and Andhra Pradesh with 7.15%. Delhi/NCR inclusive of Noida and Gurgaon would however have much higher numbers. SHIFT IN THE MARKETING PROCESS IN INDIA In the ancient times the buying and selling of things was done by barter system. Barter is a system in which exchange goods and services are directly exchanged for other goods or services without using a medium of exchange, such as money. now in this generation the marketing with the help of internet is on the rise.Most people can use the Web since it is affordable and easy to access. Internet is a fast and flexible means for marketing. Shopping on the Internet is convenient as there is no time restriction, it is comfortable since it is in a user friendly environment and there is also an instant satisfaction of ordering, paying and delivering. A one-to-one basis, as well as, a two way communication with customers through the Internet is possible. Enhancing brand image, creating awareness and providing customer service are more important than just selling the products or entertaining customers. With better technologies, companies can create a stronger brand image and thus increase sales. On the other side, it is easier for customers to receive a kind of acknowledgement; feeling that they did not waste their time . Nowadays, people live a busy life and shopping online is time consuming for them. The company also saves time since whenever a customer uses his/her credit card to purchase a product.E-marketing is seen as a promotional as well as informational tool. This new era of commerce is beneficial for marketing logi stics, a global presence, to establish and maintain a competitive edge, shorten components of supply chains, for cost savings and research advantage in india. Now companies like myntra, flipkart are providing cash on delivery to the customer which was not done before. This is a strategy which aims at payment only after the complete satisfaction of the customer. In this strategy the customer first receives the ordered product and he/she pays. This has been found quite successful in India. If any problem is found in the product ordered,then it gets replaced within a few days. Earlier the customers had to do advance payment which was not favourable in the interest of the customer as many complaints were reported in the goods which they ordered. So in this way the companies are trying to attract the customers towards themselves to increase their sales. Cash on delivery is done by Credit Cards, Debit Cards, Netbanking, ITZ Cash Cards, Cheques, Demand Drafts or cash. E COMMERCE IN INDIA The low cost of computers in india, a increase in the number of computer users,and a growing isp market are the main causes for the emergence of e copmmerce market in india.there has been a rise in number of companies taking up e commerce in india. The companies like ebay,myntra,flipkart,quikr,olx are some of the companies which have established their name in the indian e commerce market. All these sites are selling varieties of products,movies tickets,electronic gadgets,accessories,household items and much more. Now the stock exchange has also become online now. Delivery of goods to consumers by couriers at a faster rate,moreover the quality of product delivered is satisfactory.Many indian banks are also using internet banking facilities. Indias economic industry is on a growth curve and is undergoing a spurt in growth.The Online Travel Industry is one of the biggest segment in ecommerce in india and is booming due largely to the Internet-savvy urban population. The online travel industry inclused some private firms such as Makemytrip, Cleartrip and Yatra. The government has also started IRCTC, which is a successful Indian Railways initiative. The online classifieds segment is also increasing. It is broadly divided into three sectors; Jobs, Matrimonial and Real Estate. Mobile Commerce is also growing rapidly and proving to be a stable and secure supplement to eCommerce due to the record growth in mobile user base in India, in recent years[10]. The online classifieds segment is broadly divided into three sectors; Jobs, Matrimonial and Real Estate. Mobile Commerce is also growing rapidly and proving to be a stable and secure supplement to eCommerce due to the record growth in mobile user base in India, in recent years. A report by the Internet and Mobile Association of India has stated that Indiaa E-commerce market is growing at an average rate of 70 percent annually and has grown over 500 percent since 2007. E-Tailing and digital downloads are expected to grow at a faster rate, while online travel will continue to rule the major proportion of market share. According to the third edition of eBay India census 2010 conducted across 28 states and seven union territories, Gujarat has emerged as one of the top five online shopping markets in the country. Gujarat which was ranked 7th in 2009,is now ranked 4th in after Maharashtra, Delhi and Tamil Nadu. Technology related products dominate Indias domestic eCommerce, contributes 44% of totals eCommerce transactions according to the latest eBay Census.. Whereas, lifestyle product category dominates in the global trade contributes for 35% for online shopping. India is showing tremendous growth in the Ecommerce. Rival tradeindia.com has 700,000 registered buyers and it has the growth rate of 35% every year. The travel portal MakeMyTrip.com has attained Rs 1000 crores of turnovers which are around 20% of total e-commerce market in India. These facts also show that the e commerce market in india is also increasing per year. In 2012 the e commerce market size was about 50000 crores in india as compared to 1 billion in 2011.Apparently, more online users in India are willing to make purchases through the Internet. Overall e-commerce industry is poised to experience a high growth in the next couple of years. The e commerce industry has the following major sectors Travel- 51% E-Retailing-40% Cothiers-09% These are 3 major categories of e commerce market, travel being the largest among them. For online marketing the websites also play a vital role. The websites should be informative, entertaining and unique. the attention of the customer must be captured as soon as possible. They should be understandable and easy to search information needed. Moreover, it must continuously be up-to-date for most recent information about the company. Companies also use different types of strategy to know what are the wants and needs of customers. Some of them are : Product Strategy Brand recognition is made clear on the Internet but the number of purchase is not there yet. Sometimes the products are not available on the Web site and consumers hesitate before getting this particular product. To increase their confidentiality, recognized vendors should be mentioned on the Net. Authenticity is important for both sellers and products. Pricing Strategy In the long run, it will be better for the firms,if they can concentrate on offering products with the unique characteristics at the most suitable cost. Online shoppers differentiate the products/services by the benefits and quality . A low price strategy should rely on cost advantage and high volume to be able to compete. Distribution Strategy There is a necessity of a direct-to-customer process. The industry has to be the first providing unique services to always be ahead of competitors as fast as possible to make a mark in the mind of customers. Promotional Strategy This depends on the marketing research and consumer preferences. It deals as how to companies want to promote their product. FAQ questions should be provided on the websites along with the advertisements on various sites such as you tube which is most widely used by the people. CONCLUSION The Internet network is a marketing channel used by advertisers, marketers, and society to find the right combination of marketing mix to suit the customers needs. It is important for a company of this age to have access to the Internet to be more successful. Internet marketing targets consumers and Internet advertisements client marketers from companies. People always find themselves under stress of working long hours and they do not have enough time for social activities or even shopping. Thus E-commerce becomes an everyday thing and routine for them. E-mail is also famous for direct marketing in supporting E-commerce activities. Internet should be used with other media for a more effective marketing tool. Internet marketing will become even more important in the future. As more companies will have access to the Internet, they will start doing business over the Internet. Increase in the e commerces economy in india will be in another dimension where customer focus, responsible business practices and innovation are the determinants of success and not only customer relationship. Security will not be an issue anymore because software companies, banks and credit card institutions are working hand in hand to improve Internet security. Companies need to protect themselves in three areas: data integrity, confidentiality of data and authenticity by installing firewalls or routers. Customers will look for a business on the internet since there are unique opportunities for marketing a companys service, selling products and gathering information on the Net. This is the new era of innovation; where everyone will be interacting on the Web. Live video session will be available and a prospective customer may be able to talk to a customer representative directly over the internet in the future will be more beneficial in the interest of customers.

On Achievement :: essays research papers

<a href="http://www.geocities.com/vaksam/">Sam Vaknin's Psychology, Philosophy, Economics and Foreign Affairs Web Sites If a comatose person were to earn an interest of 1 million USD annually on the sum paid to him as compensatory damages – would this be considered an achievement of his? To succeed to earn 1 million USD is universally judged to be an achievement. But to do so while comatose will almost as universally not be counted as one. It would seem that a person has to be both conscious and intelligent to have his achievements qualify. Even these conditions, though necessary, are not sufficient. If a totally conscious (and reasonably intelligent) person were to accidentally unearth a treasure trove and thus be transformed into a multi-billionaire – his stumbling across a fortune will not qualify as an achievement. A lucky turn of events does not an achievement make. A person must be intent on achieving to have his deeds classified as achievements. Intention is a paramount criterion in the classification of events and actions, as any intensionalist philosopher will tell you. Supposing a conscious and intelligent person has the intention to achieve a goal. He then engages in a series of absolutely random and unrelated actions, one of which yields the desired result. Will we then say that our person is an achiever? Not at all. It is not enough to intend. One must proceed to produce a plan of action, which is directly derived from the overriding goal. Such a plan of action must be seen to be reasonable and pragmatic and leading – with great probability – to the achievement. In other words: the plan must involve a prognosis, a prediction, a forecast, which can be either verified or falsified. Attaining an achievement involves the construction of an ad-hoc mini theory. Reality has to be thoroughly surveyed, models constructed, one of them selected (on empirical or aesthetic grounds), a goal formulated, an experiment performed and a negative (failure) or positive (achievement) result obtained. Only if the prediction turns out to be correct can we speak of an achievement. Our would-be achiever is thus burdened by a series of requirements. He must be conscious, must possess a well-formulated intention, must plan his steps towards the attainment of his goal, and must correctly predict the results of his actions. But planning alone is not sufficient. One must carry out one's plan of action (from mere plan to actual action).

Supernatural in Shakespeares Macbeth - Role of the Witches Essay

The Role of the Witches in Macbeth  Ã‚   When Shakespeare wrote his play, Macbeth in 1606 a large majority of people were interested in witchcraft. This is why Shakespeare made the witches and the witches’ prophecies play a major part in the storyline of the play. In the time of Macbeth witches were not thought to be supernatural beings themselves, but supposedly gained their powers by selling their souls to Satan. There can be little doubt that most of Shakespeare’s audience would have believed in witches, and for the purpose of the play, at least, Shakespeare also accepted their reality. The three witches in the tragedy Macbeth are introduced at the beginning of the play and the brief opening few scenes give an immediate impression of mystery, horror and uncertainty. This is a sign of things to come as witchcraft is used as one of the main themes of the play. The witches create an atmosphere of evil and disorder. In the opening scene the weather is thunder and lightning which is a mirror image of the way the witches are perceived. When you think of thunder and lightning you think of evil and destruction, this is exactly the way witches are represented in this play. They are evil and cause destruction in Macbeth’s life. Banquo says in act 1 scene 3 line 124: "The instruments of darkness tell us truths, Win us with honest trifles, to betray's In deepest consequence." He thinks and says bad things of the witches. He calls them instruments of darkness and the devil. He believes that these prophecies will only bring harm even before anything begins to happen. He sees beyond the witches and can see that they are evil where as Macbeth is taken in by the witches and this ‘blindness’ is what causes his downhill spiral o... ...e is responsible for his own destiny. This is an essential theme in this tragedy. Macbeth chooses to gamble with his soul and when he does this it is only him who chooses to lose it. He is responsible for anything he does and must take total accountability for his actions. Macbeth is the one who made the final decision to carry out his actions. He made these final decisions and continued with the killings to cover that of King Duncan. However where as some facts show that the results were all of his own doing, in act 4 he returns to the witches voluntarily to find out his fate in order to see what actions he should take. This suggests that the witches did have a great influence on his actions. Work Cited Shakespeare, William. Macbeth. Literature: An Introduction to Fiction, Poetry, and Drama. Ed. X.J. Kennedy and Dana Gioia. 7th ed. New York: Longman, 1999.

Arthur Miller’s “Death of a Salesman” Essay

Who does not want to live the perfect life, the American Dream? Throughout Arthur Miller’s Death of a Salesman, Willy Loman is in pursuit of this Dream. Willy focuses on the idealistic American dream his entire life, associating it with financial success, an excellent reputation and being well liked. He makes victims of his wife and of his sons by subjecting them to mistreatment and deprivation of a strong male role model. According to the Webster’s Dictionary a victim is one who is subjected to oppression, hardship or mistreatment. Willy puts far too much pressure on his elder son Biff, not enough on his younger son Happy, and he makes a â€Å"yes-woman† out of his doting wife Linda. Willy’s ideas of the American Dream outweigh the realistic trials and tribulations that need to be overcome in order to achieve the Dream. The American Dream is one of success and Willy views success as being well liked. He wants Biff to be well liked and hence puts much pressure on him to be popular. During Willy’s flashbacks to 1929, Willy encourages Biff to be a good football player rather than a good student. Willy pays so much attention to Biff and puts so much pressure on him to succeed and to be well liked that Biff does not have anything concrete (such as marks) as a backup. Willy believes that even though Bernard can get the best marks in school, that he will not survive in the business world because he is not well liked (Miller 33). Biff wants to live up to his father’s dreams. He wants his dad to be proud of him. Before the football game at Ebbets Field, Biff promises â€Å"to break through for a touchdown,† just for his dad (32). As a teenager, and right up until he catches Willy cheating, Biff does everything he can to get into Willy’s good books. He is the star football player and popular enough to order his friends around: â€Å"Fellas! Everybody sweep out the furnace room!† (34). Then, all of a sudden, things change. After finding Willy and Miss Francis together, Biff comes to the conclusion that his father is not as important as he makes himself out to be: â€Å"he [Mr. Birnbaum] wouldn’t listen to you [Willy]† (120). This is the turning point in Biff’s life because he becomes a victim of Willy’s actions. At this point, in a hotel room in Boston, Biff gives up on his life and the dream of success when he decides that he is â€Å"not going there [the University of Virginia]† (120). Willy has ruined his son’s chances at getting a good education and a  successful career. Willy puts so much emphasis on Biff’s success, that he neglects Happy. As a result, Happy feels the need to follow in Willy’s footsteps in order to gain the level of respect and attention from his father that is given to Biff. Happy feels this neglect as a teenager and feels the need to satisfy his dad: â€Å"I’m losing weight, you notice, Pop?† (33). Happy wants to be popular and well liked in order to get some positive attention from Willy. Even as an adult, Happy holds on to the need to impress his dad and to keep him content with his life. Happy wants Biff to lie to their father about seeing Bill Oliver because Willy â€Å"is never so happy as when he’s looking forward to something† (105). Happy wants Willy to be pleased with Biff because that would keep Willy happy and could stop him from having flashbacks and talking to himself. Success in business is one of Willy’s goals for the American Dream and thus, Happy wants to be a businessman because he is seeking his father’s approval. While in pursuit of the American Dream, Willy needs someone to support him and to agree with all of his decisions. Linda is there for him throughout the hard times. She guides him by being supportive of his decisions and even supports his lying. She knows that he goes to Charley to â€Å"borrow fifty dollars a week and pretend[s] to [her] that it’s his pay† (57). Linda allows him to feel important, at least in front of his own family. Not only does she defend him in front of their sons, but she also tries to keep the peace between her husband and Biff. Willy doesn’t appreciate this as he should, turning on her when she tries to get him to listen to Biff, telling her † don’t take his [Biff’s] side all the time† (65 ). Later, when she tries to comfort him, he tells her to â€Å"get to bed† (134). She endures him yelling, â€Å"stop interrupting† (64) without breaking down, only to ask him whether she â€Å"should?sing† (68) to soothe him. He has trained her to take his harsh words and act like nothing has happened. Linda is the glue that keeps the Loman family together as she tries to get Willy and her sons to speak calmly and peacefully and to see the best in each other. Ultimately, the Loman family is affected by the American Dream gone awry.  Willy Loman is very focused on this dream and his family’s success in business. Consequently, he mistreats his sons and his wife, making victims of them. His sons do not have a strong male role model who they can look up to during their maturing years. Instead, they have a daydreaming, failing salesman for a father, whose sole objective in life is to live the American Dream. He has also trained their mother to agree and comply with everything he says. The American Dream implies happiness and for Willy Loman that happiness is to die the death of a salesman. We have to wonder how the idea of death can bring happiness to someone’s life.

Define Pneumonia And Explain Health And Social Care Essay

Pneumonia is infection that affects either one or both of the lungs. It is non a individual disease and it may hold more than 30 types of different causes, including bacteriums, Fungis and viruses. In immature kids with the age of less than 5 old ages old, viral pneumonia is the most common type of pneumonia, with its most common cause being the grippe virus. There are many other viruses that can do pneumonia every bit good, such as respiratory syncytial virus, herpes simplex virus, rhinovirus and terrible acute respiratory syndrome ( SARS ) . Community-acquired pneumonia is the most common type of pneumonia which is acquired in public countries like the school, food market shop or working topographic point. It might be caused by either bacteriums, Fungis, virus or the thorns present in the air, with the most common cause being the bacterium Streptococcus pneumoniae. Its development can besides happen following a grippe or cold [ 1 ] . Hospital-acquired penumonia which is besides known as institution-acquired pneumonia is acquired in the infirmary, peculiarly while remaining and under intervention in the intensive attention unit ( ICU ) or using a ventilator to help in take a breathing. It normally besides develops following a major surgery including thorax surgery or during dialysis in kidney dialysis centres or remaining in chronic attention centres. It has the possible to be really unsafe, peculiarly to those who are immature, aged or immune-compromised [ 1 ] .List the clinical symptoms ( systemic versus respiratory ) associated with pneumonia.Systemic symptoms [ 2 ] : – Mild or high febrility – Shaking icinesss – Concern – Loss of appetency – Fatigue, low energy – Increased perspiration and clammy tegument – Confusion ( peculiarly in the aged ) Respiratory symptoms [ 2 ] : – Cough ( may includes production of light-green or xanthous mucous secretion, even blood mucous secretion in certain types of pneumonias ) – Shortness of breath ( might merely happen while mounting up stepss ) – Stabbing or crisp thorax hurting which can decline with deep breath or coughUsing the SMART-COP tool and the information provided above calculate MR Barnes ‘ SMART-COP mark and find if Mr Barnes has mild, chair or terrible CAP.Mr Barnes ‘ SMART-COP mark is 6, which mean he has terrible CAP and has a high hazard ( 33 % ) of necessitating intensive respiratory or vasopressor support ( IRVS ) [ 3 ] . The mark might be lower than his existent mark though due to the deficiency of information sing Mr Barnes ‘ albumen concentration in plasma, bosom rate, mental position and blood pH.Complete the undermentioned intervention program for the direction of Mr Barnes ‘ CAP, as would be outlined in the patient ‘s admittance notes, utilizing the tabular array provided.Treatment programExplain the ground:– for your recommendation/responsewhen make fulling in the spaces.– the physician has ordered certain trials andobservations etcto get down the undermentioned IV empirical antibiotics ( include dosage ) : moxifloxacin 400mg IV, daily & A ; azithromycin 500mg IV, daily. Broad-spectrum antibiotics are required ab initio for the intervention of Streptococcus pneumoniae, Legionella penumophila, and enteral Gram-negative B. Since Mr Barnes is allergic to penicillin, moxifloxacin is used in topographic point of penicillin. for paracetamol 0.5 to 1g orally or aspirin 600mg orally for pleuritic thorax hurting. To supply sufficient analgesia to enable equal respiratory motions in add-on to cut downing the hazard of atelectasis and pneumonia. for auxiliary O via rhinal prongs. Because Mr Barnes ‘ O impregnation is 89 % which is rather low. for salbutamol 5mg q4h prn via atomizer. For the intervention of airflow restriction or for the betterment in mucociliary clearance. for repetition chest X ray in following 2 yearss. To do certain that the intervention is effectual for the pneumonia infection [ 1 ] . withhold Altace tablets. To forestall farther decrease in Mr Barnes ‘ blood force per unit area as he is already in hypotensive province. for day-to-day full blood scrutiny ( FBE ) , U & A ; E ‘s, Creatinine. To look into the white blood cells count and type, and besides to find the badness of Mr Barnes ‘s pneumonia infection. for QID observations ( BP, Resp Rate, Temp, O2 impregnation ) . To find whether Mr Barnes is retrieving good from the pneumonia infection. follow up blood and phlegm civilizations. To supervise the obliteration of the specific causative agents of Mr Barnes ‘ pneumonia.What changes to prove consequences, observations and patient symptoms would the medical staff and you as druggist proctor, to bespeak that the antibiotic therapy is effectual?I will supervise Mr Barnes ‘ x-ray consequence, if the x-ray consequence showed that the pneumonia infection country is cut downing so that means the antibiotic therapy is effectual. Furthermore, I will besides supervise the pulse oximetry or blood gases test consequence, if the O impregnation goes up closer to ~95 % so the antibiotic therapy is most likely effectual. Besides this, I will besides supervise the day-to-day full blood scrutiny consequence, the antibiotic therapy is effectual if the white blood cells count is returning to the normal degree. I would besides supervise the consequence of his blood and phlegm civilizations. If the figure of the causative agents of his pneumonia is continuously cut downing , that indicates that the antibiotic therapy is effectual. Besides this, I will besides supervise Mr Barnes ‘ temperature, blood force per unit area and respiratory rate as good. If all of them bit by bit returned to their several normal degrees so the antibiotic therapy is effectual. Not merely this, I will besides detect and inquire whether does Mr Barnes ‘ initial showing symptoms such as coughing that produces phlegm, pleuritic thorax hurting and feeling of unease are bettering. If they are bettering, so the antibiotic is most likely effectual.( I ) What unwritten antibiotic would you urge for Mr Barnes given all afore mentionedinformation?I would urge moxifloxacin, 400mg orally, daily for Mr Barnes [ 3 ] .( two ) What would be the recommended continuance of antibiotic intervention?The recommended continuance of antibiotic intervention is 7 yearss.( three ) In point signifier list the guidance points you would supply to Mr Barnes for thisantibiotic.Take moxifloxacin together with repasts. Avoid taking alkalizers, Fe and Zn addendums within 2 hours of taking moxifloxacin as they might interfere with the soaking up of moxifloxacin. Be certain to take moxifloxacin until finish. Moxifloxacin can ensue in giddiness, confusion or faintness, which may so take to cut down ability to drive and/or operate machinery. These effects can be exacerbated by intoxicant ingestion. If experience any tenderness of redness of sinew, discontinue moxifloxacin, do n't exert, and confer with the physician in the shortest clip as possible. It is common to see sickness, stomachic disturbance and diarrhea while taking moxifloxacin. Ensure plentifulness of fluids intake ( 1.5-2L per twenty-four hours ) while taking moxifloxacin. Avoid from utilizing urinary alkalinisers together with moxifloxacin as there is the hazard of cystalluria. Moxifloxacin might increase the caffeine ‘s effects in certain people by suppressing its metamorphosis, hence decrease in caffeine consumption might be required.For the pneumonia caused by the undermentioned pathogens, list the antibiotic ( s ) you would urge for â€Å" directed therapy † . Complete the tabular array below.Pathogen doing the pneumoniaDescription of the pathogenis it gram negative or gram positive bacteriums?is it aerophilic or anaerobiotic?is it a fungus or virus?Antibiotic recommendationNon-MRSA staphylococcal pneumonia It is a Gram-positive aerophilic bacteriums. ( facultative anaerobe if is aureus ) Di/flucloxacillin 2g IV, 4 to 6 hourly. – With penicillin hypersensitivity ( excepting immediate hypersensitivity ) : Cefalotin 2g IV, 4 hourly. Cephazolin 2g IV, 8 hourly. – With immediate penicillin hypersensitivity: Vancomycin 1.5g IV, 12 hourly. Legionella species It is a Gram-negative aerophilic bacteriums. – With mild disease: Azithromycin 500mg orally, daily for 5 yearss OR Doxycycline 100mg orally, 12 hoursly for 10 to 14 yearss. – With terrible disease: Azithromycin 500mg IV or orally, daily. PLUS Ciprofloxacin 400mg IV, 12-hourly. Pseudomonas aeruginosa It is a Gram-negative aerophilic bacteriums. Gentamycin 4 to 6 mg/kg for 1 dosage, so dosing interval is determined by nephritic map for a upper limit of either 1 or 2 extra doses. PLUS EITHER Ceftazidime 2g IV, 8-hourly. OR Meropenem 500mg to 1g IV, 8-hourly. Mycoplasma pneumoniae It is a Gram-negative facultative anaerobic bacteriums. Doxycycline 200mg orally, for the first dosage, followed by 100mg orally, daily.Mentions:FamilyDoctor.org [ home page on the Internet ] . Leawood, KS: American Acedemy of Family Physicians ; c2012 [ cited 2012 Sept 20 ] . Pneumonia ; [ about 9 screens ] . Available from: hypertext transfer protocol: //familydoctor.org/familydoctor/en/diseases-conditions/pneumonia.printerview.all.html American Lung Association [ home page on the Internet ] . Washington, DC: American Lung Association ; c2012 [ cited 2012 Sept 20 ] . Symptoms, Diagnosis and Treatment ; [ about 4 screens ] . Available from: hypertext transfer protocol: //www.lung.org/lung-disease/pneumonia/symptoms-diagnosis-and.html. eTG complete [ home page on the Internet ] . Victoria, Australia: Curative Guidelines Limited ; c2012 [ updated 2012 Jul ; cited 2012 Sept 20 ] . Available from: hypertext transfer protocol: //etg.tg.com.au.ezproxy.lib.monash.edu.au/conc/tgc.htm? id=27b1fc15b4331af2841f02ef96ddc67b Lab Trials Online [ home page on the Internet ] . Washington, DC: American Association for Clinical Chemistry ; c2001-2012 [ cited 2012 Sept 20 ] . Pneumonia ; [ about 4 screens ] . Available from: hypertext transfer protocol: //www.labtestsonline.org.uk/understanding/conditions/pneumonia/start/3 Monash University Studies Online [ home page on the Internet ] . Victoria, Australia: Monash University ; c2012 [ updated n.d. ; cited 2012 Sept 20 ] . Available from: hypertext transfer protocol: //muso.monash.edu.au/webct/urw/lc19907.tp0/cobaltMainFrame.dowebct The Ohio State University at Mansfield [ home page on the Internet ] . Mansfield, OHIO: The Ohio State University at Mansfield ; c2012 [ cited 2012 Sept 20 ] . Bacteria Binomials ; [ about 32 screens ] . Available from: hypertext transfer protocol: //www.mansfield.ohio-state.edu/~sabedon/biol4045.htm Rowlinson M. C, LeBourgeois P, Ward K, Song Y, Finegold S. M, Bruckner D. A. Isolation of a Strictly Anaerobic Strain of Staphylococcus epidermidis. J Clin Microbiol [ series on the Internet ] . 2006 March ; [ cited 2012 September 20 ] ; 44 ( 3 ) : [ about 12 screens ] . Available from: hypertext transfer protocol: //www.ncbi.nlm.nih.gov/pmc/articles/PMC1393158/Case Study 2:A definition of Epididymo-orchitis ( EO )Epididymo-orchitis is painful redness that involves either the epididymis ( epididymitis ) or the testiss ( orchitis ) or both together ( epididymo-orchitis ) [ 1,2 ] . Due to the fact that epididymis and testiss locate following to each other, distinguishing whether the redness merely affects one of these or both together can frequently be hard and therefore, epididymo-orchitis is the normally used term. Sexually transmitted infection such as gonorrhea or chlamydia is the most common cause of EO in younger work forces with the age of & lt ; 35 old ages old [ 1 ] . On the other manus, non sexually familial infection such as urinary piece of land infection is the chief cause of EO in older work forces aged 35 old ages old and above. It can normally be treated by antibiotics with full recovery in most instances without any complications [ 2 ] .( I ) Epididymo-orchitis can be acquired sexually or non-sexually ; supply a elaborateaccount of this statement.Epididymo-orchitis ( EO ) has both types of chief causes, viz. sexual causes and non-sexual causes. Sexual causes include sexually-transmitted infections, with chlamydial and gonorrhoeal infections being the most common 1s [ 2 ] . This is the most usual cause of EO in younger work forces although this can besides be the cause of EO in any work forces who are sexually active. In most instances of EO caused by sexually-transmitted infections, the urethra is normally affected and ensuing in urethritis, followed by the infections on occasion distributing down the vessel deferens and farther more to the testicle and epididymis, doing EO. Non-sexual causes include urinary piece of land infections, epidemic parotitiss virus, medicine, operations that involve the urethra or prostate, scrotum hurt and other viral infections, with urinary piece of land infection being the most common cause among thsee [ 2 ] . Urinary piece of land infections are normally caused by Gram-negative enteral bacteriums like E. coli which may on occasion distribute to the testicle and epididymis via the vessel deferens [ 2,3 ] . This affects all work forces at any age and is the most usual cause of EO in older work forces with the age of 35 old ages and supra. The ground behind this is that urine flow is normally being partly blocked with increasing age as a consequence of hypertrophied prostate or urethra narrowing, taking to higher hazard of developing urinary piece of land infection and therefore EO as complication. Mumps virus every bit good as other viruses doing viral infections may be able to make the testicles through the blood stream on occasion, and therefore, ensuing in epididymo-orchitis ( EO ) [ 2 ] . Medication such as Cordarone may besides hold the side consequence of doing EO which normally occurs with the dosage of more than 200mg. Operation which involves the prostate or urethra may present bacteriums into those sites from which the bacterium can distribute to the testicles and doing EO, although this cause is rare nowadays thanks to break surgical techniques.( two ) a list of the likely causative pathogens of EO ( sexually and non-sexuallyacquired ) and complete the following table [ 3,4,5,6,7,8,9,10 ] :Name of likely pathogenDescription of the pathogenis it gram negative or gram positive bacteriums?is it aerophilic or anaerobiotic?is it a fungus or virus?Which antibiotic ( s ) is this pathogen normally susceptible to?Sexually acquired:Chlamydia trachomatis It is a gram negative, aerophilic, intracellular bacteriums. Cefriaxone Azithromycin Doxycycline Neisseria gonorrhoeae It is a gram negative, aerophilic bacteriums. Cefriaxone Azithromycin DoxycyclineNON-sexually acquired:Escherichia coli It is a gram negative, facultative anaerobic bacteriums. Aztreonam Imipenem Mump virus It is a virus.–Haemophilus influenzae It is a gram negative, facultative anaerobic bacteriums. Chloramphenicol Doxycycline Ceftriaxone Moxifloxacin Neisseria meningitidis It is a gram negative, aerophilic bacteriums. Ciprofloxacin Ceftriaxone Penicillin Rifampin Mycobacteria TB It is a gram positive ( phylogenetically ) , stains acerb fast, aerophilic bacteriums. Isoniazid Rifampin PyrazinamideA list of the likely marks and symptoms of Epididymo-orchitisThe marks of epididymo-orchitis ( EO ) are [ 11 ] : Fever. Scrotal puffiness. Penile discharge. Groin hurting. Bloody seeds. Pain during interjection or intercourse. Tenderness and puffiness of the affected side ‘s groin country. Tenderness and puffiness of the testis associated with heavy feeling inside it. Pain in the testis exacerbated by striving or bowel motion. Pain associated with micturition. The symptoms of EO which may be seen upon physical scrutiny are [ 11 ] : Enlarged and stamp testis on the side affected. Enlarged or tender prostate secretory organ. Groin country of the affected side holding enlarged and tender lymph nodes.What other diagnostic trials would you anticipate to be hold been done or ordered for Mr Thompson to assistance in the diagnosing of EO?Other diagnostic trials which I expect to be hold been done or ordered are [ 11 ] : Testicular ultrasound Urinalysis Urine civilization ( clean gimmick ) which more than one sample might be required, inclusive of initial watercourse, midstream every bit good as following prostate massage. Screening trial for gonorrhoea and chlamydia via urethral vilification Susceptibility trial of the causative agents ( in the instance of bacterial cause ) .( I ) Which endovenous ( IV ) antibiotics would you urge for empiricalintervention of Mr Thompson ‘s Epididymo-orchitis and province the ground ( s ) for your pick?I would urge the undermentioned IV antibiotics for empirical intervention [ 12 ] : Gentamicin 4 to 6mg/kg IV, for 1 dosage, upper limit of 1 to 2 farther doses ‘ dosing interval is so determined based on nephritic map. PLUS Amoxycillin / ampicillin 2g IV, 6 hourly. The ground of taking these antibiotics is that Mr Thompson is most likely to acquire Epididymo-orchitis ( EO ) from a non-sexual cause and his EO is terrible, hence the recommended picks of antibiotics are short-run Garamycin and amoxycillin / Principen harmonizing to the eTG web site. However, as Principen can interact with Coumadin, potentially increasing the hazard of hemorrhage, amoxycillin which might merely somewhat increase the hazard of hemorrhage may be used in topographic point of it with supervising [ 12, 13 ] . Besides this, he is besides non holding hypersensitivity to penicillin and therefore, antibiotics belonging to this drug category can be used.( two ) Which trial consequences should be followed up in order to â€Å" direct † antimicrobictherapy?The trial consequences that should be followed up are [ 3,12 ] : Urine civilization Screening trial for gonorrhoea and chlamydia Susceptibility trial Testicular ultrasound of declaration of epididymo-orchitis is slow.( three ) If Mr Thompson ‘s clinical status improved and the physicians wanted to alter his IV antibiotics to an unwritten antibiotic, which one do you believe would be appropriate? List the guidance points you would supply for this antibiotic.I think cephalexin 500mg orally, 12 hoursly for the continuance of 14 yearss would be appropriate because the first-line antibiotic trimethoprim is non effectual [ 12 ] . The guidance points which I will supply are [ 14,15 ] : Try to take Keflex without nutrient, around 1 hr prior to meal or 2 hours after a repast. Take Keflex together with a full glass of H2O. It is rather common to see sickness, purging or diarrhea during intervention with Keflex. Be certain to take the full class of Keflex until finish even when experiencing better. If still see diarrhea ( watery and bloody stools ) 2 months or more after the last dosage of Keflex, contact physician in the shortest clip possible.( four ) What would be the entire continuance of intervention with antibiotics for Mr Thompson ‘s EO?Mr Thompson ‘s EO intervention with antibiotic will last for the entire continuance of 17 yearss [ 12 ] .( V ) Besides antimicrobic therapy what other therapy ( pharmacological and non- pharmacological ) should be portion of Mr Thompson ‘s intervention program?– Non-pharmacological therapy: Allow Mr Thompson to rest on bed with his scrotum elevated. Apply ice battalions to the affected scrotum country.What procedure would you set about to corroborate that Mr Thompson ‘s usual medicines are accurately prescribed on the admittance drug chart [ 16 ] ?I will transport out a Medicine Management Review. I will do verification with Mr Thompson sing to his medicine history which is obtained during his admittance to the infirmary, every bit good as with his community wellness attention supplier where appropriate. If possible, I will seek to corroborate each and every of Mr Thompson ‘s medicine history with a 2nd beginning following the undermentioned hierarchy of: Carer & gt ; Family & gt ; nursing place & gt ; ain medicines & gt ; community pharmacist & gt ; general practician ( GP ) . Beside this, I will facsimile the admittance drug chart for the intent of verification to Mr Thompson ‘s GP or community pharmacist if necessary. Furthermore, I will enter down what the physician planned for every listed medicines. I will besides do certain that all the listed medicines matches the medicines that are prescribed on the medicine chart and at the same clip, taking the physician ‘s program into history.Further informationName of drugExplanation of why you require this informationFor illustration: INR trial consequence Warfarin To look into if INR is within curative scope ; proctor for warfarin toxicity ; to find Coumadin dosage Blood force per unit area [ 17 ] Ramipril To guarantee that blood force per unit area is well-controlled within the normal scope. Serum Lanoxin degree, marks and symptoms of Lanoxin toxicity [ 17 ] Digoxin To guarantee that serum Lanoxin degree is within curative scope and to avoid Lanoxin toxicity. Heart rate [ 17 ] Amiodarone To supervise for any new marks of arrhythmia. Urine civilization / Susceptibility trial consequence [ 12 ] Gentamicin Amoxycillin / Principen Cephalexin To guarantee that the causative agents for the epididymo-orchitis is susceptible to these antibiotics and that they are suited antibiotic picks. Body weight, serum electrolytes [ 12 ] Frusemide To look into whether frusemide dose titration is required or non.There are legion possible drug related jobs in this instance ( & gt ; 10 ) . List of three ( 3 ) possible drug-related jobs associated with Mr Thompson ‘s medicine you, as the druggist, would expect and sketch how you would pull off them and/or proctor for them [ 13 ] .Digoxin and Cordarone: Problems: May take to digoxin toxicity ( such as sickness, cardiac arrhythmias and emesis ) . Management: Reduce Lanoxin dosage by around 50 % and supervise the serum Lanoxin degree every bit good as expression out for marks and symptoms of Lanoxin toxicity. If discontinuance of Lanoxin is possible so discontinue Lanoxin. Amiodarone and Coumadin: Problems: May increase the hazard of serious or even fatal hemorrhage. Management: Reduce the dosage of Coumadin by around 1/3 or 1/2 and supervise the factor II clip every bit good as INR value Amiodarone and isobutylphenyl propionic acid: Problems: May increase isobutylphenyl propionic acid ‘s plasma degree. Management: Caution with the concurrent usage of Cordarone and isobutylphenyl propionic acid. Monitor often for NSAID-related inauspicious effects and see seting the dosage of isobutylphenyl propionic acid.Mentions:Sexual Health [ home page on the Internet ] . Kingston upon Thames, Surrey: Sexual Health ; c2012 [ cited 2012 Sept 21 ] . Epididymo-orchitis ; [ about 4 screens ] . Available from: hypertext transfer protocol: //www.sexualhealthkingston.co.uk/sexual-health-information/stis/men/epididymo-orchitis Health Information and Advice [ home page on the Internet ] . England: Egton Medical Information Systems Limited ; c2012 [ cited 2012 Sept 21 ] . Epididymo-orchitis ; [ about 9 screens ] . Available from: hypertext transfer protocol: //www.patient.co.uk/health/Epididymo-orchitis.htm NZSHS [ home page on the Internet ] . New Zealand: The New Zealand Sexual Health Society Incorporated ; c2012 [ cited 2012 Sept 21 ] . Epididymo-orchitis_2009 ; [ about 3 pages ] . Available from: hypertext transfer protocol: //www.nzshs.org/treatment_guidelines/Epididyomo-orchitis_2009.pdf European Bioinformatics Institute [ home page on the Internet ] . Cambridge, UK ; c2012 [ cited 2012 Sept 21 ] . Chlamydia trachomatis ; [ about 2 screens ] . Available from: hypertext transfer protocol: //www.ebi.ac.uk/2can/genomes/bacteria/Chlamydia_trachomatis.html The Ohio State University at Mansfield [ home page on the Internet ] . Mansfield, OHIO: The Ohio State University at Mansfield ; c2012 [ cited 2012 Sept 20 ] . Bacteria Binomials ; [ about 32 screens ] . Available from: hypertext transfer protocol: //www.mansfield.ohio-state.edu/~sabedon/biol4045.htm NHS Clinical Knowledge Summaries [ home page on the Internet ] . High Holborn, London: National Institute for Health and Clinical Excellence ; c2011 [ cited 2012 Sept 20 ] . CKS Clinical Knowledge Summaries ; [ about 3 screens ] . Available from: hypertext transfer protocol: //www.cks.nhs.uk/scrotal_swellings/background_information/causes/epididymo_orchitis Chamberland S, L'Eeuyer J, Lessard C, Bernier M, Provencher P, Bergeron M. G, The Canadian Study Group. Antibiotic Susceptibility Profiles of 941 Gram-negative Bacteria Isolated from Septicemic Patients throughout Canada. Clin Infect Dis [ series on the Internet ] . 1992 Oct ; [ cited 2012 September 21 ] ; 15 ( 4 ) : [ about 15 pages ] . Available from: hypertext transfer protocol: //www.jstor.org.ezproxy.lib.monash.edu.au/stable/pdfplus/4456676.pdf? acceptTC=true Sill M. L, Tsang R. S. W. Antibiotic Susceptibility of Invasive Haemophilus influenzae Strains in Canada. Antimicrob Agents Chemother [ series on the Internet ] . 2008 April ; [ cited 2012 September 21 ] ; 52 ( 4 ) : [ about 7 screens ] . Available from: hypertext transfer protocol: //www.ncbi.nlm.nih.gov/pmc/articles/PMC2292521/ Cochrane Summaries [ home page on the Internet ] . Oxford, UK: The Cochrane Collaboration ; c2012 [ cited 2012 Sept 21 ] . Antibiotics for forestalling meningococcal infections ; [ about 2 screens ] . Available from: hypertext transfer protocol: //summaries.cochrane.org/CD004785/antibiotics-for-preventing-meningococcal-infections DUJS Online [ home page on the Internet ] . New hampshire: Dartmouth College Hanover ; c2008 [ cited 2012 Sept 21 ] . Antibiotic Resistance of Tuberculosis ; [ about 6 screens ] . Available from: hypertext transfer protocol: //dujs.dartmouth.edu/winter-2009/new-trickes-for-an-old-foe-the-threat-of-antibiotic-resistant-tuberculosis PubMed Health [ home page on the Internet ] . Bethesda, MD: National Center for Biotechnology Information ; c2012 [ cited 2012 Sept 21 ] . Orchitis ; [ about 5 screens ] . Available from: hypertext transfer protocol: //www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002259/ eTG complete [ home page on the Internet ] . Victoria, Australia: Curative Guidelines Limited ; c2012 [ updated 2012 Jul ; cited 2012 Sept 20 ] . Available from: hypertext transfer protocol: //etg.tg.com.au.ezproxy.lib.monash.edu.au/conc/tgc.htm? id=27b1fc15b4331af2841f02ef96ddc67b MicromedexA ® 2.0 [ home page on the Internet ] . U.S: Thomson Reuters ; c1974-2012 [ updated n.d. ; cited 2012 Sept 21 ] . Available from: hypertext transfer protocol: //www.thomsonhc.com.ezproxy.lib.monash.edu.au/micromedex2/librarian/ND_T/evidencexpert/ND_PR/evidencexpert/CS/5A8A78/ND_AppProduct/evidencexpert/DUPLICATIONSHIELDSYNC/75C929/ND_PG/evidencexpert/ND_B/evidencexpert/ND_P/evidencexpert/PFActionId/pf.HomePage University of Washington [ home page on the Internet ] . Seattle, Washington: University of Washington ; c2012 [ cited 2012 Sept 21 ] . Most Normally Prescribed Drugs Anti-Infectives [ about 61 pages ] . Available from: hypertext transfer protocol: //courses.washington.edu/pharm504/ABXPresentation.pdf DailyMed [ home page on the Internet ] . Bethesda, MD: U.S. National Library of Medicine ; c2012 [ cited 2012 Sept 21 ] . Keflex ( Cephalexin ) capsule [ Advancis Pharmaceutical Corporation ] ; [ about 14 screens ] . Available from: hypertext transfer protocol: //dailymed.nlm.nih.gov/dailymed/drugInfo.cfm? id=6490 # nlm34076-0 Department of Health [ home page on the Internet ] . Melbourne, Victoria: Department of Health ; c2012 [ cited 2012 Sept 21 ] . Medication Reconciliation – On Admission ; [ about 8 pages ] . Available from: hypertext transfer protocol: //www.health.vic.gov.au/sssl/downloads/qld_tool.pdf Medsafe Home Page [ home page on the Internet ] . Wellington: New Zealand Medicines and Medical Devices Safety Authority ; c2012 [ cited 2012 Sept 21 ] . Keep an Eye on Amiodarone Patients ; [ about 4 screens ] . Available from: hypertext transfer protocol: //www.medsafe.govt.nz/profs/puarticles/amiod.htm # AmiodaroneCase Study 3:A brief description of Tuberculosis ( TB ) and how it is transmitted.Tuberculosis ( TB ) is an infective bacterial disease which most often affects the lungs [ 1 ] . However it is besides able to impact other organic structure parts like the spinal column, kidney and encephalon [ 2 ] . Terbium can be fatal if it is non being treated decently. Patients with active Terbium can be treated by antibiotics intervention with the continuance of six months while patients with latent Terbium can besides be treated so that active TB will non develop [ 1,3 ] . Those patients with latent TB have a life-time hazard of 10 % to develop active TB disease and this hazard is m uch higher for those with compromised immune systems such as diabetic patients or HIV patients [ 1 ] . Terbium is transmitted from human to human via the air [ 3 ] . The TB bacterium is propelled into the air whenever a individual infected with active Terbium of the lungs or pharynx sneezings, speaks, coughs, tongues or sings [ 1,3 ] . Merely really few figure of the TB bacterium is required to be inhaled by another individual for that individual to be infected with it [ 1 ] . However, a individual who is infected with TB bacteriums but non yet manifest the disease ( latent TB ) will non convey the TB bacteriums to other individual.The likely pathogen ( s ) .The likely pathogen doing TB is the bacteriums Mycobacterium TB [ 1 ] .A list of those individuals at the greatest hazard for undertaking TB ; in peculiar in Mrs Rawat ‘s instance [ 1,2 ] .Young grownups who are in their old ages of extremum productiveness, in this instance, Mrs Rawat ‘s lone boy – Neel. Workers in installations or establishments where they are working aboard with other people who have high hazard of TB infection such as the nursing places, correctional installations and infirmaries. In this instance, Mrs Rawat herself and besides her colleagues in the local infirmary where she is working part-time. Patients who are immuno-compromised, particularly HIV patients. In this instance, certain patients ( those who have weakened immune system ) in the local infirmary where Mrs Rawat is working part-time. Tobacco users. Persons who are stateless. Injection drug users.The marks and symptoms of pneumonic TB [ 2 ] .Chest hurting Persistent bad cough that lasts more than 3 hebdomads, with blood or phlegm. Weight loss. Chills. Fatigue or failing. Loss of appetency. Sweating at dark.The diagnostic trials ( microbiological, radiological etc ) and clinical information used to corroborate the diagnosing of TB [ 2 ] .Tuberculin skin trial ( besides known as the Mantoux tuberculin skin trial ) : It is carried out by shooting a little sum of tuberculin into the lower portion of the arm ‘s tegument. After around 48 to 72 hours, qualified wellness attention worker will look for country that is raised, difficult or swollen. If such country is present, its size will be measured by utilizing a swayer. The inflammation entirely is non considered as portion of the reaction. This trial ‘s consequence is dependent on the size of such country mentioned above every bit good as the hazard of the individual being tested to be infected with TB ( TB ) bacterium and if the individual being tested is infected, the patterned advance towards TB disease. A positive trial consequence will intend that the individual being tested is infected with TB bacteriums. However, whether the infection is latent TB or active Terbium can non be determine by this trial. In add-on, this trial may give a false positive trial consequence for some people who have received the bacille Calmette-Guerin ( B CG ) vaccinum for TB disease earlier, hence extra trials may be needed in instances of positive trial consequence for this trial. TB blood trial ( besides known as the interferon-gamma release checks ( IGRAs ) ) : This trial chiefly measure the responsiveness of the immune system of the individual being tested towards the causative bacterium for TB by making blood proving in the research lab. Presently there are two IGRAs that have been approved by the U.S. Food and Drug Administration ( FDA ) which are QuantiFERONA ®-TB Gold In-Tube trial ( QFT-GIT ) and T-SPOTA ®.TB trial ( T-Spot ) . A positive trial consequence will bespeak that the individual being tested is infected with TB bacteriums. This trial nevertheless, will non be able to find the TB infection is active TB or latent TB. For people who have received the BCG vaccinum for TB disease and those who ca n't happen appropriate clip for 2nd assignment of tuberculin skin trial, this trial is the preferable trial method. Medical history: Patient ‘s TB exposure, disease, or infection history is obtained. Demographic factors such as age, origin state and business which may increase the exposure hazard of the patient to TB are besides considered. In add-on, medical conditions of the patient which may besides increase the hazard of the development of latent TB infection to active TB disease are besides determined. Physical scrutiny: This might give of import information sing the patient ‘s overall status every bit good as other factors which can alter the TB intervention program. For illustration, HIV infection position. Chest radiogram: This is for the sensing of thorax abnormalcies. In instances of TB infection, lungs lesion may appears anyplace in different form, size, denseness and cavitation. This is deficient to definitively name TB but can be used in a individual who has had positive trial consequence in the tuberculin skin trial or TB blood trial in order to govern out the possibility of that individual holding pneumonic TB. Diagnostic Microbiology: The presence of TB disease can be indicated by acid-fast-bacilli ‘s ( AFB ) presence on a phlegm vilification or any other specimen. Confirmation of the TB diagnosing can non be made based on acid-fast microscopy entirely although it is speedy and easy due to the fact that non all acid-fast-bacilli are M. TB. For this ground, civilization of all the initial samples, irrespective of their AFB vilification consequences is needed to corroborate the TB diagnosing. A positive M. TB civilization confirms the TB disease diagnosing. Drug opposition: All the initial M. TB isolated from every patients is required to undergo drug immune trial every bit early as possible so as to guarantee the most effectual intervention for the patients. For those TB patients who do non demo sufficient response to intervention or those who still have positive civilization consequences following intervention that lasted for three months or more, this trial should be repeated.Once the diagnosing of TB has been confirmed Mrs Rawat will be commenced on an anti-TB drug regimen. In your presentation address the followers:( I ) What is the handling doctor obligated to make by jurisprudence?The treating doctor is obligated by jurisprudence to describe both clinically suspected and besides confirmed TB instances to the designated section within the timeframe of 24 hours [ 2 ] . Depending on provinces, the handling doctor might be besides obligated to describe non-adherent patients with TB, where non-adherent might include intervention surcease, go forthing the infirmary against medical advice or failure in following to intervention program every bit good as other preventative steps to avoid TB transmittal [ 2 ] .( two ) List the drugs ( and the day-to-day dosage of each ) that you think Mrs Rawat will be commenced on for standard short-course therapy of TB. Using the tabular array below, for each of the four drugs used in the standard short-course therapy of TB outline the followers:Name of the drug & A ; dose [ 4 ]List the common side effects [ 5,6 ]Main guidance points you would supply to the patient about this drug- in point signifier [ 7,8,9 ] .Isoniazid 300mg orally, daily for 6 months. Peripheral neuropathy, GI upset, metabolic alterations, blood dyscrasias, hepatic alterations, vitamin B6 lack. Be certain to take all the medicine boulder clay coating. Avoid ingestion of intoxicant to forestall farther liver harm. Take on an empty tummy, at least half an hr before repasts and at bedtime. Rifampicin 600mg orally, daily for 6 months. Itching, concern, confusion, diarrhea, vision alterations, giddiness, flushing, sleepiness, behavior alterations, tummy spasms, piss, perspiration, phlegm, and cryings ruddy stain. Be certain to take all the medicine boulder clay coating. If tegument or eyes develop xanthous stain or if urine discolours to cola coloring material, contact physician every bit shortly as possible. May cause perspiration, urine and cryings to hold orange stain which is non harmful. Avoid have oning contact lenses because rifampicin can stain them for good. Avoid ingestion of intoxicant to forestall farther liver harm. Take on an empty tummy, at least half an hr before repasts and at bedtime. Ethambutol 750mg orally, daily for 2 months. Appetite loss, tummy disturbance, purging, custodies or pess numbness and prickling due to peripheral neuritis. Be certain to take all the medicine boulder clay coating. Avoid ingestion of intoxicant to forestall farther liver harm. Avoid from taking alkalizers together with ethambutol, infinite more than 2 hours apart. Pyrazinamide 1500mg orally, daily for 2 months. Stomach disturbance, weariness. Be certain to take all the medicine boulder clay coating. Avoid ingestion of intoxicant to forestall farther liver harm.( three ) Which of the four anti-TB drugs in the standard short-course therapy causes peripheral neuritis? What extra addendum is prescribed at the same time to prevent/ minimise this inauspicious consequence from happening?Isoniazid, ethambutol, rifampicin and pyrazinamide can do peripheral neuritis [ 7, 10 ] . Pyridoxine ( vitamin B6 ) can be prescribed at the same time to prevent/ minimise peripheral neuritis from happening [ 11 ] .( four ) Prior to the first dosage of the antecedently mentioned anti-TB drugs, Mrs Rawat will necessitate to undergo a series of pre-therapy trials and baseline measurings ; name these trials and briefly explain the ground for each.Name of pre-therapy trial [ 4 ]Name of drug ( where relevant )Explanation of why this information/ trial is requiredWeight Rifampicin, ethambitol, pyrazinamide [ 4 ] To find the appropriate antibiotics dose to be use [ 4 ] . Liver map trials Isoniazid + rifampicin, pyrazinamide [ 12 ] To supervise for hepatotoxicity potentially caused by the TB drugs [ 12 ] . Nephritic map trials Ethambutol [ 4 ] To supervise nephritic clearance and prevent accretion of ethambutol in the organic structure if nephritic clearance diminutions [ 4 ] . Ocular sharp-sightedness Ethambutol [ 4 ] To supervise for marks of optic toxicity [ 4 ] . Colour vision proving Ethambutol [ 4 ] To supervise for marks of optic toxicity [ 4 ] . Full blood count To supervise for anemia, neutropenia and lymphocytopenia [ 13 ] . HIV proving after appropriate guidance Rifampicin [ 4 ] To find the hazard of rapid patterned advance of TB disease / reinfection and besides possible important drug interactions with antiretroviral drugs in instance of HIV-positive [ 4, 14 ] . Screening for chronic viral hepatitis ( B and C ) Isoniazid + rifampicin, pyrazinamide [ 12 ] To find the hazard of hepatotoxicity potentially caused by the TB drugs [ 12 ] .( V ) Use the Cockcroft-Gault expression to cipher Mrs Rawat ‘s Creatinine Clearance and province the dosage ( s ) of the medicine ( s ) you would give Mrs Rawat.Ideal organic structure weight = 57.2kg Age = 60kg Height = 165cm Serum creatinine = 260 micromol / L Creatinine clearance = 0.85 = 18.38 milliliters / min – Ethambutol ‘s dose demands to be changed to 600mg orally, daily for 2 months [ 4 ] .( six )Name callings of the interacting drugs [ 15 ]Mechanism of the drug interaction & A ; clinical consequence [ 15 ]Clinical direction [ 15 ]Rifampicin – Cardizem Cadmium Rifampicin may bring on the metamorphosis of cardizem CD, doing loss of the consequence of Ca channel blocker and hence, might ensue in clinical marks and symptoms of angina or high blood pressure. Increases the dosage of cardizem Cadmium. Rifampicin – Losec Rifampicin might bring on the CYP2C19 and CYP3A4-mediated metamorphosis of Losec, ensuing in reduced Losec plasma concentrations. Avoid from utilizing Losec together with rifampicin.( seven ) If Mrs Rawat was 26 old ages old and on no regular medicines what other factors do you necessitate to see when make up one's minding on anti-TB therapy?The other factors which I need to see are whether [ 4 ] : Are the causative beings for the disease susceptible to rifampicin, INH and pyrazinamide? Is all drugs included in the regimen able to be tolerated by Mrs Rawat and that she is able to to the full adhere to the intervention? Is there grounds screening disseminated or cardinal nervous system TB? Is there presence of extended cavitation on the initial thorax X ray? Is there satisfactory response to the intervention? Is Mrs Rawat is pregnant and/or suckling?*Why is it of import to follow up these trial consequence?It is of import to follow up these trial consequence because of drug immune concern. It is of import at all clip to utilize multidrug regimens to cover the likeliness of initial drug opposition every bit good as forestalling immune beings from emerging [ 4 ] .*On obtaining these consequences, which of the four anti-TB therapy drugs could perchancebe ceased and under which fortunes?Ethambutol can be perchance ceased if the lab trial consequence showed an TB isolate which is susceptible to isoniazid and rifampicin [ 16 ] .As a druggist what could you make to promote or help Mrs Rawat ‘s conformity with all her medicines? How could you supervise patient conformity?I will explicate to Mrs Rawat about the intent of each and every of her medicines, every bit good as their name, dosing frequence, dose, common side effects and besides their timing of disposal [ 17 ] . After that, I will h old Mrs Rawat reiterating back to me the information which I have told her and besides inquire her inquiries sing what she is non able to understand. In add-on, I will seek to set up follow-up with her and inquire her about how is her medicine-taking traveling on. I will besides measure her chance of non-adherence through the usage of validated tools like the Morisky medicine attachment questionnaire if the expected clinical effects of her medicines do non look to be at that place. Following this, I will turn to every of her concerns or jobs which result in non-adherence and at the same clip, normalize and sympathize with her in order to promote her responses. I will besides supply her dose disposal AIDSs as appropriate so that it will be much easier for her to hive away and cognizing when to take her medicines every bit good as their dose. I can besides affect her household members such as her hubby or her boy in bettering her medicines attachment by reminding her to take her medic ines at the dosing clip. Last, I will stress on the effects if she fails to take her medicines as indicated, particularly on wellness effects and the ultimate impacts on her households. I could supervise her conformity by oppugning her regarding pill taking or through other methods for illustration, pill numeration and urine drug proving if appropriate and available ( urine should be discoloured to orange coloring material for the minimal continuance of 6 hours since last rifampicin dosage and may even show over 12 hours ) [ 4 ] . Other than these, the Morisky medicine attachment questionnaire can be used for this purpose [ 17 ] .Briefly list in point signifier the on-going monitoring should be undertaken whilst Mrs Rawat is on anti-TB therapy drugs? ( specific to TB drugs merely, for the intent of this instance ) [ 4 ] .Attachment to the anti-TB therapy drugs. Sputum civilization ( if phlegm is still being produced ) . Ocular sharp-sightedness and color vision monitoring every bit good as monitoring of ocular symptoms ( while she is still taking ethambutol ) . Liver map trials. Her organic structure weight. Nephritic map trials.Mentions:World Health Organization [ home page on the Internet ] . Geneva, Switzerland: World Health Organization ; c2012 [ cited 2012 Sept 22 ] . Tuberculosis ; [ about 3 screens ] . Available from: hypertext transfer protocol: //www.who.int/topics/tuberculosis/en/ Centers for Disease Control and Prevention [ home page on the Internet ] . Atlanta, GA: Centers for Disease Control and Prevention ; c2012 [ updated n.d. ; cited 2012 Sept 22 ] . Available from: hypertext transfer protocol: //www.cdc.gov/ MedlinePlus [ home page on the Internet ] . Bethesda, MD: U.S. National Library of Medicine ; c2012 [ cited 2012 Sept 22 ] . Tuberculosis: MedlinePlus ; [ about 6 screens ] . Available from: hypertext transfer protocol: //www.nlm.nih.gov/medlineplus/tuberculosis.html eTG complete [ home page on the Internet ] . Victoria, Australia: Curative Guidelines Limited ; c2012 [ updated 2012 Jul ; cited 2012 Sept 20 ] . Available from: hypertext transfer protocol: //etg.tg.com.au.ezproxy.lib.monash.edu.au/conc/tgc.htm? id=27b1fc15b4331af2841f02ef96ddc67b MIMS Online [ home page on the Internet ] . London, England: UBM Medica Ltd ; c2012 [ updated Sept 2012 ; cited 2012 Sept 22 ] . Available from: hypertext transfer protocol: //www-mimsonline-com-au.ezproxy.lib.monash.edu.au/Search/Search.aspx MedlinePlus [ home page on the Internet ] . Bethesda, MD: U.S. National Library of Medicine ; c2012 [ cited 2012 Sept 22 ] . Rifampin: MedlinePlus Drug Information ; [ about 6 screens ] . Available from: hypertext transfer protocol: //www.nlm.nih.gov/medlineplus/druginfo/meds/a682403.html HRSA HIV/AIDS Programs [ home page on the Internet ] . U.S: U.S. Department of Health and Human Services ; c2012 [ cited 2012 Sept 22 ] . Mycobacterium TB ; [ about 19 screens ] . Available from: hypertext transfer protocol: //hab.hrsa.gov/deliverhivaidscare/clinicalguide11/cg-623_mycobacterium_tb.html Sansom L. N, editor. Australian pharmaceutical pharmacopeia and enchiridion. 21st erectile dysfunction. Canberra: Pharmaceutical Society of Australia ; 2009. BC Centre for Disease Control [ home page on the Internet ] . British Columbia, Canada: BC Centre for Disease Contorl ; c2012 [ cited 2012 Sept 22 ] . Ethambutol [ about 1 page ] . Available from: hypertext transfer protocol: //www.bccdc.ca/NR/rdonlyres/F59D94C9-BDFC-4E2D-A8DB-C915F1FE8660/0/EthambutolCounsellingSheet_Field.pdf World Health Organization [ home page on the Internet ] . Geneva, Switzerland: World Health Organization ; c2012 [ cited 2012 Sept 22 ] . WHO Public Assessment Report ; [ about 2 pages ] . Available from: hypertext transfer protocol: //apps.who.int/prequal/WHOPAR/WHOPARPRODUCTS/TB180part1v1.pdf University of Pennsylvania Health System [ home page on the Internet ] . Philadelphia, PA: Penn Medicine ; c2012 [ cited 2012 Sept 22 ] . Guidelines for the Management of Adverse Drug Effects of Antimycobacterial Agents ; [ about 60 pages ] . Available from: hypertext transfer protocol: //www.uphs.upenn.edu/TBPA/treatment/managingsideeffects.pdf Thompson N. P, Caplin M. E, Hamilton M. I, Gillespie S. H, Clarke S. W, Burroughs A. K, Mclntyre N. Anti-tuberculosis medicine and the liver: dangers and recommendations in direction. Eur Respir J [ series on the Internet ] . 1995 ; [ cited 2012 September 22 ] ; 8: [ about 5 pages ] . Available from: hypertext transfer protocol: //erj.ersjournals.com/content/8/8/1384.full.pdf Jemikalajah J. D, Okogun G. A. Hematological indices in human immunodeficiency virus and pneumonic TB infections in parts of Delta State, Nigeria. Saudi Med K [ series on the Internet ] . 2009 ; [ cited 2012 September 22 ] ; 30 ( 2 ) : [ about 4 pages ] . Available from: hypertext transfer protocol: //www.smj.org.sa/PDFFiles/Feb09/13Hema20080806.pdf HIV InSite Gateway to HIV and AIDS Knowledge [ home page on the Internet ] . San Francisco: University of California ; c2012 [ cited 2012 Sept 22 ] . Tuberculosis and HIV ; [ about 30 screens ] . Available from: hypertext transfer protocol: //hivinsite.ucsf.edu/InSite? page=kb-05-01-06 # S3X MicromedexA ® 2.0 [ home page on the Internet ] . U.S: Thomson Reuters ; c1974-2012 [ updated n.d. ; cited 2012 Sept 22 ] . Available from: hypertext transfer protocol: //www.thomsonhc.com.ezproxy.lib.monash.edu.au/micromedex2/librarian/PFDefaultActionId/evidencexpert.ShowDrugInteractionsResults Heartland National TB Center [ home page on the Internet ] . San Antonio, TX: Heartland National TB Center ; c2012 [ cited 2012 Sept 22 ] . Diagnosis & A ; Medical Management of TB Disease ; [ about 76 pages ] . Available from: hypertext transfer protocol: //www.heartlandntbc.org/training/archives/tbnucama_20120718_1040.pdf American Medical Association [ home page on the Internet ] . Chicago, IL: American Medical Association ; c2012 [ cited 2012 Sept 22 ] . Tacticss to better drug conformity ; [ about 13 screens ] . Available from: hypertext transfer protocol: //www.ama-assn.org/amednews/2011/10/03/prsa1003.htmCase study 4:What is morbific endocarditis? Explain the difference between complicated and uncomplicated.Infective endocarditis ( besides known as bacterial endocarditis ) is an infection which affects that bosom ‘s interior liner ( endocardium ) or the bosom valves [ 1 ] . It happens at the damaged site of endocardium or bosom valves where there is thrombocytes and fibrin depositions. When certain micro-organisms ( most frequently bacteriums, but besides can be fungi or other bugs sometimes ) gained entry into the blood watercourse and colonise on the thrombocyte and fibrin deposition site, flora will be formed and this can take to morbific endocarditis [ 1,2 ] . The consequence from this i s holes or growings on the bosom valves or the valve tissue will hold scarring, both of which will take to a leaky bosom valve [ 1 ] . If left untreated, it may ensue in decease [ 2 ] . Complicated morbific endocarditis is when big flora or multiple emboli are involved [ 2 ] . If the morbific endocarditis patient has experienced the symptoms of morbific endocarditis for over 3 months or has experienced secondary infected events, the morbific endocarditis is besides complicated. Otherwise, the morbific endocarditis will be unsophisticated morbific endocarditis.In Simon ‘s instance what would you anticipate the likely pathogens to be?I would anticipate the likely pathogens to be Staph. aureus, unwritten streptococcus and entercococci, Gram-negative ( enteral ) rods, Fungis ( chiefly Candida ) or coagulase-negative staphylococcus [ 2 ] .List the marks ( that may be seen on physical scrutiny ) and symptoms of morbific endocarditis.– The marks of morbific endocarditis are [ 2 ] : Heart mutter Petechia Janeway lesions ( ruddy musca volitanss that are present on the thenar of custodies and pess ‘s colloidal suspensions ) Osler ‘s nodes ( painful ruddy sores that present on finger tips and toes ) – The symptoms of morbific endocarditis are [ 2, 3 ] : Fever Unusual weariness Night workout suits Loss of weight Muscle achings and strivings ( in ague morbific endocarditis ) Flu-like symptoms ( in ague morbific endocarditis ) Heart failure symptoms ( in chronic morbific endocarditis ) Joint hurting ( in chronic morbific endocarditis )Outline the diagnostic trials, blood trials, microbiological trials etc that would be used to corroborate the diagnosing of morbific endocarditis and â€Å" direct † antibiotic therapy.Patient ‘s clinical physical scrutiny and besides showing ailment ‘s history [ 2 ] . – This helps with the diagnosing and besides narrow down the range of likely causative pathogen. Using stethoscope to listen to bosom [ 2, 3 ] : – This is to enable physician to listen to the patient ‘s thorax for distinguishable sound that indicates new bosom mutter or sound alteration in old bosom mutter. The cause of bosom mutters are the defective bosom valves ‘ sound and certain bosom defects. Blood civilizations [ 2, 3 ] : – Different organic structure country ‘s blood samples are taken to find the presence of any pathogen in the blood stream. This is besides done to find the exact causative pathogen and besides the pathogen ‘s sensitiveness to different antibiotics for intervention. Echocardiography [ 3 ] : – This is used to detect valve construction and map, every bit good as bosom wall gesture and besides the overall bosom size. This trial is the most dependable diagnosing trial so far for morbific endocarditis. Chest x-ray [ 2 ] : – This is used to look out for any grounds that indicates cardiac failure. Urine dipstick [ 2 ] : – This is for the sensing of any hematuria & A ; proteinuria which are the clinical characteristics showing in 60 % to 70 % of morbific endocarditis instances. Temperature [ 1, 2 ] : – This is to look into for the presence of febrility which is one of the chief symptoms of morbific endocarditis. Serum urea & A ; electrolytes [ 2 ] : – This is to look into for any nephritic damage.What empirical endovenous ( IV ) antibiotic regimen would you anticipate Simon to be commenced while expecting the microbiology consequences? Specify the doses for each of the antibiotics.The empirical endovenous ( IV ) antibiotic regimen that I expect Simon to be commenced is [ 4 ] : Benzylpenicillin 1.8g IV, 4 hourly. PLUS Di/flucloxacillin 2g IV, 4 hourly. PLUS Gentamicin 420mg IV, for 1 dosage, followed by the finding of dosing interval for either 1 or 2 extra doses harmonizing to Simon ‘s nephritic map.At this point in clip, which antibiotic would you anticipate Simon to be prescribed? What would be the expected continuance of intervention?I would anticipate Simon to be prescribed di/flucloxacillin 2g IV, 4 hourly [ 4 ] . The expected intervention continuance is 4 hebdomads although in Simon ‘s instance, the continuance may be shorten to 2 hebdomads if there is microbiological and clinical response in the clip period of 72 to 96 hours since the beginning of the antibiotic intervention.If methicillin-resistant staphylococci aureus was the causative pathogen in Simon ‘s instance:( I ) Which IV antibiotic would you anticipate to be prescribed?I would anticipate the IV antibiotic, Vancocin to be prescribed [ 2, 4 ] .( two ) Is this antibiotic chiefly cleared by the kidneys or the liver?This antibiotic is chiefly cleared by t he kidneys [ 4 ] .( three ) At what dosage ( given that Simon ‘s creatinine clearance is 116ml/min ) ?1.5g every 12 hours [ 4 ] .( four ) How would this drug be administered and why?This drug would be administered intravenously because it has a really low unwritten bioavailability and hence, it must be given intravenously for the intervention of systemic infections such as morbific endocarditis in order for it to be effectual [ 5, 6 ] .( V ) What curative drug monitoring is involved when utilizing this antibiotic? When should the first trough degree be taken? What is the mark trough degree?The curative drug monitoring that is involved is vancomycin trough concentrations measurement [ 4 ] . The first trough degree should be taken before the 4th or the 5th Vancocin dosage and the mark trough degree is 15 3mg/L.( six ) If the consequence of the trough degree was 27mg/L, how would you construe this consequence? Would you urge a dose accommodation? If yes, what would it be?This tro ugh degree consequence is higher than the recommended mark trough concentrations for Simon [ 4 ] . I would urge a dose accommodation and adjust the Vancocin dosage to: = 0.83g = ~0.8g