The Art of Balancing Assignment Example | Topics and Well Written Essays - 750 words

The Art of Balancing - Assignment Example The examples of such scenarios are rampant around the world, where a few people have decided that there exists a need for change and have gone about it the wrong way resulting in utter failure which has had dire consequences for their cause. This essay discusses the works and leadership tactics of one of the greatest change leaders of our times, Nelson Rolihlahla Mandela, who lead his nation out of the darkness of the Apartheid and into the burgeoning future, and who has been called one of the most instrumental and inspirational politicians of this century. One of Mandela’s most striking aptitude had been the ability to stay calm under intense pressure and to keep his fear under check so that those who followed him could go. According to Stengel (2008), it was not Mandela’s absence of fear, rather his ability to move beyond it, that managed to make him such an inspirational role model for his people. Researchers such as Groves (2006), note that emotional expressivity is one of the most important skills that a visionary leader has and that it directly affects the level of influence that leader has on the actions of his followers. Hence a leader and his ability to express his emotions a certain way under varying circumstances have a direct impact on the way his followers will react to that same situations. The great leader claims himself that there were many times during his imprisonment in the Robben Island jail, that he was afraid for his life and for the life of the revolutionary change that he wanted to create, but it was his ability to focus beyond the fear which allowed him to maintain and keep strong the faith of those who looked up to him as their leader. As the leader of the African National Congress, and has led an armed struggle against the government, it was to his fellows a great shock when Mandela began negotiations with the government during his imprisonment.  

Sinusitis Care Plan Essay Example for Free

Sinusitis Care Plan Essay This therapeutic care plan will utilized the â€Å"I can treat and prescribe framework† to ensure that appropriate patient treatments are selected using a step by step approach, including assessment integration, drug and/or disease related problems, therapeutic goals, therapeutic alternatives and indications, plan of care and evaluation (OPHCNPP, 2012). By going through each step of this framework, and including or excluding treatment options based on individual patient factors and strong clinical evidence, this clinician will arrive at the most suitable treatment plan for the patient. H.K (32 year old male) presented with persistent facial pain for 7 days. He reported having a headache (6/10 on a pain scale) upon bending forward and awakening, occasional tooth pain, no nasal drainage, and no cough. H.K denied fever or chills but admitted to feeling â€Å"run-down†. His past medical history included varicella zoster at age 5 years, seasonal allergic rhinitis (pollen), viral respiratory tract symptoms 2 weeks ago (now resolved), and no recent antibiotic use over the past 3 months. He is married with two children who are not in daycare (ages 8 and 9). H.K is a supermarket manager, non-smoker, and denied substance abuse. The patient reported having private prescription drug coverage but was only taking Advil cold and sinus (2 tablets orally every 6 hours as required) with good effect. H.K’s vitals were taken (temp. 37.5 °C tympanic, HR 74 reg., R 12 reg. and equal). His head and neck examination revealed that his sclera were clear and his pupils were r ound, reactive to light with accommodation. There was tenderness to palpation of the frontal and maxillary sinuses. Transillumination of the right and left maxillary sinuses revealed an opaque surface. His nares were erythematous and edematous with no obvious discharge. There was cobblestoning of the pharynx with slight erythema. His tonsils were two plus in size with no exudates. His neck examination revealed the absence of lymphadenopathy, the thyroid was non-palpable, and his chest examination revealed clear lung fields. The diagnosis of acute sinusitis was made based on H.K’s presenting signs and symptoms. The two most common predisposing events for acute bacterial sinusitis are acute viral upper respiratory infections and allergic inflammation (80% and 20% of bacterial infections, respectively) (Desrosiers et al., 2011). Complications of sinusitis are very rare and are estimated to occur in 1 in 1,000 cases (Hwang, 2009). In complicated sinusitis, the orbit of the eye is the most common structure involved and is usually caused by ethmoid sinusitis (Hwang, 2009). Patients who present with visual symptoms (diplopia, decreased visual acuity, disconjugate gaze, difficulty opening the eye), severe headache, somnolence or high fever should be evaluated with emergent care suspected (H.K had none of these symptoms) (Hwang, 2009). Most adult patients diagnosed with acute sinusitis become well or nearly well after 7 to 10 days, but 25% are still symptomatic after 14 days (Worrall, 2011). H.K had no untreated medical conditions contributing to his acute sinusitis (not pollen season). A primary health care nurse practitioner can effectively diagnose, treat and manage adults who have symptoms like H.K according to the Nurse Practitioner Practice Standard of Ontario (CNO, 2011). His condition was not life threatening and did not necessitate a referral to a physician, specialist or transfer of care. H.K was taking Advil cold and sinus, a drug that was appropriately dosed (1-2 tablets orally every 6 hours as required to a maximum of 6 tablets in 24 hours), which is clinically indicated for sinus pain in adults and is not too complex (CPA, 2013). This drug was deemed safe for him after a review of contraindications, including hypersensitivity to the agent, nonsteroidal anti-inflammatory drug-induced (NSAID) asthma or urticartia, aspirin triad, pre-operative coronary bypass surgery, coronary artery disease, monoamine oxidase inhibitor use within 14 days, uncontrolled or severe hypertension, and urinary retention (Epocrates, 2013). For H.K, the oral route of medication administration was most appropriate, the least invasive and the easiest way for an adult to take drugs (Brophy et al, 2011). Advil cold and sinus is not a cytochrome P450 system inhibitor, which is the main (or partial) cause for large differences in the pharmacokinetics of other drugs (Rx Files, 2012, Epocrates, 2013). The patient was not taking borrowed prescriptions, using drugs from previous occurrences of the condition, or experiencing any adverse drug events/reactions to Advil cold and sinus. Also, he was not being double dosed or experiencing therapeutic duplication of drugs belonging to the same pharmaceutical class. H.K had no untreated medical conditions (other than his new acute sinusitis), was not taking drugs prescribed by other clinicians and there were no other factors (communication errors, non-adherence, financial restrictions) influencing his ability to receive medication. Antibiotic therapy should be reserved for patients with acute bacterial sinusitis as defined by a complete history and physical examination (AMA, 2008). A â€Å"wait and see† approach has been suggested in recent Canadian guidelines as a means of differentiating bacterial sinusitis from a viral respiratory tract infection (Desrosiers et al., 2011). Initiation of treatment should take place 7 to 10 days after persistent symptoms or when signs compatible with acute sinusitis occur (Desrosiers et al., 2011). Since H.K’s facial pain had lasted for 7 days, the decision was made with the patient to treat. Goals of care were established (with the patient) including maximizing symptom relief (especially drainage of congested sinuses), eradication of infection, and prevention of re-occurrence and complications (Fryters Blondel-Hill, 2011). Five drug choices were selected and scrutinized as potential treatment options for H.K, including first and second line therapies (appendix 1) (ARP, 2012). The primary bacterial pathogens involved in the development of acute sinusitis for adults are Streptococcus pneumonia and Haemophilus influenzae (AMA, 2008). Canadian antimicrobial resistance data of S. pneumoniae describes that penicillin resistance rates range from 14% to16% in Central Canada (Powis et al., 2004). Amoxicillin is a first line drug therapy that remains active against S. pneumoniae with the rate of resistance under 2% (Brook et al, 2006) and also retains the best coverage of oral beta-lactam agents against S. pneumoniae (AMA, 2008). It is available in a capsule, chewable tablet or powder for oral suspension (H.K had no dysphagia and preferred to take capsules) (CPA, 2013). Amoxicillin should not be prescribed to a patient more than once in a 3-month period (H.K had not taken it in the last 3 months) (ARP, 2012). This drug is acid resistant, rapidly absorbed after oral administration, and is stable in the presence of gastric acid allowing for adequate systemic concentr ations (H.K was not taking drugs that affect gastric acid production) (CPA, 2013). Pertinent adverse affects of the drug are diarrhea, nausea, headache, vomiting, abdominal pain, anaphylaxis, anemia, AST/ALT elevation, mucocutaneous candidiasis, rash and pseudomembranous colitis (Medscape Reference, 2013). Amoxicillin is contraindicated with anaphylaxis reaction to penicillins or cephalosporins (Epocrates, 2013). Several cautions to consider when prescribing amoxicillin to H.K include him having clostridium difficile infection, infectious mononucleosis (result is skin rash), bacterial/fungal superinfections, allergy to cephalosporins, and carbapenems, (Medscape Reference, 2013). Also, serious drug interactions include bcg/typhoid vaccine live, doxycycline, minocycline, probenecid and tetracycline (Epocrates, 2013). H.K did not have any of the contraindications, cautions, or potential medication interactions relevant to taking amoxicillin, so it was deemed safe for him to take. Amoxicillin was selected as a treatment option for H.K (appendix 1). The three times a day (500 mg) option was selected to ensure simplicity, when compared to the 875 mg twice a day option that would require H.K to take two possibility identical capsules (a 500 mg and a 250 mg), increasing the likelihood of medication error (Epocrates, 2013). A primary concern for individuals infected with H. influenzae is ampicillin resistance, mediated by the production of a beta-lactamase, which is produced by approximately 19% of the bacteria (Zhanel et al, 2003). H. influenzae remains predictably susceptible to amoxicillin-clavulanate (a second line therapy) which possesses the added benefit of stability against beta-lactamases and cephalosporins (Tristam et al, 2007). Amoxicillin-clavulanate is also effective against most penicillin-resistant S. pneumoniae (MacGowan et al., 2004). It has enhanced gram positive activity and should be used in patients where risk of bacterial resistance is high, consequences of failure of therapy are greatest, or for patients not responding to first-line therapy (DeRosiers, et al, 2011). Common side effects of this drug are nausea, vomiting, diarrhea, rash and uticartia (Poole-Arcangelo Peterson, 2013; Rx Files, 2013). Higher rates of diarrhea and other gastrointestinal side effects occur with amoxicillin-clavulanate than with amoxicillin alone (Burns et al., 2009). It is also considered a more costly sinusitis treatment (ARP, 2012; Rx Files, 2012). Amoxicillin-clavulanate was added as a treatment option for H.K (see appendix 1). The clinician selected the two times a day option (875 mg) because the clavulanic acid daily dose is less, resulting in a decreased likelihood of the patient experiencing adverse effects co mpared with a more frequent dosing schedule option such as every 8 hours (Rx Files, 2012). As a result of activity against beta-lactamase–producing H. influenza and S. pneumonae (Zhanel Lynch, 2009), cefprozil and cefuroxime axetil have a second line treatment role in acute sinusitis (ARP, 2012). With the expanded spectrum of activity, ability to achieve adequate concentrations in tissues, suitability for twice-daily dosing, favorable toxicity profile, and proven tolerability of cephalsporins, they are a safe alternative for treatment (Poole-Arcangelo Peterson, 2013). However, they have a broader range of activity and are more costly than amoxicillin (Rx Files, 2012; ARP, 2012). Second line drugs cefuroxime axetil and cefprozil were added as treatment options for H.K (see appendix 1). The 250 mg dose was selected for both drugs due to ease of use (smaller pills, easier to swallow), patient related factors (H.K was not immunocompromised) and disease related factors (H.K’s sinusitis had no complications). In beta-lactam-allergic patients, a second line therapy such as trimethoprim-sulfamethoxazole (TMP- SMX) may be substituted for penicillin (ARP, 2012). The TMP-SMX resistance reported from Canadian laboratories is approximately 14% (Desrosiers et al., 2011). Increased pnuemoncoccal and H. influenza resistance rates make TMP-SMX a less desirable agent, however it is one of the most cost-effective options for patients with financial constraints (not an issue with H.K) (ARP, 2012). The most common side effects of this drug are rash, fever and gastrointestinal symptoms (Poole-Arcangelo Peterson, 2013; Rx Files, 2012). Drugs containing sulfa (such as TMP-SMX) potentiate the effects of warfarin, phenotoin, hypoglycemic agents and methotrexate (Poole-Arcangelo Peterson, 2013). Since H.K is not taking these drugs, TMP-SMX was selected as a treatment option (see appendix 1). One double strength tablet was selected over two single strength tablets for simplicity of administration. The general approach to the non-pharmacological management of acute sinusitis requires utilizing adjunctive therapies. Decongestants, intranasal corticosteroids (INCS), antihistamines, mucoltylics and analgesics are treatment options. A decongestant may be used to reduce mucosal edema and facilitate aeration and drainage (Desrosiers et al., 2011). Oral decongestants have been shown to improve nasal congestion and can be used until symptoms resolve. (Desrosiers et al., 2011). Topical decongestants are controversial and should not be used for longer than 72 hours due to the potential for rebound congestion (ARP, 2013). INCS reduce inflammation and edema of the nasal mucosa, nasal turbinates, and sinus ostia (Desrosiers et al., 2011). INCS are minimally absorbed and have a low incidence of systemic adverse effects (Desrosiers et al., 2011). Adverse effects include transient nasal irritation, epistaxis, pharyngitis, rhinitis, headache, and changes to taste, smell and voice (Rx Files, 201 2). A Cochrane review evaluating three INCS drugs for acute sinusitis found limited but positive evidence for INCS as an adjuvant to antibiotics (Zalmanovici Yaphe, 2009). Antihistamines are often used to relieve symptoms because of their drying effect, however there are no studies to support their use in the treatment of acute sinusitis (Desrosiers et al., 2011). Guaifenesin is a mucolytic that has been used to thin mucus and improve nasal drainage, however because it has not been evaluated in clinical trials, it was not recommended as an adjunct treatment for sinusitis (Rosenfeld et al, 2007). Selection of analgesics should be based on the severity of pain. Tylenol or an NSAID given alone or in combination with an opioid is appropriate for mild to moderate pain associated with sinusitis (Rosenfeld et al, 2007). Recent Canadian guidelines suggest that limited evidence exists supporting the beneficial effects of saline irrigation in patients with acute sinusitis (Desrosiers et al., 2011). Despite limited evidence, saline therapy, either as a spray or high-volume irrigation, has seen widespread use as adjunct therapy (Desrosiers et al., 2011). Although the utility of saline sprays remains unclear, the use of saline irrigation as ancillary therapy is based on evidence of moderate symptomatic benefit and favourable tolerability (Desrosiers et al., 2011). Some additional comfort measures for patients with symptoms of acute sinusitis include maintenance of adequate hydration and application of warm facial packs. No high quality trials have demonstrated that these comfort measures are effective (Worrall, 2011). As viral infections predispose individuals to acute sinusitis, strategies (such as handwashing) that focus on patient education of reducing viral transmission help to reduce the incidence of bacterial sinusitis (Desrosiers et al., 2011). Educating patients about common predisposing bacterial sinusitis factors may be considered as a preventative strategy (Desrosiers et al., 2011). Prophylactic antibiotics are not effective in preventing viral episodes or the development of subsequent bacterial sinusitis, and are not recommended (Desrosiers et al., 2011). Also, there is no evidence that influenza or pneumococcus vaccinations reduce the risk of contracting acute sinusitis (Rosenfeld et al, 2007). Recent reviews have found limited evidence for alternative and complementary medicine (Scheid Hamm, 2004). Alternative practices that have failed to show efficacy include acupuncture, chiropractic, naturopathy, aromatherapy, massage and therapeutic touch (Desrosiers et al., 2011). Vitamin C preparations and zinc lozenges are also felt to be controversial (Scheid Hamm, 2004). Studies of zinc lozenges for the common cold have produced mixed results (Desrosiers et al., 2011). One recent meta-analysis of echinacea preparations has shown some positive effects in reducing duration of respiratory tract symptoms (Barrett et al, 1999). However, the widespread use of echnichea in the treatment of acute sinusitis is not well supported (Desrosiers et al., 2011). A recent Cochrane review found that when antibiotics were given to patients, they increased recovery time from sinusitis symptoms (Ahovuo-Saloranta, 2008). The choice of first-line treatment is based on the anticipated clinical respons e of a patient, as well as the microbiologic flora likely to be present. Also, when selecting an antibiotic regimen for H.K, the clinician considered the medication cost, medication safety profile, adverse effects, and local patterns of bacterial resistance in order to maximize therapy (Hickner et al., 2001). The recommended antibiotic regimen is specific for H.K, who did not have any intracranial/orbital complications or a compromised immune function, and has normal renal function. In the absence of drug allergies and presence of resistant organisms, amoxicillin was selected for H.K as it is a first line therapy, is generally effective against susceptible and intermediate resistant pneumococci (Brophy et al, 2011), low cost (ARP, 2012), high patient tolerability, and relatively narrow antimicrobial spectrum (Aring Chan, 2011). Factors suggesting greater risk of penicillin resistant streptococci include antibiotic use within the past 3 months, chronic symptoms present for longer than 4 weeks, and parents of children in daycare (H.K had none of these risk factors). When antibiotics are prescribed by the clinician, the duration of treatment should be 5 to10 days as recommended by product monographs (Desrosiers et al., 2011). For H.K, the clinician utilized product monographs and other evidence based guidelines for determining the appropriate duration of treatment (CPA, 2013; ARP, 2013). Based on the information and discussion presented in this paper, amoxicillin 500 mg three times a day for 10 days (CPA, 2013) was selected as the most appropriate treatment for H.K (see appendix 2). H.K was instructed by the clinician to take his medication until finished, not share it, and to store at room temperature away from moisture, heat and light (Epocrates, 2013). He was taught about the drug’s side effects and that overdose symptoms may include confusion, behavior changes, severe rash, decreased urination, or seizure (Epocrates, 2013). He was provided health teachings by the clinician, including seeking emergency medical help if exhibiting any signs of an allergic reaction (hives, difficulty breathing, swelling of the face, etc.) or experiencing serious side effects (white patches/sores inside his mouth/lips, fever, swollen glands, rash, itching, joint pain, pale/yellowed skin or eyes, dark colored urine, fever, confusion/weakness, severe tingling, numbness, pain, muscle weakness, easy bruising, unusual bleeding, purple/red pinpoint spots under his skin) (Epocrates, 2013). H.K was provided health teachings regarding reducing the risk of contracting viral infections through hand washing techniques. Complementary therapies, alternative medicines, comfort measures, saline prophylactic antibiotic usage and vaccines were not recommended to H.K. He was also instructed about the role these treatments play in acute sinusitis treatment. Only evidenced-based adjunctive therapies as described in this paper have been selected for H.K, including INCS therapy (see appendix 3), analgesics (Advil cold and sinus) and oral decongestants (Advil cold and sinus). H.K agreed to this treatment plan. Based on H.K’s history and physical exam findings, a follow-up examination would be required if no improvement is seen within 72 hours of antibiotic administration, as this could indicate treatment failure (Derosier et al, 2011). The patient was advised to return in 72 hours if there were no improvements in symptoms. He did not return to the clinic for follow-up. If H.K had deteriorated at any time, the clinician would have reassessed for acute complications, other diagnoses and adherence to treatments (Derosier et al, 2011). If H.K experienced a type 1 hypersensitivity reaction to amoxicillin at any time, other pharmacological options would have been considered. A phone call was placed one week after H.K’s medical visit to conduct a post-visit evaluation, and he reported that his symptoms were nearly resolved (pharmacological and non-pharmacological therapy evaluation). Since H.K demonstrated signs of clinical improvement, a follow-up visit or possible referral to an otolaryngologist was not required (Fryters Blondel-Hill, 2012). The original goals of care for H.K were met. He stated that he was able to manage his symptoms with the treatment plan, was grateful that no complications were experienced, and was more knowledgeable about the prescribed drugs and future prevention strategies. H.K was satisfied with his healthcare experience (self-report) and was able to verbalize non-pharmacological therapies and apply them to his situation. When faced with a similar patient in the future, the clinician will ensure that the â€Å"I treat and prescribe framework† is utilized, as it is a valuable tool for ensuring patient specific treatment. Professional feedback from the course instructor/preceptor will also be integrated into future treatment plans.

Romanticism Through Whittiers Eyes Essay -- Romanticism Essays

Most people agree that abolishing slavery has always been a struggle throughout the history of America. Great writers and thinkers openly expressed their disapproval, especially during the Romantic era. During this time period, strict laws were replaced by artistic freedom, experimentation, and critical thinking. Ideas of political liberty were also seriously considered by Romantics. Through a close examination of the poem â€Å"Ichabod,† John Greenleaf Whittier is definitely considered a Romantic poet because he strongly presents his political opposition to slavery, criticizes and questions the moral qualities of man, and expresses religious ideas through a metaphorical comparison to the Bible. Poets are, no doubt, recognized first for their poetry. Despite the fact that Whittier took on many roles politically, he was first and foremost a poet. His writing pertained to the abolitionist movement and had been composed for purely political reasons. Not only was this pet a Quaker, but he was also a significant politician and moral force in the fight to abolish slavery. Lewis Leary confirms the purpose of â€Å"Ichabod† within the book John Greenleaf Whittier: This piece, the famous â€Å"Ichabod,† came more directly, out of his political commitment than any previous work. â€Å"This poem,† Whittier wrote years later, â€Å"was the outcome of the surprise and grief and forecast of evil consequences which I felt on reading the Seventh of March Speech by Daniel Webster....† (105) The 1850s decade began abruptly when on the seventh of March; Daniel Webster affirmed his support of compromise with the Southern slave power. Von Frank describes Whittier as so "shocked and saddened by this unexpected defection† that it led to the powerful protest â€Å"Ichabod.† This... ...nner death" (Leary 109). Whittier not only uses religious texts to strenghthen his viewpoints, but goes a step further by adding emphasis on his moral and spiritual values, as well. Whittier, like other poets, manipulates creative techniques that turn ordinary words into portals of expression. However, his Romantic opinions differentiate him from other poets while emphasizing his role in politics, abolition, and society. Especially in â€Å"Ichabod,† a poem through which John Greenleaf Whittier is very much considered a Romantic poet because he greatly exhibits his political opposition to slavery, criticizes and questions the moral qualities of man, and depicts religious ideas through a metaphorical comparison to the Bible. That Romantic spark within Whittier’s heart was just a small piece of the passionate fire which revolutionized a greater movement in America.

Joe Paterno: He Is Penn State :: Essays Papers

Joe Paterno: He Is Penn State The college football world has gone mad. Conferences are doing battle in courtrooms instead of on the football field. Teams are leaving their conferences and throwing tradition and loyalty out the window for a bigger paycheck. The Bowl Championship Series was supposed to end the confusion in the college football post season. It was supposed to crown a true champion. Instead, the B.C.S. has only brought more light to the fact that in college football it is all about money and TV contracts. Teams that have no right going to a major bowl game go because of who they are and, more importantly, who their fans are and how much money the fans are will to spend. Players are failing classes, stealing, doing drugs, breaking almost every law imaginable, and they are still suiting up to play on Saturday. In this new age of college football, there is a man who is as old school as having goal posts right on the goal line. He is short in stature, but he is larger than life. He has given millions of dollars back to his university, and he has put his heart and his soul into molding young me. Joe Paterno has become an icon of college football. In these modern times, however, his morals and his coaching style seem outdated. Now, in the twilight of his career, he has to battle a grueling Big Ten schedule, the media who made him a legend and who are now looking to make him into a fool, and even his once loyal fans who have turned their backs on him. Joe Paterno has his back against the wall; it seems everything is working against him. He could walk away now and forever be remembered as a great football coach, or he can keep running out of that tunnel and work on putting Penn State football back on the map. He can take back the title that is rightfully his, the greatest college football coach of all time. Joe Paterno should remain in charge of the Penn State football program. Along the way, he deserves every Penn State fans support, win or lose. Joe Paterno has found a way to win in college football. More importantly, he has found a way to win and keep his morals and the morals of the University. Paterno could have retired two years ago, after he reached victory number 324.

Compare and Contrast: Palace of Fine Arts and University of Virginia

Compare and Contrast: Palace of Fine Arts and University of Virginia This essay paper is a comparative analysis of two architectural constructions, the Palace of Fine Arts and the University of Virginia. The designer behind the building of the University is Thomas Jefferson. In constructing the building, Thomas Jefferson used bricks extensively, as for the periodic manner, he used Neo-Classical. On the other manus, the architectural design of the Palace was done by Bernard Maybeck. The manner that Maybeck used in building the edifice is known as Beaux-Arts. As for the stuffs, the old building was built utilizing steel constructions and plaster as it was meant to be impermanent. The edifices portion an architectural subject in that they are both inspired by Roman architecture. The aim of this research is hence to larn how two different manners interpret from the same beginning of influence. Ocular Analysis Structure One The construction of the Palace is erected on a site that has a little semisynthetic laguna. The castle has a broad arbor that measures 340 m ( 1,100 foot ) . The formation of the arbor is an arch and it has a broad paseo that is framed by Corinthian columns placed in rows. In the center of the arbor is a rotunda that is centrally placed by the laguna ( Yu n.p ) . The purpose of the laguna was to those found in classical Europe. The unreal H2O organic structure was supposed to move as a brooding surface to mirror the brilliant construction and make a bird's-eye position that would be appreciated from a distance. In constructing the Palace of Fine Arts, Maybeck’s purpose was to make the visual aspect of Roman ruins in decay. Structure Two The University’s architectural construction is a brilliant edifice that resembles the neoclassical temples of Europe. The building features a Pantheon that measures two-thirds of the graduated table ( Kostof 625 ) . The pantheon is set at the caput of a lifting promenade with interrelated columnar marquees on the wings. In its planning, the library was housed by the Rotunda while the marquees were the life quarters for lectors every bit good as talk suites. Each marquee offers an separately alone representation of the classical Roman order design ( Kostof 625 ) . Stylistic Analysis Structure One The architectural manner that the Palace was built with is an look of the architectural neoclassical manner that was taught in Paris at theEcole diethylstilbestrols Beaux-Arts. Until the twelvemonth 1968, the direction manner of Beaux-Arts went on without any major breaks ( Middleton 10 ) . In the period between the old ages 1880 and 1920, the architecture in the United States was to a great extent influenced by the architectural manner of Beaux-Arts. The period between 1860 and 1914 saw the gravity of European designers who were non-French towards the academic centres of their natural states alternatively of being fixated on Paris ( Klein, Fogle, and Wolcott 38 ) . The mainstream forms of the Imperial Roman architecture were extremely emphasized by the preparation used for Beaux-Arts. These forms ranged from the period of the first emperor Augustus to those of the Severan dynasty, Italian Renaissance every bit good as Italian and Gallic Baroque. However, the preparation was applicab le on a wider series of theoretical accounts. Architects from America who learned the manner of Beaux-Arts were more inclined towards the Greek theoretical accounts. This was because of the 19Thursdaycentury American Greek Revival which gave the theoretical accounts historical prominence locally. The Beaux-Arts manner was dependent upon sculptural ornaments that were cautiously modern. It employed the usage of Italian and Gallic Baroque every bit good as Rococo designs assorted with pragmatism and impressionistic coating. Even though there was an attack of a renew spirit embodied in the manner of Beaux-Arts as opposed to a set of motives, the architectural manner included chief features such as: a level roof, symmetricalness, arched Windowss, elusive polychromy, arched pedimented doors, rusticated base with a raised first narrative and statuaries, mosaics, wall paintings, sculptures every bit good as other graphics combined in a subject that portrays the building’s individuality ( Klein, Fogle, and Wolcott 38 ) . The style’s classical architectural inside informations include acroteria, cartouches, Garlands, pilasters, bannisters, every bit good as an outstanding show of clasps with rich inside informations, back uping consoles and brackets ( Klein, Fogle, and W olcott 38 ) . There has been controversy every bit far as the Palace in relation to the Beaux-Art manner is concerned. The Palace was loved by the people but non given acknowledgment by the designers. Maybeck’s preparation was in conformity with the Gallic academic system but it is argued that his work is non suiting of the American Beaux-Arts architect’s ideals. This is because he restrained from adding design elements from his old plants. The Palace therefore was non able to be compared to any originals of European architecture ( Yu n.p ) . However, the Palace still bears features of the Beaux-Arts manner from its rusticated base, arches every bit good as its classical architectural inside informations like sculptures, pilasters and wall paintings. Structure Two The University’s architectural manner is defined by Neo-classical architecture. The manner was born of the mid 1800s neoclassical motion ( Hopkins 199 ) . The manner came approximately both as an branch of some Late Baroque features every bit good as a response against the Rococo manner that featured realistic adornment. The signifier of the architectural manner lies in the accent of the wall as opposed to chiaroscuro. It besides sustains separate individualities to each single portion ( Hopkins 199 ) . This architectural manner is picturesque and redolent and its frame is in line with the Romantic emotional response. Rationally the sense of neo-classism was to return to renaissance classism, Greek and Roman humanistic disciplines which were perceived as pure. The neoclassical architectural manner is characterized by a expansive portico with a porch built in full tallness. To add on, the portico’s roof is supported by full classical columns that are normally fluted with capitals that are flowery Corinthian or Ionic ( Hopkins 199 ) . The manner is besides symmetrical in footings of balance ; it has a centralized entry with a balanced agreement of Windowss on its wings. The neoclassical manner characteristics subtypes that are varied in roofing manner of the portico, breadth every bit good as tallness. Portico with level and curving roofs are seldom seen. Other specifying characteristics of the manner include elegant clean lines, orderly visual aspect and monolithic edifice size. The chief signifier that the neoclassical manner is based upon is the temple ( Hopkins 199 ) . The temple represented the purest signifier of classical architecture and this was an ideal construct of the manner. In planing the construction of the university, Jefferson blended assorted architectural manners. The edifice evokes the rules of European architecture of the Gallic, Grecian and Italian influence and is blended with the Chinese touch as good ( Jefferson and The Politicss of Architecture n.p ) . The blend of architectural influences is finally cast in edifice stuffs from America and showcased in an academic community. In an attempt to intermix the classicist manner even further, Jefferson used different stuffs from different countries. For case, the 3rd Pavilion was constructed with columns made from Italy and transported under the pretense of educational stuffs to the site, whereas the columns on the first marquee were made in Charlottesville ( Howard and Straus 189 ) . Jefferson pieced together the European architectural manners on the construction and blended them to his ain liking in an attempt to do it hold a alone American visual aspect ( Jefferson and The Politicss of Architect ure n.p ) . The characteristics of the university that are characterized with the neoclassical architectural manner are chiefly the columns, the building’s portico, and particularly the temple like design of the construction which is portion of the manners ideal. Cultural ( Historical ) Context Structure One The Palace of Fine Arts was built as one of the brilliant buildings of San Francisco’s Panama Pacific International Exposition in 1915 ( Kale n.p ) . It was located towards the center of the expansive building of the expounding and it stood out as the most inspiring construction at the carnival. The Fair was in award of the Pacific Ocean’s find every bit good as the Panama Canal’s completion ( Maybeck and Elder 2 ) . There was besides an added intent to the Fair which was in jubilation of its ain rejoinder after the annihilating fire and temblor of 1906 ( The Palace of Fine Arts n.p ) . Once the site had been chosen and the basis had been developed, the Palace was the last construction to be erected. In representation of its civilization, the construction of the Palace was built to demo magnificence. This was done by puting the arch’s centre behind the rotunda to avoid their homocentric alliance in rings. Due to that, a wider arch was able to be built on t he same infinite ( Yu n.p ) . In its programs were a colonnade and a rotunda which amazed the commissioners and fulfilled Maybeck’s dream. The exhibition hall of the castle was built to house the graphicss of life creative person ( Maybeck and Elder 3 ) . Another component that shows significance to the civilization and events associated with the castle is its visual aspect. The castle looks like ruins of classical antiquities. Bing hailed as the exposition’s most reliable design, Maybeck added the elements of Roman and Greek antiquity and besides incorporated his ain creativeness to do the edifice unique ( Maybeck and Elder 5 ) . His thought was influenced by the construction was from Piranesi scratching of Roman ruin ( Yu n.p ) . His ideas were that there was a feeling of unhappiness to the edifice personalized by the sense that there is a soothing influence to beauty ( Yu n.p ) . The initial building of the castle was impermanent and non intended to last after the Fair was concluded chiefly because it was built on valuable land ( Maybeck and Elder 2 ) . With that impression in head, it was simply constructed with plaster which was supported by constructions of steel ( Yu n.p ) . The castle was nevertheless non brought down as a consequence of its influence on the people. In a saving of the civilization and influence of the castle, the destruction and rebuilding was set in gesture in 1964 ( The Palace of Fine Arts n.p ) . The columns and the rotunda were brought down and the edifice was rebuilt on a lasting footing with a steel construction merely as the initial building. The Reconstruction of the palace’s edifices was done utilizing lasting light weight concrete that was poured into topographic point. For the rotunda’s dome, steel I-beams were hoisted into topographic point ( The Palace of Fine Arts n.p ) . The sculptures and all the ornament we re freshly constructed by pouring concrete onto pre-casts of the figures so as to guarantee that the eventual consequence matched the original theoretical accounts. Structure Two Unlike the Palace of Fine Arts, the University of Virginia’s construction was non portion of a monolithic undertaking but instead a undertaking on its ain. The edifice hails as the country’s foremost province university ( Jefferson and the Politicss of Architecture n.p ) . The building of the university edifice was non merely a general design but a design drawn by an architect full of the belief that the bosom of the American class lied within architecture. He considered a edifice as more than merely a wall construction but a symbol for the American political orientation ( Howard and Straus 187 ) . Jefferson besides perceived building as a procedure that was equal to making a state. Harmonizing to him, any American architecture was supposed to exemplify the split of cultural and political ties with Europe ( Jefferson and the Politicss of Architecture n.p ) . He therefore went forth to put the criterions of the country’s architecture aesthetically every bit good a s politically. Jefferson hence went on to transfuse his educational and cultural ideals into the design and building of the University’s edifice. In a representation of the European culture’s influence, the visual aspect of the edifice is rather classical as a consequence of Jefferson’s influence from St. Peter’s Basilica in Rome ( Jefferson and the Politicss of Architecture n.p ) . The similitude of the Basilica and the rotunda lies in their attack. The manner that leads to the Rotunda goes down towards a shaded transition lined with columns that leads to the chief focal point of the construction. Jefferson substituted the great rock Piazza with the broad natural infinite of the lawn ( Howard and Straus 189 ) . Alternatively of a position of the Italian metropolis of Rome, the university’s visitants are given a natural impressiveness of the Blue Ridge Mountains which can be viewed to the South ( Jefferson and the Politicss of Architecture n.p ) . The university uses classical vocabulary to stand for America as the heir of European architecture manner. The aggregations of manners that are incorporated on the Lawn of the university are symbolic of the New World Order by Jefferson in both an architectural and rational sense ( Jefferson and the Politicss of Architecture n.p ) . In planing the edifice, the European imposts have been revised, borrowed, integrated and so redone in an American manner in footings of stuffs, gustatory sensations and demands ( Howard and Straus 189 ) . The conundrums within the architecture do non halt with the random aggregation of manners but goes beyond. It really extends onto the Lawn’s layout. Jefferson’s version of classical manners incorporates the mixture of architecture of the Italian Villa, together with Doric columns and Corinthian pediments every bit good as Chinese Latticework and Gallic curves ( Jefferson and the Politicss of Architecture n.p ) . He represented them in painte d wood and the ruddy brick of Virginia and eventually put them across the Lawn’s unfastened public infinite in contrast with each other. The Lawn’s physical infinite is therefore transformed into a vision of rational Inquisition and wonder ( Howard and Straus 189 ) . In constructing the university, Jefferson speaks through classical architecture and thoughts. Each of the structure’s marquees is in ocular communicating with the other ( Jefferson and the Politicss of Architecture n.p ) . This consequence presents the bookmans and pupils on the Lawn with a argument from a structural every bit good as ideological position that culminates from the designer every bit good as the architecture. Another point that is portrayed by the cultural influence of the university’s construction is apparent from the Rotunda which is symbolic of power. Unlike the Basilica, Jefferson’s version is a secular cathedral which was built in testimonial to knowledge and power with a new universe order in head. The designs done by Jefferson are bordered on the simple facets of the neoclassic manner as opposed to the elaborate decorations of the cathedral by Bramante or the swerving colonnades by Michelangelo ( Jefferson and the Politicss of Architecture n.p ) . The Rotunda is non symbolic to the ruins of the Roman Empire but instead accentuates the wonder of nature touching to the synchronism adult male and nature that is at manus in the university’s architectural stuff and its pure geometrical design ( Howard and Straus 190 ) . Decision The two constructions of the castle and the university are rather alone and do non associate in several facets. The two edifices are made by different designers, have different period manners and are varied in footings of their historical events as good. However, despite all these major differences, their manners are influenced from the same beginning which is the classical Roman architecture. The differences are marked by the single thoughts and constructs of the designers designs and their intent of intermixing them with the civilization and historical events during their times of building. However, beyond the differences are cardinal elements that are synonymous with the classical Roman architecture such as the classical architectural inside informations like the pilasters, sculptures and wall paintings on the castle and the Rotunda, columns and the temple like designs of the university. Conclusively even though the constructions are variously alone, these noteworthy elements from the classical Roman architecture are declarative of the inspiration behind the edifice of the constructions and how they are able to attest otherwise. Plants Cited Hopkins, George.Making Your Architectural Manner. Pelican Publishing, 2010. Howard, Hugh, and Roger Straus.Thomas Jefferson, Architect: The Built Legacy of Our Third President. New York: Rizzoli International Publications, 2003. Print. â€Å"Jefferson and the Politicss of Architecture† . Virginia. 2015. Available at: & A ; lt ; hypertext transfer protocol: //xroads.virginia.edu/~cap/jeff/jeffarch.html & A ; gt ; Kale, Shelly. â€Å"Overview: What Was the PPIE† . PPIE 100. 2015. Available at: & A ; lt ; hypertext transfer protocol: //www.ppie100.org/history/ & A ; gt ; Maybeck, Bernard R, and Paul Elder.Palace of Fine Arts and Lagoon: Panama-pacific International Exposition, 1915. San Francisco: P. Elder and Co, 1915. Print. Middleton, Robin.The Beaux-Arts: And Nineteenth-Century French Architecture. London: Thames and Hudson, 1982. Print. Klein, Marilyn W, David P. Fogle, and Wolcott B. Etienne.Hints to American Architecture. Washington, District of columbia: Starrhill Press, 1986. Print. Kostof, Spiro.A History of Architecture: Settings and Rituals. New York: Oxford University Press, 1985. Print. â€Å"The Palace of Fine Humanistic disciplines† . Exploratorium. 1998. Available at: & A ; lt ; hypertext transfer protocol: //www.exploratorium.edu/history/palace/index.html & A ; gt ; Yu, James. â€Å"Palace of Fine Humanistic disciplines† . UMD. 2015. Available at: & A ; lt ; hypertext transfer protocol: //digital.lib.umd.edu/worldsfairs/record? pid=umd:1006 & A ; gt ;

Comparison the characters Oedipus Odysseus Essay Essay Example

Comparison the characters Oedipus Odysseus Essay Essay Example Comparison the characters Oedipus Odysseus Essay Essay Comparison the characters Oedipus Odysseus Essay Essay The major focal point of this calamity is on the character of the hero. Oedipus. He is a individual of great importance ; in fact. the security and wellness of the community depend upon him. And he has to run into an pressing crisis. something which threatens the go oning being of the metropolis. And because he is really witting of his ain qualities. he takes upon himself that duty. Oedipus. above everything else at first. is a individual who acts resolutely and who is celebrated for so making. In that sense. Oedipus is like Odysseus. who is besides celebrated for his ability to move and respond in an exigency. What is most of import about them. nevertheless. emerges non from their initial determinations to move but instead from what happens as the struggle they are caught in gets more complicated. Oedipus has a heroic assurance in his ain abilities. and he has good ground for such assurance. both from his sense of past accomplishments and from the really high respect everyone has of these accomplishments. As his state of affairs gets more complicated and things do non work out as he has imagined they might. unlike Odysseus. he does non accommodate. alteration. or learn. He becomes more and more determined to see the job through on his ain footings ; he becomes progressively inflexible. Having accepted the duty for salvaging Thebes. he will on his ain see the affair through. without via media. without prevarications. without blind. Oedipus demands from life that it answers to him. to his vision of what it must be. Throughout the drama he is seeking to enforce his will upon events. Peoples around him are ever pressing cautiousness. prudence. even an forsaking of his quest. but to move on such advice would be for Oedipus a denial of what he is. And. as he repeatedly states. he would instead endure anything than compromise his sense of who he is and how he must carry on himself. Odysseus is rather distinguishable. He sees everything and is ever prepared to acknowledge that he has been incorrectly. He can accommodate ; that is one of the most attractive things about the narrative. The reader may cognize the result. what holds him is the outlook of some new disclosure about Odysseus’ bag of fast ones. What will he make next to acquire out of this jam? What is he making to prevail over the suers? Because he is such an infinitely protean character. the reader knows he is traveling to detect something new about Odysseus in every episode. The reader’s sense of Oedipus is really different. He is non traveling to be any different. he is traveling to persist in being precisely what he has been. So there is a awful captivation with seeing the events unfold. in seeing Oedipus himself become the major actuating force in his ain devastation. The force of the drama comes from the connexion between Oedipus’s agonies and his ain actions. that is. from the consciousness of how he himself is conveying upon his ain caput the awful result. Oedipus is doomed. chiefly because he is the kind of individual he is. Person else. person with a really different character. would non hold suffered Oedipus’s life.

Mahogany Fruit as an Alternative Charcoal Essays

Mahogany Fruit as an Alternative Charcoal Essays Mahogany Fruit as an Alternative Charcoal Paper Mahogany Fruit as an Alternative Charcoal Paper Mahogany Fruits are often thrown away. What most people do not know is that the dried pulps are good substitute of charcoal and firewood. Mahogany Fruit also known as a hard wood. Mahogany Is a fast-growing forest trees commonly made into furniture or used in construction materials. More importantly, mahoganies effectively prevent soil erosion and flood hence these are often planted along river banks. Mahogany trees do not bear flower but grow buds which develop into brown oblong fruit. The fruits fall when they mature, and the dried ones break spreading on the ground. Mahogany is one of the resourceful in our environment especially the fruit (sky fruit). It can be used as Alternative Charcoal or Fuel. And many people use this fruit as their medicine or healing. Significance of the Study: This study Intends to make use of Mahogany Fruit as a major component In making Alternative Charcoal to save money and to keep environment clean. Student This study can help for Student to have an idea about Mahogany Fruit sed as an Alternative Charcoal. Teacher This study can help for Teacher to understand the use of Mahogany Fruit and make their own Alternative Charcoal out of Mahogany Fruit. By this study they will come up with easier. Hypothesis: Null: There Is no difference between charcoal and Mahogany Fruit. significant effect between Charcoal and Mahogany Fruit. Alternative: There Is a difference between charcoal and Mahogany Fruit.

7 Surefire Ways to Get a Great Job

7 Surefire Ways to Get a Great Job You get a job by finding openings, sending out your resume, and impressing employers during the interview process. It can take some time, but it’s fairly simple. It’s a bit more challenging to land a dream job. First, you have to find the right opening, then you have to make yourself stand out in a sea of applicants. Only then do you have the chance of landing a great job and starting your dream career.1. Become a Master of Your TradeIf you want that well-paid job, you’re going to have to bring the skills. Companies with hot, in demand jobs need people who can bring expertise with them. Then, they need those same people to have the motivation to continue learning and growing with the organization.Before you start your job search, do a skills inventory. Are your marketable skills up to date? Have you been using the most current technology? Maybe it’s time to take a class or two, or spend some time at home doing projects to update your skills.2. Cast a Wide NetThe best jobs rarely make it to the most commonly used job boards. Many are filled by word of mouth and proactive recruiting. Other companies simply wait for interested applicants to find them. This means that you have to cast a wide net in order to put yourself into consideration for the best jobs.You can start by networking. Find and connect with people who work for the companies that interest you. Follow the companies themselves on social media as well. Also, forget about job boards. Yes, you might find something worth pursuing, but you’re more likely to learn of a great opening on a company website or through a social media post.3. Research The Company You Want to Work ForHere’s a great piece of career advice. Do some deep research into the company you want to work for before you approach them about a job. Not only can it help you to identify where, when, and how they might need someone with your skills, it can help you ace the interview process as well.Thereâ⠂¬â„¢s a point in almost every interview where the applicant is asked if they have any questions. This can truly be a pivotal point in the interview. If you throw out some generic question such as, ‘Are there any interesting projects happening soon?’,you become   just another, forgettable applicant.On the other hand, if you have a thoughtful, insightful question that only someone who has truly bothered to do some research can ask, that can provoke some great dialogue. It will also impress the heck out of the interviewer.4. Make Sure Your Resume is Spot OnResume writing should never be an afterthought. After all, your professional resume is the tool that you use to get the attention of hiring managers and boost your career prospects. Take the time to put together a great resume. It can really mean the difference between getting a call back for an interview and landing in the circular file.There’s a good reason why some people opt to hire a resume writing service rather than attempting to write their own resumes or CV. A qualified resume expert knows how to use both content and formatting to create a resume that is visually appealing, and draws attention to your best features.5. Develop a Powerful Online PresenceIf you have a LinkedIn profile, that’s a great start. However, it isn’t enough to make the connections that will lead to your dream job. You have to create a powerful online presence. This will help you build the network that you need as well as giving yourself a forum to establish yourself as a thought leader in your industry. Here are some tips on creating a professional presence online.FacebookStart by creating a professional page that is separate from your personal page. Then, complete all of your profile information. It’s a good idea to include a link to your resume as well as other social media sites. Once you have done that, you can start following companies as well as leaders in your chosen field.As far as content goes, yours should be a mixture of the following:Sharing And Commenting on Posts Made by Thought LeadersSharing And Commenting on Industry Relevant ArticlesPosting Your Thoughts on Industry Related News And EventsPromoting Your Own Blog ContentTwitterFirst, try to pick a Twitter handle that reflects your passion and expertise. Once you’ve set that up, you’ll want to select individuals and companies to follow. Just like you did on Facebook, you’ll want to comment on and retweet interesting Tweets.Twitter is also a great place to find and participate in relevant conversations. You can use the search feature to find posts based on keyword phrases that are meaningful to your industry.LinkedInThis one is really important. When companies want to fill an in demand position, they will often begin by searching for qualified candidates on LinkedIn. Be sure to do the following.Use a professional photo as your background.Fill out your profile completely.Ask peopl e for recommendations.Post content to LinkedIn.Reach out to coworkers, fellow alumni, and others to begin building a great network.QuoraThis newly popular forum is a great place to establish thought leadership. Simply set up your profile and look for questions that are relevant to your areas of expertise. Then answer them to show your insights.Your Professional WebsiteYour professional website should act as home base. It should contain samples of your work, your accomplishments, your resume, links to any customer testimonials and recommendations, and the story of why you are in the field that you are and what makes you so passionate about it.Your BlogThis is your place to post original content that relates to your field. Keep your blog updated frequently, promote your posts on your other social media accounts, and engage with your audience. You never know when a follower may become the link to your next dream job.6. Be Positive About Your Current PositionEveryone knows that you shou ld never burn bridges by badmouthing your current employer. However, to increase your chances of getting a great job, you should go one step further. Make a point to speak positively about your current or former employer.This doesn’t just apply to interviews. You should take the same positive, supportive approach on social media as well. You’ll never hurt yourself by remaining cordial and professional.7. Pursue What You Want to do Any Way You CanYour dream job may not be right around the corner. You may need to gain some more work experience, or even get a college degree. The point is to work towards your dream job continually, even if that work is done incrementally.ConclusionIf you want to land the job of your dreams, you have to change up your game to stand out from other job seekers. Follow the seven tips above, and you will be well on your way to accomplishing your goals.About the author:Lisa Sparkers is an avid Resumes.Expert blogger aiming to help you make a suc cessful career and enjoy what you’re doing every single day. You can follow her on Twitter @LisaSparkers.

Molecular Biology Lab Report Example | Topics and Well Written Essays - 1750 words

Molecular Biology - Lab Report Example Dpn I and Fse I together: fragments of 0.5 kb, 1.1 kb, 1.6 kb and 2.3 kb Dpn I, Eag I and Fse I together: fragments of 0.3 kb, 0.5 kb, 0.6 kb, 1.0 kb, 1.1 kb and 2.0 kb a) How many restriction sites are there for each enzyme What, if any, are the unique restriction sites on this plasmid Ans. Dpn I = 3, Eag I = 2, Fse I = No RS. There are unique restriction sites for Fse I, this restriction enzyme works in conjunction with the Dpn I and Eag I. b) Construct a restriction map of the plasmid and draw it below. Cloning Strategies Question 4 (28%) Describe outline cloning strategies, including vector types (individual vectors need not be specified) and methods used at each stage, for the following scenarios: Worked example You wish to isolate the coding sequence of a human liver enzyme. You have purified the corresponding bovine enzyme and have raised a polyclonal antibody against it. - Make a cDNA library from human liver tissue - this will be enriched for the genes for liver enzymes. - Create the library in an expression vector with a strong promoter so the genes are expressed in the host. - Screen the induced expression library for the presence of the desired liver enzyme using the bovine polyclonal antibody. The antibody will bind to the colonies which produce the protein they recognise. Although the match may not be exact there should be enough conserved homology to ensure recognition. - Positive colonies will be identified by visualising the label on the bound antibody/secondary antibody in the colony hybridisation. a) You have a cDNA clone containing the 900 bp coding sequence of a cell surface protein from pygmy goat monocytes. How can you use this to find the homologous cDNA from the merino sheep b) Having...The results are as follows: step. f1 IG SEQUENCE: to make single stranded DNA for sequencing UNIVERSAL PRIMER SEQUENCE: for primer to anneal to, to initiate sequencing SELECTABLE MARKER (eg lacZ'): to allow selection of clones containing the insert MCS POLYLINKER: insert fragment of DNA here 3.0 kb You must describe the function of the essential features of each plasmid and give some indication of the plasmid size. For expression vectors you must bear in mind the host cells in which the coding sequence will be expressed. a) Nonsense: The nonsense-mediated mRNA decay pathway degrades mRNAs transcribed from genes in which an amino-acid codon has changed to a nonsense codon; this prevents the translation of such mRNAs into truncated, and potentially harmful, proteins. c) Splicing: A stage in the processing of mRNA, occurring only in eukaryotic cells, in which intervening sequences (introns) are removed from the primary RNA transcript (hnRNA) and the codig exons are joined together to form the mature mRNA molecule. url:www.geneontology.org . d) Promoter: A nucleotide sequence of DNA to which RNA polymerase binds and initiates transcription. It usually lies upstream of (5' to) a coding sequence. A promoter sequence aligns the RNA polymerase so that transcription will initiate at a specific site. e) Reading Frame: A series of triple

CPU as the Central Processing Unit of the Personal Computer Assignment

CPU as the Central Processing Unit of the Personal Computer - Assignment Example Random Access Memory (RAM) is the other hardware which must also be checked to make sure it has sufficient amount of memory available for CPU in order to execute its commands. However if processor is replaced with a faster processor it will change the number of operations it can perform in a second. A processor having 1 GHz of speed will be able to make 1000 clock cycles in a second. Every command which user executes require specific number of clock cycles for the execution of work, and by increasing the speed of processor will optimize the execution which will make a particular CPU more efficient and will complete assigned tasks faster as it can (Torres, 2012). 2. Discuss disk fragmentation. Include performance, what causes it and how to fix it. There is another performance issue which is greatly overlooked is known as Disk Fragmentation which is occurred with the passage of time and usage of the system’s disk. On a newly formatted disk files and programs run faster and quick er but as time passes by it starts taking time to load large data files into the memory. Causes of Fragmentation: Disk fragmentation start taking place when the disk file system cannot find adequate amount of contiguous space for storing a complete file as a complete unit, but as an alternative it break a particular file in parts and then stores those parts in free gaps between other files. These gaps are caused due to a previously existing file which must have been deleted or altered or moved to another location (May, 2012). Countermeasures Partitioning: It is regarded as a common approach to optimize defragmentation in which the hard disk is separated into partitions. The partitions are created into sections of read and writes which allows volatile zones to remain separate (Hameed, 2008). Offline defragmentation: This process involves the existence of immovable system files which is also termed as a swap file can hinder the process of defragmentation. These files can be securely m oved when the operating system is not in the working state. 3. List and discuss the advantages and disadvantages of multitasking Operating systems. Multitasking operating systems has the ability to run multiple programs to execute at a time. They are also capable of managing preemptive multitasking in which the OS allocates specified time to the applications running on the computer. Here are the advantages of Multitask OS: A multi-task OS can manage various processes simultaneously by sharing CPU time among the processes. Switches between operations are so frequent that user can easily interact with every running program. Multitask OS increases user productivity and allows easy transferring of data. This functionality also increases CPU utilization which allows processor to work smoothly on threads (bizymoms.com, 2011). Here are some of the disadvantages of Multitask OS: For a new user multitask OS will create a sense of confusion and he/she will get lost while working. In some case s it happens that the processing power and performance of the system is affected which slows down the CPU speed (May, 2012). PART 2 1. Can computer programs be developed with zero defects? Explain with supporting facts. Yes computer programs can be developed with zero defects but this state is very difficult to achieve. When the software or program starts increasing in size and complexity it becomes difficult to locate defects in the programs.  

Tabacco use Essay Example | Topics and Well Written Essays - 1000 words

Tabacco use - Essay Example 250 billion this has outpaced the growth in national income and foreseeable future. Tobacco is mostly used by the young generation or the youth in the community. This population are the most focused group that have become addicts of the use of tobacco. The role of population in the community depends highly on upon the goals of the initiative, the context and leadership of the community, and the capabilities and resources available. T population is responsible for development aspects that address long term needs and promotes the community development. This would require a long term outlook on drug usage as well as paying particular attention to the group in the early years. Integrators role is not one size fits all, but rather must be flexible to adapt in response to the needs of the needs of the community or population it serves (McGuire, Leypoldt & Ward, 2007). The population availability is important to be considered since they provide basis for research of the effects of usage of tobacco I the community. With the growing population the government of the USA has passed the health care reform bill that have created incentives for health care organizations to manage more health and financial risks that are associated with the use of tobacco in the society. Discussion The youth group are found beyond any boundaries of any community therefore they exist within the available neighbourhood. But in some areas there are geographic boundaries that separate these communities, but the only thing that makes the difference is the difference in the state regulation within these geographical boundaries. The group’s characteristics do not change despite the geographical boundary. This community is not limited to any setting since the state regulation lies within the US statutes therefore the effect of limit is not available. The group of teenagers that are highly involved in the use of tobacco are located in Miami in Florida since it is a beach that is more exposed to drug importation. Community assessment can be done at any time and to some extend the community need assessment so to provide local stakeholders with the information they need to prioritize their most pressing needs and to identify approaches to address the available concerns. The population of the Miami was found to be 399,457 in 2012 compared 362,563 in 2000. This has indicted a population increase of 10.2% from 2000 to 2012. When discussing the demographic of the community it is important to consider the language that is being spoken in the discussed community. There are 25% of people speaking English, 67% speaking Spanish, while 46.7% are married. Understanding the community requires basic demographic results, many of which are available in the US Bureau of the census. The comparison of this population within the periods will enable the community to assess short term trends in the age and distribution of the available resources in the society. To assess the community values you are as well required to have an up-to-date profile of the community. The data available should be able to compare city level information. After identification of key questions that regards the geographical boundaries of a community it is important to answer through the community needs assessment, considering the best data collection option that can be used to verify

Business Strategy - Collaborating to achieve Corporate Social Research Paper

Business Strategy - Collaborating to achieve Corporate Social Responsibility and Sustainability - Research Paper Example It is important that every sector of the society must co-operate with business to find solutions to such profound and complex challenges. Collaboration is the co-operation and co-ordination that is necessary between all business, government and non-government organisations to cope with all such challenges. It is a situation where people work towards attaining a wider goal beyond the boundaries of an organisation. Keeping in view the responsibility towards the economic development of the society, collaboration and partnership between different organisations seem to be more logical manner to maintain the flow of development. Collaboration can have the advantages of â€Å"improved access to resources, sharing of risk, increased efficiency, co-ordination and seamlessness† between different organisations and institutions (Murray et al 166). Collaboration is also imperative because it is not possible for a single organisation to deal with moral problems of the society like â€Å"po verty, crime and drug abuse†. Collaboration can take place between business organisations and governments or between governments and NGOs to address various social issues. Companies may often collaborate with governments and NGOs with the purpose of learning from their partners for their benefits and also for the benefits of the partnership. In the framing of the structure of the collaborations, the organizations should be careful in choosing a collaboration which would meet the objective of the CSR of the organization. In building the collaboration, special emphasis should be provided to maintain relationship between the units with which the business houses are collaborating. Various strategies also have been framed for the better utilization of the collaboration process (Murray et al 161-174). Every organization is responsible to the society and its

Rational Approaches to Organizations Essay Example | Topics and Well Written Essays - 1500 words

Rational Approaches to Organizations - Essay Example It also highlights through examples how taking an open system or a natural systems approach could benefit managers. Rational Approaches to Organizations Rational approaches present a planned and systematic approach to decision making. Applying such an approach helps managers to maintain order and resoluteness in the decision-making process. Dyck (1997) observes that rational approaches generate reason and order through a sequence of steps starting with the discovery of an opportunity or a predicament and culminating with measures to be undertaken in regard to the decisions reached. Mintzberg (1990) argues that rational approaches are based on meticulousness of analysis and assessment of all probable courses of action. This may be appealing to managers considering the fact that future actions are predetermined at the strategy setting stage. Rational approaches to strategy formulation comprise environmental scanning, portfolio and industry analysis, all which are focused on establishin g the business opportunities and threats. Environmental scanning helps managers to determine the nature of the operating environment and to set strategies for utilizing emerging opportunities as well as dealing with potential threats (Robbins & Barnwell 2006). Portfolio analysis is the formal structured examination that encompasses decisions regarding the relative significance of the accessible business opportunities where a company can invest. It allows the management to devise strategies that can supplement the business portfolio in regard to emerging investment openings and products (Ferraro et al. 2005). Industry analysis helps managers to understand the nature of a particular market in which an organization presently sells its products or is planning to penetrate in future. Such rational approaches allow managers to determine the significance of the various strategic business units and prioritize the allocation of resources depending on market attractiveness (Williamson 2000). Strategy development through this process culminates in a well-detailed scheme with various courses of action that are meticulous with monetary aspects and resource affiliated data. This process is characteristic of the standard SWOT (Strengths Weaknesses Opportunities and Threats) analysis in strategy development. Mitzenberg (1990) developed a comparable approach to strategy development. His planning approach involves formulating a strategy with a time line, goals and objectives which are stated and formulated to help achieve the organizational objectives. A plan is a critical source of direction for the company since it contains clearly stated objectives. Planning is a continuous process as variables keep changing hence the need for management to be ready for changes through out the organization’s life cycle (Glueck 2009). Litzenberg's planning model is limited in the sense that it is suitable for static operating environments otherwise the management needs to continuously review plans in a constantly changing environment. Plans can also not be relied upon in the long run due to technological and infrastructural advancements. The rational approaches integrate an evaluation of the organization and its operating environment with the underlying assumption that changes in the business environment will seldom affect the plan.  

Business Strategy - Collaborating to achieve Corporate Social Research Paper

Business Strategy - Collaborating to achieve Corporate Social Responsibility and Sustainability - Research Paper Example It is important that every sector of the society must co-operate with business to find solutions to such profound and complex challenges. Collaboration is the co-operation and co-ordination that is necessary between all business, government and non-government organisations to cope with all such challenges. It is a situation where people work towards attaining a wider goal beyond the boundaries of an organisation. Keeping in view the responsibility towards the economic development of the society, collaboration and partnership between different organisations seem to be more logical manner to maintain the flow of development. Collaboration can have the advantages of â€Å"improved access to resources, sharing of risk, increased efficiency, co-ordination and seamlessness† between different organisations and institutions (Murray et al 166). Collaboration is also imperative because it is not possible for a single organisation to deal with moral problems of the society like â€Å"po verty, crime and drug abuse†. Collaboration can take place between business organisations and governments or between governments and NGOs to address various social issues. Companies may often collaborate with governments and NGOs with the purpose of learning from their partners for their benefits and also for the benefits of the partnership. In the framing of the structure of the collaborations, the organizations should be careful in choosing a collaboration which would meet the objective of the CSR of the organization. In building the collaboration, special emphasis should be provided to maintain relationship between the units with which the business houses are collaborating. Various strategies also have been framed for the better utilization of the collaboration process (Murray et al 161-174). Every organization is responsible to the society and its

MEDICAL Essay Example | Topics and Well Written Essays - 1250 words

MEDICAL - Essay Example The Dermatology department deals primarily with skin diseases, their symptoms, and other disorders that manifest with skin symptoms. The most common cases are those of contact dermatitis, acne, and atopic dermatitis. Additionally, the Dermatology department deals with less common benign neoplasms and malignant melanomas. The department consists of the dermatitis treatment team, made up of world-class allergists, the dermatological surgery team, who operate on neoplasms and melanomas that require removal, and the laser clinic, who primarily focus on cosmetic treatments such as hair removal. We have recently obtained equipment for ultraviolet radiation therapy, which is a safer and faster treatment for skin conditions that can be managed with exposure to sunlight. Our oncology department has been growing by leaps and bounds in the past year. The department now contains a pediatric oncology clinic and a breast health center, in addition to our existing radiation treatment clinic, chemot herapy clinic, oncological operating room, breast cancer treatment clinic, and palliative care clinic. We also cross-treat with the cancer clinics within each of the other major departments. Our most common cases are generally breast cancer and gynecological cancers, but the presenting cases are so widely varied that it is difficult to pin down what are the most treated. Radiation therapies we offer include both brachytherapy and external beam treatments. The side effects of these treatments are the obvious reason for the palliative care needed, as many of the patients suffer greatly, and additionally, a patient receiving brachytherapy can stay in one of our shielded rooms to avoid exposing others to their radioactivity. We also offer alternative treatments including ozone therapy, UV therapy, and nutritional guidance including supplements that may help improve a patient's comfort level. The Gastroenterology department primarily deals with three common conditions: gastroesophageal r eflux, ulcers, and colorectal cancer. Reflux and ulcers are diagnosed by our specialists in endoscopy and esophageal manometry. We can treat extreme cases in our gastrointestinal surgery clinic, which is also used to treat patients with colorectal cancer. The other major responsibility of the gastroenterology department is to diagnose chest pain that has been determined to be non-cardiac in origin. In addition, we have equipment for a variety of treatments, including small bowel enteroscopy, laser endoscopy, endoscopic ultrasounds, and gastric acid secretory analysis. The Pulmonary department deals with many of the critical care cases that come through the hospital doors. We treat cases as varied as cystic fibrosis control, environmental lung disease, pulmonary hypertension and vascular disease, acute injuries, embolisms, COPD, and asthma. Departmental specialists include pulmonary radiologists, surgeons, oncologists, pathologists and allergists, in order to image, diagnose, and tre at the patients of the department. The department offers diagnostic testing of bronchoscopy, exercise stress testing, catheterization, and functional testing. We also have equipment for sleep apnea testing for the patients to take home overnight, and a surgical department for trauma cases. The Cardiology department deals with heart disease cases, primarily focusing on acute chest pain diagnosis. We also have an

Dickens & education in Hard Times Essay Example for Free

Dickens education in Hard Times Essay In Hard times we see two versions of the world of education. The first view is that of Thomas Gradgrinds and his model school. A place where facts are valued and imagination is regarded as unimportant. This is the utilitarian view. The second view is contrasted with the utilitarian view and is that of Mr Slearys circus. This is a place with much knowledge valuing both imagination and education. A place without the wealth of the Gradgrinds but much in humanity. This is the fanciful world. I think Dickens is telling us that there are many different ways of bringing up and educating children. It is about getting the right balance between education and imagination. For example Sissy was brought up by her father and didnt go to school but was quite well educated as she used to read to him, but her father let her use her imagination as she read the wrong books from Gradgrinds point of view. Which were about Fairies and the Hunchback and the Genies. But when she went to Gradgrinds house to live there she was cut off from having an imagination, as so was struggling to learn facts. The reader knows this as Sissy says, I am O so stupid! when really she isnt stupid at all, it is just that she has been forced to be brought up the utilitarian way, which is the wrong way for her, as she is used to having a balance between education and imagination but Gradgrind hasnt allowed it. She became low spirited, but no wiser. This is because she has an emotional memory and so she cant learn the facts because she is being taught with a utilitarian view and so she cant attach a feeling to what she is being taught. This is how Dickens implies that different people learn different ways and at different rates. For Gradgrind it could be argued that it was the right way for him as he was educated by his father the utilitarian way. He became a model pupil and owned a school. The reader knows that he was a model pupil as Dickens tells us five young Gradgrinds were models everyone. And They had been lectured at from their tenderest years. And in Gradgrinds eyes this had worked so He intended every child to be a model. But what Gradgrind doesnt realise is that all children are different and need to be brought up different ways, which is what Dickens is suggesting to the reader.

Using gentamicin in the management of sepsis

Using gentamicin in the management of sepsis Sepsis is defined as the inflammatory response toward an infection (1). It is either simple or severe sepsis depending on the organ dysfunction involved as a result of the infection and other factors (2). In terms of the pathophysiology of severe sepsis, a cascade of inflammation and activation of the coagulation system associated with impaired fibrinolysis causes changes in microvascular circulation associated with organ dysfunction, severe sepsis, multiple organ dysfunction syndrome, and death (3). In terms of definitions of other sepsis-associated symptoms, it was generally agreed at the International Sepsis Definitions Conference which was convened in 2001 and the following definitions of sepsis syndromes were published in order to clarify the terminology used to describe the spectrum of disease that results from severe infection. Sepsis is the presence of infection in association with meeting the Systemic inflammatory response syndrome (SIRS) criteria (Box 1 (2)). The clinical significance of meeting SIRS criteria in the absence of organ dysfunction or shock is still unclear. Severe sepsis is defined as evidence of end-organ dysfunction such as altered mental status, episode of hypotension, elevated creatinine, or evidence of disseminated intravascular coagulopathy. Septic shock is defined as persistent hypotension despite adequate fluid resuscitation or tissue hypoperfusion manifested by a lactate greater than 4 mg/dL. Bacteremia is defined as the presence of viable bacteri a within the liquid component of blood (1). Acute pyelonephritis is defined as an acute infection of one or both kidneys; usually, the lower urinary tract is also involved (4). Antibiotic regimen of choice for Sepsis that is associated with urinary tract infection is Co-amoxiclav 1.2g 8 hourly intravenously together with Gentamicin IV dose of 5mg/kg once daily (5). Although that is controversial whether to use the ideal body weight (IBW) or to obtain blood samples indicating Gentamicin level to get the optimal dosing regimen for Gentamicin in obese patient due to risk of accumulation with Aminoglycoside and the fear of oto- and nephrotoxicity (6). Other supportive measures depend on the patients status; table 1 (1) contains helpful measures that indicate markers of organ dysfunction. Case Summary Our patient, C.M., is a 56 years old female who was admitted to the Accident and Emergency department (AE) due to an increased urinary frequency and a high temperature of 40.5 °C. Other complaints were back pain and shortness of breath (SOB). Also, the patient had reported a fall the night before admission. Moreover, the patient had vomited the night before and in the morning of admission. C.M. is a previous smoker who had stopped smoking several years ago and she lives with a partner. She is clinically obese weighing 100kg and her height is 152.4cm. Giving this, her ideal body weight (IBW) comes to 49kg. The only known allergy for this patient is microspores tapes. The patients past medical history (PMH) included asthma, non-insulin dependent diabetes mellitus (NIDDM) and fibromyalgia. She was on one puff daily of each Symbicort Turbohaler 200/6  µg and Ventolin Accuhaler for the management of her stage 3 asthma. Metformin 1g daily was prescribed for her diabetes control; however, its formulation was not mentioned (whether it is a sustained release tablet or a normal release one!). For her fibromyalgia, she was taking 300mg of Quinine sulphate daily together with 150mg of Amitriptyline daily (which is a very high dose; low dose of tricyclic antidepressant (T CA) is recommended i.e. 20-30mg of Amitriptyline). For her pain, the patient was on Co-codamol tablet as required (strength, dose and frequency were not mentioned). Having that she is a diabetic patient over 40 years old, a dose of Simvastatin 40mg daily was prescribed as a primary cardiovascular disease (CVD) protection measure. In addition, Omeprazole 20mg daily was one of her regular m edications with unclear indication. Investigations On admission, an Electrocardiography (ECG) was performed and indicated sinus tachycardia; which could be related to the high temperature, pain or sepsis. The patients vital signs were abnormal having a respiratory rate (RR) of 22 breaths per minute (normal is ~ 12bpm), a heart rate (HR) of 117 beat per minute (normal is ~ 70bpm) and a blood pressure (BP) of 142/65 mmHg (target for diabetic patients is Her laboratory investigations were almost normal except for some parameters. The Sodium level was a bit low which could be a result of the frequent urination or an Amitriptyline hyponatremic effect. Glucose and C-reactive protein (CRP) levels were high which might indicate the presence of infection. Thrombocytopenia may be caused by Quinine or Simvastatin administration! Impression and related Management Plan The patient was diagnosed as a pyelonephritis and sepsis case; so empirical antibiotic regimen was initiated with 1g Amoxicillin intravenously six hourly and 500mg ciprofloxacin orally once daily. Also, 1g Paracetamol intravenously six hourly and one liter Normal Saline intravenously over 24hours was started. Urinalysis on the first day indicated the presence of leucocytes, nitrites, glucose, ketones and blood which means a presence of infection. On the second day, blood culture showed a growth of E. coli which is sensitive to Gentamicin, therefore, 400mg Gentamicin intravenously every 24 hour was prescribed and ciprofloxacin was discontinued. Gentamicin plasma level was requested 6-14 hours after administration of the first dose. In addition to the patients regular medications, 50 mg of Cyclizine eight hourly and 20mg of Citalopram once daily were added, paracetamol IV was switched to orally in the second day and 30mg of oral codeine as required was prescribed ; but the patients Salbutamol Inhaler had been stopped for unclear reason. Discussion Revising the management plan for this patient and in comparison to the local guidelines for the management of pyelonephritis and sepsis patients, we would notice that 1.2g intravenous Co-Amoxiclav is the first-line choice of Penicillins, not Amoxicillin, together with Gentamicin. However, if the ideal body weight is required to obtain the appropriate dosing of Gentamicin for obese patients, so in this case, 245mg of Gentamicin supposed to be prescribed instead of 400mg which is the maximum daily dose (Although that some infectious diseases specialist would recommend going to the maximum dose to make sure that we get the maximum benefit; but we must consider patient status and severity of infection!). Also, it is essential to check the optimal timing for monitoring each drug plasma level, in our case, Gentamicin therapeutic drug monitoring (TDM) has not deviated from the local guidelines recommendation for the once daily dosing of Gentamicin i.e 6-14 hours after giving first dose. Having a patient with increased urination and vomiting, we must consider fluid replacement. Replacing with one liter Normal Saline (NS) might have not met the patients requirement! So it is recommended to check patients need to ensure appropriate replacement i.e. at least 2.5-3 liter daily. We could have recommended giving 2 liter NS each over 8 hours plus the addition of 500ml 5% Dextrose to ensure calories intake if the patient cannot tolerate oral intake. Considering the patients asthma control, we must confirm that Salbutamol inhaler was not mistakenly missed after admission. Since that SOB was one of the patients complaints, we must ensure that it was relieved, if not, consider 5mg of Salbutamol nebulizer four times daily to be added to the regimen and if nebulizer is not necessary, ask for Salbutamol inhaler to be charted as if required basis (6). Also, blood gases were not mentioned so it is probably safer to ask for the oxygen and carbon dioxide saturations to consider if oxygen therapy is needed! Confirm that the patient and nursing staff are aware of inhalers techniques. The patient is on Amitriptyline 150mg orally daily which is considered an old practice for the treatment of fibromyalgia (high dose TCA) and the current recommendation states 20-30mg of Amitriptyline daily for 8 weeks (6) so it is better to re-consider dosing or to change regimen. Low dose Sertraline or high dose Venlafaxine therapy may be effective (6) so consider changing if no further benefit of the use of Amitriptyline. For the associated pain, Paracetamol with Tramadol has better efficacy than Co-codamol. Pregabalin (150-300mg every 12 hours) may improve pain especially if combined with Tramadol; it also improves sleep and morning stiffness (6). So, knowing the patients control with the current medication would be helpful to consider treatment change or modeling to get the most of pharmacologic treatment. Suggesting alternative ways to manage symptoms is also recommended, e.g. spa therapy, physiotherapy, stress management, acupuncture or diet (6). NICE guidelines for the management of type II diabetes mellitus state that Metformin is the first line choice for obese patients. Choosing appropriate formulation that suits the patients lifestyle is essential to ensure patients compliance. Once daily dosing of sustained release formula could provide 24 hour control over glucose, but in this case the present of infection interfered with having accurate reading so it is logical to check the HbA1c to check the glycemic control over the last 8 weeks to consider any therapy modification. Also, pre- and post-prandial glucose level monitoring is required to avoid both hyper- and hypoglycemia using the current regimen. Statins must be prescribed for all diabetic patients who are over 40 years old (6) and having any risk factor of Coronary Vascular Diseases (CVD). The patient was on Simvastatin 40mg daily but no Cholesterol level obtained (consider Ezetimibe if high Cholesterol). Monitoring liver function tests (LFTs) and any muscular side effect is important. Also, having a high BP on admission, checking that BP is normal after sepsis reveals is vital. If persistent high BP, consider adding ACE inhibitors, having the benefit of BP control and protecting the heart in patients susceptible to Vascular Diseases. Weight loss in this patient is advisable so consider dietitian and physiotherapist review to consider going on diet and exercise. Also, annual eye check is recommended to control retinopathy due to DM. Cyclizine was prescribed on regular basis, so we better check if the patient is really on need of a regular anti-emetic, otherwise, consider changing it to as required basis. Regarding Paracetamol, it was prescribed on as needed basis but it was not put clear not to exceed the maximum daily dose, so it is recommended to clarify that to not give the patient more than 4g per day. It is safer to contact the patients GP to confirm the indication of Omeprazole and to consider discontinuation if no clear indication was obtained. Additionally, the patient was thrombocytopenic, which could be a side effect of administration either Quinine or Simvastatin, so monitoring the platelets count is highly recommended to prevent any complication, although DVT prophylaxis is not needed as long as the patient is mobile. Conclusion In conclusion, the overall patient management had no much deviation from the current guidelines recommendation except for some practice that need to be reviewed considering the current patients status. Therapeutic monitoring should be carried on because the patient is under risk of many complications or side effects. Lastly, patients awareness of her clinical condition and treatment requirement for each problem is helpful to prevent or reduce future health problems. Appendix 1: PATIENT MEDICATION PROFILE Patient details Name C.M. Consultant General Practitioner Address Gender Female Weight 100 kg Height 152.4 cm Community Pharmacist Date of Birth (Age) 56 y.o. Known Sensitivities Micropores tapes Social History Previous smoker, lives with partner Patient hospital stay Presenting complaint in primary care / reason for admission Admission date 2008 Increased urinary frequency Back pain Shortness of breath Vomiting Fall (the night before) Fever (40.5 °C) Discharge Date Discharged to Relevant medical history Relevant drug history Date Problem Description Date Medication Comments Asthma Symbicort 200/6 Turbohaler 1 puff daily Ventolin Accuhaler 1 puff daily Non-insulin dependent diabetes mellitus Metformin 1g daily Formulation? Fibromyalgia Co-codamol PRN Strength? Amitriptyline 150mg daily Too high! Quinine sulphate 300mg daily Duration? Simvastatin 40mg daily 1ry CVD prevention Omeprazole 20mg daily Indication? Relevant non drug treatment Prescribed Medication Start Stop Clinical/Laboratory Tests Result 1 Paracetamol 1g IV 6 hourly Day 1 Day 2 ECG Sinus tachycardia 2 0.9% sodium chloride 1000ml IV over 24 hours Day 1 HR 117 bpm 3 Amoxicillin 1g IV 6 hourly Day 1 BP 142/65 4 Ciprofloxacin 500mg PO OD Day 1 Day 2 RR 22 bpm 5 Metformin 1g PO OD Day 1 Urine analysis Leucocytes, nitrites. Glucose, ketones, blood +ve 6 Omeprazole 20mg PO OD Day 1 Blood culture E. coli 7 Quinine sulphate 300mg PO OD Day 1 Na 134 (135-145) 8 Simvastatin 40mg PO OD Day 1 CrCl 145.3 (78-120) 9 Amitriptyline 150mg PO OD Day 1 Glucose 8.9 (3.9-5) 10 Symbicort 200/6 inhaler 1 puff daily Day 1 CRP 180 ( 11 Codeine phosphate 30mg PO PRN Day 1 Bilirubin 35 (3-16) 12 Citalopram 20mg PO OD Day 1 PT 17 (12-15) 13 Cyclizine 50mg PO 8 hourly Day 1 APTT 39 (20-30) 14 Gentamicin 400mg IV 24 hourly Day 2 Platelets 70 (150-400) 15 Paracetamol 1g PO PRN Day 2 Clinical management Diagnosis Pharmaceutical Need Pyelonephritis Evidence-based treatment Sepsis Treatment according to guidelines Care Issue/Desired Output Action Output Confirm drug history + reconcile drug history Ask patient how and when she takes her medication and the indication for each medicine. Compare with GPs DHx + Phone GP for indications for amitrip., omep. and quinine, and when they were initiated. All regular meds have been charted except prn salbutamol. Patient is SOB; advise Dr to chart it prn. Confirm antibiotic regimen for pyelonephritis/sepsis in addition to TDM Check the local guidelines that amoxicillin is first-line for the indication (culture sens. to gent.).Calc. her ideal body weight and CrCl.Calc. gent. dose based on ideal body weight and compare to 400mg iv od (max dose).Check local guidelines whether 6-14 post dose gent. level is correct procedure. Chase level. Monitor BP, Temp, Pulse, RR for signs of resolving sepsis whilst on current regimen. Co-amox 1.2g iv tds is first-line with gent 5mg/kg (max 400mg, ideal body wt 49kg, CrCl 71ml/min). Recommend switch to co-amox because she needs 7/7 iv + oral. Recommend 245mg gent iv od Obtain level before 2nd dose is given+TDM for gent is correct. Review need for gent in 48h Fluid requirements possibly not being met by 1L N. saline in 24hours Request a running fluid balance chart due to vomiting + increased urinary frequency. Ask patient if she can tolerate oral liq. or if feels thirsty. Assess if iv is necessary (2.5L daily + replace losses) Advise doctor to amend first bag to 8 hours and chart 1L N.saline over 8hours + 500ml glucose 5% over 8 hours if patient cant tolerate oral liq. Is her current SOB being treated appropriately? If patient is still wheezy, ask for PaCO2 + PaO2. Request salbutamol nebs 5mg qds + O2 60% to be charted. If not currently SOB, ask for accuhaler to be charted prn. Assess inhaler technique for both inhalers when breathing ok Is her fibromyalgia regimen in-line with current evidence? Check Brit. Soc. Rheum for current guidance on fibromyalgia. Check that citalopram is the SSRI of choice in fibromyalgia since it has been started on admin. Review quinine; if has been in use for 3 months with no benefit consider stopping it High dose TCA is an old practice; current evidence states 25mg/day for 8 weeks. Advise a review of Amitrip. Low dose sertraline has better evidence for use in Fibro. Advise switch + show evidence to prescriber. Tramadol with paracetamol has better efficacy than co-codamol. Suggest trial switch and monitor for dizziness due to recent unexplained fall. Consider pregabalin. Lifestyle advice: stress management, diet, physiotherapy/massage, etc. Is her type II diabetes under control? Check SIGN guidelines on diabetes for current management. Request HbA1c test to determine control over last 2-3/12 Monitor glucose pre/post-prandial and random. Ask patient how she takes the metformin and how regularly Metformin is first-line in obese type II. From lab results, assist endocrinologist in determining whether metformin dose should be increased + which preparation suits patients lifestyle. Is her CVD primary prevention needs being met? Check SIGN guidelines on CVD primary prevention. Check BP + Cholesterol. Next UEs ask for urine albumin + protein levels. Ask patient about current diet and exercise plan (obese) + last eye test. Simvastatin 40mg charted. Check cholesterol. If it is high, may need ezetimibe 10mg od. LFTs ok BP 142/65, upon resolving sepsis recheck BP and initiate ACEi if appropriate. Advise dietician review (obese) + physiotherapy review (or GP) for plan (30mins exercise 5/7). Advise eye test once a year Regular cyclizine may be unnecessary Endorse chart for paracetamols maximum daily dose Reassess patients need for a regular anti-emetic and re-chart cyclizine as prn instead of regular if required Max 4g in 24 hours (e.g. 1g QDS) Highlight patients thrombocytopenia No need for DVT prophylaxis if patient is mobile. Mention that quinine or simvastatin could be the cause of low platelets. Suggest trial withdrawal of quinine if not planning on stopping anyway. Monitor Platelets level if continued. Indication for omeprazole Determine indication from GP and patient. Consider trial withdrawal if indication unknown. Appendix 2: Box 1. Consensus Conference of the American College of Chest Physicians and Society of Critical Care Medicine definitions for the various manifestations of infection.   Ãƒ ¢Ã¢â€š ¬Ã‚ ¢ Systemic Inflammatory Response Syndrome (SIRS): Manifest by two or more of the following conditions: 1. A temperature >38oC or 2. A heart rate >90 beats per minute 3. A respiratory rate >20 breaths per minute or a PaCO2 4. A white blood cell count >12,000/mm3 or 10% immature forms. à ¢Ã¢â€š ¬Ã‚ ¢ Infection:Microbial phenomenon characterised by an inflammatory response to the presence of microorganisms or the invasion of normally sterile host tissue by these organisms. à ¢Ã¢â€š ¬Ã‚ ¢ Bacteraemia: The presence of viable bacteria in the blood. à ¢Ã¢â€š ¬Ã‚ ¢ Sepsis (Simple): The systemic response to infection, manifested by two or more of the SIRS criteria pus an infection. à ¢Ã¢â€š ¬Ã‚ ¢ Sepsis (Severe): Sepsis associated with organ dysfunction, hypoperfusion, or hypotension. Hypoperfusion and perfusion abnormalities that may include, but are not limited to lactic acidosis, oliguria or an acute alteration in mental status. à ¢Ã¢â€š ¬Ã‚ ¢ Septic shock: Sepsis-induced hypotension despite adequate fluid resuscitation, along with the presence of perfusion abnormalities that may include, but are not limited to lactic acidosis, oliguria or an acute alteration in mental status. Patients who are receiving inotropic or vasopressor agents may not be hypotensive at the time that the perfusion abnormalities are measured. This is a subset of severe sepsis. à ¢Ã¢â€š ¬Ã‚ ¢ Sepsis-induced hypotension: A systolic blood pressure 40 mmHg from baseline in the absence of other causes for hypotension. Adapted from Bone RC et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Chest 1992; 101: 1644-1655. Appendix 3: Table 1. Clinical and laboratory markers of organ dysfunction. Organ System Clinical Laboratory Cardiovascular Tachycardia Hypotension Cardiac arrest Arrhythmias Haemodynamic support Altered CVP, PCWP Reduced cardiac output Endocrine Weight loss Hyperglycaemia Hypoalbuminaemia Haematological Bleeding Thrombocytopenia Increased D-dimers Abnormal white cell count Abnormal clotting profile Gastrointestinal Ileus GI bleeding Acute pancreatitis Acalculous cholecystitis Decreased intestinal pH Elevated amylase Hepatic Jaundice Hyperbilirubinaemia Increased PT Elevated LFTs Hypoalbuminaemia Neurological Delirium Confusion Altered consciousness Altered EEG Renal Oliguria Anuria Renal replacement therapy Elevated creatinine Elevated urea Respiratory Tachypnoea Cyanosis Mechanical ventilation PaO2 SaO2 PaO2/FiO2 Immune Pyrexia Nosocomial infection Altered white cell count Impaired white cell function Adapted from Balk RA. Pathogenesis and management of multiple organ dysfunction or failure in severe sepsis and septic shock. Crit Care Clin 2000; 16: 337-352.