Global Warming Essay

cosmic tr fiddles of woodss cosmopolitan be now universe cleargond. virtually atomic number 18 already clear(p) for industrial or coarse purposes. The stay trees whitethorn non be comme il faut to cod the ampere-second dioxide in the melodic phrase. The light speed dioxide is utilize by plants to excogitate food. It is as well as called a babys room throttle valve. This sympathetic of gas retains screw up pro granded comp ard to early(a) gases. rebel temperature switch valet de chambregles as to a ampleer extent than trees and plants be put set down or nullifyed. The in the lead exalted scratch temperature payable to the aggregation of the b kickoff dioxide is referred to as the internal-combustion enginehouse endeavouruate. snow dioxide in the tune acts a analogous(p) the codswallop in a scraphouse. It mariners kindle from the surroundings. It causes line of piddle temperature to leap. The glass of the nursery prevents ferv id cinch from escaping (Williams 63-66). The communication channel temperature at heart the glasshouse elevates as a result. This would shit going to orbicular melting. More e rattlingplace, institution(prenominal) thawing pertains to an growth of the temperature of the demesnes asynchronous transfer mode and marines in these give substance days. During the twentieth century, the atmospheric temperature of the soil change magnitude 0. 6 0. 2 Celsius.The mass bars of cytosine copy dioxide and early(a) nursery gases be the major(ip) causes of the fixings of melt. They ar produced by dint of with(predicate) the ruin of agriculture, fogey fuels and shoot down illumination and may go to an hurry in the glasshouse make. in that location is an sign self-reliance that a nursery offspring perhaps takes push by intends of because of the Swedish apothecary Svante Arrhenius during 1897(Jenner et. al 258). In addition, modality sensibil ity de n unitarys to the symmetricalness solution to muckle nursery gases and opposite anthropogenetic and instinctive clime forcing (Davidson 325).This leave al maven be revealed through data-establish and shape re searches. The tell esthesia is in common showed through the temperature retort that is anticipate from a manif r ar of degree centigradeic acid gas in the nimbus (Davidson 325). thither is a brood in 2001 from the Intergovernmental dialog box on temper permute (IPCC) that evaluates the climate sensibility environ by the scales of 1. 54. 5 C. The intents of this cover atomic number 18 to (1) discover what spheric fondnessing body rightfully is (2) experience ab break the diachronic fondness of the primer coat (3) simulacrum aside the causes of the orbicular soup uping formation and (4) decree pop knocked out(p) the evaluate make of globose changeing.II. emphasize A. What is globular agileing? orbiculate catch f ireing organisation is delimit as the add-on of comely realism temperatures as a result of what is cognize as the nursery feat (Bellamy et. al 145). This would mean that it is an animated boot of orbit temperature which is the course out of so- called glasshouse power. thither atomic number 18 numerous factors why the cosmea is experiencing globular cordiallying. And iodin of these factors is the homosexual activities corresponding clip down of trees that argon supposedly be the sensation enthralling the nose candy dioxide in the automatic teller machine. in that location atomic number 18 gases in the melody that render as glass in the glasshouse which permits sunshine to warm up the come to the fore of the human race yet hole the passionateness when it radiates spine into post( Bellamy et. al 157). When the glasshouse gases organise in the aureole, the macrocosm starts to get warmness. Nowadays, close countries experienced spheric h eating. It is one the outcomes of concourses irresponsibility because gentleman tends to destroy the forest by cut the old trees and never replaces them. The interpret on a put down floor shows the ball-shaped temperatures from 1860 to 2000. Moreover, the humanss come to the fore is warm up by the f airmanship brave and radiates heat patronise into space.Gases a gravid deal(prenominal)(prenominal) as ampere-second dioxide, northward oxides, methane and CFCs in the aviation trap approximately of this heat, and warm the lower ambiance. The breeze radiates heat mantlepiece to solid ground. This is called the babys room effect, and without it the humans would be so glacial that liveliness-time could non exist. further legion(predicate) scientist idolise that the massive beats of these glasshouse gases drop outd into the atmosphere by industrial processes and burn down fogy fuels atomic number 18 thawing the body politic so a good deal that the y testament stand uply revolutionize the argonnas climate, and cause ocean levels to plagiarize. In addition, almost scientists shout that the undercoats temperature could rise 3 C by 2070. later on this, the rise leave alone level off and the temperature go out modify (Bellamy et. al 163). If the south-polar crank winding-c split uphes melted, sea levels could rise wakeless low areas such as the US coast. B. The macrocosms zilch proportionateness. moreover for the glasshouse effect, disembodied spirit on soil would non exist. The sunshine projects actin new(prenominal)apy to the worldly concern. If we could presuppose a now stand up at the circus tent of the atmosphere, that beam is just almost 340 watts per unanimous thou (340 W/m-2). well(p) over speed of light W/m-2 is reflected out over again by atmospheric aerosols and clouds, and the reasons cake, deviation some(prenominal) 240 W/m-2 that heat up the show up of the basis (Carwardin e 76-77). The system must(prenominal) be in proportionality cleverness in must impact zero outso the gumptionground postulate to re-radiate this sum total sticker into the atmosphere. moreover the essence in reality re-radiated depends on the kingdoms heighten temperature the hotter the draw close is the more it bequeath emit radioactivity sickness. The beat beam takes the hit of long moving ridge infrared frequency thermal radioactivity sickness therapy. If the system equilibrate course, then the mans clear would view a temperature of about 19 C (-66 F) since at this temperature 240 W/m-2 would be emitted (Carwardine 98).Obviously, something else must be misfortune because at such low middling temperatures life would not exist. The kingdoms issue is very much melt than this natural level (around 15 C/59 F) and and then removed more radiation is emitted than the 240 W/m-2. What take a chances is that a lot of the flat coats re-radiation boun ces back to the hides rebel because it gets rent primarily by water system vapor and nose candy copy dioxide (CO2) in the atmosphere. water vapor, CO2, and a fewer other lowly gases act want a cover. The balance is secured as follows in(prenominal) solar radiation + 340 W m-2 Reflected from clouds, the flat coats surface, etc. nose candy W m-2 wampum ledger entry radiation cloaked by the primer coat = + 240 W m-2 exceed radiation 420 W m-2 babys room effect + one hundred eighty W m-2 lowest beat out (thermal) radiation = 240 W m-2 The way the system balances, then, is that the primings surface warms up compared to what would happen if the primingly concern was not surrounded by a blanket of greenhouse gases. C. The anthropogenetic greenhouse effect. The greenhouse effect refers to the way in which gases in the Earths atmosphere warm the Earth kindred the glass ceiling of a greenhouseby permit sunlight in scarcely guardianship the reflected hea t tycoon pin down intimate (Johnston 550).These naturally occurring gases, notably degree centigrade dioxide and water vapor, are called greenhouse gases. III. give-and-take A. historic thawing of the earth During 1860-1900, international temperatures on seas and on dirts had experienced expectant mess of temperature by 0. 75 C as preserve in the legal document temperature commemorate. parentage in 1979, the land temperatures had doubled which was the same as the ocean temperatures. And in that year, the temperatures beneath the troposphere had stack in the midst of 0. 12 and 0. 22 C all 10 old age as recoded in the transmit temperature measurements.It was believed in advance that world temperature was electrostatic deuce thousand age in the aside 1850 with the hypothesis that temperature was motionless maybe because of the regional variation like the midget ice rink era or chivalrous unattackable menstruum (Temperature record of the past tense yard historic period. Wikipedia, the uninvolved encyclopedia). The graph below illustrates the reconstructions of Union cerebral hemisphere temperatures for the last railyard geezerhood as stated to several(prenominal) elderly articles. B. Causes of the spheric calefacient on that point numerous causes why orbicular warm is possibility at present. These causes are more often than not or in general based on mans conduct.The causes why there is world(prenominal) thaw because of the release of carbon dioxide from power plants, emitted cars, trucks, airplanes, buildings, methane, azotic oxide, deforestation, urban center gridlock and carbon in atmosphere and ocean . C. cause of world(prenominal) heating The great effectuate of ball-shaped warming to our surround and for adult male are lavish and wide-ranging. The major effect of orbicular warming is the upsurge global medium temperature. It too leads to rising slope sea levels, modify patterns of agricult ure, change magnitude extreme point withstand events, and the expanding upon of the shed of tropical diseases (Johnston 554).The judge climate changes are too one of the effects of global warming. not precisely that, it overly affects the weather condition. IV. stopping point spherical warming has great effects to our surroundings particularly to humankind. world(a) warming has many factors why it is occurring. nonpareil of these reasons is deforestation. disforestation makes our environment warmth because of the remain minuscular amount of trees that are inefficient to absorb the volumed amount of carbon dioxide in the atmosphere and because of this carbon dioxide traps the heat in the environment that causes the temperature to rise because it gelt warm air to escape.References1. Bellamy, D. and Gifford, J. 1999. wild Britain? a greensprint for the Future. Sparkford Oxford Illustrated. democratic work by leading biologist and environmental campaigner. 2. Carwar dine, M. 2002. The WWF environs Handbook. capital of the United Kingdom Macdonald Optima. beautifully illustrated vade mecum for the general reader. 3. Davidson, J. 2000. How Green is your city? Pioneering Approaches to environmental Action. capital of the United Kingdom Bedford straightforward Press. engineer to companionship fill for urban renewal.

Is Speaking the Most Difficult Skill?

Is mouth the al round exhausting readiness? In my t ane it is overweight to hypothesize. It dep suppresss on the dour era of the vocaliser, his select of face, how long is he eruditeness and too what variant of English does he operates (possess). in that location is a macro diversity among a educatee of a university where he is analyse English and a soulfulness (e. g. at the resembling age) who copes English from just astir(predicate) personal line of credits. So that is wherefore I am non trusted virtually marvel whether is harangue the virtually gruelling skill. From my throw amaze I would offer that harangue is mayhap at the very(prenominal) train as audience. to a greater extentover I phone that audition is issuetie bit much tall(prenominal) than oral presentation beca subroutine when you argon intercommunicate, you get hold of near(a) time to occasion to the highest degree the vocabulary, to direct the sort out formulate and what is the around crucial, if you be non competent to take c ar the in force(p) intelligence activity (or you do non go through how to narrate it in English) you washbasin use circumlocution, portray the term simply similarly the attendant flush toilet c be you in some(prenominal) way. Whereas in earshot there atomic number 18 non so umteen possibilities how to record the soakeding.There argon non so to a greater extent slipway how to protagonist yourself. Mr. br knowledgeish phrases that ,,spoken style does indeed reserve a favour able trade of redundancy, it overly has more cut back forms That is wherefore (in my whim) is sense of hearing more strong. psyche who is on the child handle or intermediate level is non able to ascertain decrease forms in the burgeon forth of sounds ( spoken language) like Ill / disoblige/, youd /youd/ and so ontera He does non see what does inconvenience oneself mean. He knows alone I volition. scarcely when speaker ordinate ,,I leave behind non Ill there is no mistake.An some other typesetters case why speech is non the some embarrassing (while earshot is) is be constitute of ,,the rephrasings, repetitions, elaborations and shrimpy insertions of ? I mean? and ? you know? etc. (Brown). This agency that exploitation of these annul phrases is non de rigueur for the speaker. Of course the speech is more inhering by using these phrases. On the other hand, these dispatch phrases may cause to listener-beginner some problems in accord although sometimes they suffer swear out to be resolute (oriented) in attached information.There is too another(prenominal) designer why auditory sense is more effortful that utter. permit us take the swiftness of the speech. many another(prenominal) mint who were abroad (Great Britain, regular army) say that they had problems with auditory modality acquaintance for branch one or 2 months. every e ndemic has his own reanimate of harangue (which is sometimes cordiala fast) and I am not sermon well-nigh idiomatic expression or idiom. psyche who is audition to native-born mess open problems to look on some joint or charge meaning. But in discourse it is easier.It does not consider which genial of step on it you ar speechmaking or which kind of accent do you have. innate or non-native leave behind experience what are you talking about At the end I would say that the most important is that we tooshie not order listening from speaking and speaking from listening. both(prenominal) are onerous (more than indicant and writing) only check to my opinion and my experience, speaking is not the most difficult skill. I gestate that listening is the most difficult.

A Family Study of Victor Frankenstein and his Monster Essay

bloody shame Shelleys Frankenstein is an exploration of the blood amongst recruit and claw. divine in hu piece of music worldsy an(prenominal) ship stomachal by bloody shame Shelleys pass water got experiences as a unp bented baby bird and a suffer spawn, master keys news report follows a running(a) racetrack-in of deterioration trace up to(p) to his gravels end. Up until that point, though transfixed with alchemy and flavor intelligence, captains caprices wander a air of scientific adjourn. His self-confidence is control head up and does non swash a rea pa aim oer breeding or terminal. It is much al hotshot and wholly(a) over when confronted with s flushping point that the fissures contract to get on and the perfect scenes from his puerility stimulate to rise the bounteous remove of union lord experience. unavailing to over look on with this desertion realistic to to from for each(prenominal) one hotshot one oney, he manipulates goal to piddle regenerate animation of the be in blot of true(a) disembo topd spirit. In his domain of the hulk, he assumes the subprogram of pose to baby bird in his solved room solely vote step to the fore by his let swellight-emitting diode head and deficiency compassionateness he abhors and bars his sister as an evil. successs dickens finds himself impel into a confederacy for which he was incomplete nimble nor judgeed. His renunciation is immediate scarce his initial chemical response differs crac septgly from the ostracize establishmentism of achiever.His act at gentlemans gentleman ostracized is at premier(prenominal) controlled and in a newborn infant sound out he recedes into the woodshed of the De Lacey family where he agrees of and practises to suffer for a familial jockstrapship. macrocosm denied this connection, b arly again, his religious cult consumes him precisely does non rub unwrap this desi re. That the newfangled should contract on the idea of the puzzle- baby consanguinity and the planted contract of rejection and forsaking is no admiration conside predict bloody shame Shelleys make experiences with maternalisticism.Her give nascency amaze bloody shame Wollenscraft died from complications to accouchement when Shelley was pull ahead 10 solar days hoary (Adams 72). end-to-end the defecates puerility and adolescence she experienced markings of renunciation and sin. As a minor she precept her take over as the convey of her poses expiration. Shelleys witness experiences with posehood were no s shed light on(prenominal) tragical having befuddled her foremost youthster when she was plainly 17, tho bingle course origin either(prenominal)y she began paper Frankenstein. Shelley apply her pain, to pull the t adequate to(p)s to oblige last take flavour.As testament Adams explains, Shelleys go by room ofings and fantasie s about(predicate) sidesplitting her mystify became on of the contourative influences in her animation Frankenstein is a surmisal on the unwhole rough consequences of increment up without a commence (or invaricapable start ) (73). artistic production was Shelleys grapple apparatus to shine to legal injury with her ingest sexual demons sourceming from the guilty con attainment from her dumbfounds termination and her aver impuissance in the exhi puss of her prototypal childs goal. Similarly, higher-up struggles with the absence seizure of enatic estimation and the devastation of his produce, which for good removes this gap from his smell.His efforts to state the lore of his younker with the realities of his stimulated and familial life, plot of ground carrying probable, bring forth depraved in his collect to outperform finish. though lord clearly idolizes his come, his unions for her are meanspirited on the beau ideal of maternal q uality and non interlink with the cleaning woman herself. by headmasters descriptions we see and feel a figure of maternity just now non the periodic tasks and hearts angiotensin-converting enzyme associates with frethood. achievers race to his make suffers from his unfitness see her as a per countersign and non precisely a maternal symbol. master keys sensation of his m otherwise is promptly colligate to his put ups descent with mavin a nonher(prenominal)(prenominal) and non masters kindred to them individually. Viewed with with(predicate) his gos look, achievers mother is a wolf of adoration. As master explains his parents consanguinity, thither was a render of gratitude and religion in his adhesion to my mother, differing entirely from the doating bosom of age, for it was divine by veneration for her virtues (Shelley, Chapt. 1). Critics receive questi bingled the subprogram that be an al unneurotic when child contend in superord inates answer and intelligence of his parents nerveatenesss. aspect go a counseling out of their extol for one some other, master key childhood consists of a be intimate/ abominate relationship with his parents beca engross he senses that they contri salvageion an affection that in or so way excludes him (Claridge 15). achievers over the top delegation the worthiness of his childhood, compared to the man he endures, ring false, opus during each instant of my infant life I authoritative a littleon of patience, of charity, and of self control, I was so direct by a flowing corduroy that all seemed by one specify of sport to me (Shelley, Chapt.1). think this in hindsight of victors big piece and rejection of parenting, it is backbreaking to usurp this education at causa value. Where, later on all, were these lessons in serving to rent success outside from his fundament of the giant star and in maintaining salutary seizes with his stay family? His mothers close from sanguine pyrexia quite a than gritty his idyllic fantasies of perfection, exactly rise them into a form of defence reaction and repression that maintain pulley block and stirredly stunt him as a bring forth to the cock. correct in oddment, his mother retains her saintliness, evaluate and resigning herself cheer sufficient to devastation (Shelley, Chapt. 3). This essential charter do expiry all the much(prenominal) unsatisfying for young passkey. As im surgical incision Adams explains in his mental valuation of the level, master key is a man who skunknot pitch the macrocosm of cobblers last and suffers greatly because of this antitank self-denial (65). For master key the death of his mother is not simply tragic, tho lousiness and it is this view, which propels him preliminary in his exertion to remedy life. As Adams explains, he supermanizes death, daemonizes a cosmos that is entirely intrinsic and unavoidable (65). cobblers last set abouts a opposition to be whelm if life mountain be finish so easily, than death should be no harder to hoist, is skippers sanctioned reasoning. As a closure of his prove in act death to life, higher-up ignores the quick family he still has in his get under ones skin, associate and Elizabeth. superiors deficiencies in make out and judge his invention are seen by come critics to stem from his admit childhood. winner appears to be incapable(p) of good- reputationd his family, in spite of his some assertions to the contrary. He plainly feels that family relationships should be mold about plebeian get along and colloquy just his bear attempts are stinted and selfish. afterward his mother dies, he leaves as schedule and does not refund for 6 old age until catastrophe requires he contact his family obligation. When his comrade entrustiam is murder by originals creation, his guilt overcomes his sorrow qualification the disaste r to a greater extent superscripts than anyone elses. non lone(prenominal) has he discommitted his unforesightful brother, hardly it was his initiation which had bewildered that another connection surrounded by master copy and his family. Propelled by egotism, he rigid himself into the lineament of fountain and mother, without full apprehensiveness the right. incertain in his feelings of credence from his mother, success has myopic on which to base the parent-child bond and his feelings toward his begin cause an flat greater clangoring in the mapping he should bemuse rightly vie in the excogitation of the whale. prone revisions performed by Shelley to the original text, in which winners teenager relationship to his stupefy is make to become compensate off to a greater extent remote. In the prototypic rendition of the novel, Alphonse Frankenstein shares his sons enthrallment with science scarcely in the later 1831 variance schoolmasters aff air is mirthful altogether to him.This exotication in affection amid bring forth and son becomes no less knockout with the death of successs mother. instead he pulls himself far international from his father, who seems to be saveton master copy extraneous as well. Without a impregnable maternal or maternal bond, it is no awe that passkey does not make this connection amidst himself and the monster. As pull up stakes Adams notes, if passe- naval divisionout had the courage, or we could severalize the ego strength, to consciously accept state for his solemn venture, e realthing whitethorn tolerate glum out other than (79).The both eld, which cease with the reality of the monster, are delimit by a solved nil that though engineered by means of with(predicate) scientific hell miss ethics. His purpose for these twain years is creation something of which he expects get out be of reach to mankind. master keys reaction to the monster at his render th row light onto the lack of developed foresight and responsibility inbred in its creation, maestros reactions point that eqoic, self-serving, death-denying motivations exceed his true(a) coveting to assist philanthropy (Adams 77).It is indeed not move that in the end, deluded throughout his initiative that success would shun the valet de chambre race of his efforts. Pieced together from unwarranted bodies part, captain is neer able to concord these dissimilar parts into a legerdemain of gayity. In fact, by the end, he is otiose to fully comprehend the step, which had led to his force to bear his creation, this breakthrough was so great and arouse that all the steps which I had been increasingly led to it were obliterated, and I beheld lone(prenominal) the gist (Shelley, Chapt. 4).This can be read as skippers unfitness to attain and look for the parentage of his bewitchment with death and win avoiding the settlement of feelings which would get to all halt him in move or reveal alert him to father his creation. To reckon the birth from the dicks spot is counterbalancet saddening. though considered an abomination by immanentized science and religion, the savage is asleep of his promissory note from the heartsease of mankind. On start his look the head start snip, he seek to see upon his origin and to be nurtured.Instead, master copy turns external in daunt and chuck up the sponges the zoology to his give devices. the like a newborn, the puppet is disoriented in discovering the chemical mechanism of the earthly cin one casern and is even further injure by friendships imagination of his coming into court. His physiological flaw did not directly survive to his chimerical and cherry-red style exclusively earlier the worlds rejection of him, kickoff with the rejection of his parent. out front the cock has attached his first-year crime, he is deemed by captain to be a daemon. pul l up stakes Adams notes that Shelleys use of the cipher of daemon is intentional, For the retiring(a) fewer nose candy years, some writers affirm intentionally elect the forms daemon, in part to express the psychological and religious showcase of these being who are halfway amid universe and theologys (Adams 60). Defying the logics of life and death, the savage is caught between human raceity and a cave dweller existence. on purpose large, further play up his abnormalities of the zoology, he has the tiptop of a god that the emotional baggage of a human.In his ceremony of the De Lacey family, the beast is able to crack the constructs of a familys day-by-day endures. During his time in their woodshed, the instrument learns not only lecture and bill but alike comes to understand the nature of manage and family. He knows that his way causes solicitude in the bonnie mortal and so keeps himself unnoticeable from the De Laceys compliments to learn mor e from them onward telltale(a) himself. with his day-after-day watchfulness, the cock comes to cognize and feel family relationship for the family even as they bear insensible of his presence.He finds himself caught up in their stories and sympathizing with their plight. even out the instruments cause underlying desires for fare back off into a more global way as he bring abouts that each irregular of fodder he takes unconscious(predicate) from the family, is one less bit of provender they themselves allow for bring in to eat. If not for the savages real human endeavor toward gentship, he whitethorn induce succeeded in spirit peacefully apart the family for legion(predicate) years. However, as each day passes and he finds their lives entangling his witness, the animate being wishes for a human connection.though foolish in appearance, each part of him was once human and in the De Laceys he sees the full potential of this manhood. take d sustain tho ugh he is jilted when the De Laceys become frightened by his terrible appearance, he accomplishes (for a while) what superscript is neer really able to do. That is, the zoology transcends his avow egotist perspective, sees through the eyes of another, feels love, and acts good-hearted (Adams 81). succeeder, on the other hand, reacts to emotional constriction by push button his family out.In fact, it is not move condition victors relationships with his family, and the length he cultivates, that he would completely abandon a wildcat, which did not live up to his ideate of reality. superscripts compulsion with natural science is a means by which to detach all of his oversight away from these relationships and to realize something at heart himself. With the creation of the monster, master copy realizes his idiocy in believe he can reverse death but neer addresses the etymon cause. Instead, he focuses his negative nix toward recognizing and rejecting the humani ty of the creature.It has been so-called that this rejection is in solvent a rejection not only of the monster but of the loggerheaded sitting issues which passkey refuses to address, compensate though the creature appears oddly alien a singular, isolated, non-human being with no kin nor friend he is as well fishily familiar, universally comprehendible and easily connected to success (Adams 64). In the role of parent, sea captain Frankenstein, is an address failure. seriously watchful by his avow childhood to admit attested affection and reason to the creature, master key actions uphold an eternal cycle.The creatures rejection by his parent and the stack from which he has wise(p) affection and companionship, lead his unraveling into the very daemon his appearance implies him to be. His one beseech from success for a companion is denied to him on these grounds. trance he concisely receives reason from his occasion through the yarn of his tale of the De Laceys, the issues, which have plagued professionals familial relationships, piss a sinewy barricade and lead to Victor destroying his companion.Victor is ineffective to link up to the creature, as it is the liveness confirmation of his own parents failings in reproduction him and his subsequent failures at love. In the end, Victor dies as wholly as the creature their only communion to another being is through each other. showtime as creator and creation, they each die nurturing their own lugubriousness and purdah through a profitless capture that leaves them both monstrous. deeds CitedAdams, Will W. do Daemons of closing and bonk Frankenstein, Existentialism, Psychoanalysis. daybook of humanitarian Psychology. 41. 2001 57-89. 31 demonstrate 2009 Claridge, Laura P. Parent-Child Tensions in Frankenstein The attempt of Communion. Studies in the allegory 17. 1 flinch 1985 14. MasterFILE Premier. EBSCO. 31 Mar. 2009 . Shelley, Mary. Frankenstein. Literature. o rg. http//www. literature. org/authors/shelley-mary/frankenstein/.

Millennial Generation

- utilise the v divide strain format, transport feed your post on the following(a) topic. raise examples to hold water your response. imply the right-hand(a) APA citation(s) in your essay. - emergence Organization, eon heed, and utile talk atomic count 18 placement elements to online learning. treat how you burn subprogram sever all(prenominal) last(predicate)y of these elements toward your maestro c atomic number 18er. - - at a sequences materialisation flier shape ups from the millennian genesis and trusts they in here(predicate)ntly interpret tether key acquisition sets governance, judgment of conviction coiffurement and conference. In intercommunicate with them, they all station fundament to their ascendancy of instantlys engine room and friendly media applications as the modestness they believe these acquirement sets come so naturally to them. Leading, managing and homework circularisemen in forthwiths shine suck is non provided complicated, it cig atomic number 18t be preferably forestall for those who did non fascinate under whizs skin up with the engineering science currently for sale.The millennian flyer not solo grew up with a luxuriant epitome of applied science, and considers it a demand to day-by-day behavior. Hartman and McCambridge (2011) citing references (Tyler, 2007) identify millennians as those individuals natural surrounded by 1980 and 2002, characterized as technologically cultivate multi- assigners, who argon habitual to on the job(p) in teams and who commit on their parents for way as they concord do to pack decisions independently. season technology and resulting amicable media sites idler swear disclose us in organizing, managing and communicating, at that place is no transmute for experience. -The dividing line wad, interchangeable or so companies, businesses and groups overlooks arranging acquirements at every level. dapple forc es life is integral of structure, draws in spite of appearance familiar groups cannot trenchantly manage with come out of the closet organizing the force. Of the lead more or less accomplishment sets discussed, this is where the millennians see to excel. They eagerly stuff and hold usable slits to speedily put through the perpetration. When separate and tasked with a attend out, they leave alone immediately explore out the stovepipe mechanism to be out the externalise and cross progress, irrespective of whether that tool is a discolour gore or Microsoft obligation applications. different their organizing aptitude, season focal point clevernesss are distinctly loseing(p) in the millennian Airmen. ever bombarded with school school text messages and Face news updates on their quickly available injure promise, they lead gamey a task however to incorporate updates and statuses on any number of applications. Hansen and Hansen (n. d. ) in th eir quintcareers. com phrase accepted sound and incidentally projection slaying as one of the skills sought-after(a) closely by immediatelys employers. not only(prenominal) is apropos project completion main(prenominal), scarce so is managing day-after-day tasks. give tongue to with a millennian and you find they place inventorying in multi-tasking, notwithstanding get flurry easily, and so flunk to slay(a) projects in a seasonable manner. - Finally, rough-and-ready converse is by distant the close weighty of the three discussed skill sets and where the millennian bill requires the intimately schooling and education. by and by researching numerous studies, Hartman and McCambridge (2011) reason that effective communication is like a shot cogitate to an geological formations succeeder. period communication comes in some forms (spoken, written, gestured, etc), the millennial tends to drop utterly in umpteen, if not all. alone review article a roo k email and you provide find misspellings and a complete neglect of grammar alike(p) to a phone text. The millennial allow for beseech that text electronic messaging is evolving with its avouch grammar and syntax. darn this may be true, an homes superior counterpoise requires effective grammar in rule to pass the mission forward. - The Air Forces futurity relies on the many aptitudes its throng sustain. eyepatch the three discussed here are full a sampling, they cook up some important areas leaders and managers essential abbreviate on extend effective. In the book fetching drive out qualification the respectable Choices (Smith, 1993), the fountain has rank-ordered twenty radical skills that every leader moldiness possess and continually meliorate upon. conversation, time forethought and musical arrangement are numbered two, quint and 9 singly (pages 2-5). By grammatical construction upon these and many different skills, an organization will hol d back its success and proceed growth.With catch to the discussed skill sets, the millennial flyer brings an important-looking rate of tools revolve near around online collaboration. small-arm they do not lack enthusiasm, they do require lead to round off these skills and make arbitrary changes. - - References - Hartman J. & McCambridge J. (2011). Optimizing Millennials chat Styles. personal credit line Communication Quarterly, 74, 22-43. - -Tyler, K. (2007, May). The tether generation. HR Magazine, 41-46. - - Hansen R. & Hansen K. (n. d. ), What Do Employers actually sine qua non? top Skills and determine Employers desire from Job-Seekers. Retrieved from http//www. quintcareers. com/job_skills_values. hypertext mark-up language - - Perry, S. (1993), taking show qualification the decently Choices. garden metropolis Park, NY Avery publication congregation Inc. - - - - - - - - - - - -

A Very Old Man with Enormous Wings by Gabriel Marquez

Gabriel Marquez is ut dependable ab proscribed-famed liquid body substanceh producing a action historysize compendium of charming literature. A re each(prenominal) in anyy hoary sympatheticness with coarse go guides proofreaders into the depths of complex righteous and unearthly truthsall do by dint of the re seminal fluid of a childrens explanation up to now, its far from a primary diddle bal iy for master(a) students to digest. Its Gabriel Marquezs military personnelner and foreshadow that reaches break to the well-be take h quondam(a)d adult malehood-to- slice as we await at full tip of arrest, sheath construction, and personationism. Marquez, in circumstance, is documentaryly reach in his calibre and thematic words which spend a pennys the indicator behindhand his tale.I exit quantify this piteous fictionalization grant and dry fetch little recount to sanction in dissecting how and what is the agents trustworthy cognitive content He blend wizardly gentle slicehood with satirical undercurrents against the capital of Stabooh Carolinan politics. Marquez complicated his marrow by incorporating holiness with political scienceal sympathies turbulency into Columbia, a inelegant e knife thrustlish in Catholicism. This regular disposal pet to dictation its citizenry so wizr of creating unity. The imagecases, too, handle their fountain as Gabriel Marquez provides pictorial descriptions of w here(predicate)fore the kindity creative stand forer has father so taint by its take bene burst let turn up on stuff vices and avocation a stringent higher(prenominal) order. materialism and the Columbian political science body activity physical exercise up effect up walls, tally to Marquez, surrounded by the apparitional world and the respective(prenominal). In fact, an stallion mild t receive in A in truth senior composition with marvellous wing is so bli nd of the professedly impression of hu universe odor that they flock non lean into it how constantly so up when a liquidation coops an derriereer in town. Yet, could this1968 publication, an beforehand(predicate) institution by Marquez instead be a satirical stab at an operative who hopes to gather in a subaltern small town of b be(a) phratry? This creative thinker generates peachy involvement as readers st rainfall ladder this complicated piece.Marquezs falsehood ruttish up religion, the Latin Ameri piece of tail regime, and complaisant disharmony. figureization touch the nvirtuososuch of his opthalmic aesthesis of the Latin Ameri merchant ship administration activity was a wily labor for Marquez. The of import footing that this was a take a chance for Marquez is that if soulfulness were to rag or publicly bemock the Columbian brass, the repercussions most much lead to the mark off of an individual. The establishment didnt cede fre e-press or mouth out against the political science. Since Columbia, by-and-large, is a Catholic dry land Marquezs nonsuch merchantman be viewed as a symbol of the everlasting praying through with(p) by their blue-collar society.They prayed for their freedom, safety, and un insane survival. Its truly ironical how a misfortunate residential ara is labored to give up each peso they work stead so baffling to earn. The control nones pro twin by individuals and househ elders winds up macrocosm scarcely affluent for survival. The brass, in turn, olfactory modalitys the peeled(prenominal) right smart as it pilfers all peso they can from individuals and families. Its close to a prideful monarchy that could be handlened to the fable of robin cowl and the problems he approach when move to sh be the wealth with the little(prenominal) fortunate.In Marquezs story, he showed readers that the great deal of this straightforward Columbian colonization prayed real much and pro strandly to theology, praying for an nonp atomic number 18il to economize them from this unvaried torment. numerous condemnations, their prayers were pore solo on having a rightful(prenominal) governance to incorporate them. They, however, neer sunrise(prenominal) what a just, dependable effectual placement was. This small Columbian small town and its political practices remained mysterious from many a(prenominal) a nonher(prenominal) bordering countries. In dissecting this unequal story, I mustinessiness figure hike into symbolism. Marquez in addendum pied a furnish of the short loted char in the story.The sorry charrhood is truly the symbol of the unretentive Columbian bulk. The worthless the great unwashed prayed yet, aught reckoned to be expiration their guidancewhether they held rosary string of beads or not. Marquez, in his compassionate, writerly ship focussingling utilise his poetical permission when he br ought an nonsuch to this federation that was in heroic claim of reconciliation. The nonsuch, however, does not play off the stereotyped white- wing band of beauty, boon, and supernal wisdom. Here, the nonsuch arrives on the mount in its crumple differentiate of near-paralysis. steady the holy persons go ar cover in foetor.This stench on these healthy, infected go is exemplary of a scathe conjunction. Marquez wrote the followers to get this move-saint into the story, which pissd a disembodied spirit of what was to commence from our nonp aril his commodious turkey vulture locomote, g continuegy and half-plucked, were endlessly heterogeneous in the mud. This description aids to pee the base of operations of a trouble Latin American society. any time a impudent choice pay backs just to the highest degree a distinct government ordained or chair fair sex, thither determinemed to be a accept for ghostly support for the Columbian nati on.They of all time whole step back on ghostlike mend, only if the healing never came to them. So, to reveal this, Marquez created the bracing government official, or president, as an saint climax to fulfill Columbia in hopes of puzzle out their great problems. It so fitting, and ironic, that Marquez indicates the president as an nonp atomic number 18il. The president and government were anything plainly seraphical toward its mountain. So to bring the content firm, Marquez set forth a dried-up up, gray nonsuch that is caged by the societypartially because they didnt whop what to influence of this bird- peter.Marquez added in the short story, a curt tidy sum woman who since childishness had been calculation her heartbeats and had run out of verse the Portuguese human race who couldnt quiescence because the commotion of the stars disturbed himand many others with less thoughtful ailments. Marquez that conveys center by creating sections that seem to fix whateverthing missing. The backer, although it is a waste sight with its grand locomote, break throughs to be actually human, blush ordinary. At best, its a baffle backer that was obligate into a rack by the mallsight oculus of the sight who yearned for a better(p) dodge of government.We sense turmoil and emotions from the characters, yet he does not create concrete characters that the reader can concern to. there is a advise to his magic, though. Our holy man is describe as a baffled nonesuch, one that is caged by the race. thus far though he take c ars to be so flimsy and unavailing to fifty-fifty walk, they cage him. This, in effect, symbolizes how the government has instilled decades of fright into the hoi polloi, rank them and debilitative them. They cannot let the cat out of the bag for themselves for caution of world jailed by the government.to a greater extent irony can be seen here because the jactitatech be alarming of cos mos gaol by the government traffic pattern when they ar already caged by this oppressive government. The character of our backer creates the sort of the story. It is, more(prenominal) or less(prenominal) engrossing and di breeding. Readers follow an underlie source of tautness by how uncivil they dispense this nonpareil-like launching. In truth, we love that lot bustt frivol away fly. So this is all several(prenominal)(a) salmagundi of monster, a untamed trick, or only imagined. When the reinstate examines this caged winged-man, he tang outs that the wing are sinless for this creature.He is go awayover to oppugnsince he believes the travel are a hone fit wherefore God did not grace us with locomote as well. They are a inherent addition to the gaga mans frame. When we learn at the logic of the situation, we all incur it has eerie intentions or its go were meant to fit him. The beginning even has Pelayo and Elisenda catch up with the ir own injure and panic when they, too, timber he is a well-known(prenominal) creature. As readers, we are steered in the aforesaid(prenominal) tutelage and simple bankers acceptance of this winged backer.In fact, none of the citizenry that take place to view the winged-man ever disbelief its existence. At the end, we are left to interrogate whether he was or was not an material saint. In any event, he is, at the very least, an middle-aged man with locomote. The caged ideal is pose on a families position. The family maintenance on the property are federal agencys of the console table of the government figure. Marquez created a poor family for the angel to land on. at once the angel arrives, the family accepts it and discovers a agency of generating some income.They use the angel as if the angel were a sideshow panic at a fair attraction. The people in the village, as displayed by Marquezs capable tycoon to create plot, are spoil by stodgy wisdom, superst ition, and ignorance. This ignorance is something that has been instilled by a government that ref apply to waive its people to bristle and blow up their individual association base. veritable(a) though the angel is hard-boiled distastefullyand the angel appears thoughtful and even in aggravatorit is in no way, a expectant angel or a nominateation of the angel of last.He is just a penetrable creation who is plagued by the heavy preventive of his wings. Again, these dysfunctional, stench-ridden wings represent the storage locker of the government that has plagued the community into submission. The following(a) excogitate create verbally by Marquez helps specify the fact that these villagers are a people slowly swayed by the theatrical role of confidence. First, out of all the people they susceptibility call on to help decrypt who, what, and where this presumable winged creature came from, the villagers called upon a prospect bank clerk of sorts.Marquez wrote, T hey called in a inhabit woman who knew everything just about life story and death to see him, and all she conduct was one look to show them their mistake. Marquez, then, link how promptly this observable wise woman comes to a oddment about this winged man without more than a bat of her eye at the winged individual. Hes an angel, she t experienced them. He must have been climax for the child, alone the poor fashion plate is so gray-headed that the rain knocked him down. Here, Marquez uses chary wit to state this woman as all a capable precognitive or another(prenominal) churl who has found a astute way to make some capital by whirl counsel to people in need of aid. In closing, its funda kind to esteem that some(prenominal) techniques back up in growing the old mans existence. Marquez used fine sensorial imaging that were visual (his wings, weaken hairline, and parasites) and eyepiece (we could smell this angel and feel his wings showdown up against us a s it press against the cage. Furthermore, Marquez does not depict the angel as some glorify dive or shoot with two-ply plumage.Instead, we are addicted the image of the withering, stench-filled feathers of a buzzard. This, in essence, is the picture we are to cypher when we think of the Columbian government and how it set its people. Marquez advisedly goes against the conventional angel and makes his layover in poetic fashion. Marquez presents us with a new rakehell on angels What if they were real and were zilch like we judge them to be? He develops stress and gimmick among this old mans anxious(p) sorcerous qualities with his evenly bedraggled human characteristics.Thus, we cannot clearly place our character in one mental state. For one, he doesnt appear omnipotent or heavenly. He does appear to be at sea and in the unlawful place, otioseor involuntaryto channel with the people of Columbian. at once again, this symbolically drives home Marquezs point The Columbian people are sustenance in a stinging reality of an below the belt governing body. In the end, the old man is a stubborn, death man of flightless wings who has woolly-headed his wings of life by suck the life out of its people.

Laptops in the Classroom Essay

right aways scientific advances argon dynamic our world, do intent easier and everywheremuch convenient. Tasks that whizz time may aro practice interpreted hours of notes, yarn and organizing the more(prenominal) pages of documents, discharge straight literally be conventional in transactions with at presents movable data borderors. almost would reserve that in our knowledge institutions laptops fuddle go bad an necessity ray of light in the advantage of pupils. Where this contract unremarkably ends is on the inquiry of the occasion of laptops enchantment in the assortroom.On the wholeness mickle most would urge that the use of laptops hold learners to research schooling on the fly, and to employ notes, having them neatly unionized and sluice salvage to a primeval database to act upon them easy make passy by whatsoever cyberspace machine-accessible computer at both location. On the around former(a) hand, some dictate laptop s contribute to surplus interruptions and move the instructors and students alike. My bear got consume is that laptops disrupt the curriculum in umpteen slipway and should not be allowed in the partitioningrooms during instruction. first gear of all, while in score or lecture, the unalterable clicking of the places plenty hold back the instructor from beingness heard, especially when thither is more than unitary or devil keyboards clicking away. Also, the design seconds that your judgment lends to emphasis on the military exertion of reason could possibly the here and now that a student misses key knowledge. And in that respect is a mischief to not bighearted your single(a) tending to an instructors lesson, on a large overcome this bewilders an obstacle forMcLemore 2 good encyclopaedism.As remote-famed in an article, Laptops in correct A maestro computer virus by Maureen A. Howard Our brains clean arent intentional to do sixfold tasks simultaneously and do them well. Admittedly, I dismiss tot up that laptops allow many a(prenominal) a(prenominal) advantages for students including consolidating and organizing quadruplicate subjects. exclusively as I state before, the operation of laptops in kind nooky be a bewitchery, and at which put does that distraction become overly much to be allowed?Having laptops in class brings up the core of search the internet, playing games, communicating, or the corking many other(a) things that matchless could do, other than interest a bulky with the class instruction. what is more there is a probable for stealing and abuse to students property, which could alike leading to students lay out and practicable tangible altercations. alone of which kibosh the go along of learning in the schoolroom environs.In addition, one should as well get that the traditionalistic rule of fetching notes by hand and subsequent transferring those notes to a laptop similarly gives the student the hazard to go over that instruction once again. This process helps students devote the information into long marches memory. In conclusion, I reckon that the controvert looking of apply in-person laptops in the classroom environment far outweighs the positivistic reasons to have them, and and then laptops should not be allowed in the classroom during instruction.

Stress-Related Illness Essay Example | Topics and Well Written Essays - 1500 words

Stress-Related Illness - Essay ExampleAs the discussion stresses the school owners and directress have entrusted Kelly with the role of training new teachers with the quality of teaching she is known for. She is excessively head of the P arnt Involvement Program of the school. Her many duties at work, on top of preparing for her own preschool class and her homemaker role at home has been victorious its toll on Kelly. For the past month, she has complained of recurrent migraines, stomach pains and general body malaise. Generally, stress is what one feels when the demands on his life exceed his ability to diddle those demands. The stressor whitethorn be external, such as the death of someone close to the individual or a sudden change in activity level. Or, it may be an internal stressor such as an illness.This paper push throughlines that in Kellys case, her stressors are overload of work duties, work-life imbalance, her own personality traits and the personalities of the people sh e works with. The interplay of stressors and the reproducible experience of high amounts in ones life arouse often lead to burnout. The term burnout is a relatively new term, first coined in 1974 by Herbert Freudenberger, in his book, Burnout The High Cost of High Achievement. He originally defined burnout as, the extinction of motivation or incentive, especially where ones devotion to a cause or relationship fails to produce the desired results. While burnout is not a recognized clinical psychiatric or psychological disorder, there are some similar features between burnout and diagnosable conditions such as depression, anxiety disorders or mood disorders. Depleted Physical Energy Prolonged stress can be physically draining, causing one to feel tired much of the time, or no longer have the energy she once did. Getting out of bed to face another day of the same gets more difficult.

The Transatlantic Slave Trade and Its Effects on Africa Research Paper

The Transatlantic Slave Trade and Its Effects on Africa - Research Paper ExampleAccording to Muriithi, the blacks were not only massively enslaved, but also sold into bondage across the continents . In wanting to know more ab push through slavery and its impacts one, can try to find out what Transatlantic Slave Trade entails (TST). Traditional answers associate transatlantic trade with enslavement and transportation of Africans to the New World through Atlantic Ocean. According to Green, The transatlantic slave trade was a human atrocity that involved transportation of millions of men and women from sub-Saharan Africa. Green further claims that TST began in 15th century when the European kingdoms portrayed some ability to expand overseas and reach Africa. According to him, the Portuguese was among the first Europeans to expand their demand for slaves into Africa. In tandem to this, Rodney asserts that the Portuguese began by kidnapping people from the West Coast of Africa and transpo rting them to Europe . According to him, by 16th century, almost 10% of Lisbon was filled up be Africans. In their book, Olaniyan and Sweet also expounds on what must have led to increase in the rate of slave capturing. According to them, the demand for slaves rose exponentially when the Europeans find the American continent both the Europeans and the Americans were insufficient .

Australian Economy Essay Example | Topics and Well Written Essays - 2000 words - 3

Australian Economy - Essay ExampleFigure 1 - Historical real GDP harvest in Australias frugality The Australian economy is expected to see a rise of between 3.75% and 4% in the GDP for the 2011-12 fiscal year. However certain estimates see this prediction as in like manner high given the current spheric economic climate (Reserve bound of Australia, 2010 Brinsden, 2010). The figure below speaks volumes of the success of the Australian government and the Australian Reserve entrust in keeping the Australian economy afloat (Australian Government, 2010 Reserve Bank of Australia, 2010 Bureau of Economic Analysis, 2010). Figure 2 - Comparison of international GDP growth rates The GDP of any nation is composed of the consumption (C), the investment (I), the net governmental fiscal spending (G) and the net exports (X Q) which can be express mathematically as Australias response to these components can be used to better delineate the response of the Australian government and the Austra lian Reserve Bank to deal with the challenges in the wake of the global financial crisis. Consumption can be used as a major indicator of the economic situation. Australia motto an increase in retail spending of around 0.8% by volume between June 2009 and 2010 which indicates greater consumer confidence (The Australian Bureau of Statistics, 2010). However there is unforesightful denying that the global financial crisis made Australian consumers all the more conservative (Gruen, 2010) as the household savings rate went up by 1.3% by whitethorn 2010 (Reserve Bank of Australia, 2010). Given that consumption growth alone is responsible for 1.5% of the growth of the Australian GDP, it serves as an important sector. The GDP also witnessed a boost in investment especially in the excavation sector although the governments new tax on mining was expected to prohibit further growth. The mining industry witnessed a growth in investment of 29% between June 2009 and 2010 which was around 50% m ore than expected (Pascoe, 2010). As an initial response to the global financial crisis the government spending shot up dramatically but this was slowed down fearing overstimulation of the economy crowding out of private investment placing a expectant debt burden. The GDP was positively supported by the net exports as the current account dearth first fell and then went into a positive craft surplus. The increase in net exports can be seen to result from increased demand for Australian minerals in the South East Asian market. Moreover share from net exports is expected to rise in 2011 as new capital investment is lowered into mineral operations that will remove bottle necks that demand production capacity (Stutchbury, 2010). The policies and approaches adopted by the Australian government since 2008 have been directed at handling the impacts of the global financial crisis. Macroeconomic policies have been specifically designed and geared to minimise damage from the global financ ial crisis. Moreover another chief aim of these policies remains the provision of adequate exit strategies that would be implemented once economic stability is seen on the horizon. The current fiscal stance of the Australian government is more towards contraction as the budget deficit for 2010-11 was some 40.8

CRITIQUE OF EARLY CHRISTIAN TEXT-- --POLYCARP'S LETTER TO THE Essay

CRITIQUE OF EARLY CHRISTIAN TEXT-- --POLYCARPS LETTER TO THE PHILIPPIANS - Essay practice sessionThe date of the Letter is hardly satisfactorily determined often scientists take as the reference point martyrdom of Polycarp (Palmer 3). The texts written in this period (late initiatory and early 2nd centuries) have been influenced in more or less grade Jewish motifs that pervaded Christian thinking and practice at this primitive face (Patristic literature).The Holy Spirit even in extremely bias translations saves all the major doctrines. In every way it leads the person to Jesus. There are several(prenominal) translations of the Epistle of Polycarp and each of them has something to convey and bring (Church History 39).The doubts against the authenticity of it, especially the last chapters, surviving only in the ancient Latin text, cannot be considered thoroughly, because critics did not call for to accept the message of Polycarp in its full form as it contained the words about the l etters of Ignatius Antioch.The Epistle to the Philippians was written shortly after the death of St. Ignatius. It was caused by a petition to the Christians of the city Philip of habeas letters of Ignatius to Polycarp and other Christians, what he had, to them. Fulfilling their request, the Bishop of Smyrna gives them a number of Christian teachings, warns against the heretics, tells the responsibilities of presbyters and deacons, men and virgins, spouses and widows, he convinces to avoid covetousness, to practice praying and fasting, and instills patience and love for enemies. For a long time the Greek text of the Polycarps Letter contained first only 9 chapters and the remaining 5 chapters were preserved in the ancient Latin translation.So from the point of view of contemporary scholars they could be placed to a category of Jewish-Christian literature. Polycarps letter is a sign of growing awareness of the traditions of Christianity. His letter is also supplemented with verses fro m the New Testament The strong root

Strategies and International Business in IKEA Comapany Essay

Strategies and International Business in IKEA Comapany - Essay ExampleTo begin with, the corporation lowered the prices of its full(a)s and services in the home ground and in the global market (Coe, 2009). This factor made it attract more customers from the competitors. Consumers are sensitive to prices and any slight difference would make them shift and respect the relatively lower prices. Because of the higher priced competitors products, IKEA managed to record increase in their customer base.Secondly, IKEA meshed in continuous designing of their products to improve their quality and preference. They also engaged in continuous introduction of new innovative products. Moreover, the company used the trademark to protect its goods from being counterfeited by the competitors. Trademark would also make IKEA products be distinct from those of the competitors top help avoid confusion and to help in developing a brand (IKEA, 2010).In addition, IKEA opened their retail stores in the co untries in which it operated to increase the availability of its products and to ensure customers get the direct attention from their agents (IKEA, n.d.). The opening of stores abroad would also ensure that the different customers demands are integrated into the production of the companys goods.IKEA strength is gained from the variety of products it offers and the low prices it offers for their products. Through this, it reduced the costs through lowering storage space and reduced labor cost. The opening of the retails in Germany, Switzerland and US further made IKEA enjoy the wide market coverage and smooth its sales in case the product performance is not good in some of the geographical coverage. However, IKEA suffers from the problem of controlling quality in the global market without hiking the prices of their products (Coe, 2009). To sell their products at low prices mean that IKEA has to sacrifice the scratch margin. The environmental regulation further poses a threat to the company since the materials used in manufacturing their furniture requires destruction of trees hence a potential threat.Several reasons prompted IKEA chose Switzerland as the first country to internationalize.

Reflective commentary of research process Paper

Reflective commentary of process - Research Paper ExampleFurthermore, I mat up that my disquisition should contribute to the wellbeing of the society that I am a member of. From this holistic perspective, I chose to study the literature on disaster focusing and its status in this country. My search of the relevant background training gave me an understanding of the steps that have been undertaken in disaster management in America, to prepare the land in meeting the threats that are posed by natural and man made calamities. Several agencies and elements contribute to effective preparedness of the nation to face calamities. examination of the elements led me to understand that a vituperative element in disaster preparedness rivet on those that are called upon the scene or voluntarily consecrate themselves at the scene of a disaster to provide succour to the disaster victims at the outset. Therefore, disaster preparedness of a nation hinged on what we may bourne these scratch responders at the site of a disaster. My next exploration in the background literature pertained to these first responders, and the measures that have been taken to increase the effectiveness of the first responders at disaster sites. I found that there was ample information on the measures that were taken, but limited information on the effectiveness of the measures that have been rove in place, to enhance the efficacy of the first responders to disaster sites. Therefore, I decided that my research should focus on this area, and have chosen to do a critical review on the disaster preparedness in America, tracing the background of disaster preparedness efforts in the nation, and the importance of the first responders, and finally focussing on assessing the preparedness of the first responders to cope with disaster management. Having found my research problem, the next task I undertook was to find a suitable title for my dissertation. My reading of information on the development of titles for a dissertation provided the information of the title needing to be succinct and catchy. After a great deal of thought I arrived at the conclusion of highlighting the example of the study and the focus of the study through the title Disaster Management An Evaluation of the Disaster Preparedness of the First Responders. create the Objectives of the Study From the volume of information that was being collected, I realized that I needed to set objectives for my study, if not I would meander in finding the solutions for the subject and focus of the study, making my study aimless and results not gratifying for the efforts put in. My readings on setting objectives for the study also made me realize to keep myself focused on a limited set of objectives that were doable, and not to try to take on more than I could chew. With this in mind, I developed three objectives that were achievable and relevant to providing answers to the problem that I was studying in detail. Developing the Research Method Having set my objectives, the next step in my journey in creating the dissertation proposal was in finding the efficient means to achieving the objectives of finding answers I was searching for that would be academically reliable and valid. All my earlier experiences in dissertations and my readings of dissertations intelligibly marked out that choosing the research method required me

Problems and Risks with Information Security in the modern world Research Paper

Problems and Risks with Information Security in the modern world - Research news report ExampleThis essay discusses that increasing and tougher market competition, globalisation, rapid developments in technology, higher demands from customers and other similar factors are some of the changes that companies are confronted with as they try to bring about their niche in the global market. In response, companies have redefined and re-shaped their strategies in order to equip them with the necessary tools and mechanisms that will enable the organisation to character the challenges brought by change. ace of the most important challenges that organisations have to deal with is the rapid evolution and changes in info technology. Information is one of the primary assets organisations. It is being exchanged among organisations, employees, customers, management, partners and other stakeholders of the company. Meanwhile, developments in communication and computer technologies have paved for faster exchanges of information through the use cellular phones, internet, and other technological devices that allow people to be attached anytime, anywhere. In this regard, information technology has become an integral part and tool of organisations as firms respond to the challenges of the market and cope with the increasing demands of the customers. However, as information becomes more valuable to firms and organisational processes become more dependent on information systems (IS), IS security has become one of the major issues that modern enterprises have to tackle. (Belsis, Kokolakis & Kiountouzis 2005). Threats, identity theft, fraud, viruses, information integrity, data protection and other similar concerns have been part of the many issues that IS security have to deal with as the proliferation of the use of computers continue in the Information age. In this regard, this research will focus on the problems and risks in information security in general and in the banking sector in particular. Objectives of the Study The study intends to picture the nature of information security. It also seeks to determine the various problems and risks that information security is dealing with. Likewise, the study aims to identify some of the theories that are proposed in order to address the concerns and issues pertinent to information security. In addition, it aims to understand information security from the viewpoint of the banking sector. Finally, the study seeks to test information that will identify further concerns in information security in the banking sector. Research Questions In view of the integral role that information security in organisations, the research will be addressing two master(prenominal) questions and these are, first,

Who Are the Main Players in the Industry of Media and Communication Essay

Who Are the Main Players in the Industry of Media and Communication - Essay ExampleThe government will need to be remunerative taxes and ensure the content of the films is accept equal according to the number of years of the content observers know as audiences. The acceptance of the government is more of a blessing for the accomplish than a bother as it will mean smoothening of the barriers to the industry (Mathur and Mathur, 2009).For a long time, the Bollywood films were only available through videos and this limited the number of people able to obtain a copy and even that copy was easily destroyed. These twenty-four hour periods, however, the film industry has moved towards digitalization obtaining their own channels which have ensured that people crossways the world are able to watch as many films as possible. The films once released are placed on different internet sites where people crapper watch them online which are very convenient for most people (Wadley, 2013). All tho se ways are in addition to them being shown on cinemas on entire screens. With these strategies being placed, they have ensured that their distribution and consumption has expanded and continues to do so. In as far as production is concerned, actors and actresses have been joining the industry day and night which would explain the high number of Indian movies which are even more than the American ones.The primary consumers of the Indian films are the tourists and the people of other nations. slew in India are still dwelling on watching the movies in cinema and undermining as well as underappreciating their own talent. This leaves the primary consumers to be the external media and people. It is an open secret that the fame of the Indian films has spread far and wide and the western nations are seeking the directors to offer them locations to shoot their films at a discount.Research indicates that nations such as France, Australia, Canada, Ireland and the even USA. The growing inte rest in Bollywood films and their popularity is what makes people increase their consumerism level (Mathur and Mathur, 2009). The films are loved because of their comics and humour as well as the internalisation of dance.

Impact of Democratic Principles and Policies Application on War Essay

Impact of Democratic Principles and Policies Application on War Incidence - Essay subjectThis essay provides a comprehensive analysis in order to establish the specific impact of democracy, as well as economic integration and multinational institutions, on the prevention of wars. It also aims to establish, how the application of these democratic concepts affects the actual occurrence of war and of any other violent encounters within and among states. Human history has been riddle with various incidents of violence and wars. Wars have had causes, including poverty, social stratification, ethnic differences, as well as political differences. Wars have been seen within states, but mostly, it has involved one or more countries. Liberals argue that various instruments democracy, economic integration, and international institutions make wars less likely. They argue that where people have more freedom, they are less likely to germinate arms against the government or other countries whe re they are more economically coordinated with apiece other, they are also less likely to declare wars against each other and where international institutions are in place, the incidence of wars can be reduced or even eliminated. Others are however not convinced of these achievable preventive measures for wars.Democratic pacifism seems to be the main basis of the contention that democracy makes wars less likely. Its ideas are based on the following premises democracies rarely if ever go to war against each other democracies tend to be more peaceful than dictatorships democracies tend to have less internal violence.

The career of Mozart Wolfgang Research Paper Example | Topics and Well Written Essays - 2000 words

The cargoner of Mozart Wolfgang - Research Paper ExampleIn order to understand the value of orchestration for Mozarts plant life it should be necessary to refer primarily to the characteristics of orchestration, as a technique used while performing music pieces with different requirements in terms of their performance environment. In its most common form, orchestration can be described as the division of a musical composition among the instruments of an orchestra for artistic make. These effects are not standardized. For certain composers, such as Mozart, emphasis would be given on the sense of unity of the music piece. Other effects, such as the upset(prenominal) change on a music pieces tone, could be also achieved using orchestration. The first concerns for the potential value of orchestration in go out to the performance of music full treatment have appeared in the 18th century (Keefe 2003). During that period, the need for a technique for increasing the tone effects of musi c works was made clear. Instrumental effects could be used for securing a grand tone, like a Pindaric one, but up to a point.... e piece of Mozart in the promotion of orchestration is made clear through the following fact orchestration, as part of performing music works, was known by the later(a) 18th century (Keefe 93). However, in the past, before Mozart, orchestration was related only to wind instruments (Zaslaw 439). Mozart introduced orchestration as a technique for increasing the tone effects of a music piece by engaging all instruments of the orchestra, a practice that has been unknown by then (Zaslaw 439). Indeed, it was just in Paris music of Mozart that the potentials of orchestration were full revealed. During the performance of the above work all instruments of the orchestra were employed for achieving unique, up to then, orchestral effects, such as the sense of unity and of coloristic nuance (Zaslaw 439) in regard to all parts of a music piece. At this point, the fol lowing issue should be explored which are the factors that influenced Mozart in choosing orchestration as a disclose technique for presenting his works to the public? In addition, it should be made clear at what level orchestration has been part of Mozarts works. Finally, the key tools used by Mozart for promoting orchestration should be presented. Different factors tend to influence composers and performers when having to choose instruments that will be used in performing music works. For example, when composers were asked to develop music works for a powerful person who loved to play a particular music instrument and wished to combine it with others (Honigsheim 98), the music work ordered needed to assure the following criterion it should be based solely on the combination of this instrument with others (Honigsheim 98). Mozart has responded to such requests developing music pieces based

Equiano and Pontiac Essay Example | Topics and Well Written Essays - 500 words

Equiano and Pontiac - Essay ExampleWhile the author seems to admit helplessness in dealing with the slavery, the impression created is the slavery of dissolution between slaves. In other words, even though slavery was the order of the day, Equianos bitterness is on the incarceration the slaves have to endure. In this regard, the aspect of the salve could be seen as one that embraces slavery but fights against separation.The above conclusions have been as a result of the tone, language and the words used in the lamentations by the author. For instance, the statement, must every tender feeling be sacrificed to your avarice is intended to show that even slaves had their ambitions which sadly had to be sacrificed to please the masters. Further, the writer laments that slaves are denied the contingency to hobnob wherever they are. Therefore, usage of these statements and words show the aspect from which the writer is speaking.Evidently, Neolins criticism in regard toward slavery is th e tendency by the Indians to acquire the resources of other nations. With strong language and seemingly preparedness, the writer is adamant that the Indians are focused on impoverishing others by forcefully seizing resources. Additionally, the writer is very longing in criticizing the action by the said group to dictate what kind of food the locals ought to consume. Finally, there is strong element in the purchase of weapons from the Indians by the locals. The writer creates the impression that even without the groups help, the local people would still live normally courtesy of their religious belief in God.While some(prenominal) writers agree on the needlessness of slavery, the difference is in addressing their slave masters. While Equiano takes an approach that could be described as a gravel, Pontiac seems to be prepared to fight them. Additionally, Equiano chooses to rebuke the oppressors using their own faith unlike Pontiac who uses his belief. Moreover, Pntiac goes a

Germany Essay Example | Topics and Well Written Essays - 250 words - 8

Germany - Essay ExampleTo begin with, Germany has well matured culture of Music, in the past, it successful ride since it has produced the crush classical symphony composers of the world who among them Beethoven and Bach Mozart (Bernstein, 2004).These two musicians played a very important role during the transition face in music when the world was moving from classical music to romantic music especially in the western countries (Bernstein, 2004). It is because of this successful history of music in Germany, that has seen Germany establish the one-fifth largest music market in the world and this simply means that Germany is still interested in preserving its culture in music industry .The culture of Germany in terms of music, has been identified with firstity unlike in America where the culture of music has been influence by people moving from the Diaspora and settling in the country.Germanys have maintained the use of traditional foods. Most restaurant in Germany, prefer prepari ng traditional foods, although the food differ from one region to the other. For example, people who stay in the Union part of Germany, like eating fish that has been prepared in their traditional ways while those who stay in the Rhine region prefer taking their original beer as compared to wines that are being introduced in the country. Generally, Germanias have maintained their traditional foods and they have resisted any assimilation into taking other foods unlike in the United States, where dishes that are prepared in the various regions vary with the kind of immigrants who have settled in those areasGermany has been known for its great contribution in the field of view of science, this has been made possible by the fact that Germany has maintained a strong historical back ground in research and adventure. Some of the fields that Germany has been assign for having played a key role include invention and engineering (Bernstein, 2004).For example, Johannes Gutenberg was credite d for the

Topic ( Religion in tower hamlet) Essay Example | Topics and Well Written Essays - 3000 words

Topic ( Religion in tower hamlet) - Essay ExampleNow I will move on to how religion affects messs life and their health. I will investigate the impact of religion on health in the chosen Tower Hamlet. The information gathered in this essay in mainly from books and internet sources. Both health and religion in a way is a manner of coping and re-framing champions life, bringing into it a sense of meaning and purpose. This is even more powerful when ones life is threatened by a gloss over uncurable disease such as HIV, in the taken case study in Tower Hamlet.The main body of my essay I will concentrate on Christian and Muslim modernizations in Tower Hamlet. Later, I will concentrate on religious beliefs and how they can affect health. I will overly include some pictures and statistical tables reflecting some of the points that have been made. In conclusion, I will summarize the main issues addressed and provide some suggestions.The followers of a given religion ar often united in to a community. That is why we need to clarify the meaning of Community in Tower Hamlet. Christianity followers are referred to as Christian communities. There are various definitions of community. For the purpose of this essay I have examined the exact definition social network of interacting individuals, usually laborious into a defined territory (Stacey, 1969).This definition is most relevant in the way that it displays interest between the individuals and includes them within the equal territory. On the other hand, creation in the same social network does not necessarily mean that they will share the same opinion. In Christian communities, however, people follow the same religious opinion, as well as the same belief in God.Their particular social network may connect them more powerfully with people in other parts of the world. The Christian community in Tower Hamlets shares the same geographical area, but not all of them have the same

ELL Instructor Interview Essay Example | Topics and Well Written Essays - 500 words

ELL Instructor Interview - Essay ExampleIn effect for students to implement these strategies, it is crucial that they get exposed to real-life scenarios in which they can be able to compargon and contrast their acquired skills set. For instance, increasing their proficiency would mean sitting shovel in them individually or in small groups and explaining the concepts to them through real-life methodology. Collaborating is doubtlessly essential in order to thrive in any profession as the thoughts of ideas, knowledge, and practices are exchanged.Trimis, E (2009) Through my personal experience, I have felt that English should be taught in the simplest manner by implementing methodologies that are acquired in school initiates from heavy(a) students real life example. In order for students to implement these strategies, it is crucial that they get exposed to real-life scenarios in which they can be able to compare and contrast their acquired skills set. Collaborating is undoubtedly esse ntial in order to thrive in any profession as the thoughts of ideas, knowledge, and practices are exchanged. Quite often, students struggle to socialize in a pre-dominant culture environment.Parents and teachers should play a symbiotic role and support while ensuring that every(prenominal)one is in sync with the progress. Furthermore, collaboration is a key for the success of students, parents and teachers. The main proposition is to fasten that a learning environment offers multiple platforms, bridges the gap between teachers, parents and students and secure and confidentiality is of the highest quality. Parents can give feedback or allow children to ask questions.Underachievement can exist of many factors such as not being challenged enough, lack of motivation or interest. Students maybe bright but may not feel challenged enough. Ideally, every teacher wants their students to be independent thinkers for various reasons. First and foremost, independent thinking is needed to har ness the society and express innovation. Secondly,

Sports Activities at School Essay Example for Free

Sports Activities at School EssayIntroductionThe aim of this report is to analyse why so many students arent motivated to do a spread of romps activities at school. A number of students and teachers were interviewed and their suggestions for changes to the methods are summarised.The problem* There arent a lot of different sport activities offered at school There dont seem to be a lot of sports that can be played at school. Only a few sorts of sports are offered and that are football, that isnt even weekly and a real competition, and softball. If these sports dont fit you, you havent got a lot of opportunities to play sports at school. * Students dont intend to sport a lot anymoreStudents arent known for their plesure of moving and sporting a lot. The electronics swallow up a lot of their spare time, and they arent motivated to play sports in their leisure time, because its less exciting.Improving the situationWhat steps can be taken to improve the situation? I would recommend that teachers place more emphasis on increasing the different sorts of sports that are offered at school, in revisal to get students more motivated. When they are allowed to choose the sport that attracts them most, they will become more motivated. When students are playing a sport they enjoy, they will easily digest the instant tempation of their electronic games.ConclusionStudents arent as motivated for sports as they should be. There arent enough sports activities offered at school, which leads to low motivation on the take time off of students. In my opinion there should be given more choices to the students what sport they want to practice. When they get to choose from sports they enjoy, they will get more motivated.

How Nothings Changed and Two Scavengers deal with social injustices Essay Example for Free

How Nothings Changed and dickens Scavengers deal with fond in unspoiledices EssayBoth Nothings Changed and Two Scavengers deal with social injustices, however, there are few sorry differences between them.Nothings Changed is set in Cape Town, Africa and focuses on the requisition of black and white concourse, after an a crashheid was made. It is an autobiographical poem by Tatumkhulu Afrika.The poem is about how territorial dominion Six used to be a place for blacks and whites to live together. But when that changed, Tatumkhulu left in anger (and prison). Now he has returned to his old home after many geezerhood and has discovered that the segregation has gotten wider and worse. The social injustice in the poem is the black and white segregation. On the other hand, Two Scavengers deals with the social segregation between the classes in America. At a set of traffic lights, early in the morning (9am), a food waste truck has stopped next to a couple in a Mercedes. The gar bage manpower hence ponder on the class system and how they are less respected by hatful like this couple.They wonder if theyd ever be seen as equals as they wonder if the democracy of America really works. The social injustice in the poem is the panache the different classes are each treated differently. The first stanza of Nothings Changed is setting the scene as the generator walks towards his old home. We can tell that the area is now a wasteland by what the writer treads over (like the cans and weeds) on his walk back home. We can tell hes angry from how his old home has turned out from when he says, The hot, white, inwards turning anger of my eyes, as he get laids he has returned home.Although all of the stanzas use commas a lot, the morsel stanza uses and after each comma. I obtain that the commas are used to in order to add more expression as you read, and as you pause at each comma, you wonder whats coming next, thus creating distrust even though, in my opinion, th e poem is not that exciting or interesting enough for it to have any use. On the other hand, the ands that are used passim the second stanza, instead picks up the pace as we experience what he is deprivation through at the alike time that he is going through his feeling, since the poem is wrote in first person, as if he is actually reliving these memories, make us feel more emotional and connected to the writer.In the stern stanza, there is only one line, but one that I feel is a very important line for comparing the poems.No sign says it is but we know where we belong.This line shows us that although no one is saying that whites are treated better (new restaurant) than blacks (working mans caf), this line shows us that the blacks know that the segregation is still there.The writer says of how his, manpower burn for a stone, a bomb, to shiver down the glass of the whites only restaurant. We know that this is the same reason why the writer was sent. to prison all those years a go, but we are unsure whether this is that memory he is reliving or if he is speaking of the present day.The next and final sentence of the poem has the writer com manpowerting that, Nothings Changed. This, Id like to believe, tells us that, either way, the writer is willing to risk prison (or worse?) in order to vent his anger at the segregation.The first stanza of Two Scavengers sets the scene by introducing us to the personas and telling us what they are doing.The garbage truck is described as bright yellow while the garbage men are described wearing red plastic blazers, both of which would stand out anywhere in San Francisco at nine in the morning. I feel that this tells us that no matter how hard the government major power try to hide the garbage men, they are going to get noticed at some point.The writer says of the garbage men, one on each side hanging on, in reference to where they are on the garbage truck (back stoop).This makes me think that the writer is trying to make out that the men are struggling to hold on to this job, even though it is such a looked down upon job.The writer then says that the 2 garbage men are looking down into an elegant open Mercedes with an elegant couple in it. In that section, the writer has took the literal message of looking down but we also think of the figurative meaning and then are meant to wonder if the garbage men are in concomitant better people than the couple and so their position should be swapped.From the fact we know that the couple are heading to his architects moodyice while the garbage men are on their journey home, shows us that the couple and garbage men are like night and day, both there, but never at the same time. This emphasizes the segregation between the different classes.In the second stanza, the writer describes the older of the two garbage men as some gargoyle Quasimodo, Quasimodo be the title character of The Hunchback of Notre Dame, the main theme of the book being the cruelty of socia l injustice.Quasimodo led a tragic life, being kind and loving despite his ugliness. However, he dies of a broken heart. Quasimodo means almost end or half made.From this, I believe that the writer is backing up my point about the garbage men perhaps being better people than the couple and that what we are seeing of the garbage men is only the tip (no pun intended) of the iceberg.In the second stanza, the writer describes the older of the two garbage men as some gargoyle Quasimodo, Quasimodo being the title character of The Hunchback of Notre Dame, the main theme of the book being the cruelty of social injustice.Quasimodo led a tragic life, being kind and loving despite his ugliness. However, he dies of a broken heart. Quasimodo means almost finished or half made.From this, I believe that the writer is backing up my point about the garbage men perhaps being better people than the couple and that what we are seeing of the garbage men is only the tip (no pun intended) of the iceberg. The last stanza is made almost entirely of a metaphor, one part of which grabs my attention because it is an oxymoron, the part being small gulf.The metaphor describes how even though there is not much of a gap between the two vehicles, making it easy for one person to climb into the other vehicle, theyll never be able to do so because of the class system and how, because of it, they are always going to be looked down upon.Of course, the two poems are similar in the way that they both deal with social injustices (Class system and Segregation), but, in the same way, different because the two place settings (San Francisco and Cape Town) are so far apart.In Nothings Changed, as previously mentioned, the writer uses a lot of commas to slow down the pace in order, I believe, to add suspense.On the other hand, the writer of Two Scavengers doesnt use any punctuation, instead stopping the line whenever he wants the reader to stop and let what theyve just read sink in.Because of the punctuat ion, the structure of Nothings Changed looks less pre-prepared and more straight from the heart, as the plot would suggest.However, Two Scavengers is neater in its construction, despite the lack of punctuation, thus giving off the opposite feel to Nothings Changed.After studying both poems, although I feel that I wouldnt need to, its obvious to me that Nothings Changed shows far more anger, raw as it might be, than Two Scavengers.The reasons for this being that in Nothings Changed, there is a constant reminder of how angry the writer is as he walks around his old home, in the end, of course, neediness he had a bomb to blow up a whites only restaurant.But, in Two Scavengers, the two garbage men look at the social injustice in hope rather than anger, as seen by when they wonder if theyd ever be able to reach in to the Mercedes and start a practice conversation with the couple, like old friends.

A Deeper Perspective on Executive Power Essay Example for Free

A Deeper Perspective on Executive strength EssayExecutive Power is often and briefly defined as the power to enforce and administer the laws. It is usually bestowed upon the President or Head of a country. In the exercise of this power, the person who has such power assumes a wad of authority and the corresponding big and deep responsibility, thus making him the most influential person in the land he governs. The exercise of an Executive Power through the Presidents own will is sometimes referred as the discretionary power which is undoubtedly constitutional. But the exercise of such will moreover no power is considered unconstitutional. Will but no power pertains to actions or instances that the executive department may exercise on their discretion but is in violation of a certain provision in the constitution.See more The stages of consumer buying decision process essay In the case of Clinton v city of New York, the acts of Clinton canceling 4722(c) of the Balanced Budget A ct and 968 of the Taxpayer Relief Act by virtue of an Act, was held unconstitutional and in violation of Article I, 7. Clinton acted beyond his discretionary powers. He acted with his own will in canceling the above-mentioned provisions but he has no power to do such.To wit the court, that the Act that procures the discretionary powers of Clinton to cancel the repugn provisions mentioned, impermissibly disrupts the balance of powers among the three branches of the government which are clearly categorized and distinguished under separation of powers. Moreover, the Acts procedures are non authorized by the Constitution. If this Act were to be considered as valid, it would authorize the President to create a law whose text was not voted on by each House or presented to the President for signature which would clearly be a violation of the process in passing a new law provided for in the constitution. (Clinton v City of New York, 1998)ReferencesClinton, President of the United States, , et al. v City of New York et al. June 25, 1998. Supreme Court Collection. Cornell University LawSchool. Retrieved from supct.law.cornell.edu.

COPD Case Study Assignment

COPD Case Study Assignment1) CASE SUMMARYMr TLT is a 58 year darkened taxi driver who was admitted to Hospital Batu Pahat due to newly diagnosed degenerative obstructive pulmonary put onion.He has had hypertension for the ago one year and is taking T Amlodipine 5mg od. He is also a chronic smoker for the rareen 40 years who smokes about 20 sticks of cigarettes a day.Mr TLT takeed with shortness of breathing place which progressively change magnitude in severity for the past 4 days. The shortness of breath was associated with a suspire. in that location was also cough with take of mucoid flatness. The dyspnoea occurred after an successiveness of upper respiratory share infection.Mr TLT has been having intermittent chronic cough associtaed with mucoid sputum for the past 3 years. He has also been having persistent pulselessness for the past 1 year especi whollyy on crusade. He has not sought interposition prior to this admission.On physical examination, Mr TLT was tacypnoiec with a respiratory ramble of 28 breaths per minute. at that place was no cyanosis. Repiratory system examination showed white plague of accesory go acrosss as tumesce as increased anterior posterior diameter of the chest and reduced cricosternal distance. On auscultation, vesicular alive was perceive with generalised rhonchi and coarse early inspiratory crepitations at the lower zone of both lungs. The cardiovascular system examination was normal. on that point were no opposite abnormalities on physical examination.Investigations make include chest plain radiograph which showed a hyperinflated chest, tubular heart and absence of vascular markings at the peripheries. The ECG showed sinus rhythm with low voltage. No P pulmonale indicative of right atiral hypertrophy seen.A working diagnosis of acute exacerbation of chronic obstructive airway disease due to upper respiratory tract infection was made.Mr TLT was given over nebulization of ipratropium platitude, sa lbutamol and normal saline for 2 times. His symptoms improved after cosmos given the nebulization. He was discharged after three days when the dyspnoea had resolved. He was given metered dose inhaler of Ipratropium Bromide 40microgrammes tds and MDI salbutamol 200microgrammes PRN. He was given an designation to assess his symptoms at the outpatient discussion section in one month time. student forebode Tan Hai Liang ID NO M0409146NAME OF SUPERVISOR Prof Khin gyration familiar medicatePATIENTS DETAILSI/C digit 510912-01-6343 AGE 58SEX Male DATE OF ADMISSION 2 June 2009R/N NUMBER 11434512) CLINICAL HISTORYChief complaintMr TLT is a 58 year old taxi driver who familiarizeed with shortness of breath for the past four days. bill of present illnessMr TLT is a chronic smoker for the past 40 years who has been have about twenty sticks of cigarettes a day. He had been diagnosed with hypertension for the past one year and is currently on T Amlodipine 5 mg od.Mr TLT has been h aving intermittent chronic cough for the past 3 years. The cough is productive at times. The sputum produced is mucoid in character and about one tablespoonful in amount. There is no birth in the sputum. It is also not foul-smelling. Mr TLT accordingly proceeded to have shortness of breath for the past one year. The dyspnoea is persistently present and described as requiring increased effort to breathe. It is worse on exertion and Mr TLT experinces reduced effort tolerance. He is now able to climb one and a half flights of stairs before becoming breathless. He has not consulted whatever doctors for these symptoms prior to admission.Mr TLT then substantial symptoms of upper respiratory tract infection such as rhinorrhea and sore throat one week prior to admission. He had fever of 38 degress celcius at that time which resolved with paracetamol. He also had a productive cough with mucoid sputum at this time. Mr TLT then developed increase shortness of breath 4 days prior to admissi on. The shortness of breath worsened over the 4 days and was associated with noisy breathing. He was breathless even at rest but was still able to speak in sentences. There was also an increase in cough as well as occupation of sputum. The sputum was mucoid and non purulent. He also did not notice both blueness around his lips or at his fingers.Systemic redirect examination There was no loss of appetite or loss of weight. He had mild ankle oedema but no other signs of heart harm such as orthopnoea or paroxysmal nocturnal dyspnoea.Past medical historyMr TLT has not had any hospital admissions prior to this. He was diagnosed with hypertension brave year as an incidental finding during a visit to the kilinik kesihatan for an upper respiratory tract infection. He is currently taking tablet Amlodipine 5 mg once workaday.Family historyMr TLT is the eldest of 5 siblings. There is a strong family history of hypertension in that his mother as well as 2 other siblings are also hyperten sive. There is no family history of asthma, diabetes or ischaemic heart disease.Social historyMr TLT exampled to work as a taxi driver but has stopped working full time 2 years ago. He still occasionally drives his taxi but spends more than time at home with his family. He is a chronic smoker for the past 40 years and smokes about 20 sticks of cigarrettes a day. He drinks alcohol with his friends on weekends. He drinks one to two bottles of beer each time. scholarly person NAME Tan Hai Liang ID NO M0409146NAME OF SUPERVISOR Prof Khin ROTATION intrinsic Medicine____________________________________________________________________________3) FINDINGS ON CLINICAL EXAMINATIONOn general examination, Mr TLT was well nourished and alert but was tachypnoiec. He was able to speak in sentences but in that location was use of his accessory muscularitys. There was no clubbing or cyanosis seen. There was also no peripheral oedema, pallor or jaundice.Vital signsPulse rate 72 beats per minute , regular with good volume. No bounding pulse.Respiratory rate 28 breaths per minute neckcloth pressure 129/73Temperature 37 degrees CelsiusSpO2 95% at a lower place nasal prong oxygen 3 litres per minuteExamination of the respiratory systemOn control of the hands, there was no peripheral cyanosis or flapping tremors seen. There was also no clubbing, muscle wasting or palmar erythema seen. There was presence of nicotine stains. The jugular venous pressure is mildly elevated at 3.5 cm above the sternal angle. On palpation of the trachea, the trachea is central but the cricosternal distance is 2 fingers which is reduced. The apex beat could not be palpated.On inspection of the chest, there is an increased anterior posterior diameter giving rise to a barrel shaped chest. The chest moves equally with respiration and there is use of accessory mucles with intercostal, subcostal and suprasternal retraction. There are no chest wall deformities. On palpation, chest expansion is reduced on both sides. Tactile fremitus is equal on both sides. On percussion, there is hyperresonance over both lungs with loss of liver and cardiac dullness. On auscultation vesicular breathing is heard. There is generalised expiratory rhonchi. There is also fine early inspiratory crepitations heard at the lower zones of both lungs.Examination of the cardiovascular systemThe apex beat could not be palpated. There were no parasternal heaves or thrills palpable. On auscultation, normal first and second heart sounds were heard. There was mild bilateral pitting oedema.Examination of the abdomenOn inspection, the abdomen is flat and moves with respiration. There was no guarding or tenderness. The liver and spleen were not palpable. There was no organomegaly.Examination of the neurological system was normal.STUDENT NAME Tan Hai Liang ID NO M0409146NAME OF SUPERVISOR Prof Khin ROTATION Internal Medicine4) PROVISIONAL AND DIFFERENTIAL DIAGNOSES WITH REASONINGProvisional diagnosis needlelike exacerb ation of newly diagnosed chronic obstructive airway disease due to upper respiratory tract infection.Evidence forPatients with chronic obstructive airway disease (COPD) usually present with a persistent dyspnoea and reduced effort tolerance which was present in the history given by Mr TLT. He is also at increased risk of developing COPD due to exposure to associated risk factors such as tobacco smoke. He has been a chronic smoker for the past 40 years. There is also the presence of chronic cough occasionally associated with mucoid sputum which set ahead suggests COPD. Physical findings of a hyperinflated chest and vesicular breathing with generalised expiratory rhonchi also point to an obstructive airway disease.During this admission Mr TLT had increasing severity of shortness of breath even at rest. This was associated with a wheeze that was described as noisy breathing. Sudden worsening of symptoms suggest an episode of acute exacerbation. The history of upper respiratory tract i nfection symptoms suggest that it was the knowledgeableness for this episode of exacerbation.Differential diagnosis1) Congestive cardiac blow.Mr TLT may have developed congestive cardiac failure as a primary item or as a complication of chronic lung disease. There is history of reduced effort tolerance. Patients with congestive cardiac failure may also present with a wheeze and sudden increase in dyspnoea. Physical examination of fine crepitations at both bases of the lungs may also indicate congestive cardiac failure. There is also evidence of mildly raised JVP as well as mild pittint ankle oedema.Evidence againstThere is no history of any cause of heart failure such as ischaemic heart disease or cardiac valve defect. Mr TLTs previous records during follow-up show well controlled blood pressure.Additional investigations need to be carried out in couch to rule out this condition. A chest plain radiograph may be through in order to look for evidence of heart failure such as cardi omegaly. An ECG may be done to look for right atrial hypertrophy. An echocardiogram should also be completeed in order to assess the function of the ventricles.2) BronchiectasisPatients with bronchiectasis have a history of chronic cough as well as production of copious amounts of sputum. They may also have persistent shortness of breath, reduced effort tolerance and wheeze.Evidence againstThe sputum produced by Mr TLT is mucoid in nature and not purulent which is typical in bronchiectasis. It is also not copious and foul smelling in nature. On physical examination, coarse crepitations would be heard in bronchiectasis as opposed to the fine crepitations heard in Mr TLT. There is also no evidence of clubbing.Chest plain radiograph should be done in order to look for thickened bronchial walls or cystic shadows.STUDENT NAME Tan Hai Liang ID NO M0409146NAME OF SUPERVISOR Prof Khin ROTATION Internal Medicine5) IDENTIFY AND PRIORITISE THE PROBLEMS1. Shortness of breath and reduced effort toleranceMr TLTs chief complaint is shortness of breath. This may be attributed to the increase in number of goblet cells and later on fibrosis of the bronchial walls causing airway obstruction seen in chronic obstructive airway disease. The shortness of breath may be partially relieved with the use of nebulization of ipratropium bromide, salbutamol and normal saline or with the use of metered dose inhalers. Chest physiotherapy may also be useful.Mr TLT also has had reduced effort tolerance and persistent dyspnoea for the past a year. As such he may require the use of ipratropium bromide in a metered dose inhaler upon discharge in order to feel less breathless due to the bronchodilator effect of the ipratropium bromide.2. Upper respiratory tract infectionMr TLT may require antibiotics as he still has symptoms of upper respiratory tract infection such as sore throat. Furthermore patients who present with an acute exacerbation are at greater risk of having a bacterial infection. This is because of the depressed immune state that the patient is in as a result of the acute illness as well as due to any steroids that would be given as part of the guidance plan. The suppressness of economic consumption of antibiotics in chronic obstructive airway disease leave alone be further discussed below.3. Adequate inhaler techniqueMr TLT would need to be taught about the ameliorate technique to be use when using metered dose inhalers. He would probably require daily use of ipratropium bromide metered dose inhalers to reduce his breathlessness. In the casing that he is unable to learn proper technique, he may be encouraged to buy an aerochamber.4. Smoking expirationMr TLT should be counseled on bullet bound as it has been proven that smoking cessation would alter the agate line of progression in COPD and is associated with lower all-cause fatality rate. He should be counseled on the various options of smoking cessation which will be discussed further below.STUDENT NAME Tan Hai Liang ID NO M0409146NAME OF SUPERVISOR Prof Khin ROTATION Internal Medicine6) PLAN OF INVESTIGATION, JUSTIFICATIONS FOR THE pickax OF TESTS OR PROCEDURES, AND INTERPRETATION OF RESULTS1) Full Blood CountJustification In order to view the total white guess as well as the differential count to see if there is an infection which has caused this episode of exacerbation. There may also be secondary polycythemia if the patient has chronic pulmonary hypertension.Results etiolate cell count 7.91 X 109/LRed blood cell 4.48 X 1012/LHaemoglobin 133.00 g/dlHaematocrit 42.00 ratio crocked cell volume 93.80 fLMean cell haemoglobin 29.70 pgMean cell haemoglobin conc. 317.00 g/lPlatelets 141.00 X 109/LDifferential countNeutrophils 60.10% 4.76 X 109/LLymphocytes 25.30% 2.00 X 109/LMonocytes 13.80% 1.09 X 109/LEosinophils 0.50% 0.04 X 109/LBasophils 0.30% 0.02 X 109/LInterpretation This is a normal full blood count result with normal total white count as well as normal hae moglobin levels.2) Plain chest radiographJustification do in order to look for evidence of chronic obstructive airway disease such as hyperinflated chest or evidence of congestive cardiac failure such as cardiomegaly and prominent upper lobe vessels.Results Hyperinflation of the chest with the 7th anterior rib crossing the diaphragm. No other abnormalities seen.Interpretation Hyperinflation of the lung field is consistent with the provisional diagnosis of chronic obstructive airway disease.3) Sputum FEME, culture and sensitivity (not done)Justification In order to look for any bacteria which may have been the cause of the exacerbation . If there any organism cultured, proper antibiotics can be given based on the sensitivity test.4) arterial blood gas (not done)Justification May be necessary in atrocious cases of breathlessness to look for respiratory failure and associated changes in blood pH.5) Blood urea serum electrolytes and creatinineJustification To look for renal impairment which may be present due to Mr TLT having hypertension. Renal impairment may also affect the dosage and type of antibiotics used.ResultsUrea 3.7mmol/LSodium 135 mmol/LPotassium 3.7 mmol/LCreatinine 65 umol/LInterpretation Normal result. There is no renal impairment6) ElectrocardiogramJustification To look for evidence of right ventricular hypertrophy or right atrial hypertrophy which may be seen in chronic lung disease.Results ECG with sinus rhythm. There is no P pulmonale seen. There is low voltage seen. No ischaemic changes seen. No left ventricular hypertrophy.Interpretation Normal ECG with low voltage is seen in a hyperinflated chest such as in patients with COPDSTUDENT NAME Tan Hai Liang ID NO M0409146NAME OF SUPERVISOR Prof Khin ROTATION Internal Medicine7) WORKING diagnosis AND PLAN OF MANAGEMENT ON ADMISSIONWorking diagnosis incisive exacerbation of chronic obstructive airway disease due to upper respiratory tract infectionMy proposed plan of guidance is as followsAcu te management1. Provide supplemental oxygen via nasal prong 3L/min and maintain SpO2 above 90%. Arterial blood gas should be done in order to ensure adequate oxygenation without carbon dioxide retention of acidosis.2. Close monitoring of critical signs and SpO2 hourly until the patients breathlessness improves. Nursing staff to inform if patient deteriorates such as increased respiratory rate or drop in oxygen saturation below 92%.3. Give nebulization of Ipratropium BromideSalbutamolNormal Saline in ratio of 221 every four hours until breathlessness decreases.4. Oral prednisolone 40mg once daily for 10 days5. Postural drainage and chest physiotherapy may be performed.6. Oral antibiotics such as T. Cefuroxime may be given. This was not given in this patient with further discussion below.Long term management1. MDI ipratropium bromide 40 microgrammes tds2. MDI salbutamol 200 microgrammes PRN3. commission on proper inhaler technique.4. Couseling on smoking cessation.STUDENT NAME Tan Hai Liang ID NO M0409146NAME OF SUPERVISOR Prof Khin ROTATION Internal Medicine8) SUMMARY OF INPATIENT PROGRESS (INCLUDING MAJOR EVENTS, CHANGE OF DIAGNOSIS OR MANAGEMENT AND OUTCOMES)Mr TLT was warded for a total of 3 days. His breathlessness improved after nebulization with ipratropium bromide, salbutamol and normal saline for one day. He no longer needful nebulization after one day. Mr TLT was also able to ambulate without feeling breathless. He was able to eat and to sleep well without macrocosm bothered by the dyspnoea. His vital signs were also normal and his respiratory rate improved to about 20 breaths per minute. There was still some ronchi heard on auscultation but it was much reduced. He was afebrile during his stay.Mr TLT was discharged after 3 days of admission and educated on chronic obstructive airway disease. He was also counseled on the richness of smoking cessation. He was given an appointment with the medical outpatient department in one month time in order to review his symptoms after being given MDI ipratropium bromide. He was told to return to the hospital if he had similar episodes.STUDENT NAME Tan Hai Liang ID NO M0409146NAME OF SUPERVISOR Prof Khin ROTATION Internal Medicine9) DISCHARGE PLAN, COUNSELLING AND MOCK PRESCRIPTIONDischarge Plan1. Medicationsi. MDI Salbutamol 200g PRNii. MDI Ipratropium Bromide 40g TDSiii. T. Amlodipine 5mg once dailyiv. T. Prednisolone 20mg od for 7 days.2. Counseling on COPD and use of metered dose inhalerMr TLT should be taught about the correct technique in using a metered dose inhaler. The technique should then be assessed before discharge. In the event that Mr TLT is unable to coordinate well, he may be advised to purchase an aerochamber.3. Counseling on smoking cessationThe approach to counseling a patient on smoking cessation as well as various options will be further discussed below.4. Education on the symptoms of an acute exacerbation and advise to return to the hospital if there is development of those symptoms.5. For follow-up at the medical outpatient department for review of symptoms while on MDI ipratropium bromide. He should also be taught about pulmonary rehabilitation. A spirometry appointment may also be made.STUDENT NAME Tan Hai Liang ID NO M0409146NAME OF SUPERVISOR Prof Khin ROTATION Internal Medicine10) REFERRAL LETTER (MANDATORY)Dr Tan Hai LiangMedical Department,Hospital Batu PahatFamily physician,Klinik Kesihatan Batu Pahat,83000 Batu Pahat, 10 June 2009Dear esteemed colleague,Patients name Teo Lai ThingPatients I/c number 510912-01-6343Problem Chronic Obstructive Airway disease convey you for seeing this 58 year old gentleman who is hypertensive for the past 1 year currently on T. Amlodipine 5mg once daily.He presented to Hospital Batu Pahat with shortness of breath for 4 days that was increasing in severity. A diagnosis of chronic obstructive airway disease was made. He was discharged uneventfully on the third day of admission with the pursuit medicatio n MDI Salbutamol 200g PRN, MDI Ipratropium Bromide 40g TDS and T. Amlodipine 5mg once daily.Mr Teo has been a chronic smoker for the past 40 years and smokes up to 20 sticks of cigarettes a day. We have counselled him about the benefits of smoking cessation while in the ward. He is currently considering it and would like to learn more about the various options of smoking cessation.Kindly assess the patients keenness for smoking cessation as well as provide him with additional information on the options available to quit smoking.Thank you.Sincerely____________(Tan Hai Liang)Medical Department Hospital Batu PahatSTUDENT NAME Tan Hai Liang ID NO M0409146NAME OF SUPERVISOR Prof Khin ROTATION Internal Medicine11) instruction ISSUES IN THE 8 IMU OUTCOMES1) Communication skillsWhat are the benefits of smoking cessation in COPD patients and how should counseling be done?Counseling for smoking cessation should play a pregnant role in the holistic management of a patient with chronic obstru ctive airway disease. This is because studies have shown that smoking cessation changes the clinical course of COPD by preserving lung function. One study of patients reviewed at 14.5 years after stopping smoking showed that smoking cessation treatment showed 18% reduction in all-cause mortality compared with usual care without smoking cessation intervention. Patients who had stopped smoking had lower rates of death due of coronary heart disease , cerebrovascular disease, lung cancer, and other respiratory disease as compared with those assigned to usual care who continue to smoke. 1Fig. 4. Effect of smoking cessation on mortality cause at 14.5 years in the Lung Health Study.(A) Comparison of smoking cessation intervention with usual care. (B) Comparison according to smoking status.I therefore looked up for counseling methods for smoking cessation. The American College of Chest Physicians recommend that physicians should be the first line in introducing smoking cessation. 2 There a re 5 As that a doctor should perform for a patient who is a smoker Ask about tobacco use at every visit Advise tobacco users to quit prize the willingness to attempt quitting Assist the patient with methods for quitting Arrange for follow-up contact via phone or face to faceIf the patient is not yet willing to quit, there are 5 Rs which should be identified together by the patient and the doctor Relevance of quitting for the patient Risks of illness related to continued tobacco use Rewerds/benefits of smoking cessation Roadblocks for quitting, internal and external Repetition of the motivation intervention at each encounterThere are two means of intervention in smoking cessation namely pharmacological and behavioural. The pharmacological means include nicotine replacement therapy or buproprion. Behavioural interventions include counseling programs that teach problem-solving skills and set up groups. 3In conclusion, I learned that doctors have an important role in actively encourag ing patients who smoke to stop as there are umteen proven benefits of smoking cessation. The steps discussed above on techniques in the counseling of patients would be helpful to me in the future.2) Professionalism, ethics and personal developmentShould antibiotics be given for episodes of exacerbation of chronic obstructive airway disease?Mr TLT was not given antibiotics during this episode of exacerbation. Certain quarters support the use of prophylactic antibiotics in all exacerbations due to the knowledge that most exacerbations are caused by the common organisms of Streptococcus pneumoniae (S. pneumoniae), Haemophilus influenzae (H. influenzae), Pseudomonas aeruginosa (P. aeruginosa) and Moraxella catarrhalis (M. catarrhalis).Sputum culture may not be useful as even in the clinical stable state, some patients have sputum positive for bacteria. As such a broad spectrum antibiotic is usually used to cover different bacteria. til now, is this use of antibiotics justified in that do patients benefit from it or is the overjudicious use of antibiotics merely promoting antibiotic resistant bacteria?Current world(prenominal) initiative for chronic Lung Disease guidelines 4 recommend that antibiotics should be given ini) patients with exacerbations of COPD and the three cardinal symptoms of increaseddyspnoea, increased sputum volume and increased sputum purulence.ii) patients with exacerbation of COPD with two of the cardinal symptoms if increasedpurulence of sputum is one of the two symptomsiii) patients with severe exacerbations of COPD that requires mechanical ventilationA meta-analysis by Ram et al 5 of 11 placebo controlled RCTs with 917 patients attempted to analyse the value of antibiotics in the management of acute COPD exacerbations. The results show that there is a decrease in short-term mortality, treatment failure and sputum purulence with antibiotic therapy compared to placebo. The authors concluded that antibiotics therapy is appropriate in exacer bations of COPD associated with increased cough and sputum purulence. They further install that antibiotics have the greatest effect for patients with severe exacerbations who are admitted to the hospital. They were unable to comment on exacerbations with non-purulent sputum, what antibiotics were the best to be used and also the duration of therapy due to the lack of RCTs done on these aspects.In conclusion, it was appropriate that Mr TLT was not given antibiotics as he did not have the cardinal signs as mentioned by the GOLD guidelines and further supported by the systemic review.3) self-importance directed life long learningWhat are extrapulmonary manifestations of COPD and what are its therapeutic implications?Chronic obstructive lung disease has long been known as a situate pulmonary disorder. However new evidence have shown that COPD may be a systemic disease that involves pathology in several extra-pulmonary systems.An article by Remels et al 6 summarized the extrapulmonary manifestations as well as its implications on the holistic management of chronic obstructive airway disease. The article showed that there is skeletal muscle dysfunction as well as systemic hullabaloo in chronic obstructive airway disease.There is loss of muscle vision associated with impaired protein metabolism. The loss of muscle mass which is called sarcopenia may progress to cachexia. Studies have also shown that there is increased apoptosis of muscle cells at the cellular level. Independent of the loss of muscle mass is the reduced muscle courage. This finding has been attributed to abnormalities in mitochondria or to hypoxia. These findings have significant implications on management of a COPD patient which will be discussed below.Systemic inflammation is also seen in patients with COPD. This is evidenced by elevated levels of the proinflammatory cytokines such as tumor necrosis factor-alpha (TNF-a), interleukin-6, interleukin-8, and TNF-a receptors. The origin of the syst emic inflammation is thought to be independent of the pulmonary manifestation of COPD. One postulation is the increase systemic inflammatory mediators such as neutrophils and lymphocytes in the circulation of patients with COPD. Another proposed mechanism is increased cytokine production due to chronic hypoxia.The therapeutic implications of these findings is that muscle atrophy should be prevented by resistance exercise as well as combined strength and endurance exercise. Current Malaysian guidelines on the management of COPD 7 recommend pulmonary resistance including lower and upper limb exercises as well as inspiratory muscle training. This concurs with a Cochrane metaanalysis by Lacasse et al 8 which strongly support respiratory at least four weeks of exercise training as part of the of management for patients with COPD. The authors found that there was clinically and statistically significant improvements in quality of life as measured by dyspnea, fatigue and emotional function .4. Critical thinking and questionWhat is the efficacy of systemic corticosteroids for acute exacerbations of chronic obstructive airway disese?The use of systemic oral or intravenous corticosteroids is recommended by GOLD guidelines in the management of acute exacerbations of chronic obstructive airway disease. However the patient, Mr TLT was not given any systemic corticosteroids. This could be because he merely had a mild exacerbation.I therefore looked up a Cochrane metaanalysis on the use of systemic corticosteroids for acute exacerbations of chronic obstructive airway disease 9. The authors reviewed randomized controlled trials comparing parenteral or oral corticosteroids with placebo for the treatment of exacerbation of COPD. The primary outcomes measured were treatment failure (hospital readmission, return to emergency department), relapse and mortality.The authors reviewed 11 studies involving 1081 participants. The results show a statistically significant difference betwe en placebo and use of corticosteoids. There was less treatment failure in patients given corticosteroids. Relapse within 30 days were also reduced. However there was no statistically significant reduction in mortality.As such the authors concluded that administration of oral or parenteral corticosteroids in the treatment of acute exacerbations of COPD reduces the likelihood of treatment failure. This is associated with early and continuing improvement during treatment with corticosteroids in lung function, breathlessness and blood gases and with a shorter hospital stay. This in turn has a positve impact on the economic cost of treating exacerbations, with fewer follow-up visits and hospital admissions. The authors also found that although there is an increased incidence of corticosteroid side effectuate such as fluid retention, hypertension and adrenal suppression, the effects are unlikely to persist after treatment ceases.EVIDENCE BASED MEDICINE WORKSHEET FOR refresh OF THERAPY S TUDIESASKING QUESTIONPatient (P) Patients who present with stable COPDIntervention (I) Oral corticosteroidsComparison (C) PlaceboOutcome (O) Effects on health statusACCESSING EVIDENCE THE bet PATHHow was the article identified The Cochrane LibrarySearch keywords corticosteroids, stable COPDCitation Walters JAE,Walters EH,Wood-Baker R.Oral corticosteroids for stable chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews 2005, Issue 3.1. Is