Cinderella Man Film Essay

Cinderella Man is a film about The Great Depression. How is this period in history depicted in the film? The film Cinderella Man is based on a true story about a boxer James J Braddock, during the Great Depression in the 1930’s. Braddock, his wife Mae and his three kids were very well off, due to the fact that Braddock was doing very well with his boxing and winning lots of fights, which resulted in lots of money. This all changed very suddenly when Braddock’s career was turned upside down when the Great Depression hit. The first scene in the film which shows that times were starting to get tough is when there is a transition scene from 1928-1932, where there is a slow left pan fade starting from their dresser with lots of accessories such as jewellery, a photo in a nice frame, a watch and a stack of money which Braddock earned from winning a fight that night, and the pan ends with a shot of their dresser during the great depression which is clearly much less accessorised with very little jewellery, a razor, a false tooth and the same photo but without the frame. As Braddock and his family were very well off before the great depression this scene really illustrated how tough the times were and there were many people much worse off than Braddock’s family. Another scene in the film that portrayed the period of the Great Depression was the scene when Braddock went to the Docks to work. Each day unemployed men would wait at the gate and hope to get picked to work on the docks that day. This scene gives you as a viewer a sense of truth about the movie and when the men are stretching out their arms through the bars it demonstrates how desperate people are getting. After it shows the men begging to get picked to work it switches to a close up shot of a newspaper getting dropped on the ground with the title â€Å"unemployed hits record 15 million†. The close up shot of the newspaper really emphasises that the film is during the great depression, and nearly everyone is unemployed; and this shot works perfectly in depicting this point in time. The next scene which indicates the film is during the great depression I personally think is the most effective. Jim and Mae are so low on money that they can’t afford to keep their three c hildren, one who is sick at home and Mae sends them off without telling Jim and this leads to them fighting. After this is changes to a high angle close up on the EMERGENCY RELIEF ADMINISTRATION OF NEW JERSEY and hundreds of people filling out welfare application forms. The camera then pans to Braddock when it is his turn and the woman at the counter says to Braddock- â€Å"I never thought I’d see you here Jim†. When the woman at the counter says this to Braddock it makes me as a viewer think that if Braddock is associated with wealth and he has lost everything, then what does the average person have left? As many other scenes in the film, this one really proves that the film is during the great depression and thousands and thousands of people are hardly surviving. The last scene I am going to talk about which represents the time of the great depression is probably the most effective in getting the message across that the film is during the great depression, and this scene is in Hooverville which is a place where lots of little shanty’s were built by homeless people dur ing the great depression. This scene in the film is very loud and gruesome, with sounds such as police sirens, breaking glass, people yelling and people vomiting. The camera shows lots of people running around, bodies on the ground and small fires everywhere. This scene uses a hand held camera to emphasise the franticness of the people, and shows the occasional close up of individual’s faces to show that they are scared. Immediately after it shows a close up of Mike’s face when he says ‘tell Sarah I’ll be late.’ it flashes straight to a close up of a coffin with a number on it and then another close up on Mae’s grief stricken face. Because mikes coffin only has a number on it, it shows that NO one could afford a personalised coffin and all these people to the government were simply just numbers. At a glance this film is just about boxing, but as you watch it you learn that there is a deeper meaning to the film, and shows the story of one man, who went from having everything to nothing, and then struggled his way through the great depression, and in Braddock’s words he ‘was fighting for milk.’

Child Marriage: A Silent Health and Human Rights Issue Essay

Abstract Marriages in which a child under the age of 18 years is involved occur worldwide, but are mainly seen in South Asia, Africa, and Latin America. A human rights violation, child marriage directly impacts girls’ education, health, psychologic well-being, and the health of their offspring. It increases the risk for depression, sexually transmitted infection, cervical cancer, malaria, obstetric fistulas, and maternal mortality. Their offspring are at an increased risk for premature birth and, subsequently, neonatal or infant death. The tradition, driven by poverty, is perpetuated to ensure girls’ financial futures and to reinforce social ties. One of the most effective methods of reducing child marriage and its health consequences is mandating that girls stay in school. Key words: Child marriage, Early marriage, Maternal mortality Child marriage, defined as marriage of a child under 18 years of age, is a silent and yet widespread practice. Today, over 60 million marriages include girls under the age of 18 years: approximately 31 million in South Asia, 14 million in sub-Saharan Africa, and 6.6 million in Latin America and the Caribbean (Figure 1). Each day, 25,000 girls are married and an anticipated 100 million girls will be married in 2012.1 Over 60% of girls are married under the age of 18 in some sub-Saharan countries and Bangladesh, and 40% to 60% of girls undergo child marriage in India (Figure 2). Figure 1 Number of women aged 20–24 who were married or in union before age 18, by region (2006). CEE/CIS, Central and Eastern Europe and the Commonwealth of Independent States. Reproduced with permission from United Nations Children’s Fund. Progress †¦ Figure 2 Percentage of women aged 20–24 who were married or in union before age 18 (1987–2006). Reproduced with permission from United Nations Children’s Fund. Progress for Children: A World Fit for Children Statistical Review. New York: †¦ Child marriage has been referred to as early marriage or child brides, but these terms are not optimal. Early marriage does not imply that children are involved, and the term is vague because an early marriage for one society may be considered late by another. The term child brides glorifies the tradition by portraying an image of joy and celebration. Most of these marriages are arranged by parents, and girls rarely meet their future husband before the wedding. The girls know that after the wedding they will move to their husband’s household, become the responsibility of their in-laws, and might not see their own family or friends for some time. Although child marriage includes boys, most children married under the age of 1 8 years are girls. In Mali, the ratio of married girls to boys is 72:1; in Kenya, it is 21:1; in Indonesia, it is 7.5:1; in Brazil, it is 6:1; and even in the United States, the ratio is 8:1.2–4 Go to: Human and Children’s Rights The United Nations and other international agencies have declared that child marriage violates human rights and children’s rights. The Universal Declaration of Human Rights states that individuals must enter marriage freely with full consent and must be at full age. In 1979, the Convention on the Elimination of All Forms of Discrimination Against Women stated that child marriage is illegal. In 1989, the Convention on the Rights of the Child defined children as persons under the age of 18 years. Many countries passed laws changing the legal age of marriage to 18 years, but enforcement of these laws, and of laws requiring marriages to be registered, is weak.5 For example, although the legal age of marriage is 18 years, in Mali 65% of girls are married at a younger age; in Mozambique, it is 57%; and in India, it is 50% (Figure 3). In some parts of Ethiopia, although the legal age of marriage is 15 years, 50% of younger girls are married, and in Mali, 39% of younger girls are married. Furthermore, in some regions, an arranged marriage occurs at birth.6 Figure 3 (A) Percentage of girls (aged 15–19 years) who are currently married. (B) Percentage of women aged 20 to 24 years married before age 18. Reproduced with permission from Mathur S, Greene M, Malhotra A. Too Young to Wed: The Lives, Rights, and Health †¦ Go to: Factors Driving Child Marriage Three main forces drive child marriages: poverty, the need to reinforce social ties, and the belief that it offers protection. Child marriage is predominantly seen in areas of poverty. Parents are faced with 2 economic incentives: to ensure their daughter’s financial security and to reduce the economic burden daughters place on the family. Child marriage is first and foremost a product of sheer economic need. Girls are costly to feed, clothe, and educate, and they eventually leave the household. Marriage brings a dowry to the bride’s family. The younger the girl, the higher the dowry, and the sooner the economic burden of raising the girl is lifted. By marrying their daughter to a â€Å"good† family, parents also establish social ties between tribes or clans and improve their social status. Parents also believe that marrying their daughters young protects them from rape, premarital sexual activity, unintended pregnancies, and sexually transmitted infections, espe cially human immunodeficiency virus (HIV) and AIDS.5 Go to: Health Consequences of Child Marriage Isolation and Depression Once married, girls are taken to their husband’s household, where they assume the role of wife, domestic worker, and, eventually, mother. These new homes can be in a different village or town. Because of the high dowry paid, husbands are usually much older than the girls (and thus have little in common with them) and their new brides are expected to reproduce. Polygamy may also be acceptable in some of these regions. As a result, the girls feel rejected, isolated, and depressed. Some girls realize that survival requires embracing their new environment and proving their fertility. They lose their childhood and miss the opportunity to play, develop friendships, and be educated. Risk of Sexually Transmitted Infection and Cervical Cancer Parents believe that marrying their daughters early protects them from HIV/AIDS. Research has shown the opposite: marriage by the age of 20 years is a risk factor for HIV infection in girls.7 In Kenya, married girls are 50% more likely than unmarried girls to become infected with HIV. In Zambia, the risk is even higher (59%). And in Uganda, the HIV prevalence rate of married girls and single girls between the ages of 15 and 19 years is 89% and 66%, respectively. Their husbands infected these girls. Because the girls try to prove their fertility, they had high-frequency, unprotected intercourse with their husbands. Their older husbands had prior sexual partners or were polygamous. In addition, the girls’ virginal status and physical immaturity increase the risk of HIV transmission secondary to hymenal, vaginal, or cervical lacerations.5 Other sexually transmitted infections, such as herpes simplex virus type 2, gonorrhea, and chlamydia, are also more frequently transmitted and enhance the girls’ vulnerability to HIV. Research demonstrates that child marriage also increases the risk of human papillomavirus transmission and cervical cancer.8 Risks During Pregnancy Pregnant girls in malaria regions were found to be at higher risk for infection. Of the 10.5 million girls and women who become infected with malaria, 50% die. Their highest risk is during their first pregnancy. Pregnancy not only increases the risk of acquiring malaria, but pregnant girls under the age of 19 have a significantly higher malaria density than pregnant women over the age of 19.9 They are also at significant risk of malaria-related complications such as severe anemia, pulmonary edema, and hypoglycemia. Rates of HIV and malaria coinfection are highest in Central African Republic, Malawi, Mozambique, Zambia, and Zimbabwe, where more than 90% of the population is exposed to malaria and more than 10% are HIV positive. Having both diseases complicates the management and treatment of each. HIV-infected patients have a higher likelihood of getting a more severe form of the malaria parasite, Plasmodium falciparum. They are less likely to respond as well to antimalaria medication. Malaria increases HIV viral load and increases the mother-to-child HIV transmission rate. Data demonstrate that the combination of these diseases proves deadly to the young pregnant mother.10 Risks During Labor and Delivery Deliveries from child marriages are â€Å"too soon, too close, too many, or too late.†11 Forty-five percent of girls in Mali, 42% in Uganda, and 25% in Ethiopia have given birth by the age of 18. In Western nations, the rates are 1% in Germany, 2% in France, and 10% in the United States (Figure 4). Girls between the ages of 10 and 14 years are 5 to 7 times more likely to die in childbirth; girls between the ages of 15 and 19 years are twice as likely.12 High death rates are secondary to eclampsia, postpartum hemorrhage, sepsis, HIV infection, malaria, and obstructed labor. Girls aged 10 to 15 years have small pelvises and are not ready for childbearing. Their risk for obstetric fistula is 88%.13 Figure 4 Percentage of women, aged 20 to 24 years, married and giving birth by age 18. Reproduced with permission from Mathur S, Greene M, Malhotra A. Too Young to Wed: The Lives, Rights, and Health of Young Married Girls. Washington, DC: International Center †¦ Risks for Infants Mothers under the age of 18 have a 35% to 55% higher risk of delivering a preterm or low-birthweight infant than mothers older than 19 years. The infant mortality rate is 60% higher when the mother is under the age of 18 years. Data demonstrate that even after surviving the first year, children younger than 5 years had a 28% higher mortality rate in the young mothers cohort.14 This morbidity and mortality is due to the young mothers’ poor nutrition, physical and emotional immaturity, lack of access to social and reproductive services, and higher risk for infectious diseases. Go to: Discussion Disheartening as this information may be, there is encouraging news. Data show that in countries where poverty has decreased, such as Korea, Taiwan, and Thailand, the incidence of child marriage has also declined. Media attention raises awareness of the issue and can prompt change. After a highly publicized story in 2008, in which a 10-year-old Yemeni girl fled her husband 2 months after being married and successfully obtained a divorce, Yemen increased the legal age for marriage from 15 to 18 years. More importantly, numerous children, inspired by this case, have sued for divorce.15 Research has long enforced the importance of education for girls and their families. Child marriage truncates girls’ childhood, stops their education, and impacts their health and the health of their infants. Governmental and nongovernmental policies aimed at educating the community, raising awareness, engaging local and religious leaders, involving parents, and empowering girls through education and employment can help stop child marriage. Programs that have shown success are those that give families financial incentives to keep their daughters in school, those that feed children during school hours so parents do not have to bear that responsibility, and those that promise employment once girls have completed their schooling.1 Education not only delays marriage, pregnancy, and childbearing, but school-based sex education can be effective in changing the awareness, attitudes, and practices leading to risky sexual behavior in marriage. Main Points †¢Over 60 million marriages include a girl under the age of 18 years. †¢The main forces that drive child marriage are poverty, the need to reinforce social ties, and the belief that marriage at an early age protects girls from rape, unintended pregnancy, and sexually transmitted infection. †¢Marriage before the age of 18 increases the rate of human immunodeficiency virus (HIV) infection in girls. †¢High death rates during pregnancy are secondary to eclampsia, postpartum hemorrhage, sepsis, HIV infections, and obstructed labor. The infant mortality rate is 60% higher when the mother is under the age of 18 years. †¢Education not only delays marriage, pregnancy, and childbearing, but school-based sex education can be effective in changing the awareness, attitudes, and practices leading to risky sexual behavior in marriage. Go to: References 1. Mathur S, Greene M, Malhotra A. Too Young to Wed: The Lives, Rights and Health of Young Married Girls. Washington, DC: International Center for Research on Women; 2003. pp. 1–15. 2. United Nations, authors. World Marriage Patterns. New York: United Nations Population Division, Department of Economic and Social Affairs; 2000. 3. Population Reference Bureau, authors. The World’s Youth 2006 Data Sheet. Washington, DC;: Population Reference Bureau; 2006. [Accessed February 25, 2009]. http://www.prb.org/pdf06/WorldsYouth2006DataSheet.pdf. 4. Alan Guttmacher Institute, authors. Into a New World: Young Women’s Sexual and Reproductive Lives. New York: Alan Guttmacher Institute; 1998. 5. Nour NM. Health consequences of child marriages in Africa. Emerg Infect Dis. 2006;12:1644–1649. [PMC free article] [PubMed] 6. Bruce J, Clark S. Including Married Adolescents in Adolescent Reproductive Health and HIV/AIDS Policy. Geneva: World Health Organization; 2003. 7. Joint United Nations Programme on HIV and AIDS, authors. World AIDS Campaign 2004: Women, Girls, HIV and AIDS. Strategic Overview and Background Note. [Accessed February 25, 2009]. http://www.etharc.org/aidscampaign/publications/wac2004.pdf. 8. Zhang ZF, Parkin DM, Yu SZ, et al. Risk factors for cancer of the cervix in a rural Chinese population. Int J Cancer. 1989;43:762–767. [PubMed] 9. Dzeing-Ella A, Nze Obiang PC, Tchoua R, et al. Severe falciparum malaria in Gabonese children: clinical and laboratory features. Malar J. 2005;4:1. [PMC free article] [PubMed] 10. World Health Organization, authors. Malaria and HIV Interactions and Their Implications for Public Health Policy. Geneva: World Health Organization; 2004. [Accessed February 25, 2009]. http://www.who.int/malaria/mal aria_HIV/MalariaHIVinteractions_report.pdf. 11. Marriage and the family. [Accessed February 25, 2009]. Interactive Population Center Web site. http://www.unfpa.org/intercenter/cycle/marriage.htm. 12. United Nations, authors. We the Children: End-Decade Review of the Follow-Up to the World Summit for Children. Report of the Secretary-General (A/S-27/3) New York: United Nations; 2001. 13. United Nations Children’s Fund, authors. Fistula in Niamey, Niger. New York: United Nations Children’s Fund; 1998. 14. Adhikari RK. Early marriage and childbearing: risks and consequences. In: Bott S, Jejeebhoy S, Shah, Puri C, editors. Towards Adulthood: Exploring the Sexual and Reproductive Health of Adolescents in South Asia. Geneva: World Health Organization; 2003. pp. 62–66. 15. Walt V. A 10-year-old divorcà ©e takes Paris. Time. 2009. Feb 3 [Accessed February 25, 2009]. http://www.time.com/time/world/article/0,8599,1876652,00.html.

English Torts Law Essay Example | Topics and Well Written Essays - 1500 words

English Torts Law - Essay Example The defendant is required under English Torts Law on negligence to compensate the claimant by payment of damages or fine or by heeding an injunction as duly determined by the court. This should effectively deter people from being careless in the conduct of their duties. In a way this intends to enforce a standard of behaviour, to protect the life, welfare, and interest of unwilling victims of another person’s act of negligence. This principle on negligence is not new. In Bible times, the Divine Law dictates that a man could be deemed guilty by his negligence: â€Å"In case you build a new house, you must also make a parapet for your roof that you may not place bloodguilt upon your house because someone falling might fall from it.† –Deuteronomy 22:8, The New World Translation of the Holy Scriptures. Negligence Defined "Negligence  is the omission to do something which a reasonable man, guided upon those considerations which ordinarily regulate the conduct of hum an affairs, would do, or doing something which a prudent and reasonable man would not do. The defendants might have been liable for negligence, if, unintentionally, they omitted to do that which a reasonable person would have done, or did that which a person taking reasonable precautions would not have done." (Blyth v. Birmingham Water Works English Torts Law on Negligence The Torts Law particularly on negligence has its own precedence from the Divine Law itself. Negligence is one of those torts in which damage must be proved. Once a breach of duty has been established, the claimant must therefore also show that the breach has resulted in injury or damage (the causation issue) and that the injury or damage is sufficiently closely connected to the breach (the remoteness issue). The Tort of Negligence developed in 1932 beginning with the case of Donoghue v Stevenson which established the Duty of Care owed by manufacturers to end consumers. The following elements must be established to warrant the claim of negligence: 1. There must be a Duty of Care between the claimant and the defendant. 2. A clear breach in the Duty of Care is established. 3. Such breach resulted to some damage to the claimant. 4. There is no applicable defence to the defendant. Duty of Care In the first negligence case (Donoghue v Stevenson), Lord Atkin spoke of the backbone of the duty of care known as the neighbour principle by saying that defendant must take reasonable care to avoid acts or omissions which can be reasonably foreseen would possibly injure a neighbour, one who would closely or directly be affected by any acts or omissions. Lord Atkins stated that: â€Å"You must take reasonable care to avoid acts or omissions which you can reasonably foresee would be likely to injure your neighbour. Who, then, in law is my neighbour? The answer seems to be - persons who are so closely and directly affected by my act that I ought reasonably to have them in contemplation as being so affected w hen I am directing my mind to the acts or omissions which are called in question†. The case of Caparo Industries plc v Dickman in 1990 gave rise to the Caparo three-way test, which is the modern day test for determining duty of care: 1. It is reasonably foreseeable that the claimant may be harmed by the defendant’s failure to observe reasonable care. 2. The relationship of the claimant and the defendant indicates a sufficient relationship of proximity or remoteness. 3. It is fair, just and reasonable to impose on the defendant a duty of care towards the claimant. In 1934 Lord Wright said: â€Å"In strict legal analysis, negligence means more than heedless or careless conduct, whether in omission or commission:

Water Balance. Sediment Yield Essay Example | Topics and Well Written Essays - 750 words

Water Balance. Sediment Yield - Essay Example usual concepts employed to study landscape morphology do not essentially hold for dry land environments, where extreme proceedings are responsible for most erosion and sediment transport. The finest descriptions are from areas of vertical soils in the waterway Country of inland Australia, where they arise widely. They have also been explained on 'tabra' soils in the Sudan. What these areas have in common is the establishment of the soil outside into hummocky landscape. In the Australian examples this is due to gilgai, in the Sudanese example to differential compaction of the soil on climate 0 channel links can be developed per square kilometre. The hummocky surface makes flow to focus close by in lower areas where its greater depth causes it to be faster and livelier. This deliberation of flow causes waterways to form linking the depressions. Other features contributing to conduits formation are that slumps are more often covered than mounds, and as a consequence the floodplain there is often more cracked and eroded. It would seem as purely phenomena for land area or at least similar channels haven't yet been explained from other surroundings. Amongst other things, a lack of foliage seems essential to enable over bank flow to cut conduits where it wouldn't otherwise have enough energy. What is their protection possibility They have not been depicted in the rock record. The gilgai they are connected with has often been illustrated; however it is likely that the reticulate channels would be very difficult to spot. Firstly they are shaped in and transport sediment typically identical in composition to the mass of the floodplain sediment, thus leave-taking no textural signature of their presence. Secondly, the changes in soil formation which cause their formation would also tend to obliterate any signatures of their presence. In the last three decades of the 20th century a file on pending sediment yield (SSY) and it's controlling factors, which have information for 4140 river basins of the Earth, was created by geomorphologies of Kazan State University (Russia). Features shaping the values of SSY are overflow, river basin area, relief height, rock and soil opus, the thickness and structure of vegetable cover and degree of anthropogenic especially agricultural mastering of basin natural landscapes. According to N.I. Makkaveev (1955) and many other researchers, the study of river sediment yield is the most ambitious and precise method of judgment of erosion intensity. The specific suspended sediment yield (t km-2 year-1) and degree of anthropogenic mastering of river basin landscapes in various height regions of the Earth Dominating tendency Hemispheres of the Earth northern southern Rising 34.02 ( 34.7) 24.94 ( 72.0) Descending 26.83 ( 27.4) 1.69 ( 4.9) Relatively permanent 21.30 ( 21.8) 5.42 ( 15.6) No data area 15.79 ( 16.1) 2.60 ( 7.5) Total area 97.97 (100.0) 34.65 (100.0) The areas (106 km2) with different dominating tendencies of erosion intensity and suspended sediment yield changes in hemispheres of the Earth during the second half of the 20th century There is also an ordinance which is made to the following purposes: The hazard areas of North Augusta are subject to episodic flood which consequences in loss of life and property, health and safety hazards, disruption of commerce and governmental services, unusual public expenditures for flood fortification and relief, and injury of the tax base, all of which

Hypersensitivity Reaction Essay Example | Topics and Well Written Essays - 1250 words

Hypersensitivity Reaction - Essay Example Hypersensitivity Reaction This paper aims to review the immunological mechanisms giving rise to the four groups of hypersensitivity. It also compares and contrasts hypersensitivity reactions caused by antibodies and those caused by T-lymphocytes, while also discussing the clinical consequences of each of the reactions using examples. Hypersensitivity reactions can be divided into type I-IV, based on the various involved mechanisms. Type I, often associated with allergy, is mediated by IgE. IgE triggers basophil and mast cell degranulation cross linking with antigen. Type II occurs on binding of the host’s cells to antigens, which marks them for destruction (Phillips, 2006 p89). Mediation is by IgG and IgM antibodies. Type III hypersensitivity triggering occurs due to aggregates of IgM, IgG, complement proteins, and antigens deposited in tissues. Type IV hypersensitivity’s mediation is by macrophages, monocytes, and T cells. Infectious diseases and autoimmune involve this hypersensitivity in thei r reactions. Most hypersensitivity injuries develop due to interactions between antibodies and antigens or between sensitized T-lymphocytes and antigens. The general symptoms  accompanying the reaction depend on the involvement of either T-lymphocytes, or antibodies. During antibody involvement, immediate hypersensitivity results, while T-lymphocyte involvement results in delayed hypersensitivity reaction. Immediate hypersensitivity includes immune complex reactions, cytotoxic reactions, allergic reactions, and anaphylaxis. Delayed hypersensitivity includes infection allergies and contact dermatitis. Antibody Mediated Hypersensitivity vs. T-lymphocyte Mediated Hypersensitivity Antibody mediated hypersensitivity depends on the antigen nature, its frequency, and antigen contact route (Phillips, 2006 p11). It also depends on antibody type that reacts with the antigen. The initial antigen dose is known as sensitizing dose. On exposure, a latent period follows. Later, a dose of the sam e antigen, referred to as shocking or eliciting dose, sets off the reaction. This results in tissue damage. In T-lymphocyte mediated hypersensitivity, T-lymphocytes function rather than antibodies. These T-lymphocytes function in cell mediated immunity. They produce Lymphokines, which stimulate macrophage influx in order to perform phagocytosis. This results in immune response exaggeration. For both antibody mediated and T-lymphocyte mediated hypersensitivity reactions, local tissue destruction results. However, destruction of tissue by T-lymphocyte mediation occurs via phagocytosis. For antibody mediated hypersensitivity, reactions begin minutes after antigen administration (Phillips, 2006 p31). On direct administration of the antigen directly to the tissue, for example, injection or bee stings, a systemic reaction occurs. For instance, anaphylactic shock may result. When the contact involved is superficial, involving epithelial tissue, a localized reaction results, for example, ha y fever and asthma. These reactions can also be referred to as atopy or allergy. T-lymphocyte mediated hypersensitivity, on the other hand, requires one day or more in order to develop. It can manifest in the form of infection allergy, such as in the tuberculin test (Phillips, 2006 p34). A second manifestation of T-lymphocyte mediated hypersensitivity is contact dermatitis. Large blister like lesions accompany the reaction, with vesicles surrounded by redness. The vesicles usually itch intensely.

Ch.5 - Book - America's Courts and the Criminal Justice System by Essay

Ch.5 - Book - America's Courts and the Criminal Justice System by David W. Neubauer, Henry F. Fradella - Essay Example Discretionary decision making occurs in the criminal courts to determine whether the person will enter the system and the kind of treatment the offender will receive while in the system. These decisions lead to development of behaviors, policies and attitudes which are not formally reviewed through the traditional channels within the legal system. In addition, the decisions making laws exist to the distinct disadvantage of the minor offender. The value system, attitudes and characteristics of the people empowered to implement discretion laws as well as the absence of structures to review decisions has contributed to discretionary justice. The decisions are exercised by a local patrolman determine the kind of laws to be enforced and against which person. Discretionary decisions made by a prosecutor determine the person to be charged with an offense and the nature of charge to be passed. The judge exercising discretionary powers in respect to passage of a sentence will determine the am ount of time the person will remain in the

Referral propose an e-commerce strategy and architecture Assignment

Referral propose an e-commerce strategy and architecture - Assignment Example ep up with the new lifestyle that the global community is getting acquainted to in a massive rate of change, business and commerce is finding a niche that is centrally positioned within this culture. Thanks to the information age that has caught up with the corporate world like any other sector of the society, business has gone hi-tech to capture infinite opportunities at the global platform. Every industry is at the helm of its realignment within the spirit of these new trends of embracing the internet as a flexible promotional platform that captures every corner of the world. It is on such a window of opportunity that e-commerce has established in the world of business transactions to materially change commerce from order placement, delivery, tracking and bill clearance. One of such an industry is the apparels industry which contrary to earlier opportunities can now make such presence as the automobile industry or any other industry. Contained in this discourse is the e-commerce situation at the Khanga Apparel Corporation. The elements of e-commerce have been highlighted in the case study to disclose the said opportunity presented by the information communication and technolog y platform at the highest global level. Clothing and textile business presents one of the most customer demand and preference driven markets which rely on the physical shopping than any other arrangement. The nature of customer preferences attached to the physical needs makes the industry to be seemingly rigid and inflexible on the promotional front. According to TIA (n.d., p1), there are a number of attributes that distinctively characterize the apparel industry particularly on the influence they possess over the consumer decision making regarding purchasing. According to the report, findings on the consumer research conducted by the NPD Group in 2010, consumer behaviour is highly sensitive in this industry. As an arising observation, it is expected that the choice of approaches for

Can We Talk Research Paper Example | Topics and Well Written Essays - 250 words

Can We Talk - Research Paper Example Failure to have self disclosure, the two parties will develop some internal anger and without proper channel to vent it out, for instance proper communication skills, it may worsen the problem. I remember back in the day, I and my wife never used to open up to each other and it really cost our relationship dearly. This failure to open up in many cases is necessitated by poor communication between spouses. Self-disclosure is very important and in fact directly related to contentment and satisfaction in relationships (Can We Talk? Role Of Communication In Marriage, 2011). Gender differences have to be put in consideration despite the fact that research has actually found very big difference between genders in as afar as communication is concerned .Similarities also exist. Personally I can relate to so many similarities for instance, both men and women like being talked to nicely without being shouted at. Despite the fact that social research is normally based on generalization and some people do not fit in some of those generalizations. Personally I do not fit in most of the generalizations may be because of my split

Li Ning Company Limited Organizational Background and Audit Assignment

Li Ning Company Limited Organizational Background and Audit - Assignment Example Li Ning has its headquarters in Beijing, the Chinese capital. According to its website, Li Ning has extensive presence in the entire country. It has reportedly a reliable network of retailers and manufacturers for its supply chain, and a host of franchise owners distributing the products. Li Ning, therefore, is well-entrenched throughout the country, and has probably perfected the art of marketing and selling which have made the company successful in all its current businesses. The company started operations in 1989, the same year LI-NING was registered as a trademark. Since then, it has sponsored numerous sports delegations of China to various national and international events, where the sponsored teams brandished their Li Ning sportswear. In 1993, the company started franchising its business operations, a strategic move that helped it reach its target market in distant areas and remote provinces, thereby helping the company established its foothold in the country’s huge market for footwear and sports-related products. Li Ning is a multi-faceted business operation that is pro-active and a leader in the industry. It has its own research and development center, and a design center established in 1998. It is a proud company to claim that it is the first sports business in China to have implemented an Enterprise Resource Program (ERP) system, a system which uses internet technology that integrates its supply chain with its internal operations.

Need for Accounting Standards Essay Example for Free

Need for Accounting Standards Essay Critically evaluate the need for accounting standards and the need for a set of principles on which they are based. Accounting Standards Accounting standards contain a set of rules and governing practices for the treatment of all financial transactions. The main objective of accounting standards is to establish recognition, measurement, presentation and disclosure requirements dealing with financial transactions and key events which are important in the financial statements of companies. These financial statements give end-users important information, as well as an in depth understanding about an organizations performance, position and cash flow. Some examples of users of financial statements include potential investors, employees, suppliers and government agencies. As such, accounting standards provide the basic framework for financial statements to be presented in a fair and credible manner, such that it reflects the true overview of the financial status of an organization. These standards also help to present financial statements in a standardized and coherent manner, so that end-users worldwide are able to extract information and make decisions based on them. Advantages of Accounting Standards One advantage of having accounting standards is that it helps to ease the understanding of financial statements. What this means is that with accounting standards, financial statements reflect the financial position and status of an organization in a clear and coherent manner. With the need to publish financial statements in accordance to accounting standards, it also improves the credibility and reliability of the information present in the financial statements. End users, such as potential investors, top management and stakeholders, are able to make more informed decisions with greater confidence based on the information extracted. Accounting standards also provides guidance for accountants in their line of work. When financial reporting issues arise, accountants may refer to published accounting standards to determine how to publish an event. Some examples of these issues include new accounting transactions and new actions incorporated by an organization. Since accounting standards serve both as a reference and a guideline to accountants, this reiterates the transparency, reliability and credibility of financial statements when they are published based on a common accounting framework. Disadvantages of Accounting Standards A disadvantage of using accounting standards is in its inflexibility. For example, an accountant working in an organization which complies with accounting standards might find himself having a hard time in his line of work. This is because he has to make the organization’s unique experience fit into the guidelines laid out in published accounting standards. Another disadvantage of accounting standards is in its cost to comply with the standard. When a company decides to comply with the new standard, it must first consider the requirements of the standard, and what actions the company must take to implement the standard and the cost to do so. In many cases, this proves to be very costly as implementing and complying with a new standard would require system upgrades and employee training. Principle-based Standards Principle-based standards (PBS) is a framework of generally accepted accounting principles (GAAP) which accountants use for financial reporting. Some examples of the guidelines found in PBS include regularity, consistency, sincerity, prudence, continuity, periodicity and good faith. In PBS, an accountant follows these simple key objectives which help to ensure good reporting. The rules and guidelines set out in PBS only serves as reference and guide the accountant when he is doing his financial reporting. Advantages * Flexible, its broad guidelines allows it to be used in various circumstances * Allows companies to produce financial report using a method that best suit them Disadvantage * Lack of guidelines could lead to variation in financial reporting, making it difficult in terms of comparability Rules-based Standards Rule-based standard (RBS) refers to a list of detailed rules that must be followed when preparing financial statements. The list of rules serves as a checklist when accountants prepare financial statements at the end of a company’s fiscal year. This approach is more favoured by accountants because in preparing the financial reports by following the RBS checklist, it reduces the possibility of being brought to court if their judgements of financial statements are found to be incorrect. Advantages * Having a defined list of rules in preparing financial statement allows standardization, improving consistency which allows comparability between different companies * Easier to audit for compliance purposes Disadvantage * Having to follow a detailed set of rules results in rigidity, each transaction is accounted with respect to each rule. * Accountants have to comply to the rules set forth in RBS or face penalties for non-compliance. Conclusion In conclusion, there is a necessity for accounting standards when companies prepare their financial reports. Financial statements prepared based on accepted accounting standards not only gives users a detailed overview of the financial position of a company, but also assures users that the information they had obtained is reliable, credible and transparent. Question 2 The International Accounting Standards Board’s Framework for the Preparation and Presentation of Financial Statements requires financial statements to be prepared on the basis that they comply with certain accounting concepts, underlying assumptions and (qualitative) characteristics. Five of these are: Matching/accruals, substance over form, prudence, comparability and materiality. Briefly explain the mean of each of the above concepts/assumptions. IASB Framework The International Accounting Standards Board (IASB) framework is drawn up and used in preparing and presenting financial statements. The framework was drawn up and approved in April 1989 and published in July 1989. It was adopted by the IASB in April 2001 and later in September 2010; the Conceptual Framework for Financial Reporting 2010 was approved by the ISAB. (Deloitte, 2012) The purpose of the framework is to lay down guidelines to help ISAB shape the preparation and presentation of financial statements for end users. The IASB Framework acts as a guideline to the Board in establishing future frameworks and as well as a guide to solving accounting issues that are not addressed directly in an International Accounting Standard or International Financial Reporting Standard or Interpretation. The scope of the framework includes the objective of financial report, the qualitative characteristic of useful financial information, the elements of financial statements and the measurement of the elements of financial statements. The focus would be on five of the many qualitative characteristics present in the IASB Framework. The five qualitative characteristics, namely matching/accruals, substances over form, prudence, comparability and materiality would be further discussed in detail as follows: Matching/Accruals Concept Accruals concept is an accounting method that measures the performance and position of a company by journaling economic events regardless of when cash transactions occur. According to this concept, the revenues and expenses are recognized when they are earned or incurred and not when actual money is received or paid. The matching concept is an extension of the accruals concept, whereby revenue earned by the company and the expenses incurred by a company to earn that revenue has to be accounted in the same accounting period. For example, a business records its utility bills as soon as it receives them and not when they are paid, because the service has already been used. The company ignores the date when the payment will be made. Substance over Form Substance over form is the concept that the information shown in the financial statements and accompanying disclosures of a business should reflect the underlying realities of accounting transactions, rather than the legal form in which they appear. This would result in a true view of the affairs of the entity to be presented. Substance over form is critical for reliable financial reporting, particularly in cases of revenue recognition, sales and purchase agreements. For example, a lease might not transfer ownership to the leasee but the leasee has to record the leased items as an asset if it intends to use it for major portion of its useful life or where the present value of lease payment is fairly equal to the fair value of the asset, etc. Although legally the leasee is not the owner, so the leased item is not his asset, but from the perspective of the underlying economics the leasee is entitled to the benefits embedded in the use of the item and hence it has to be recorded as an a sset. Prudence Concept The prudence concept, also known as the concept of conservatism, refers to be cautious when it comes to the recording of business transactions. It is stated that under the prudence concept, the amount of revenues recorded should not be overestimated; neither should the amount of expenses be underestimated. One should be conservative in recording the amount of assets, and not underestimate liabilities. (Steven Bragg, 2011) In terms of profit and loss, anticipated profits cannot be recorded down as profits until they materialize. Some examples of exercising prudence is when company’s inventory should be valued ‘at cost or market price, which is less’, and a provision should set up for an allowance for doubtful accounts. Comparability Concept Comparability is one of the key qualities which accounting information must possess. Accounting information is comparable when accounting standards and policies are applied consistently from one period to another and from one region to another. The characteristic of comparability of financial statements is important because it allows us to compare a set of financial statements with those of prior periods and those of other companies. Financial statements of one entity must also be consistent with other entities within the same line of business. This should aid users in analyzing the performance and position of one company relative to the industry standards. It is therefore necessary for entities to adopt accounting policies that best reflect the existing industry practice. For example, a company which sells mobiles phones values its inventory based on First In First Out (FIFO) method previously, it must continue to do so in the future so as to preserve consistency in the reported inventory balance. A switch to other methods may cause a shift in the value in the inventory, which results in lack of basis of comparability. Materiality Concept It is stated that information is material if its omission or misstatement could influence the economic decisions of users taken on the basis of the financial statements (IASB Framework) Materiality therefore relates to the significance of transactions, balances and errors contained in the financial statements. Materiality defines the threshold or cutoff point after which financial information becomes relevant to the decision making needs of the users. Information contained in the financial statements must therefore be complete in all material respects in order for them to present a true and fair view of the affairs of the entity. For example, the government of the country in which a company operates in working on a new legislation which would seriously impair the companys operations in future. Although there are no figures involved, but the implication on the company would be so great that it would be material for this information to be made known to parties it may concern. References IASB Framework, 2012, http://www.ifrs.org/current-projects/iasb-projects/conceptual-framework/Pages/Conceptual-Framework-Summary.aspx (Cited 23 December 2012) Deloitte IAS Plus, History of IASB Framework, http://www.iasplus.com/en/standards/standard4 (Cited 23 December 2012) Steven Bragg, 13 March 2011, What is the prudence concept in accounting, http://www.accountingtools.com/questions-and-answers/what-is-the-prudence-concept-in-accounting.html (Cited 23 December 2012)

Effectiveness Of Salt Versus Oral Mouthwash Biology Essay

Effectiveness Of Salt Versus Oral Mouthwash Biology Essay This experiment aims to compare the effectiveness of salt versus oral mouthwash in inhibiting the growth of oral bacteria such as Treponema denticola, Fusospirochetes, Porphyromonas gingivalis and so on. These are chosen as subjects of experiment as they cause Periodontal Disease or Gingivitis among people. Finding a solution to prevent the growth of these disease-causing bacteria will help solving the problem.[10] Salt or Sodium Chloride is an ionic compound bonded together by ionic bond between Sodium ion and Chloride ion. Table salt is a processed salt where it is used as a condiment and food preservation. Salt is currently mass-produced by evaporation of seawater. It is also proved to provide medicinal effects. For example, people often heal wounds using salt solution and it is good against infections as it reduces inflammation of wounds. Moreover, researches nowadays have proven salt can bring about an effect in inhibiting the growth of bacteria. This is why people often use a cup of water with two tablespoons of edible salt as mouthwash. Nevertheless, salt solution can be used to treat sore throats. Salt is considered antibacterial because it creates no wet condition for bacteria to grow in. In other words, salt is very good at dehydrating and absorbing water from anything it comes contact with. Salt solution does not kill the bacteria but it inhibits the growth of them. Therefore, it is considered as bacteriostatic.[9][12] Mouthwash is a product made for enhancing oral hygiene. Some brands of mouthwash claim that they can help to kill bacteria causing gingivitis and bad breath. Anti-cavity mouth rinse uses fluoride compound to protect against tooth decay. A person has to gargle the mouthwash without the need of brushing and flossing teeth. Besides, mouthwash can also help removing mucus and food particles which are situated down in the throat. This product is bactericidal where it kills bacteria which are found in mouth. Active ingredients  in commercial brands of mouthwash can include  thymol,  eucalyptol, menthol,  chlorhexidine gluconate,  benzalkonium chloride,  cetylpyridinium chloride,  methylparaben,  hydrogen peroxide,  domiphen bromide  and sometimes  fluoride,  enzymes, and  calcium. Ingredients also include water, sweeteners such as  sorbitol,  sucralose,  sodium saccharin, and  xylitol. However, there is some evidence which shows that mouthwash contributes to oral cancer. This is shown by a literature review by McCullough and Farah from 2008 published in the  Dental Journal of Australia.[13][14] Oral hygiene is very important to prevent dental problems and bad breath. One of the common ways to practise oral hygiene is tooth brushing. Some people may use oral mouthwash to kill the disease-causing bacteria situated inside the mouth. One of the common disease regarding oral hygiene is Gingivitis. Gingivitis is a term used to describe non-destructive  periodontal disease. Gingivitis is often caused by types of bacteria stated above. Bacteria activity caused by these microorganisms can lead to severe effects including refractory periodontitis and acute necrotizing gingivitis, resulting in bone resorption and tooth loss. Gargling with oral mouthwash is effective but the price is expensive. Furthermore, it is not always available at any outlets all the time. Practising to gargle with salt water is a convenient method to keep the oral cavity clean. Table salt can be easily obtained from any outlets and the price is far cheaper than any oral mouthwash. One thing good about salt is it does not cause side effects as no artificially made chemicals are contained within it. But how does the effectiveness vary compared to commercial oral mouthwash?[15] Experimental Hypothesis : There is a significant difference for the effectiveness of commercial mouthwash in inhibiting oral bacteria compared to salt solution of concentration greater than or equal to 0.4moldm-3. Null Hypothesis : There is no significant difference for the effectiveness of commercial mouthwash in inhibiting oral bacteria compared to salt solution of concentration greater than or equal to 0.4moldm-3. Variables : Manipulated variable : Types of antibacterial solution Responding variable : Number of bacteria colony found on nutrient agar Fixed variables : Temperature of incubation period, contents of nutrient agar, type of bacteria cultured, time taken for gargling mouthwash. Apparatus : Bottles of inoculum, work table, sterilised petri dishes, micropipette, 1000ml conical flask, Bunsen burner, incubator, 100ml beaker, electronic balance, 250ml volumetric flask, filter funnel, dropper, stopper, bio-hazard waste bin. Materials : Sterilised cotton buds, sterilised distilled water, distilled water, commercial mouthwash B, disinfectant, tissue papers, Dettol solution, gloves, teats of micropipette, nutrient agar solution, aluminium foil, solid Sodium Chloride. Planning Two trial experiments were conducted in overall. The first trial experiment was carried out to determine which commercial mouthwash is the best in inhibiting the growth of oral bacteria. The commercial mouthwash which has the highest inhibition rate will be compared to salt solution. Three types of commercial mouthwash namely A, B and C were used. Three sterilised petri dishes were obtained. A swab sample was taken before gargling the commercial mouthwash. This was tagged as before to indicate the number of bacteria colony found in nutrient agar before commercial mouthwash was used and acted as a control. Three human subjects were volunteered to gargle each type of commercial mouthwash. This was assuming that the number of oral bacteria in every person is the same. After gargling three types of commercial mouthwash for 10 seconds, three swab samples were obtained from every subject. The bacteria were cultured and platted and the number of bacteria colony found on agar was counted. Al l sterilised petri dishes were then placed in an incubator for a week. The result showed that commercial mouthwash B has the highest bacterial inhibition rate. Types of commercial mouthwash Number of bacteria colony found on nutrient agar Control 7 A 4 B 1 C 2 Table 1.1 : The number of bacteria colony found on nutrient agar with respective commercial mouthwash used. The second trial experiment was done to determine the time taken to gargle commercial mouthwash B in order to obtain the maximum inhibition rate. In other words, this trial was carried out to choose a suitable period of gargling mouthwash. Five sterilised petri dishes were obtained. Four types of gargling period had been chosen in this trial which were 5, 10, 15 and 20 seconds. Four human subjects were volunteered to gargle for every period of time. Commercial mouthwash B was used as it gave the highest rate of bacterial inhibition from the first trial conducted. A swab sample was obtained before the trial proceeded. This was labelled as before to indicate the number of bacteria colony found in nutrient agar before gargling commercial mouthwash B and acted as a control. Every human subject was ordered to gargle commercial mouthwash B with the respective period of time chosen earlier. After gargling, four swab samples were obtained from each subject. The trial was again assuming that the amount of oral bacteria in every person is the same. The bacteria was cultured and platted and the number of bacteria colony found on nutrient agar was counted. All sterlised petri dishes were then placed in a incubator for a week. The result showed that a period of 10 seconds to gargle commercial mouthwash B has the highest bacterial inhibition rate. Time taken to gargle commercial mouthwash B / seconds Number of bacteria colony found on nutrient agar 0 8 5 5 10 2 15 2 20 2 Table 1.2 : The number of bacteria colony found on nutrient agar with respective period of time to gargle commercial mouthwash B. Real Experimental Procedures Preparing salt solution of various concentrations Mass of an empty 100ml beaker was weighed using an electronic balance. For 0.1M salt water, 1.4625g of solid Sodium Chloride (NaCl) was weighed. The weighed solid was then dissolved in the 100ml beaker using distilled water. The solution was poured into a 250ml volumetric flask using a filter funnel. The beaker and filter funnel were rinsed with distilled water and added into the volumetric flask. Distilled water was carefully added into the volumetric flask until the level of solution reached the graduation mark. Dropper was used instead to prevent any exceed above the graduation mark. A stopper was fitted on the mouth of volumetric flask and the solution was shaken carefully. Steps 1 to 8 were repeated by replacing 1.4625g of NaCl with 2.925g for 0.2M, 3.4875g for 0.3M, 5.850g for 0.4M and 7.3125g for 0.5M. Preparing inoculums of bacteria A sterilised cotton bud was used to obtain the swab sample from mouth. The cotton bud was then dipped into a bottle of inoculum containing a quarter volume of sterilised distilled water and labelled as before. The cotton bud was then disposed off. After gargling 50ml salt water with concentration of 0.1M, another swab sample was obtained and dipped into bottle of inoculums containing sterilised distilled water. This was labelled as 0.1M. Step 3 was repeated by replacing 0.1M salt water with 0.2M, 0.3M, 0.4M, 0.5M and commercial mouthwash B. Preparing petri dishes with bacteria Work table was sprayed with disinfectant to kill all the bacteria present. Table was wiped with several pieces of tissue papers. Hands were washed with Dettol solution to ensure no bacteria were found. Gloves were worn on both hands. Three sterilised petri dishes were obtained. A bottle of inoculum (before) was taken. A micropipette was used and calibrated to 200 microlitres. Teat of micropipette was placed at the edge of micropipette. Hands were forbidden to touch the teat so that it would not be contaminated with bacteria. The bottle of inoculum was opened using a hand and the end of micropipette was pressed gently to suck the content of inoculums. The cap of bottle was closed and the content of inoculum was placed in the first petri dish. The lid was opened slightly till the teat can be placed in the petri dish. The end of micropipette was pressed fully to release the sucked content of inoculums. The teat was then expelled into a bio-hazard waste bin. Same procedures were repeated for second and third petri dishes. Steps 6 to 13 were repeated by replacing bottle of inoculum (before) with bottle labelled 0.1M, 0.2M, 0.3M, 0.4M, 0.5M and commercial mouthwash B. Preparing bacterial lawn Nutrient agar solution was poured into a 1000ml conical flask. The solution was left to cool down for several minutes. After several minutes, the mouth of conical flask was heated with a Bunsen burner. This was done so that the aluminium foil could be capped on the mouth of conical flask for sterilising purpose. The mouth of conical flask was placed gently at a petri dish. The culture solution was poured into the petri dish until it was one-third full. This process is known as platting. Aluminium foil was capped back on the mouth of conical flask. The petri dish containing bacteria and agar solution was swirled gently by pressing and moving the petri dish on the table. The petri dish was left on the table for 10 minutes. This was done to ensure that the culture solution is solidified. Steps 1 to 7 were repeated for every petri dishes. All petri dishes were inverted and stored in an incubator for a week. After one-week incubation period, all petri dishes were observed for bacterial activity. Risk Assessment A complete aseptic procedure was used throughout the experiment. The work table was sprayed using a disinfectant to kill all the foreign bacteria present. Hands were washed with Dettol solution and gloves were worn so that I would not be infected by the bacteria when having a meal. Sterilised petri dishes were used because it contained only the oral bacteria when experiment was carried out. This was important to maintain the validity of results obtained. Sterilised distilled water was also used to make sure only oral bacteria were cultured. Teats of the micropipette were disposed off into a bio-hazard waste bin because they were contaminated with bacteria and could possibly infect other people. Disposing off the teats will solve the problem. The lid of petri dish was opened slightly when introducing bacteria into the petri dish. This was done to prevent any foreign bacteria in the lab to grow and reproduce in the petri dish containing agar solution. Distilled water was used to prepar e various concentrations of salt solution to make sure no other impurities would affect the concentration or molarity of the solution. The electronic balance was tarred to reset the reading value before weighing a specific mass of solid Sodium Chloride. Dropper was used to prevent any exceed above the graduation mark of volumetric flask when dilution was carried out. Mouth of conical flask was heated with Bunsen burner to ensure no contamination from other bacteria. Aluminium foil was capped back on the mouth of conical flask to prevent any foreign bacteria from entering the conical flask. At the end of the experiment, all petri dishes were sent for autoclaving for disposal purpose. Results Types of antibacterial solution Number of bacteria colony found on nutrient agar 1stReading 2ndReading 3rdReading Mean Value Control 7 6 8 7.0 0.1M Salt Water 9 6 5 6.7 0.2M Salt Water 8 5 7 6.7 0.3M Salt Water 6 5 7 6.0 0.4M Salt Water 3 2 3 2.7 0.5M Salt Water 2 1 1 1.3 Commercial Mouthwash B 1 0 2 1.0 Table 1.3 : Number of bacteria colony found on nutrient agar with respective types of antibacterial solution used. Keys : 1st reading was obtained from first petri dish. 2nd reading was obtained from second petri dish. 3rd reading was obtained from third petri dish. Graph 1.1 : Bar chart of mean number of bacteria colony found on nutrient agar against types of antibacterial solution. Statistical Analysis There is no significant difference for the effectiveness of commercial mouthwash in inhibiting oral bacteria compared to salt solution of concentration greater than or equal to 0.4moldm-3. The calculated U-values are more than the Ucrit value which is zero at 5% significance level. The null hypothesis is not rejected as the U-values are not lower than Ucrit value. Therefore, null hypothesis is accepted and the experimental hypothesis is rejected. There is insufficient evidence to state that there is a significant difference for the effectiveness of commercial mouthwash in inhibiting oral bacteria compared to salt solution of concentration greater than or equal to 0.4moldm-3. 0.4M salt solution Rank Commercial mouthwash B Rank 3 5,5 0 2 1 3.5 1 1 2 5.5 1 3.5 à ¢Ã‹â€ Ã¢â‚¬ËœRank sample 1 14.5 à ¢Ã‹â€ Ã¢â‚¬ËœRank sample 2 6.5 Table 1.4 : Calculations for Mann-Whitney Test. Formulae for calculating U-values : U1 = n1n2 + n1(n1+1) à ¢Ã‹â€ Ã¢â‚¬ËœRank sample 1 2 U2 = n1n2 + n1(n1+1) à ¢Ã‹â€ Ã¢â‚¬ËœRank sample 2 2 Keys : n1 = size of the sample 1 (0.4M salt solution) n2 = size of the sample 2 (Commercial mouthwash B) à ¢Ã‹â€ Ã¢â‚¬ËœRank sample 1 = total rank of sample 1 à ¢Ã‹â€ Ã¢â‚¬ËœRank sample 2 = total rank of sample 2 Calculations of U-values for both samples U1 = (3)(3) + (3)(3+1) 14.5 = 0.5 2 U2 = (3)(3) + (3)(3+1) 6.5 = 8.5 2 Significance level = 5% Value of Ucrit according to table = 0 Data analysis From the experiment conducted, it is shown that the mean number of bacteria colony found in nutrient agar due to commercial mouthwash B is lower than other salt solutions with various concentrations. When the concentration of salt solution is less than 0.4moldm-3, there is a large difference for the mean number of bacteria colony found between commercial mouthwash B and salt solution. The result changes when concentration of salt solution increases to 0.4moldm-3 where there is only a small difference for the mean number of bacteria colony found in nutrient agar. Commercial mouthwash B and salt solution are proven for inhibiting growth of oral bacteria. The number of oral bacteria found in mouth will drop significantly after gargling because antibacterial solutions kill or prevent the bacteria from growing. The most suitable method to find out the effect of antibacterial solution on the growth of oral bacteria is to count the number of bacteria colony found on nutrient agar after gargling the solutions. The results obtained are compared with the number of bacteria colony found before gargling the solutions which acts as a control. Temperature of incubation is set constant at 36.9oC where it represents the exact body temperature of a human body.[3] Commercial mouthwash B contains an active ingredient namely Chlorhexidine gluconate. It has both bactericidal and bacteriostatic mechanisms of action. It is a type of cell membrane agent. It disrupts the structure of cell membrane, causing the rigidity of the cell membrane to be broken down. This active chemical binds onto lipopolysaccharides, situated at outer membrane of Gram-negative bacteria, disrupting the structure lipid bilayer consisting of phospholipids. When the fluid lipid bilayer is broken down, cell organelles and metabolites no longer bordered by cell membrane. Loss of metabolites results in death of a bacterium.[1][6] Salt solution has a different mechanism in inhibiting growth of oral bacteria. Every microorganism needs an aqueous environment to thrive in. In low concentration of salt solution, the surrounding environment is hypotonic. The solute concentration remains higher than the surrounding solution. Oral bacteria have the ability to pump in ions with the energy comes from ATP by respiratory enzyme found in mesosomes. This ion pump moves ions from surrounding solution into the body of oral bacteria. There is water potential from surrounding solution to the cytoplasm of oral bacteria. Water moves into the cell by osmosis and this gives an aqueous environment which is favourable for oral bacteria to grow and reproduce. At high concentration of salt solution, the solute concentration in the surrounding solution is greater than the cytoplasm of oral bacteria. This is because the ion pump cannot keep up to pump in more ions efficiently. There is water potential from cytoplasm of bacteria to surro unding solution. Water moves out from cell by osmosis. Oral bacteria are dehydrated and eventually die within a minute. [5][7][8] However, there is a difference in mean number of bacteria colony found when different antibacterial solutions are used. The difference is mainly because active ingredient in commercial mouthwash B kills the bacteria and they can no longer reproduce again. When salt solution is used, bacteria may move away from the solution which has high solute concentration. Bacteria are not killed and may have the chances to reproduce again. Sample number 75% lake water 50% lake water 25% lake water 10% lake water Distilled water Sea water 183 162 154 95 32 10 8 185 24 20 16 4 1 1 186 33 38 29 2 0 2 187 266 247 109 16 3 5 187 224 214 125 17 11 7 188 290 285 146 41 8 14 Table 1.4 : number of bacteria found in respective water sample.[16] (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC545388/pdf/jbacter00775-0012.pdf) From the above data, it was an experiment conducted Dr.Claude E. Zobell and D. Quentin Anderson to investigate the number of bacteria found in different water sample. It can be seen that the number of bacteria colony decreased tremendously when the bacteria were cultured in a sample of sea water. Sea water has a high concentration of salt which will provide a high solute concentration compared to cytoplasm of oral bacteria. The difference from my data and theirs will be discussed in the evaluation section. Evaluation There are a few limitations found in this experiment. Contamination may occur when introducing bacteria into the petri dish. Foreign bacteria found in the air may enter the petri dish and reproduce in the nutrient agar. This was inevitable because lamina floor was broken down and could not be used for this experiment. A known species of a bacterium cannot be used as it is not available in the lab. Therefore, swab samples were obtained and these contained a mixture of bacteria as stated above. Experiment cannot be conducted only on a type of bacterium. Besides, nutrient agar solution may not be sterilised completely as the autoclave machine in the lab was broken down and spare parts were not available by that time. Therefore, nutrient agar solution was sterilised using a pressure cooker. This caused other foreign bacteria to survive and reproduce in the nutrient agar. The period of incubation chosen is a week because the bacteria cultured from swab samples are low in number. This requ ires a longer period for bacteria to grow and reproduce. The human subjects involved may not gargle the antibacterial solutions in a correct way. This will affect the validity of data obtained during observation. Lastly, the genetic makeups of bacteria found in swab samples are not known. This could not be prevented as a specific strain of bacterium was not recognised. As a result, some of the bacteria may have mutated and probably resistant to the antimicrobial solutions. The results obtained will be affected. These are the reasons why the findings are different from this experiment and experiment conducted by Professor above. The experiment can be modified by using a known strain of bacterium. This will increase the validity of data significantly. Moreover, different type of nutrient agar which is favourable for oral bacteria to grow can be used. This will cause the bacteria to grow and reproduce faster than expected. Thus, results can be obtained earlier. Furthermore, nutrient agar solution can be sterilised with an autoclave machine so any foreign bacteria present will be killed. Conclusion There is no significant difference for the effectiveness of commercial mouthwash in inhibiting oral bacteria compared to salt solution of concentration greater than or equal to 0.4moldm-3. Null hypothesis is accepted. Source Evaluation Source 1, 2 and 3 are published books thus the information are reliable. Sources 4 to 8 are journals. They are written by scientists all around the world and these are obtained from Science Direct webpage. Therefore, it is trustable. All the information should be factual and accurate. Source 9 and 16 are websites containing journals as well. Its journals are well-known and most of them are written by famous scientists. Sources 10,11,12,13 and 15 are websites of Wikipedia. Most of the data and information obtained here have citations and they are partially reliable and valid. Source 14 is the official website of Australian Dental Association. The information contained here is mainly about the effect of chlorhexidine. It is very reliable. Therefore, it should not contain any biased points based on arguments made.

Declining Population of Loggerhead Sea Turtle :: Biology

Declining Population of Loggerhead Sea Turtle The title of this paper is pretty self explanatory and the facts are simple. The solution is feasible but yet, not enough action is being taken to make a difference. You would think that we as humans being the dominate creatures of the earth, would be able to understand the simplicity of knowing the negative effects of our carelessness and the impact it has on the creatures around us†¦Creatures that are close to defenseless when put in comparison with mankind. I didn’t want there to be a great mystery surrounding what my presentation is about because there doesn’t have to be. Most people either don’t know or don’t care about the declining population of the loggerhead sea turtles. While I can not change the attitude of a person who is apathetic, I can help increase the knowledge of a person who is ignorant about this subject. Ignorance would be a very good word to describe my amount of knowledge in this area before I began this study on loggerhead sea turtles. The saddest part of this story is that we as humans are too involved with ourselves and concerned about our own wellbeing. We will not take the time to step back and wonder how the creatures of this world are â€Å"getting along†. If we could just forget about ourselves for one minute and try to help out the creatures that are continually struggling to survive the negative effects that our growing and careless population has placed on them. Even though loggerheads are the most common of all sea turtle species found on the United States coasts, recent studies have show that this amazing turtle population is in steep decline and will be in danger if we do not begin to find out why its population is declining and what we can do to reverse this effect. The International Union for the Conservation of Nature listed the loggerhead as threatened in 1978. This means that the loggerhead has been considered "vulnerable for becoming extinct" for thirty years because of the numbe r of turtles left. Recent studies of loggerhead population have found that the number of females that nest in the Southeastern United States is continuing to decline at an alarmingly rapid rate. The United States Federal Government has reported that the loggerhead turtle population decline is not just something to be concerned about in one area of the world but it is a world wide problem.

Journey to the Midwest: The German Immigration :: essays research papers fc

Journey to the Midwest: The German Immigration   Ã‚  Ã‚  Ã‚  Ã‚  Many German immigrants in 1901 risked everything for a dream of better things in America and the promise of freedom and wealth. Although, when they arrived many realized that the streets were not paved with gold as they had believed, but rather filth. This is the detailed description of why one family left Germany, what happened after they arrived in America, and how they adapted to life in the Midwest. Momma- I have arrived in America finally. The journey was long and crowded on the boat, but hopeful. I was glad that Wilhelm was here to travel with me. We knew when we had reached America, there was a beautiful statue of a woman and it gave us all hope to see it. She was a great welcome into the country. When we got off the ship, we were ushered to a smaller boat and taken to this beautiful island. The building was large and beautiful. Immediately, men in uniform gave us a stamp on our clothes and we had to stand inline with the other people from our ship. It took all day and we spoke to many people, they asked us questions and looked at our eyes. There was nowhere to sit, so we were very tired at the end of the day. Finally though, we made it through and we are in America! Wilhelm and I are traveling to see papa now. We are so excited to see papa, although the journey to see him maybe long. Momma, please be strong and kiss Heinrich for me. I miss you and pray that I will see you an d the family very soon. –Love, Edda   Ã‚  Ã‚  Ã‚  Ã‚  Today, many Germans live throughout the U.S.; especially in the Midwest. More likely then not, they came here in the late 1800's- 1900's. During the 1860’s many revolutions took place in Germany and many families experienced the poverty that almost always follows war. In one 20 year span, in the late 1800's, Germany went to war at least 7 times taking on neighboring countries such as: Austria, France, Belgium and Russia. Much money was spent on the war effort in Germany. People were taxed heavily just to buy bullets for the army. Through all this, word was spread like wild fire through Germany that a new country in the west across the water was offering freedom and a promise of happiness for anyone who would make the long journey to the new country: America.

Women in Veterinary Medicine Essay -- History Medical Science essays

Women in Veterinary Medicine There is a long history in the sciences of women being subjected to inequality. In almost every area of science, engineering, and technology women are underrepresented. Veterinary medicine is one field where the tide is turning. If one were to look at the admissions profile of any university in the United States it would be evident that women and men comprise an equal share of the entering classes. This of course has not always been the case. The women of the past have had difficulty in entering this field and making it female friendly. Their efforts have been worthwhile - veterinary medicine now has the greatest equality of all the health professions next to nursing. The History The legacy begins in 1910 when the first two women were granted veterinary degrees (AVMA, 1999). By 1930, there were 30 women who had been granted DVMs (Pritchard, 1989). These women were the pioneers for today's female veterinarians. They faced many hardships in their academic and professional careers - hardships began at the admissions level. A book published in 1963 states that "because a number of women have dropped out or fail to continue in veterinary medicine, admissions committees are reluctant to accept more than a few women students." It also claimed that the usual qualifications for a veterinarian are "unusual" in a woman (Riser, 1963). For those women who were lucky enough to be admitted to a veterinary college, it did not get any easier. Early women veterinary students faced resentment from male colleagues and faculty. Women were willing to carry the same academic load as the men did. However, some colleges banned women from certain courses - often times giving no reason for their exclusion (Assoc. ... ... 1997 The Association for Women Veterinarians (AWV-web). 2000. http://www.awv-women-veterinarians.org/ Honsch, J.D. "The New Face of Veterinary Medicine." June 6, 2000. http://www.vetcentric.com/magazine/magazineArticle.cfm?ARTICLEID=873 KPMG LLP Economic Consulting Services. "The Current and Future Market for Veterinarians and Veterinary Medical Services in the United States." JAVMA. Vol. 215 no. 2. July 15, 1999. 161-183 Pritchard, W.R. (ed.). Future Directions for Veterinary Medicine. Pew National Veterinary Education Program (pub.). Durham, NC. 1989. Also found at: http://www.equinevetnet.com/vetcareer/womenvetmed.html Riser, W.H. Your Future in Veterinary Medicine. Richards Rosen Press, Inc. New York. 1963. 141-145 Turner, S. "Women are changing the face of veterinary medicine." Careers in Veterinary Medicine. 2001. http://www.vin.com/Careers/ Women in Veterinary Medicine Essay -- History Medical Science essays Women in Veterinary Medicine There is a long history in the sciences of women being subjected to inequality. In almost every area of science, engineering, and technology women are underrepresented. Veterinary medicine is one field where the tide is turning. If one were to look at the admissions profile of any university in the United States it would be evident that women and men comprise an equal share of the entering classes. This of course has not always been the case. The women of the past have had difficulty in entering this field and making it female friendly. Their efforts have been worthwhile - veterinary medicine now has the greatest equality of all the health professions next to nursing. The History The legacy begins in 1910 when the first two women were granted veterinary degrees (AVMA, 1999). By 1930, there were 30 women who had been granted DVMs (Pritchard, 1989). These women were the pioneers for today's female veterinarians. They faced many hardships in their academic and professional careers - hardships began at the admissions level. A book published in 1963 states that "because a number of women have dropped out or fail to continue in veterinary medicine, admissions committees are reluctant to accept more than a few women students." It also claimed that the usual qualifications for a veterinarian are "unusual" in a woman (Riser, 1963). For those women who were lucky enough to be admitted to a veterinary college, it did not get any easier. Early women veterinary students faced resentment from male colleagues and faculty. Women were willing to carry the same academic load as the men did. However, some colleges banned women from certain courses - often times giving no reason for their exclusion (Assoc. ... ... 1997 The Association for Women Veterinarians (AWV-web). 2000. http://www.awv-women-veterinarians.org/ Honsch, J.D. "The New Face of Veterinary Medicine." June 6, 2000. http://www.vetcentric.com/magazine/magazineArticle.cfm?ARTICLEID=873 KPMG LLP Economic Consulting Services. "The Current and Future Market for Veterinarians and Veterinary Medical Services in the United States." JAVMA. Vol. 215 no. 2. July 15, 1999. 161-183 Pritchard, W.R. (ed.). Future Directions for Veterinary Medicine. Pew National Veterinary Education Program (pub.). Durham, NC. 1989. Also found at: http://www.equinevetnet.com/vetcareer/womenvetmed.html Riser, W.H. Your Future in Veterinary Medicine. Richards Rosen Press, Inc. New York. 1963. 141-145 Turner, S. "Women are changing the face of veterinary medicine." Careers in Veterinary Medicine. 2001. http://www.vin.com/Careers/

High Gas Prices Threaten Northern Nevada’s Economy

The article ‘Oil costs threaten Nevada's economy’ in the Reno Gazette-Journal is about how the rising gas prices are expected to cause economical hardship for Northern Nevada.The problems stem from the fact that tourism is very important in this area with most of the tourism business coming from people driving from California (Cox, 2007).   With the high gas prices people are not expected to travel as much, meaning that the tourism is going to be lower in this area.Less tourism means less money coming in and that is not good for the economy of this area.   The effects are expected to be seen over the next couple of years and will likely affect Northern Nevada only since the rest of the state gets most of its business from tourists traveling by air.   The overall conclusion of the article is that rising gas prices are going to cause a drop in tourism in the northern parts of Nevada, but the likelihood of this impact is going to be something that can be overcome and should not devastate this area of the state.The impact on the state of Nevada, according to the article, is one of a short term nature that is a localized issue and will not affect the whole state.The cause of the issue is that high gas prices are causing people to travel less and the economy in northern Nevada relies heavily upon people visiting, mostly from those driving in from California (World Now, 2001-2007).   The fact that the economy of the area is so dependent upon travel means that when travel decreases, business decreases (Cox, 2007) and money is lost.According to the article, it is likely to be a problem that will surface over the next couple of years, but it something that can probably be handled and will not cause long term problems with the economy of Northern Nevada.   Nevada has seen such hardships before and managed to survive through them, so it is predicted that the state will come through this just fine, too (World Now, 2001-2007).Based upon the information given by the expert in the article, the whole state is not going to impacted just the northern part (World Now, 2001-2007) and basing my opinion on this, I believe this is not a huge issue the state will need to deal with.Las Vegas is the biggest attraction in the state and it is located in the south, so it is really doubtful that the economy of the whole state is going to see a huge impact by gas prices.   Overall, the effects will likely be minimal on a state wide level and mainly concentrated to the northern area.   Ã‚  With that in mind it really does not seem like a major issue that should worry people in Nevada.   It is not going to cause the economy to take a nose dive or anything of that nature.It seems Nevada has handled such problems before and the businesses should be able to survive despite the issues (Cox, 2007).   While it may be hard for the next couple of years, Northern Nevada will bounce back.   It is a popular tourist destination and is bound to stay th at way despite the cost of gas.   Perhaps the only downfall is going to be the effect on small businesses, which may not be able to survive the hard times.  Ã‚   A little loss over an extended period of time could make it hard for a small business to afford to be able to operate.In my opinion, gas prices are hurting business and people all over the country, so the problem is not really unique to Nevada.   However, as it states in the article, Northern Nevada is a big concern due to the fact that the majority of business comes there from people who are driving into the area (Cox, 2007).   It would make sense that as gas prices rise, people are going to be using cheaper methods of travel and may go elsewhere that they can get to by air.So, in the long run, it is likely that this impact will be felt pretty hard by those businesses in the north, but with all the information and opinions expressed on the past occurrences of rough economic times, there is little doubt that this ar ea will not have problems bouncing back.   It is a short term problem that will probably not cause long term effects.   Additionally, it is not going to effect the whole state, but rather just business in the north.   

Tesco’s Success Story

Tesco's success story Some of the key reasons for  Tesco’s  success include: Tesco  has been particularly successful because of its powerful brand. It has a reputation for value, low prices and for being customer focused. Its brand equity and associations have helped the company to expand into new sectors and markets. Tesco  has also been strong in public relations, advertising and building profile in catchment areas on a local level. This local approach to marketing appears to be a key driver for success. Tesco  has a good range of products, including own label products.It seeks to provide excellent customer service, and ensure high levels of customer satisfaction. The own label products have helped strengthen profits for the group, and it broad appeal through good, better, best (finest ranges) caters for the widest consumer audience. Aggressive overseas expansion has helped to keep profits high. The organisation has expanded into Eastern Europe, emerging nations su ch as China and South Korea and even the US, through mid market supermarkets known as, â€Å"fresh and easy†.Its strategy of being close to the customer has been assisted in the UK specifically, when  Tesco  developed different formats for shopping (convenience, metro, express, superstores). It has been the best retailer for format delivery and obtaining some of the best retail positions. It gained a first mover advantage when it launched  Tesco. com, which is one of the biggest and most successful online retailers. This part of the business continues to grow market share and has provided a channel to sell non-food items and other areas of the business including finance.Information technology has revolutionized the retailer, not only in stock-control and distribution worldwide, but also in terms supplier management. It has enabled better I) retailer-manufacturer innovation ii)  shorterning  of decision making and greater knowledge sharing. Tesco  is one of the mos t advanced companies in consumer understanding aided by IT (e. g. Dunhumby  and  Tesco  Clubcard  data). Consumer data has i) shaped product offerings ii) ranges iii) given  Tesco  a better understanding of consumer segments and shopping profiles and iv) helped marketing to build loyalty and develop promotion offerings that suit target groups.This level of sophistication has helpedTesco  to remain leader within the UK market. Suppliers are internationally sourced, and  Tesco  gains scale economies from its large buying volumes. This has enabled the company to keep prices down and supported its low price strategy aimed at the broad consumer market. However, the company has been criticized for its management of suppliers and clashes with the farmers union. There has been growing opposition to the supermarket because of its size, and the government (through the Monopolies and Mergers Commission) has been involved in ensuring competitive markets in the UK.Recent acquis itions such as T;amp;S stores, have led to a high concentration, with only few dominant players within the market. The organisation has a diversified product portfolio, which includes telecommunications, finance, insurance, which provides cross and up sell opportunities to customers. Profits have been invested to support research and development, and its aggressive international expansion plans. Read more:  http://www. businessteacher. org. uk/business-resources/case-study-database/tesco-case-study/#ixzz2B9gukB98

Beetlejuice Screenwrite

The beginning of the film starts out with a camera overlooking the whole town of which this movie is going to take place. As the credits end, the camera ends up focused on a large house on a hill. You can clearly tell that the house is made up of some sort of material, but it was used as a way to introduce one of the main characters. A spider crawls up on top of the model house and in comes Adam. The first thing he does is carelessly pick up this massive spider as if it where one of his pets and carries it to a window where he releases it.Right off the bat you could tell hat this man is kind to nature and very gentle with the way he handled the spider. In comes his wife, Barbara, who is filled with Joy and love. Their mutual understanding of each other makes them love each other more and more. They both hear something come from outside and realize that it is a house bidder trying to sell their home to people that are more â€Å"deserving† of it. This house bidder assumes that because Just two people are living in a large home by themselves that it is irrational for them to agree to sell it.The one thing that both Adam and Barbara share is their eagerness to keep their home. The couple denies the house bidder and then drives into town to pick up some supplies. Looking at the surrounding environment makes it obvious that Adam and Barber's home is the focal point of the town. Adam leaves his car to go in the store to get the supplies, when he realizes that the clerk isn't at the front desk he takes money out of his pocket and puts it into the cash register himself. This again, exemplifies the honesty of this man.On the drive back home, they see a dog in the road and Barbara quickly swerves off the road crashing into a wooden bridge that is completely unstable. Their car ends up falling into a river and the scene cuts. They end up back at their house but do not realize how they got there. After very bizarre things occur to them, they start to question what h as happened. They find a book titled â€Å"book for the Deceased† and realize that they have in fact died. The first conflict comes into play when they are trying to adjust or figure out why they cannot step out of their own house.The character Betelgeuse is introduced and although we do not get a full view of him we figure out what type of character he is. Betelgeuse is a ruthless and mean person. He seems like the type that has no problem in taking advantage of you. From the start, you can foreshadow that this character will be a conflict of interest later on in the film. The movie then switches to the new family that has began to move into the now vacant house. The door to the house slams open and large amounts of furniture are being moved in.It's as if the writer of this movie wanted the audience to feel like the house was being torn down and re-done from the ground up. First is Delia, who is a red haired woman, and the first impression is that she is a stuck up, conceite d, but neat and tidy person. She takes pride in her pieces of artwork even though they're clearly not well done. Then there is her husband Charles, who is the influential and uptight dad that is searching for seamlessly deserving relaxation. The Daughter is introduced as a disturbed and rebellious gothic girl.You could tell by the way she admires the houses cob webs and are ghosts living in her new home. Deli's assistant, is a very feminine character that is oblivious and careless with his actions. He acts as a big shot and talks like one too. Both Delia and her assistant share a mutual outlook with how things should be. When Barbara and Adam realize that new people have moved into their house they come furious and want to drive them out. This is another conflict introduced in the movie and it depicts the click © of ghosts trying to haunt people.Adam and Barbara try scaring the new house owners but realize they aren't doing a good Job at it. The ignorance these two characters have pushes them to learn more about who they are and the new abilities they have as Ghosts. The way this screenwriter set up the characters along with the conflicts really creates a good buildup, thus making the movie more enjoyable and fun. There are multiple conflicts, which make the viewer wonder how each one of them is going to be resolved.

Cardiovascular Diseases

Cardiovascular disease Introduction Heart disease is No. 1 killer disease worldwide. It causes 12 million deaths annually. Thanks to the rising health awareness and government programmes this number significantly reduce during last 30 years. Coronary heart disease and cardiovascular disease Cardiovascular diseases are diseases of the heart (cardiac muscle ) or blood vessels (vasculature).Cardiovascular disease (CVD) means all the diseases of the heart and circulation (blood vessels disease) including coronary heart disease (angina and heart attack) and stroke, as well as coronary and periphery blood vessels disease (problems with circulation). Diseases from this group are the biggest killer in Europe and USA, but developing and non-develop countries too. The final and most tragic consequence of different types of heart disease is heart attack with tragic consequences. Heart diseases are caused by atherosclerosis, a disease of arterial blood vessels resulted from atheroma i. . plaques accumulated (forming; sticking) on artery walls which makes the blood vessels nonelastic and narrowed and leads to decreased blood flow. For the atherosclerosis doctors very often use alternative name chronic cardiovascular disease. The opposite group acute heart disease made group of diseases which are dangerous for patients lives. Acute heart diseases include conditions or illnesses which usually have a rapid onset of symptoms and may resolve within days with or without treatment.A condition or illness that is sudden or severe. On the other hand a condition or illness that arises slowly over days or weeks and may or may not resolve with treatment made a group of chronic heart disease. Both of them are caused by atheroma and the most known are next: a) Acute heart disease Heart attack is caused by lack of O2 in heart muscle cells. Very often it is caused by rupture of â€Å"hard plaques† patches which result in blood clots and partially or completely block blood flow and ca use a heart attack.When a fiber cap becomes thin, these â€Å"hard plaques† can suddenly rupture, spilling their contents, resulting in blood clots that partially or completely block blood flow and cause a heart attack http://www. authorstream. com/Presentation/nitin-35423-heart-diseases-science-technology-ppt-powerpoint/ Cholesterol glossary. http://www. mybwmc. org/library/28/000225 Stroke Stroke is death of brain cells caused by obstructed blood flow to parts of the brain. Since the level of LDL cholesterol is main cause of narrowed of blood vessels, it is necessary control it. If not treated properly, high LDL cholesterol can cause a stroke.Cholesterol glossary. http://www. mybwmc. org/library/28/000225 b) Coronary heart disease Heart disease (coronary heart disease), When the plaque build up in th conorary arteries heart does not get sufficient blood, the condition is called coronary artery disease or coronary heart disease. Atherosclerosis is a disease of arterial blood vessels in which plaques form on artery walls. This is a consequence of different substances circulating in the bloodstream (inflammatory cells, proteins, cholesterol and calcium) sticking inside the vessel walls. Plaque patches influence on narrowing blood flow in the artery. ttp://www. bodybuilding. com/fun/gastelu5. htm Peripheral artery disease (reduced blood flow in the limbs, usually the legs Coronary plaque Coronary plaque is a term which use in practice as a synonym for atheroma or atherosclerosis. Patches of atheroma are formed from substances that circulate in the bloodstream. They consist of lipid, or fat, cores covered by collagen fiber caps which are sticking to the inside of the vessel walls. Over time plaque or patch of atheroma increases making an artery narrower and the blood flow through the artery is reducing.We can see the changes in blood vessels caused by plaque in the Figure 1. Figure 1 Artery with the patches of atheroma – plaque Preventing Cardiovasc ular Diseases. Patient. co. uk. emis < www. patient. co. uk/health/Preventing-Cardiovascular-Diseases. htm> (March 13, 2013) http://medicineworld. org/blogs/heart/blog/permalinks/Jan-2006/coronary-plaque-detection-by-molecular-imaging. html> (March 13, 2013) Mature plaques typically consist of two main components: soft, lipid-rich atheromatous â€Å"gruel† and hard, collagen-rich sclerotic tissue.Lipid-rich and soft plaques are more dangerous than collagen-rich and hard plaques because they are more unstable and rupture-prone and highly thrombogenic after disruption. Researchers have found that many people who have heart attacks do not have arteries narrowed by plaque. Many heart attacks are now known to be caused by soft or vulnerable plaques, located on an inflamed part of an artery. This plaque can burst, leading to the formation of a blood clot that can cause a heart attack. The 2009 issue of â€Å"The American Journal Pathology† edited explanation of those relatio ns discovered by Olga Ovchinnikova and er colleagues. They found that inflammation results in the formation of soft (vulnerable) plaque which is filled with different cell types that promote blood clotting. This leads to a reduction of mature collagen, resulting in thinner caps that are more likely to rupture, even in the cases when total level of plaque isn’t extremely high. The authors advocate different viewpoints about relations between the plaque level and structure, i. e. its influence on heart attack. The first group claims that described types of blockages cause only about 30 percent of heart attacks.On the other hand, some sources state that more than two-thirds of acute coronary events result from rupture of coronary plaques. However problems that plaque creates are extremely dangerous for people’s life and it is very important to prevent and monitor its appearance and changes. Graphs of vulnerable plaque and rupture of plaque which causes a heart attack is p resented below. Figure 2 Vulnerable atherosclerotic plaques. Vulnerable atherosclerotic plaques. A. Atherosclerosis in a chronic disease that leads to plaque rupture and vascular occlusion. B.Cross-section of a lethal coronary plaque rupture. Adapted from Heistad D. Unstable coronary-artery plaques. N Engl J Med. 2003. Atherosclerosis Modeling In-vitro. http://www. remedi. uzh. ch/research/disease. html Figure 3 Plaque Rupture and Heart attack http://hon. nucleusinc. com/generateexhibit. php? ID=30468&A=1027 Factors influencing plaque growth and stability Based on everything mentioned above and medical experience the conclusion about relations between heart attack and other cardiovascular disease and the level of plaque increasing are found.The higher the level of plaque the higher risk of heart disease will be. The level of plaque will increase as the result of high level of cholesterol, type LDL, so called â€Å"bad cholesterol† in blood. When the level of LDL is normal, bl ood can pass in and out of the blood vessels without problems, but if it significantly increase particles of the blood will accumulate and sooner or later provoke trigger (cause) heart attack. Other very important factors influencing plaque level increasing are high blood pressure and cigarette smoking.Both factors accelerate the plaque formation changing (damaging) artery walls and even more, helping cholesterol forming. Medical experience proved that plaque composition and vulnerability (hard or soft plaque) is more responsible for the conversion of a stable disease to a life-threatening condition than the plaque size. Except the plaque vulnerability the risk of plaque disruption is are consequence of rupture triggers (extrinsic forces). Soft plaque – lipid-rich one is more dangerous because of its instability and higher probability for rupture.Even (IAKO) Although â€Å"hard plaque† that one having higher level of calcium influence on the blood vessels walls and the ir â€Å"hardness† experience show that heart attacks are mostly caused by soft plaque disruption. Figure 4 Plaque rupture and its consequences in the form of heart diseases http://www. nature. com/nrg/journal/v7/n3/fig_tab/nrg1805_F2. html Risk factors of coronary heart disease Risk factors influencing cardiovascular disease we can group based on their stability into the three groups: a) Modifiable risk factorsIn this group hypertension is the most dangerous risk factor for heart attacks, but even more for stroke. It is forming as the result of abnormal blood lipid levels which means high total cholesterol, high levels of triglycerides and high levels of low-density lipoprotein or low levels of high-density lipoprotein (HDL). Smoking, physical inactivity, Type 2 diabetes, and a diet full with saturated fats are risk factors strongly influencing the heart disease. All of them are treatable and patients (individuals) belonging into the different types of risk customersâ€℠¢ groups should avoid practice them. b) Non-modifiable risk factorsThe factors from this group mostly are constant, like the case in gender or family history. Others are changing when time is passing, like age and lifestyle and personal habits. Older people have more chance to get heart attack and the man, especially those having â€Å"bad medical history†. Ration between man and woman are changing when women past the menopause. After that the level of risk is similar as the men’s one. As I’ve presented there is direct correlation between cardiovascular disease and condition and health of blood vessels, more precisely of developing atheroma, means level and structure of plaque in vessels.On the other development of plaque and its level is directly influenced by level of cholesterol and some other elements which are connected with individual person and his/her life and genetic predispositions. As with the other diseases everybody has some risk of developing ather oma, but some risk factors increase the risk level for several categories. Those risk factors include: fn 12 †¢Fixed risk factors – factors that person cannot change: oA strong family history which means close relatives who developed heart disease or a stroke before they were 55 (for males) or 65 (for female). Severe baldness in men at the top of the head. oAn early menopause in women. oAge. Older people have more risk to develop atheroma. oEthnic group. Medical data show that people from different ethnic group have different risk for heart diseases. †¢Treatable or partly treatable risk factors include different health problems caused basically by the same causes as the: oHypertension (high blood pressure). oHigh cholesterol blood level. oHigh triglyceride (fat) blood level. oDiabetes. oKidney diseases causing diminished kidney function. All factors from this group have to be controlled and monitor.Any kind of their complication probably will trigger more serious pr oblems such as heart attack or stroke. †¢Lifestyle risk factors that can be prevented or changed. Actually these factors PRETHODE precede to those belonging to the second group. Except the genetic factors way of life and daily habits are the more responsible for different kind of heart diseases. Those factors are: oSmoking (Smoking cigarette increase blood pressure, decrease HDL; damages arteries and blood cells and increases heart attacks. Passive smoking is also a risk factor for cardiovascular disease ) oLack of physical activity. Obesity (People who are overweight (10-30% more than their normal body weight) have 2 to 6 times the risk of developing heart disease. ) oAn unhealthy diet and eating too much salt. oExcess alcohol. Looking on those three groups one can easily conclude that people with â€Å"bad predisposition† having high fixed risk factors have to think about their lifestyle risk factors even more, in order to try to decrease the second group of factors (t reatable or partly treatable risk factors). On the other hand some of risks are more dangerous than the others; for example smoking increases risk for heart disease more than obesity.And of course combination of two or more risk factors increases significantly the level of risks; older man (or woman) who smokes, without physical activity and with bad eating habits has more chance to get some of previously explained disease than the one who have â€Å"just one of bad habits†. The more risk factors someone has the greater is the likelihood that he/she will develop cardiovascular disease, unless taking action to modify his/her risk factors and working to prevent them compromising his/her heart health.That doesn’t mean that people with â€Å"good genes† can be irresponsible and ZANEMARITI risk factors from other groups. With or without genetic predisposition modern life significantly increases a risk of heart disease for everybody. Hormones impact on lipids and othe r risk factors Different numbers of man and women died from heart attack initiated a lot of research about hormones' influence on the risk factor and heart disease development. Number of men died from the heart attack outnumbered the number of women in pre-menopause period, but in the post-menopause data show completely opposite situation.A percentage of women in post-menopause having heart disease and dying from heart attack increase dramatically and now outnumbered the men. The main reasons for those changes are connected to the level of hormones and their influence on level and structure of cholesterol and consequently on risk factors and heart disease. As mentioned before total cholesterol actually is made of two different types of cholesterol: LDL – low density lipoprotein (LDL), so called bad cholesterol and high density lipoprotein (HDL).High levels of LDL cholesterol lead to atherosclerosis increasing the risk of heart attack and ischemic stroke. HDL cholesterol redu ces the risk of cardiovascular disease as it carries cholesterol away from the blood stream. http://www. walgreens. com/marketing/library/careguides/careguide. jsp? docid=000225=28=High%20Cholesterol Estrogen, a female hormone, raises HDL cholesterol levels, partially explaining the lower risk of cardiovascular disease seen in premenopausal women.But after menopause (natural or surgical) when a level of estrogen significantly decreases total cholesterol rises, low density lipoprotein (LDL) cholesterol rises, and high density lipoprotein (HDL) cholesterol does not change or decreases slightly. This is the reason why negative hormones’ effect after menopause increasing more than proportionally. Some authors argue that even influence of estrogen on LDL and HDL level is proved it is yet unclear whether increase in risk is caused, at least partially, by increased level of androgen (the other of hormones belong to steroid as estrogen too), which is characteristics of menopause too. This sexual dimorphism means a lower incidence in atherosclerotic diseases in premenopausal women, which subsequently rises in postmenopausal women to eventually equal that of men. These observations point towards estrogen and progesterone playing a lifetime protective role against CAD in women. As exogenous estrogen and estrogen plus progesterone preparations produce significant reductions in low-density lipoprotein (LDL) cholesterol levels and significant increases in high-density lipoprotein (HDL) cholesterol, this should in theory lower the risk of CAD.UKLOPITI U ONO GORE Among estrogen's positive effects on the heart are: †¢Reducing the LDL (â€Å"bad†) cholesterol in the blood. †¢Increasing the HDL (â€Å"good†) cholesterol in the blood. †¢Helping to keep blood vessels open. †¢Lowering blood pressure at night. †¢Reducing blood viscosity (how sticky the blood is), a property that may cause blood clots which could result in a heart attack o r stroke. Estrogen's effects on clotting are complicated, however, since there also is an increased risk for thromboembolism (a blood clot that blocks a vessel) in women taking estrogen. Possibly enhancing fibrinolysis, which is the body's natural process for breaking down blood clots. Read more: http://ehealthmd. com/content/what-are-benefits-hrt#ixzz2NbWR3MxY http://ehealthmd. com/content/what-are-benefits-hrt#axzz2NbW1GJJN Nutrition guidelines As presented before three different groups of risk factor exist. Some of them people can change but the other are fixed, non-changeable because they caused by genetic heritage ( ) influences. Controllable factors are connected to the lifestyle of person.Lifestyle changes can prevent or slow the development of coronary plaque and heart disease. In order to prevent a disease development one have to keep track of his/her blood pressure and cholesterol levels. Choosing a heart-healthy diet is vital in controlling weight, which helps keep blood pressure and cholesterol levels down. Foods high in cholesterol and saturated fat should be avoided, and quitting smoking is imperative. Regular exercise and an increased overall activity level contribute to heart health and help reduce stress.The risk of cardiovascular disease is possible to reduce following recommendation for lifestyle changing: Cessation of smoking and avoidance of second-hand smoke. Nutrition should ensure a healthy diet wiht total diet no more than 8% of saturated + trans fatty acids of total energy intake. All people, especially ones with high risk factors should lower alcohol consumption As the prevention physical activities are recommended – at least 30 minutes of moderate intensity physical activity per day or three days week (i. e. 150 mins/week minimum). Currently practiced measures to prevent cardiovascular disease include: †¢A low-fat, high-fiber diet including whole grains and plenty of fresh fruit and vegetables (at least five portions a d ay)[29][30] †¢Tobacco cessation and avoidance of second-hand smoke;[29] †¢Limit alcohol consumption to the recommended daily limits;[29] consumption of 1-2 standard alcoholic drinks per day may reduce risk by 30%[31][32] However excessive alcohol intake increases the risk of cardiovascular disease. [33] †¢Lower blood pressures, if elevated, through the use of antihypertensive medications[citation needed]; †¢Decrease body fat (BMI) if overweight or obese;[34] Increase daily activity to 30 minutes of vigorous exercise per day at least five times per week;[29] †¢Decrease psychosocial stress. [35] Stress however plays a relatively minor role in hypertension. [36] Specific relaxation therapies are not supported by the evidence. [37] Routine counselling of adults to advise them to improve their diet and increase their physical activity has not been found to significantly alter behaviour, and thus is not recommended. [38] http://www. news-medical. net/health/What-i s-Cardiovascular-Disease. aspx http://www. barnesandnoble. om/w/prevent-halt-and-reverse-heart-disease-joseph-piscatella/1100260037 Primary and secondary prevention of heart disease It is necessary start with prevention from heart disease as early as possible. Changes in the number of people killed by heart attack in developed countries show that prevention and awareness about this group of disease help to http://circ. ahajournals. org/content/123/20/2274/F2. expansion. html health plans must continue to drive cardiovascular care further along the continuum toward primary prevention of cardiovascular disease (CVD).CVD risk factors should be managed not only after a coronary event has occurred, but also before the onset of such and event. Ideally, health lifestyles should be promoted with all patients so that risk factors for CVD never develop. In this way, CVD care can be moved from the inpatient setting to the outpatient setting. Sidney C. Smith Jr, MD. Focus on Cardiovascular Dise ase; A Word About the Quality of Care in Cardiovascular Disease. Director, Center for Cardiovascular Science and Medicine University of North Carolina at Chapel Hill. http://www. qualityprofiles. rg/leadership_series/cardiovascular_disease/cardiovascular_introduction. asp Key priorities for implementation Primary prevention of CVD †¢For the primary prevention of CVD in primary care, a systematic strategy should be used to identify people aged 40–74 who are likely to be at high risk †¢People should be prioritised on the basis of an estimate of their CVD risk before a full formal risk assessment. Their CVD risk should be estimated using CVD risk factors already recorded in primary care electronic medical records †¢Risk equations should be used to assess CVD risk People should be offered information about their absolute risk of CVD and about the absolute benefits and harms of an intervention over a 10-year period. This information should be in a form that: opresen ts individualised risk and benefit scenarios opresents the absolute risk of events numerically ouses appropriate diagrams and text (See www. npci. org. uk) †¢Before offering lipid modification therapy for primary prevention, all other modifiable CVD risk factors should be considered and their management optimised if possible.Baseline blood tests and clinical assessment should be performed, and comorbidities and secondary causes of dyslipidaemia should be treated. Assessment should include: osmoking status oalcohol consumption oblood pressure (see ‘Hypertension’, NICE clinical guideline 34) obody mass index or other measure of obesity (see ‘Obesity’, NICE clinical guideline 43) ofasting total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides (if fasting levels are not already available) ofasting blood glucose orenal function oliver function (transaminases) thyroid-stimulating hormone (TSH) if dyslipidaemia is present †¢Statin therapy is recommended as part of the management strategy for the primary prevention of CVD for adults who have a 20% or greater 10-year risk of developing CVD. This level of risk should be estimated using an appropriate risk calculator, or by clinical assessment for people for whom an appropriate risk calculator is not available or appropriate (for example, older people, people with diabetes or people in high-risk ethnic groups) †¢Treatment for the primary prevention of CVD should be initiated with simvastatin 40 mg.If there are potential drug interactions, or simvastatin 40 mg is contraindicated, a lower dose or alternative preparation such as pravastatin may be chosen. Secondary prevention of CVD †¢For secondary prevention, lipid modification therapy should be offered and should not be delayed by management of modifiable risk factors. Blood tests and clinical assessment should be performed, and comorbidities and secondary causes of dyslipidaemia should be treated.Assessment sho uld include: osmoking status oalcohol consumption oblood pressure (see ‘Hypertension’, NICE clinical guideline 34) obody mass index or other measure of obesity (see ‘Obesity’, NICE clinical guideline 43) ofasting total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides (if fasting levels are not already available) ofasting blood glucose orenal function oliver function (transaminases) othyroid-stimulating hormone (TSH) if dyslipidaemia is present. Statin therapy is recommended for adults with clinical evidence of CVD †¢People with acute coronary syndrome should be treated with a higher intensity statin. Any decision to offer a higher intensity statin should take into account the patient’s informed preference, comorbidities, multiple drug therapy, and the benefits and risks of treatment †¢Treatment for the secondary prevention of CVD should be initiated with simvastatin 40 mg. If there are potential drug interactions, or simvasta tin 40 mg is contraindicated, a lower dose or alternative preparation such as pravastatin ay be chosen †¢In people taking statins for secondary prevention, consider increasing to simvastatin 80 mg or a drug of similar efficacy and acquisition cost if a total cholesterol of less than 4 mmol/litre or an LDL cholesterol of less than 2 mmol/litre is not attained. Any decision to offer a higher intensity statin should take into account informed preference, comorbidities, multiple drug therapy, and the benefit and risks of treatment http://www. eguidelines. co. uk/eguidelinesmain/guidelines/summaries/cardiovascular/nice_lipid_modification. phpHow to lower the risk of cardiovascular disease The risk of cardiovascular disease is possible to reduce following recommendation for lifestyle changing: Cessation of smoking and avoidance of second-hand smoke. Nutrition should ensure a healthy diet wiht total diet no more than 8% of saturated + trans fatty acids of total energy intake. All peop le, especially ones with high risk factors should lower alcohol consumption As the prevention physical activities are recommended – at least 30 minutes of moderate intensity physical activity per day or three days week (i. . 150 mins/week minimum). Cessation of smoking The aim of this measure is complete cessation of smoking and avoidance of second-hand smoke. Patient and their families need to stop smoking. Those who are unable to quit may need professional help in form of counselling, behavioral therapy and even pharmacological therapy. Nicotine replacement therapy (NRT) is the first line choice of medication. Nutrition The aim of this measure is to ensure a healthy diet. Total diet should have no more than 8% (of total energy intake) of saturated + trans fatty acids.All patients are advised to take approximately 1g Eicosapentaenoic acid (EPA) and Docosahexaenoic acid (DHA) and more than 2g Alpha Linolenic Acid (ALA) daily. Diet should have vegetables, fruits and legumes, g rain-based foods, moderate amounts of lean meats, poultry, fish and reduced fat dairy products. EPA and DHA can be obtained from oily fish and marine n-3 (fish oil) capsule supplements. Alcohol consumption All patients should be advised to lower alcohol consumption. Men should drink no more than 2 standard drinks per day and women no more than 1 standard drink per day. Physical activityThe aim of this measure is to raise physical activity and exercise to the recommended goal of at least 30 minutes of moderate intensity physical activity on most, if not all, days of the week (i. e. 150 mins/week minimum). Maintaining a healthy body weight The aim should be to achieve a waist measure of less than or equal to 94 cm in men and less than or equal to 80 cm in women. The body mass index (BMI) should be maintained at 18. 5–24. 9 kg/m2 Lowering blood cholesterol The aim of therapy should be to maintain blood cholesterol at: †¢Low density lipoprotein (LDL) at – less than 2. mmol/L †¢HDL – more than 1. 0 mmol/L †¢Triglyceride (TG) less than 1. 5 mmol/L The blood cholesterol can be maintained with the use of pharmacotherapy. Statins are commonly used lipid lowering drugs. Those with diabetes and atherosclerosis need stringent blood cholesterol control as well. Other lipid lowering drugs include fibrates like gemfibrosil, clofibrates etc, Ezetimiber and niacin. Lowering blood pressure High blood pressure is one of the important risk factors for cardiovascular disease. Those with coronary heart disease, diabetes, kidney disease or stroke need tight blood pressure control.The aim should be a blood pressure of less than 130/80 mm of Hg. Diabetes and blood sugar control Those diagnosed with diabetes need stringent blood sugar control to prevent cardiovascular damage. HbA1c levels should be maintained at less than 7%. Other drugs to lower risk of cardiovascular disease Other drugs used to lower risk of cardiovascular diseases include: †¢ Antiplatelet agents – this includes Aspirin and Clopidogrel. These drugs when given to patients with risk of heart attacks may prevent such attacks and events. †¢ACE inhibitors like Enalapril, Captopril, Lsinopril and Cardiovascular Diseases Cardiovascular disease Introduction Heart disease is No. 1 killer disease worldwide. It causes 12 million deaths annually. Thanks to the rising health awareness and government programmes this number significantly reduce during last 30 years. Coronary heart disease and cardiovascular disease Cardiovascular diseases are diseases of the heart (cardiac muscle ) or blood vessels (vasculature).Cardiovascular disease (CVD) means all the diseases of the heart and circulation (blood vessels disease) including coronary heart disease (angina and heart attack) and stroke, as well as coronary and periphery blood vessels disease (problems with circulation). Diseases from this group are the biggest killer in Europe and USA, but developing and non-develop countries too. The final and most tragic consequence of different types of heart disease is heart attack with tragic consequences. Heart diseases are caused by atherosclerosis, a disease of arterial blood vessels resulted from atheroma i. . plaques accumulated (forming; sticking) on artery walls which makes the blood vessels nonelastic and narrowed and leads to decreased blood flow. For the atherosclerosis doctors very often use alternative name chronic cardiovascular disease. The opposite group acute heart disease made group of diseases which are dangerous for patients lives. Acute heart diseases include conditions or illnesses which usually have a rapid onset of symptoms and may resolve within days with or without treatment.A condition or illness that is sudden or severe. On the other hand a condition or illness that arises slowly over days or weeks and may or may not resolve with treatment made a group of chronic heart disease. Both of them are caused by atheroma and the most known are next: a) Acute heart disease Heart attack is caused by lack of O2 in heart muscle cells. Very often it is caused by rupture of â€Å"hard plaques† patches which result in blood clots and partially or completely block blood flow and ca use a heart attack.When a fiber cap becomes thin, these â€Å"hard plaques† can suddenly rupture, spilling their contents, resulting in blood clots that partially or completely block blood flow and cause a heart attack http://www. authorstream. com/Presentation/nitin-35423-heart-diseases-science-technology-ppt-powerpoint/ Cholesterol glossary. http://www. mybwmc. org/library/28/000225 Stroke Stroke is death of brain cells caused by obstructed blood flow to parts of the brain. Since the level of LDL cholesterol is main cause of narrowed of blood vessels, it is necessary control it. If not treated properly, high LDL cholesterol can cause a stroke.Cholesterol glossary. http://www. mybwmc. org/library/28/000225 b) Coronary heart disease Heart disease (coronary heart disease), When the plaque build up in th conorary arteries heart does not get sufficient blood, the condition is called coronary artery disease or coronary heart disease. Atherosclerosis is a disease of arterial blood vessels in which plaques form on artery walls. This is a consequence of different substances circulating in the bloodstream (inflammatory cells, proteins, cholesterol and calcium) sticking inside the vessel walls. Plaque patches influence on narrowing blood flow in the artery. ttp://www. bodybuilding. com/fun/gastelu5. htm Peripheral artery disease (reduced blood flow in the limbs, usually the legs Coronary plaque Coronary plaque is a term which use in practice as a synonym for atheroma or atherosclerosis. Patches of atheroma are formed from substances that circulate in the bloodstream. They consist of lipid, or fat, cores covered by collagen fiber caps which are sticking to the inside of the vessel walls. Over time plaque or patch of atheroma increases making an artery narrower and the blood flow through the artery is reducing.We can see the changes in blood vessels caused by plaque in the Figure 1. Figure 1 Artery with the patches of atheroma – plaque Preventing Cardiovasc ular Diseases. Patient. co. uk. emis < www. patient. co. uk/health/Preventing-Cardiovascular-Diseases. htm> (March 13, 2013) http://medicineworld. org/blogs/heart/blog/permalinks/Jan-2006/coronary-plaque-detection-by-molecular-imaging. html> (March 13, 2013) Mature plaques typically consist of two main components: soft, lipid-rich atheromatous â€Å"gruel† and hard, collagen-rich sclerotic tissue.Lipid-rich and soft plaques are more dangerous than collagen-rich and hard plaques because they are more unstable and rupture-prone and highly thrombogenic after disruption. Researchers have found that many people who have heart attacks do not have arteries narrowed by plaque. Many heart attacks are now known to be caused by soft or vulnerable plaques, located on an inflamed part of an artery. This plaque can burst, leading to the formation of a blood clot that can cause a heart attack. The 2009 issue of â€Å"The American Journal Pathology† edited explanation of those relatio ns discovered by Olga Ovchinnikova and er colleagues. They found that inflammation results in the formation of soft (vulnerable) plaque which is filled with different cell types that promote blood clotting. This leads to a reduction of mature collagen, resulting in thinner caps that are more likely to rupture, even in the cases when total level of plaque isn’t extremely high. The authors advocate different viewpoints about relations between the plaque level and structure, i. e. its influence on heart attack. The first group claims that described types of blockages cause only about 30 percent of heart attacks.On the other hand, some sources state that more than two-thirds of acute coronary events result from rupture of coronary plaques. However problems that plaque creates are extremely dangerous for people’s life and it is very important to prevent and monitor its appearance and changes. Graphs of vulnerable plaque and rupture of plaque which causes a heart attack is p resented below. Figure 2 Vulnerable atherosclerotic plaques. Vulnerable atherosclerotic plaques. A. Atherosclerosis in a chronic disease that leads to plaque rupture and vascular occlusion. B.Cross-section of a lethal coronary plaque rupture. Adapted from Heistad D. Unstable coronary-artery plaques. N Engl J Med. 2003. Atherosclerosis Modeling In-vitro. http://www. remedi. uzh. ch/research/disease. html Figure 3 Plaque Rupture and Heart attack http://hon. nucleusinc. com/generateexhibit. php? ID=30468&A=1027 Factors influencing plaque growth and stability Based on everything mentioned above and medical experience the conclusion about relations between heart attack and other cardiovascular disease and the level of plaque increasing are found.The higher the level of plaque the higher risk of heart disease will be. The level of plaque will increase as the result of high level of cholesterol, type LDL, so called â€Å"bad cholesterol† in blood. When the level of LDL is normal, bl ood can pass in and out of the blood vessels without problems, but if it significantly increase particles of the blood will accumulate and sooner or later provoke trigger (cause) heart attack. Other very important factors influencing plaque level increasing are high blood pressure and cigarette smoking.Both factors accelerate the plaque formation changing (damaging) artery walls and even more, helping cholesterol forming. Medical experience proved that plaque composition and vulnerability (hard or soft plaque) is more responsible for the conversion of a stable disease to a life-threatening condition than the plaque size. Except the plaque vulnerability the risk of plaque disruption is are consequence of rupture triggers (extrinsic forces). Soft plaque – lipid-rich one is more dangerous because of its instability and higher probability for rupture.Even (IAKO) Although â€Å"hard plaque† that one having higher level of calcium influence on the blood vessels walls and the ir â€Å"hardness† experience show that heart attacks are mostly caused by soft plaque disruption. Figure 4 Plaque rupture and its consequences in the form of heart diseases http://www. nature. com/nrg/journal/v7/n3/fig_tab/nrg1805_F2. html Risk factors of coronary heart disease Risk factors influencing cardiovascular disease we can group based on their stability into the three groups: a) Modifiable risk factorsIn this group hypertension is the most dangerous risk factor for heart attacks, but even more for stroke. It is forming as the result of abnormal blood lipid levels which means high total cholesterol, high levels of triglycerides and high levels of low-density lipoprotein or low levels of high-density lipoprotein (HDL). Smoking, physical inactivity, Type 2 diabetes, and a diet full with saturated fats are risk factors strongly influencing the heart disease. All of them are treatable and patients (individuals) belonging into the different types of risk customersâ€℠¢ groups should avoid practice them. b) Non-modifiable risk factorsThe factors from this group mostly are constant, like the case in gender or family history. Others are changing when time is passing, like age and lifestyle and personal habits. Older people have more chance to get heart attack and the man, especially those having â€Å"bad medical history†. Ration between man and woman are changing when women past the menopause. After that the level of risk is similar as the men’s one. As I’ve presented there is direct correlation between cardiovascular disease and condition and health of blood vessels, more precisely of developing atheroma, means level and structure of plaque in vessels.On the other development of plaque and its level is directly influenced by level of cholesterol and some other elements which are connected with individual person and his/her life and genetic predispositions. As with the other diseases everybody has some risk of developing ather oma, but some risk factors increase the risk level for several categories. Those risk factors include: fn 12 †¢Fixed risk factors – factors that person cannot change: oA strong family history which means close relatives who developed heart disease or a stroke before they were 55 (for males) or 65 (for female). Severe baldness in men at the top of the head. oAn early menopause in women. oAge. Older people have more risk to develop atheroma. oEthnic group. Medical data show that people from different ethnic group have different risk for heart diseases. †¢Treatable or partly treatable risk factors include different health problems caused basically by the same causes as the: oHypertension (high blood pressure). oHigh cholesterol blood level. oHigh triglyceride (fat) blood level. oDiabetes. oKidney diseases causing diminished kidney function. All factors from this group have to be controlled and monitor.Any kind of their complication probably will trigger more serious pr oblems such as heart attack or stroke. †¢Lifestyle risk factors that can be prevented or changed. Actually these factors PRETHODE precede to those belonging to the second group. Except the genetic factors way of life and daily habits are the more responsible for different kind of heart diseases. Those factors are: oSmoking (Smoking cigarette increase blood pressure, decrease HDL; damages arteries and blood cells and increases heart attacks. Passive smoking is also a risk factor for cardiovascular disease ) oLack of physical activity. Obesity (People who are overweight (10-30% more than their normal body weight) have 2 to 6 times the risk of developing heart disease. ) oAn unhealthy diet and eating too much salt. oExcess alcohol. Looking on those three groups one can easily conclude that people with â€Å"bad predisposition† having high fixed risk factors have to think about their lifestyle risk factors even more, in order to try to decrease the second group of factors (t reatable or partly treatable risk factors). On the other hand some of risks are more dangerous than the others; for example smoking increases risk for heart disease more than obesity.And of course combination of two or more risk factors increases significantly the level of risks; older man (or woman) who smokes, without physical activity and with bad eating habits has more chance to get some of previously explained disease than the one who have â€Å"just one of bad habits†. The more risk factors someone has the greater is the likelihood that he/she will develop cardiovascular disease, unless taking action to modify his/her risk factors and working to prevent them compromising his/her heart health.That doesn’t mean that people with â€Å"good genes† can be irresponsible and ZANEMARITI risk factors from other groups. With or without genetic predisposition modern life significantly increases a risk of heart disease for everybody. Hormones impact on lipids and othe r risk factors Different numbers of man and women died from heart attack initiated a lot of research about hormones' influence on the risk factor and heart disease development. Number of men died from the heart attack outnumbered the number of women in pre-menopause period, but in the post-menopause data show completely opposite situation.A percentage of women in post-menopause having heart disease and dying from heart attack increase dramatically and now outnumbered the men. The main reasons for those changes are connected to the level of hormones and their influence on level and structure of cholesterol and consequently on risk factors and heart disease. As mentioned before total cholesterol actually is made of two different types of cholesterol: LDL – low density lipoprotein (LDL), so called bad cholesterol and high density lipoprotein (HDL).High levels of LDL cholesterol lead to atherosclerosis increasing the risk of heart attack and ischemic stroke. HDL cholesterol redu ces the risk of cardiovascular disease as it carries cholesterol away from the blood stream. http://www. walgreens. com/marketing/library/careguides/careguide. jsp? docid=000225=28=High%20Cholesterol Estrogen, a female hormone, raises HDL cholesterol levels, partially explaining the lower risk of cardiovascular disease seen in premenopausal women.But after menopause (natural or surgical) when a level of estrogen significantly decreases total cholesterol rises, low density lipoprotein (LDL) cholesterol rises, and high density lipoprotein (HDL) cholesterol does not change or decreases slightly. This is the reason why negative hormones’ effect after menopause increasing more than proportionally. Some authors argue that even influence of estrogen on LDL and HDL level is proved it is yet unclear whether increase in risk is caused, at least partially, by increased level of androgen (the other of hormones belong to steroid as estrogen too), which is characteristics of menopause too. This sexual dimorphism means a lower incidence in atherosclerotic diseases in premenopausal women, which subsequently rises in postmenopausal women to eventually equal that of men. These observations point towards estrogen and progesterone playing a lifetime protective role against CAD in women. As exogenous estrogen and estrogen plus progesterone preparations produce significant reductions in low-density lipoprotein (LDL) cholesterol levels and significant increases in high-density lipoprotein (HDL) cholesterol, this should in theory lower the risk of CAD.UKLOPITI U ONO GORE Among estrogen's positive effects on the heart are: †¢Reducing the LDL (â€Å"bad†) cholesterol in the blood. †¢Increasing the HDL (â€Å"good†) cholesterol in the blood. †¢Helping to keep blood vessels open. †¢Lowering blood pressure at night. †¢Reducing blood viscosity (how sticky the blood is), a property that may cause blood clots which could result in a heart attack o r stroke. Estrogen's effects on clotting are complicated, however, since there also is an increased risk for thromboembolism (a blood clot that blocks a vessel) in women taking estrogen. Possibly enhancing fibrinolysis, which is the body's natural process for breaking down blood clots. Read more: http://ehealthmd. com/content/what-are-benefits-hrt#ixzz2NbWR3MxY http://ehealthmd. com/content/what-are-benefits-hrt#axzz2NbW1GJJN Nutrition guidelines As presented before three different groups of risk factor exist. Some of them people can change but the other are fixed, non-changeable because they caused by genetic heritage ( ) influences. Controllable factors are connected to the lifestyle of person.Lifestyle changes can prevent or slow the development of coronary plaque and heart disease. In order to prevent a disease development one have to keep track of his/her blood pressure and cholesterol levels. Choosing a heart-healthy diet is vital in controlling weight, which helps keep blood pressure and cholesterol levels down. Foods high in cholesterol and saturated fat should be avoided, and quitting smoking is imperative. Regular exercise and an increased overall activity level contribute to heart health and help reduce stress.The risk of cardiovascular disease is possible to reduce following recommendation for lifestyle changing: Cessation of smoking and avoidance of second-hand smoke. Nutrition should ensure a healthy diet wiht total diet no more than 8% of saturated + trans fatty acids of total energy intake. All people, especially ones with high risk factors should lower alcohol consumption As the prevention physical activities are recommended – at least 30 minutes of moderate intensity physical activity per day or three days week (i. e. 150 mins/week minimum). Currently practiced measures to prevent cardiovascular disease include: †¢A low-fat, high-fiber diet including whole grains and plenty of fresh fruit and vegetables (at least five portions a d ay)[29][30] †¢Tobacco cessation and avoidance of second-hand smoke;[29] †¢Limit alcohol consumption to the recommended daily limits;[29] consumption of 1-2 standard alcoholic drinks per day may reduce risk by 30%[31][32] However excessive alcohol intake increases the risk of cardiovascular disease. [33] †¢Lower blood pressures, if elevated, through the use of antihypertensive medications[citation needed]; †¢Decrease body fat (BMI) if overweight or obese;[34] Increase daily activity to 30 minutes of vigorous exercise per day at least five times per week;[29] †¢Decrease psychosocial stress. [35] Stress however plays a relatively minor role in hypertension. [36] Specific relaxation therapies are not supported by the evidence. [37] Routine counselling of adults to advise them to improve their diet and increase their physical activity has not been found to significantly alter behaviour, and thus is not recommended. [38] http://www. news-medical. net/health/What-i s-Cardiovascular-Disease. aspx http://www. barnesandnoble. om/w/prevent-halt-and-reverse-heart-disease-joseph-piscatella/1100260037 Primary and secondary prevention of heart disease It is necessary start with prevention from heart disease as early as possible. Changes in the number of people killed by heart attack in developed countries show that prevention and awareness about this group of disease help to http://circ. ahajournals. org/content/123/20/2274/F2. expansion. html health plans must continue to drive cardiovascular care further along the continuum toward primary prevention of cardiovascular disease (CVD).CVD risk factors should be managed not only after a coronary event has occurred, but also before the onset of such and event. Ideally, health lifestyles should be promoted with all patients so that risk factors for CVD never develop. In this way, CVD care can be moved from the inpatient setting to the outpatient setting. Sidney C. Smith Jr, MD. Focus on Cardiovascular Dise ase; A Word About the Quality of Care in Cardiovascular Disease. Director, Center for Cardiovascular Science and Medicine University of North Carolina at Chapel Hill. http://www. qualityprofiles. rg/leadership_series/cardiovascular_disease/cardiovascular_introduction. asp Key priorities for implementation Primary prevention of CVD †¢For the primary prevention of CVD in primary care, a systematic strategy should be used to identify people aged 40–74 who are likely to be at high risk †¢People should be prioritised on the basis of an estimate of their CVD risk before a full formal risk assessment. Their CVD risk should be estimated using CVD risk factors already recorded in primary care electronic medical records †¢Risk equations should be used to assess CVD risk People should be offered information about their absolute risk of CVD and about the absolute benefits and harms of an intervention over a 10-year period. This information should be in a form that: opresen ts individualised risk and benefit scenarios opresents the absolute risk of events numerically ouses appropriate diagrams and text (See www. npci. org. uk) †¢Before offering lipid modification therapy for primary prevention, all other modifiable CVD risk factors should be considered and their management optimised if possible.Baseline blood tests and clinical assessment should be performed, and comorbidities and secondary causes of dyslipidaemia should be treated. Assessment should include: osmoking status oalcohol consumption oblood pressure (see ‘Hypertension’, NICE clinical guideline 34) obody mass index or other measure of obesity (see ‘Obesity’, NICE clinical guideline 43) ofasting total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides (if fasting levels are not already available) ofasting blood glucose orenal function oliver function (transaminases) thyroid-stimulating hormone (TSH) if dyslipidaemia is present †¢Statin therapy is recommended as part of the management strategy for the primary prevention of CVD for adults who have a 20% or greater 10-year risk of developing CVD. This level of risk should be estimated using an appropriate risk calculator, or by clinical assessment for people for whom an appropriate risk calculator is not available or appropriate (for example, older people, people with diabetes or people in high-risk ethnic groups) †¢Treatment for the primary prevention of CVD should be initiated with simvastatin 40 mg.If there are potential drug interactions, or simvastatin 40 mg is contraindicated, a lower dose or alternative preparation such as pravastatin may be chosen. Secondary prevention of CVD †¢For secondary prevention, lipid modification therapy should be offered and should not be delayed by management of modifiable risk factors. Blood tests and clinical assessment should be performed, and comorbidities and secondary causes of dyslipidaemia should be treated.Assessment sho uld include: osmoking status oalcohol consumption oblood pressure (see ‘Hypertension’, NICE clinical guideline 34) obody mass index or other measure of obesity (see ‘Obesity’, NICE clinical guideline 43) ofasting total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides (if fasting levels are not already available) ofasting blood glucose orenal function oliver function (transaminases) othyroid-stimulating hormone (TSH) if dyslipidaemia is present. Statin therapy is recommended for adults with clinical evidence of CVD †¢People with acute coronary syndrome should be treated with a higher intensity statin. Any decision to offer a higher intensity statin should take into account the patient’s informed preference, comorbidities, multiple drug therapy, and the benefits and risks of treatment †¢Treatment for the secondary prevention of CVD should be initiated with simvastatin 40 mg. If there are potential drug interactions, or simvasta tin 40 mg is contraindicated, a lower dose or alternative preparation such as pravastatin ay be chosen †¢In people taking statins for secondary prevention, consider increasing to simvastatin 80 mg or a drug of similar efficacy and acquisition cost if a total cholesterol of less than 4 mmol/litre or an LDL cholesterol of less than 2 mmol/litre is not attained. Any decision to offer a higher intensity statin should take into account informed preference, comorbidities, multiple drug therapy, and the benefit and risks of treatment http://www. eguidelines. co. uk/eguidelinesmain/guidelines/summaries/cardiovascular/nice_lipid_modification. phpHow to lower the risk of cardiovascular disease The risk of cardiovascular disease is possible to reduce following recommendation for lifestyle changing: Cessation of smoking and avoidance of second-hand smoke. Nutrition should ensure a healthy diet wiht total diet no more than 8% of saturated + trans fatty acids of total energy intake. All peop le, especially ones with high risk factors should lower alcohol consumption As the prevention physical activities are recommended – at least 30 minutes of moderate intensity physical activity per day or three days week (i. . 150 mins/week minimum). Cessation of smoking The aim of this measure is complete cessation of smoking and avoidance of second-hand smoke. Patient and their families need to stop smoking. Those who are unable to quit may need professional help in form of counselling, behavioral therapy and even pharmacological therapy. Nicotine replacement therapy (NRT) is the first line choice of medication. Nutrition The aim of this measure is to ensure a healthy diet. Total diet should have no more than 8% (of total energy intake) of saturated + trans fatty acids.All patients are advised to take approximately 1g Eicosapentaenoic acid (EPA) and Docosahexaenoic acid (DHA) and more than 2g Alpha Linolenic Acid (ALA) daily. Diet should have vegetables, fruits and legumes, g rain-based foods, moderate amounts of lean meats, poultry, fish and reduced fat dairy products. EPA and DHA can be obtained from oily fish and marine n-3 (fish oil) capsule supplements. Alcohol consumption All patients should be advised to lower alcohol consumption. Men should drink no more than 2 standard drinks per day and women no more than 1 standard drink per day. Physical activityThe aim of this measure is to raise physical activity and exercise to the recommended goal of at least 30 minutes of moderate intensity physical activity on most, if not all, days of the week (i. e. 150 mins/week minimum). Maintaining a healthy body weight The aim should be to achieve a waist measure of less than or equal to 94 cm in men and less than or equal to 80 cm in women. The body mass index (BMI) should be maintained at 18. 5–24. 9 kg/m2 Lowering blood cholesterol The aim of therapy should be to maintain blood cholesterol at: †¢Low density lipoprotein (LDL) at – less than 2. mmol/L †¢HDL – more than 1. 0 mmol/L †¢Triglyceride (TG) less than 1. 5 mmol/L The blood cholesterol can be maintained with the use of pharmacotherapy. Statins are commonly used lipid lowering drugs. Those with diabetes and atherosclerosis need stringent blood cholesterol control as well. Other lipid lowering drugs include fibrates like gemfibrosil, clofibrates etc, Ezetimiber and niacin. Lowering blood pressure High blood pressure is one of the important risk factors for cardiovascular disease. Those with coronary heart disease, diabetes, kidney disease or stroke need tight blood pressure control.The aim should be a blood pressure of less than 130/80 mm of Hg. Diabetes and blood sugar control Those diagnosed with diabetes need stringent blood sugar control to prevent cardiovascular damage. HbA1c levels should be maintained at less than 7%. Other drugs to lower risk of cardiovascular disease Other drugs used to lower risk of cardiovascular diseases include: †¢ Antiplatelet agents – this includes Aspirin and Clopidogrel. These drugs when given to patients with risk of heart attacks may prevent such attacks and events. †¢ACE inhibitors like Enalapril, Captopril, Lsinopril and