Friday, November 29, 2019

Earth by Deepa Mehta. When the state is falling apart.

Of all the elements that a human being needs to reach the state of happiness, freedom must be at the top of the list. However, when shaking the hideous chains off, the has-been â€Å"prisoner† of a more powerful opponent might feel completely lost. When the long desired independence is finally granted, the ones who have never been taught to act on their own are most likely to be lost and even frightened.Advertising We will write a custom essay sample on Earth by Deepa Mehta. When the state is falling apart. specifically for you for only $16.05 $11/page Learn More The shock that came along with the Partition of India was far too huge to overcome it (Bates), even though the freedom that was eventually granted to the Indian people had been awaited for for decades (Partition of India). By disclosing a personal drama to the audience, Deepa Mehta’s 1947 (Earth) tells a story of a tremendous political change and the following challenge that India had to face in order to survive. The way in which Mehta manages to intertwine the Indian political and economical situation of the time with the lives of ordinary people is truly incredible. To start with, she managed to place the leading characters, i.e., Shanta and her friends, in a specific microcosm where social and religious differences do not matter. Lenny, belonging to Parsi family, her ayah Shanta being a member of the Hindu population, and the Muslim suitors of Shanta represent both the chaos in which India at the moment of its partition existed, and the delicate balance that needed to be restored. Thus, Mehta set a contrasting element to the violence and chaos that gripped Indian during its partition process. Unlike many documentaries, 1947 (Earth) is packed with metaphors. Every single frame leaves an impression and gives a lot of food for thoughts; however, by far the most meaningful scene seems to be the one including Ice Candy Man and Lenny talking about the lions. It is hard to come up with an accurate metaphor for the conflict that took place between the Muslims and the Hindu in 1940s; however, Mehta manages to nail it down precisely. Comparing the religious conflict and the opponents to a pride of lions, she makes it clear that this pivoting point in Indian history was bound to come eventually: â€Å"’Who’s guarding the lions?’ – ‘Nobody.’† (1947 (Earth)). Finally, the issue of religious tolerance (or its absence, for that matter) should be brought up. By portraying friendship between the representatives of different religions, Mehta makes it clear that religious tolerance is the only approach to tackle the related conflicts. However, a number of states consider the murder of an â€Å"infidel† acceptable. Thus, two different religious visions collide. There are different opinions on the given issue.Advertising Looking for essay on art and design? Let's see if we can help you! Get your first paper with 15% OFF Learn More However, to kill someone in the name of God seems a very disturbing idea. Since God is the Creator, it is only Him to decide who is going to live and who has to die. Therefore, murdering people whose vision does not comply with one’s religious beliefs can be regarded as an attempt to run the world instead of God, which itself is a blasphemy. With that being said, a murder, no matter for what cause it is committed, is always wrong. Even though the movie does contain a number of inaccuracies, which is rather excusable for a feature film, 1947 (Earth) still manages to capture the story of Partition and disclose its legacies to the audience in a very accurate way. Works Cited 1947 (Earth). Dir. Deepa Mehta. Perf. Aamir Khan, Mari Sethna and Nandita Das. New Delhi, IN: Cracking the Earth Films Inc., 1999. DVD. Bates, Cridspin. The Hidden Story of Partition and Its Legacies. 3 Mar. 2011. Web. http://www.bbc.co.uk/history/british/modern/ partition1947_01.shtml. Partition of India. n. d. Web. https://en.wikipedia.org/wiki/Partition_of_India. This essay on Earth by Deepa Mehta. When the state is falling apart. was written and submitted by user Jaylee Francis to help you with your own studies. You are free to use it for research and reference purposes in order to write your own paper; however, you must cite it accordingly. You can donate your paper here.

Monday, November 25, 2019

Acute Cholecystitis Essay Example

Acute Cholecystitis Essay Example Acute Cholecystitis Essay Acute Cholecystitis Essay kulasekar Definition Cholecystitis is inflammation of the gallbladder, usually resulting from a gallstone blocking the cystic duct. Gallbladder inflammation usually results from a gallstone blocking the flow of bile. Typically, people have abdominal pain that lasts more than 6 hours, fever, and nausea. Ultrasonography can usually detect signs of gallbladder inflammation. The gallbladder is removed, often using a laparoscope. Cholecystitis is the most common problem resulting from gallbladder stones. It occurs when a stone blocks the cystic duct, which carries bile from the gallbladder Causes In 90% of cases, acute cholecystitis is caused by gallstones in the gallbladder. Severe illness, alcohol abuse and, rarely, tumors of the gallbladder may also cause cholecystitis. Acute cholecystitis causes bile to become trapped in the gallbladder. The build up of bile causes irritation and pressure in the gallbladder. This can lead to bacterial infection and perforation of the organ. Gallstones occur more frequently in women than men. Gallstones become more common with age in both sexes. Native Americans have a higher rate of gallstones. Symptoms The main symptom is abdominal pain particularly after a fatty meal that is located on the upper right side of the abdomen. Occasionally, nausea and vomiting or fever may occur. Exams and Tests A doctors examination of the abdomen by touch (palpation) may reveal tenderness. Tests that detect the presence of gallstones or inflammation include: Abdominal ultrasound Abdominal CT scan Abdominal x-ray Oral cholecystogram Gallbladder radionuclide scan A CBC shows infection by an elevated white blood cell count [pic] Outlook (Prognosis) Patients who have cholecystectomy usually do very well. Possible Complications Empyema (pus in the gallbladder) Peritonitis (inflammation of the lining of the abdomen) Gangrene (tissue death) of the gallbladder Injury to the bile ducts draining the liver (a rare complication of cholecystectomy) Cholecystitis is classified as acute or chronic. Acute Cholecystitis: Acute cholecystitis begins suddenly, resulting in severe, steady pain in the upper abdo men. At least 95% of people with acute cholecystitis have gallstones. The inflammation almost always begins without infection, although infection may follow later. Inflammation may cause the gallbladder to fill with fluid and its walls to thicken. Rarely, a form of acute cholecystitis without gallstones (acalculous cholecystitis) occurs. Acalculous cholecystitis is more serious than other types of cholecystitis. It tends to occur after the following: Major surgery Critical illnesses such as serious injuries, major burns, and bodywide infections (sepsis) Intravenous feedings for a long time Fasting for a prolonged time A deficiency in the immune system It can occur in young children, perhaps developing from a viral or another infection. Chronic Cholecystitis: Chronic cholecystitis is gallbladder inflammation that has lasted a long time. It almost always results from gallstones. It is characterized by repeated attacks of pain (biliary colic). In chronic cholecystitis, the gallbladder is damaged by repeated attacks of acute inflammation, usually due to gallstones, and may become thick-walled, scarred, and small. The gallbladder usually contains sludge (microscopic particles of materials similar to those in gallstones), or gallstones that either block its opening into the cystic duct or reside in the cystic duct itself. A gallbladder attack, whether in acute or chronic cholecystitis, begins as pain. The pain of cholecystitis is similar to that caused by gallstones (biliary colic) but is more severe and lasts longer- more than 6 hours and often more than 12 hours. The pain peaks after 15 to 60 minutes and remains constant. It usually occurs in the upper right part of the abdomen. The pain may become excruciating. Most people feel a sharp pain when a doctor presses on the upper right part of the abdomen. Breathing deeply may worsen the pain. The pain often extends to the lower part of the right shoulder blade or to the back. Nausea and vomiting are common. Within a few hours, the abdominal muscles on the right side may become rigid. Fever occurs in about one third of people with acute cholecystitis. The fever tends to rise gradually to above 100. 4 ° F (38 ° C) and may be accompanied by chills. Fever rarely occurs in people with chronic cholecystitis. In older people, the first or only symptoms of cholecystitis may be rather general. For example, older people may lose their appetite, feel tired or weak, or vomit. They may not develop a fever. Typically, an attack subsides in 2 to 3 days and completely resolves in a week. If the acute episode persists, it may signal a serious complication. A high fever, chills, a marked increase in the white blood cell count, and essation of the normal rhythmic contractions of the intestine (ileus- see Gastrointestinal Emergencies: Appendicitis) suggest pockets of pus (abscesses) in the abdomen near the gallbladder from gangrene (which develops when tissue dies) or a perforated gallbladder. If people develop jaundice (see Manifestations of Liver Disease: Jaundice) or pass dar k urine and light-colored stools, the common bile duct is probably blocked by a stone, causing a backup of bile in the liver (cholestasis). Inflammation of the pancreas (pancreatitis) can develop. It is caused by a stone blocking the ampulla of Vater, near the exit of the pancreatic duct. Acalculous cholecystitis typically causes sudden, excruciating pain in the upper abdomen in people with no previous symptoms or other evidence of a gallbladder disorder. The inflammation is often very severe and can lead to gangrene or rupture of the gallbladder. In people with other severe problems (including people in the intensive care unit for another reason), acalculous cholecystitis may be overlooked at first. The only symptoms may be a swollen (distended), tender abdomen or a fever with no known cause. If untreated, acalculous cholecystitis results in death for 65% of people. Diagnosis Doctors diagnose cholecystitis based mainly on symptoms and results of imaging tests. Ultrasonography is the best way to detect gallstones in the gallbladder. Ultrasonography can also detect fluid around the gallbladder or thickening of its wall, which are typical of acute cholecystitis. Often, when the ultrasound probe is moved across the upper abdomen above the gallbladder, people report tenderness. Cholescintigraphy, another imaging test, is useful when acute cholecystitis is difficult to diagnose. For this test, a radioactive substance (radionuclide) is injected intravenously. A gamma camera detects the radioactivity given off, and a computer is used to produce an image. Thus, movement of the radionuclide from the liver through the biliary tract can be followed. Images of the liver, bile ducts, gallbladder, and upper part of the small intestine are taken. If the radionuclide does not fill the gallbladder, the cystic duct is probably blocked by a gallstone. Liver blood tests are often normal unless the person has an obstructed bile duct. Other blood tests can detect some complications such as a high level of a pancreatic enzyme (lipase or amylase) in pancreatitis. A high white blood cell count suggests inflammation, an abscess, gangrene, or a perforated gallbladder. Treatment People with acute or chronic cholecystitis need to be hospitalized. They are not allowed to eat or drink and are given fluids and electrolytes intravenously. A doctor may pass a tube through the nose and into the stomach, so that suctioning can be used to keep the stomach empty and reduce fluid accumulating in the intestine if the intestine is not contracting normally. Usually, antibiotics are given intravenously, and pain relievers are given. If acute cholecystitis is confirmed and the risk of surgery is small, the gallbladder is usually removed within 24 to 48 hours after symptoms start. If necessary, surgery can be delayed for 6 weeks or more while the attack subsides. Delay is often necessary for people with a disorder that makes surgery too risky (such as a heart, lung, or kidney disorder). If a complication such as an abscess, gangrene, or perforated gallbladder is suspected, immediate surgery is necessary. In chronic cholecystitis, the gallbladder is usually removed after the acute episode subsides. In acalculous cholecystitis, immediate surgery is necessary to remove the diseased gallbladder. Surgical removal of the gallbladder (cholecystectomy) is usually done using a flexible viewing tube called a laparoscope. After small incisions are made in the abdomen, the laparoscope and other tubes are inserted, and surgical tools are passed through the incisions and used to remove the gallbladder. [pic] Pain After Surgery: A few people have new or recurring episodes of pain that feel like gallbladder attacks even though the gallbladder (and the stones) have been removed. The cause is not known, but it may be malfunction of the sphincter of Oddi, the muscles that control the release of bile and pancreatic secretions through the opening of the bile and pancreatic ducts into the small intestine. Pain may occur because pressure in the ducts is increased by sphincter spasms, which hinders the flow of bile and pancreatic secretions. Pain also may result from small gallstones that remain in the ducts after the gallbladder is removed. More commonly, the cause is another problem, such as irritable bowel syndrome or even peptic ulcer disease. Endoscopic retrograde cholangiopancreatography (ERCP) may be necessary to determine if the cause of pain is increased pressure. For this procedure, a flexible viewing tube (endoscope) is inserted through the mouth and into the intestine, and a device to measure pressure is inserted through the tube. If pressure is increased, surgical instruments are inserted into the tube and used to cut and thus widen the sphincter of Oddi. This procedure (called endoscopic sphincterotomy) can relieve symptoms in people who have an abnormality of the sphincter. Background Acute cholecystitis (AC) occurs as a result of inflammation of the gallbladder (GB) wall usually secondary to cystic duct obstruction. In 90% of patients, AC is initiated by impaction of a calculus in the neck of the GB or in the cystic duct. 22 Acute acalculous cholecystitis (AAC) represents inflammation of the GB in the absence of GB calculi. AAC occurs more commonly in children and adults who are critically ill or in those who have recently undergone stress in the form of severe trauma, burns, or major surgery. Acute emphysematous cholecystitis is characterized by the presence of gas within the wall and/or lumen of the GB. It occurs more commonly in diabetic men and less frequently in association with cholelithiasis. Emphysematous cholecystitis is considered either a complication of AC or a separate entity. For excellent patient education resources, see eMedicines Liver, Gallbladder, and Pancreas Center. Also, visit eMedicines patient education article Gallstones. Pathophysiology AC represents an acute inflammation of the GB caused in most instances by obstruction of the cystic duct, usually by a gallstone and resulting in acute inflammation of the GB wall. AC is one of the major complications of cholelithiasis. The inflammatory process begins with a calculous obstruction of the cystic duct or GB neck. The exact mechanism by which GB inflammation is initiated is unknown. Microorganisms can be identified in 80% of cases early in the disease onset; such organisms include primarily  Escherichia coli, other gram-negative aerobic rods, enterococci, and a number of anaerobes. The bacterial invasion is not considered  to be  a primary event, because in 20% of patients, no bacterial growth  occurs in  surgical specimens. 1 The general consensus is that bacterial infection is a secondary event,  not an initiating one. Spontaneous resolution of AC may occur within 5-7 days after onset of symptoms,  because of reestablishment of cystic duct patency. In the majority of such cases, fibrotic wall thickening of the GB occurs, which  is characteristic of chronic cholecystitis. In more than 90% of cholecystectomy specimens, the histologic pattern is  AC superimposed on chronic cholecystitis. If the cystic duct patency is not reestablished, inflammatory cell infiltration of the GB wall follows,  with the occurrence of  mural and mucosal hemorrhagic necrosis. Gangrenous cholecystitis may  be seen  in as many as 21% of AC patients. Acalculous cholecystitis occurs in a different clinical setting, occurring  more often in males, usually children and in those older than 65 years. The pathophysiology of acalculous cholecystitis is  not well  understood but is probably multifactorial. Systemic mediators of inflammation, localized or generalized tissue ischemia, and bile stasis probably work to gether. The population at risk for acalculous AC often has predisposing factors for bile stasis; such  populations include patients with  starvation, on parenteral nutrition, using narcotic analgesics, and  lacking mobility in postoperative states. Hypovolemia and shock also predispose such patients to tissue ischemia, although ischemia may be a primary event causing acalculous AC,  such as  small-vessel vasculitis,  or may be  a complication of hepatic chemoembolization. Often, functional cystic duct obstruction is present and is related to inflammation and viscous bile. Extrinsic compression may also play a role in the development of bile stasis. The majority of patients with acalculous AC disease have secondary infection with gram-negative enteric flora3; however, in patients with typhoid fever, infection as a primary event has been  identified with  Salmonella organisms. AIDS-related cholecystitis and cholangiopathy may be secondary to cytomegalovirus (CMV) infection  and infections with Cryptosporidium organisms. In patients who have  emphysematous cholecystitis,  ischemia of the GB wall is followed by infection with gas-forming organisms that produce gas in the GB lumen, in the GB  wall, or both. In 30-50% of patients, preexisting diabetes mellitus is present,  and the  male-to-female ratio  is 5:1. 22 Gas may be confined to the GB; however, in 20% of cases, gas is also seen in the rest of biliary tree. Gallstones are not present in 30-50% of cases, and the mortality rate is 15%. 2  There is a predisposition  for gangrene formation and perforation, but clinical symptoms are mild, which can be deceptive. Emphysematous cholecystitis  may occur after  chemoembolization  as palliation  for hepatocellular carcinoma,  following atheromatous embolism during aortography, and after GB hypoperfusion during cardiorespiratory resusc itation. The following factors have been  associated with acalculous cholecystitis4: Surgery, particularly abdominal Severe burns Gastroenteritis Severe trauma Total parenteral nutrition (TPN) Mechanical ventilation Blood transfusion reactions Dehydration Narcotic analgesia Diabetes mellitus Antibiotics, particularly broad spectrum Hepatic arterial embolization (islet cell tumors and hepatocellular carcinoma) Postpartum complications Vascular insufficiency and vasculitis such as systemic lupus erythematosus (SLE) and Sjogren syndrome Arteriostenosis/hypertension AIDS, CMV, Cryptosporidium infections Typhoid Empyema of the GB may develop as a complication of AC. In AC, the GB is usually distended  as a result of  inflammatory cells mixed with bile and calculi. The bile becomes infected as the disease progresses. In 85% of patients, the cystic duct disimpacts, and  the inflammation in the GB settles. If the cystic duct remains obstructed, the inflammatory process may progress to a GB empyema and  eventually  result in  perforation. Frequency United States Because of the close relationship between gallstones and AC, the distribution and the incidence of AC follow that of cholelithiasis. Gallstones may be present in more than 20 million  persons in the United States,  resulting in 500,000 cholecystectomies annually. In 10-20% of patients, AC complicates the course of symptomatic gallstones. 2   AAC accounts for 5-15% of cases of AC,22 with the  incidence  being higher in ICU patients, particularly  those with burns and trauma. Most cases of AC in the ICU are acalculous, but in this setting, the overall incidence of acalculous AC is only 0. 2%. In the majority of postoperative cases (90%), AC is acalculous. 5 Mortality/Morbidity The AC mortality of 5-10% is  mostly confined to patients older than 60 years. AC may be complicated by empyema, gangrenous cholecystitis, GB perforation, pericholecystic abscess, and bilioenteric fistula. Gangrenous cholecystitis is a frequent cause of GB perforation. Suppurative complications are more frequent in the elderly. Most localized perforations can be satisfactorily treated by means of surgery. Although free intraperitoneal perforation is  rare, it is associated with a mortality of 25%. Necrosis of the GB wall occurs in about 60% of cases of acalculous cholecystitis because gangrene and perforation are frequent. Mortality can be as high as 9-66%. 6 The higher mortality in AAC  has been  attributed to delayed diagnosis and comorbidities. The morbidity associated with emphysematous cholecystitis is also higher, because  GB wall gangrene and perforation. Recurrent symptoms are common in patients with AC who are treated expectantly, and most patients need elective cholecystectomy. Race Because of the close relationship between gallstones and AC, the incidence of  AC is expected to be higher in races with a higher incidence of gallstones. Such populations include Native Americans and persons of Chinese or Japanese descent. Sex The male-to-female ratio of AC is 1:3. AAC is more common in men than in women; the male-to-female ratio in AAC is 2-3:1. Acute emphysematous cholecystitis is also more common in men than in women. Age AC affects all age groups, but the peak incidence is in  persons aged 40-60 years. Approximately 50% of cases of AC in children are acalculous. Anatomy The GB stores and concentrates bile,  and the ducts function as a bile drainage system. The flow of bile through the bile ducts is affected by several factors, including hepatic secretory pressure, tone in the sphincter of Oddi, the rate of GB fluid absorption, and GB contraction. Anatomically, the GB is a pear-shaped musculomembranous reservoir lying in the GB fossa on the inferior aspect of the liver. The fundus of the GB lies close to the nterior abdominal wall and near the hepatic flexure of the colon. The surface marking of the GB fundus is in the region of the costal cartilage. At this point, it is covered by peritoneum, and its proximity to the hepatic flexure of the colon may obscure it. The body of the GB is adjacent to the duodenum, which indents and produces a frequent ultrasonographic artifact that mimics gallstones or a mass in the GB. An inflamed GB may perforate into the colon or duodenum because of the close proximity of the GB to these structures. The mucosa of the GB neck is thrown into folds, giving an echogenic appearance that may also mimic gallstones. A small pouch, known as the Hartmann pouch, projects from the right side of the GB neck. When visible, this finding is frequently associated with pathology, particularly dilatation. The GB fundus is often folded over, and the GB then assumes a double-barrel appearance. Pseudoseptation of the GB fundus  caused by  kinking or, occasionally, a true septum called the phrygian cap is seen in 2-6% of GBs. The phrygian cap is of no pathologic significance. A cystic artery supplies the GB, and it is usually a branch of the right hepatic artery. The artery lies in the triangle made by the liver, the cystic duct, and the common hepatic duct (CHD). Other, smaller tributaries supply the GB  through the right hepatic artery via the GB bed through the liver. Usually, the right hepatic artery passes behind the CHD and the cystic artery crosses behind the cystic duct. In 25% of cases, the common hepatic artery passes in front of the CHD and the cystic artery in front of the cystic duct. Recognition of GB blood supply is gaining increased importance because of vascular intervention in the liver, particularly chemoembolization. Catheters should be placed distal to the cystic artery to prevent embolic material from entering the cystic artery and causing GB ischemia. Ultrasonographic anatomy The GB is a pear-shaped anechoic structure indenting the inferomedial aspect of the right lobe of the liver. A linear echogenic line representing fat in the main interlobar fissure is interposed between the GB and the right main portal vein. The GB mucosa is hyperechoic, the submucosa and the muscle layer are hypoechoic, and the serosal surface fatty layer is hyperechoic. A linear fold is present on the posterior GB wall at the junction of the body and neck. Called the junctional fold, this structure is of no pathologic significance. Sound waves from the spiral valve of the neck may cast an acoustic shadow and mimic a gallstone. The normal thickness of the GB wall is usually less than 3 mm. Provided that the patient has been fasting for 8-12 hours, visualization of the normal GB should be nearly complete. In a truly fasting patient, nonvisualization of the GB is a pathologic finding in 96% of patients. GB dimensions The normal GB usually measures 7-10 X 2-3. 5 cm. In the fasting patient, the normal dimensions of the GB seldom exceed 4 X 10 cm. The size of the GB generally increases with age, but the GB wall thickness is unaffected by age. The normal wall thickness is 2-3 mm. Neonatal GB dimensions are 0. 5-1. 6 cm (mean, 0. 9 cm) X 2. 5 cm. The wall thickness is usually 1 mm. GB anomalies Many anatomic anomalies affect the GB. The recognition of these anomalies is important in the context of GB disease. Errors in GB surgery are frequently a result of the failure to appreciate variations in the anatomy of the biliary system. Anomalous positioning or orientation of the GB includes situs inversus when the GB is in the left upper quadrant. A GB  in the left lobe of the liver without situs inversus is rare. Heterotaxia, which represents an intermediate situs with GB in the midline, may be associated with asplenia, polysplenia, pulmonary isomerism, and congenital heart disease. An anomalous orientation may be present when the GB is vertical or horizontal. It may descend into the right iliac fossa, particularly in the presence of the Riedel lobe. Unusual locations include intrahepatic, suprahepatic, lateral, anterior abdominal wall, and retrorenal sites. The GB may also be present in the thorax, in the falciform ligament and/or interlobular fissure, and in the transverse mesocolon. A wandering GB results when the GB is suspended on its own mesentery. Recognition of this anomaly is important because  such a GB is  prone to torsion. Agenesis is a rare anomaly found in 0. 04-0. 07% of autopsies. Agenesis may be associated with biliary atresia, imperforate anus, CHD, and common bile duct (CBD) anomalies. Rarely, the GB opens separately into the duodenum. The most common anomalous shape is due to the phrygian cap, in which the fundus of the GB is folded back on itself, producing a kink in the fundus. The GB may rarely appear as a diverticulum with no cystic duct. Other anomalies include fishhook, a siphon, and an hourglass configuration. A diverticulum of the GB is extremely rare and usually located at the neck of the GB. This is rarely symptomatic unless it is complicated by calculus disease. Regarding GB duplication, true duplication is rare, but it has been reported in as many as 1 in 3000-4000 people, with a male-to-female ratio of 2:1. Triplication is even rarer, and it may be an incidental finding at autopsy. In duplication, each GB may have a separate cystic duct or there may be 1 shared cystic duct. A septate GB may have an isolated transverse septum. True duplication has a longitudinal septum. A multiseptate GB is extremely rare, with multiple loculi connected by small pores; patients with this condition are particularly prone to bile stasis and calculus formation. With an anomalous cystic duct insertion, the cystic duct may insert into the CBD or CHD high or low. The cystic duct is often intramural, running for some distance in the wall of the CBD within a common sheath. Congenital stenosis of the cystic duct is extremely rare, and it may be complicated by calculus disease. Heterotopic tissue may be present within the GB, where gastric or pancreatic tissue has been described within the GB wall. This tissue may mimic tumors. Clinical findings AC usually occurs with right upper quadrant pain and tenderness. The abdominal pain increases with time. The site of pain is usually the right subcostal region, although the pain may begin in the epigastrium or the left upper quadrant and then shift to the right subcostal region to the area of the GB inflammation. Referred pain to the right shoulder or the interscapular region may be experienced. Approximately 70% of patients have had previous attacks of similar pain that spontaneously resolved. Anorexia, nausea, and vomiting may occur, but vomiting is seldom severe. Most patients are afebrile and have no leukocytosis. When fever occurs, the patients temperature is seldom  higher than 38 °C. Chills are unusual, and their presence suggests a complicated cholecystitis (abscess or associated cholangitis). Palpation of the right subcostal area reveals muscle spasm. During deep inspiration, the tenderness becomes suddenly worse and produces an inspiratory arrest called the Murphy sign. The Murphy sign  cab be elicited with an ultrasound probe. In approximately 35% of patients, a distended, tender GB may be palpable as a distinct mass. This is an important clinical finding and may confirm the diagnosis. Approximately 20% patients with AC may have mild jaundice, which may be related to common hepatic and/or bile duct edema or to the presence of calculi within the CBD. 22 Most patients improve within 24 hours after hospitalization, and signs and symptoms gradually subside. However, persistent pain, fever and leukocytosis, chills, and more severe localized or generalized tenderness may indicate complicated disease such as abscess formation or GB perforation. The development of empyema of the GB can produce systemic toxicity, and it may be a predictor of GB perforation. Leukocytosis is pronounced with empyema and is usually in the range of 10,000-15,000/? L. The clinical differential diagnosis includes acute pancreatitis, perforated peptic ulcer, gonococcal perihepatitis (Fitz-Hugh-Curtis syndrome) in women, acute hepatitis, pneumonitis, pyelonephritis, cardiac disease, sickle cell crises, and leptospirosis. AAC is difficult to diagnose clinically. It occurs often in children (50%) and in patients who are critically ill or who have recently undergone stress from severe trauma, burns, or surgery. Predisposing factors include prolonged fasting, immobility, and hemodynamic instability. Often, these patients cannot express pain; however, fever, jaundice, vomiting, abdominal tenderness, leukocytosis, and hyperbilirubinemia should lead to a high index of clinical suspicion. Children with AAC more often present in the outpatient setting than in other settings, and they usually present with  right upper quadrant  pain in the absence of gallstones. These patients are usually treated by means of cholecystectomy. Some elderly patients have few signs during their initial presentation with AC. A minority of adult patients, mostly elderly patients with AAC, also present in the outpatient setting. These cases are diagnosed and treated early and are associated with a good prognosis. Causes Hemolytic o Hemolytic anemias such as congenital spherocytosis (43-85%), sickle cell disease (7-37%), and thalassemia o Cardiac causes such as mitral valve stenosis and prosthetic heart valves o Pernicious anemia o Aortic aneurysm o Hypersplenism Metabolic o Overweight, female sex, fair complexion, fertile, and age of 40 years or older o Diabetes mellitus o Obesity o Hemosiderosis o Pregnancy o Prolonged use of estrogen/progesterone o Hyperparathyroidism o Cystic fibrosis o Pancreatitis o Hypothyroidism Muscular dystrophy o Crohn disease o Ileal resection and intestinal malabsorption o Type IV hyperlipidemia o Surgical bypass for obesity o Cholestasis Miscellaneous o Chronic hepatitis o Cirrhosis o Congenital biliary malformation (eg, Caroli disease) o Parasites (eg, ascariasis, liver flukes), which form a nidus for development of calculi o Drugs such as methadone o Biliary strictures ( eg, oriental cholangiohepatitis [bile stasis]) Genetic o Genetic predisposition in populations such as Native Americans o Higher incidence of intrahepatic gallstones in Chinese and Japanese populations Preferred Examination Clinically, few signs differentiate uncomplicated AC from complicated AC. Complications of AC may have serious clinical implications. These complications include perforation, pericholecystic abscess, and development of empyema and bilioenteric fistula. Therefore, radiologic imaging makes a substantial contribution to the differential diagnosis. Ultrasonography significantly aids  in the diagnosis of AC, although most ultrasonographic signs are not typical but suggestive of AC. Inflammatory pericholecystic reaction in the GB fossa is better depicted with CT than with other techniques. Also, CT is useful in making the differential diagnosis when obesity or gaseous distention limits the use of ultrasonography. MRI can demonstrate the same morphologic changes as CT, displaying inflammatory changes in the GB wall, pericholecystic fat, and intrahepatic periportal tissues. Plain radiography greatly contributes to the diagnosis of emphysematous pyelonephritis, and ultrasonographic and CT scan results can further confirm the diagnosis (although  CT scanning is  not strictly needed  to make  the diagnosis). Cholescintigraphy is an extremely sensitive diagnostic modality in diagnosing AC, although the findings are nonspecific. Oral cholecystography is of historical interest and has no role in the diagnosis of AC. Arteriography is seldom required for AC. Limitations of Techniques Plain radiographic findings may be entirely normal. Radiolucent calculi are visible. Opaque calculi in the  right upper quadrant  on plain abdominal radiographs may be an incidental finding and is not necessarily related to AC. Oral cholecystography is of historical interest and has a low sensitivity and specificity in the diagnosis of AC. The main features of AC on ultrasonography are all nonspecific findings. Examples include GB thickening, calculi in the GB, a positive ultrasonographic Murphy sign, and pericholecystic fluid. The sonographic Murphy sign is negative in as many as 70% of patients with AC. In a perforated GB, the wall of the GB is not well delineated, and a localized interruption of the wall may not be noted at the site of perforation. Ultrasonography has problems in making the diagnosis in obese patients and in patients with gaseous distention. The technique remains operator dependent. CT exposes the patient to a radiation burden, which may not be necessary. Arteriography is invasive and is seldom indicated. MRI has a limited availability; it is expensive; and it has problems in making the diagnosis in patients with certain prosthetics, surgical clips, cardiac pacemakers, or claustrophobia. Although cholescintigraphy is  sensitive, it has a low specificity and involves the use of ionizing radiation.

Thursday, November 21, 2019

Nanyang Technology University and Management theories Essay

Nanyang Technology University and Management theories - Essay Example As to Bedeian (1993), the Hawthorne Studies developed an onset focus on how the employees can be motivated through the approaches used by the management in human relationship. After Hawthorne Studies, a lot of related studies had been conducted by many researches that tried to explain how people from the organization can be best motivated and why motivation of employees is needed (Terpstra, 1979). According to Smith (1994), people from the organization must be motivated for survival; since, employees help the organization to survive. It comes to the point wherein managers like me must understand the need of the people in the organization to ensure that the employees are well-motivated. However, according to Bowen & Radhakrishna (1991), motivating the employees can be the most complex among the many functions of the managers, as people differences occur and needs and interests among individuals in the organization greatly exist. Comparing the needs of younger people and those that grow old in the organization, the younger people tend to be well-motivated with remuneration increases than that of the older ones. As people grows older, challenges in work beco mes more of a motivator than money per se (Kovach, 1987). However, when the managers learn the skills needed in motivating people in the organization, the benefits in the organization can be fully achieved. According to Cranfield School of Management 'Leading and motivating the [your] staff helps bring about' (2008, n.p.): Higher staff retention - A well-motivated person in the organization will not intend to leave the organization as they achieve satisfactions on the organization itself. This in return leads to the reduction of recruitment costs. Management must bear in mind that a person lost in the organization is a skill and time lost of the organization. Higher levels of productivity- The organization benefits from well-motivated people as the people level of productivity is increased. The saying goes that people whose needs and integrity are uplifted work harder than those who are less motivated. More innovation and creativity- People in the organization who are well-motivated to work due to a better understanding of their needs and interests led them to accept better changes and guide them to be more innovative and creative. Higher profits- This is a by-product of increase in production and more innovative and creative people in the organization. A better reputation - A well-established organization brought about by well-motivated people create a better reputation in the industry and trust is built from the points of view of the business world. Understanding the Management Theories In order to fully understand people, the management must understand the different theories behind managing people in the organization. These theories may guide the management to the implementation of the organizations missions and visions in accordance to their programs; as well as these theories may help them to fully evaluate the organization's strengths and weaknesses in terms people management. As I have studied the different th

Wednesday, November 20, 2019

Islamic Finance Case Study Example | Topics and Well Written Essays - 500 words

Islamic Finance - Case Study Example Hence, the present state of this Islamic finance is trying to upgrade and cope up with the economic, banking and finance crisis with trend and advance in technology and it seems it will still be involving from generations to generations. The view of charging interest on Islamic finance regarding riba is that their basic idea is they like money contribute to this Islamic finance used to develop mosques’ rather than other projects (Swartz, 2011). In accordance to Sharia Islamic religious law riba is considered manipulative and unlawful (Swartz, 2011). In addition, interest from the contributed money is often criticized because perspective view of these whole issues states that it is an effortless profit where the borrower is expected to pay as a form of compensation to the lender. Even in cases like where creditor has right of possession of debtor’s property if he or she is unable to settle the debt. Therefore, riba is an economic issue concerning the Muslims. In the fact, it is unlawful and discouraged in one way or another since the inception of this Islamic finance and still Islam is still withstanding this beliefs. Hence, the major concern in analysis to this monetary transaction is to evade riba des pite the reality that it is the foundation to growth in economics, banking and finance (Hart, Childs & Boyle, 2013). For Islamic finance to grow and develop a strong basis, banks have introduced use of tawarruq and inah to aid in improving Islamic economic, banking and finance with the intention of replacing the old concepts, which are prohibited in Islam. However, this has ignited controversy and criticism for many believe that the dealings are not Sharia compliant citing their argument that there is no main economic activity involved about Sharia law. Therefore, application of tawarruq and Inah banking system in Islamic finance is invalid and in effective. This is because this monetary institution will face an extensive

Monday, November 18, 2019

Theories and Performance Imperatives of Organizational Leadership Research Paper

Theories and Performance Imperatives of Organizational Leadership - Research Paper Example From this research it is clear that effective leaders support the optimal performance of a group of subordinates. They add great value to an organization. Highly effective executives who are also known as peak performers are noted to have productivity rates that are 25 to 50 percent higher than their average or poorly performing counterparts. Highly effective leadership is characterized by productivity, health, relational behaviour, or a combination of these factors, which result in performance at optimal level. The main goals of effective leadership are: facilitating organizational goal setting and helping to achieve them, promoting optimal levels of individual motivation, commitment and satisfaction, facilitating effective interactions among individuals within teams, helping employees to set high goals for themselves, and place the organization’s effectiveness above their own self-interests. The effective leader operates simultaneously on the performance as well as the peopl e of the organization or unit. Performance includes the process of how things get done, the length of time taken, as well as the outcome of productivity and quality. The aim of performance is productivity, and the aim for people is health. The effective leader operates both requirements successfully, emphasizing both productivity and health. Productivity is the ratio of input to output; and increased productivity has beneficial outcomes such as higher profits and market share. On the other hand, people encompasses the skills, talents, competencies and needs of the employees, leaders and other stakeholders involved with a particular corporation or organization. Health is similar to productivity in being a measure of outcome, and is manifest in both the individual as well as the corporation. For individuals, health includes physical and psychological well-being, job satisfaction, and other factors (Sperry, 2003). Thus, the fundamental premise regarding effective leadership is that it is a function of both productivity and health, and they are inter-connected. By realizing the importance of the people dimension, the effective leader ensures that employees’ levels of commitment and morale remain high, burnout does not occur, and

Saturday, November 16, 2019

Impact of Social Media on US Political Campaigns

Impact of Social Media on US Political Campaigns Mass Media as a Representation of the First Amendment in Hillary Clinton’s Current Campaign In a recent video, Hillary Clinton has declared that she will indeed run for presidency in the year 2016. And while her usage of mass media is not unique to her presidential campaign, one could argue that hers is by far the one with the greatest reach internet users around the world grow by the thousands each day (Internet Society Global Internet Report) and is a perfect representation of how mass media has played an important role in her political campaign. The media, as you will see, can influence politics both foreign and domestic. Political figures, such as Hillary Clinton, use mass media as a tool to promote desired agendas in a presidential campaign. As the First Amendment states, â€Å"Congress shall make no law respecting an establishment of religion, or prohibit the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the Government for a redress of grievances† (Kluwer XXXV). In many ways, social media, and mass media as it is consumed today is a 21st century version to this foundational law, as it provides a platform for people across all social classes to interact and share their opinions, virtually and vicariously assembling without having to physically come together. She is certainly not the first, but Hillary Clinton’s usage of mass media epitomizes the representation of First Amendment in modern day society as a foundation to their campaign. Mass media is a diversified technology made to reach a large number of people by mass communication. Such technology is used to convey information electronically through a number of devices, for instance television, radio, recorded music and film. As well, Social media attribute to web-based technologies that provide platform for individuals and community to share, exchange information, ideas, and pictures/videos in virtual communities like Facebook and Twitter. Politics has grown to be integrated with mass media since the development of one of the first successful newspapers ever, (Boston Newsletter) which was created over a century ago by John Campbell in the year 1704 (Baran). This was the beginning of an inevitable change in global communication. Since then, other media friendly devices have cemented their spot in the industry such as the television, the radio, cell phones and social media (e.g. Facebook, Twitter, Youtube). It is with these tools, protected by the First Amendment that people peek into what is going on in the world around us, from business to warfare, from sports to political events. One of the most renowned political events in history happened to be televised. â€Å"The great debate of 1960† between John F. Kennedy vs. Nixon on September 26th (Matthews). It was in this classic debate that both the world and all political figures had realized the importance of telegenics. Americans nationwide had a front row seat to the tremendous transformation of both society and politics and its cohesive relationship through television broadcasting (Baran). â€Å"Richard Nixon did not understand the power of television† (Matthews). Nine out of ten American families had a TV set in their homes by 1960 (Matthews). His misunderstanding led to his lack of personal preparation. It was documented that Kennedy rented out the top two floors of Chicago’s Ambassador East Hotel and studied homemade note cards filled with probable questions put together by his staff (Matthews). On the contrary, Nixon who is well known for his debating skills chose to sit and wait unti l the day of the debate. Moments before the debate, one of Nixon’s trustees, Henry Cabot, warned him to â€Å"avoid being his own Herblock caricature, the swarthy bully of Alger Hiss and Helen Douglas. Erase the assassins image! (Matthews).† Sources say that this was the final blow to Nixon’s defeat. As millions of Americans watched from the comfort of their home, his persona was shot down, what made Nixon the great debater, was now watered down into a spitting image of Kennedy’s gentlemen-like behavior. According to sources, Nixon’s angry focus is what might have been the missing ingredient in order for him to win over Kennedy and his TV friendly tactics (Matthew). Minor things like Nixon’s notorious 5 o’clock shadow might have been overlooked by the public even though it gave him a distinctively negative look as opposed to Kennedy’s clean cut nonchalant mien (Matthews). This debate was seemingly equal in verbal content but th e favoring persona belonged to Kennedy because of his telegenic preparation. It is not only about how one looks on television, it is also about what is said, how one says it and how everything is presented before the public. Hillary Clinton, unlike Nixon, is not ignorant to the importance of appearance positioning before the public through mass media. She uses television mass media and print media, such as the New York Times, to her advantage. Focusing even more on appearing confident and qualified for the presidential position. Hillary Clinton announced her official presidential candidacy on Sunday April 12th, 2015. John Podesta, a long time ally to Clinton also sent an official email to her supporters, then she launched a YouTube video to promote her campaign ad to the public (National Public Radio). This is the major relevancy of mass media and its recipients. The evolution of media has brought forth the bridge between the people and politics. Hillary Clinton’s campaign sets her strategy to further progress her public image and to improve her perception in the eyes of the public through social media among other public mediums. Clinton’s presence in the media, however does not begin during her presidential, and even her secretarial position in Congress. Born in Chicago, Illinois on October 26 of 1947, Hilary Clinton is the daughter of Hugh Ellsworth Rodham and Dorothy Emma Howell Rodham (National First Ladies’ Library). Her parent’s firm emphasis on the importance of status and prestige, but most importantly, appeal and charisma before the public complemented her collegiate excellence at her various universities, particularly leading her to graduate as Senior Class President from Yale Law School and was an active democratic supporter (National First Ladies’ Library). She found a breath of inspiration in her early years to work in public service because of a speech delivered by reverend Martin Luther King (National First Ladies’ Library), a perfect representation of the First Amendment. In 1974 after the Nixon Presidential term was over she became a staff member of the Univ ersity of Arkansas Law School where she met her future husband Bill Clinton (National First Ladies’ Library). She was later married to the 42nd president of the United States, Bill Clinton and became the 67th U.S Secretary of State between 2009 and 2013 (BIO). Although Hillary has had a colorful past in her career and in the public eye, she endured a taste of media publicity that most people would have rather left hidden. In 1998 the spur in the news about the Monica Lewinsky Scandal involving then president Bill Clinton and his affair with the 21 year old at the time was certainly not advantageous to her position in the public sphere. The media was engrossed and in and particularly at fault for the escalation of the events that had taken place. In addition to political media, it correlates with the First Amendment. â€Å"Protection of civil liberties and civil rights is perhaps the most fundamental political value in American society†(American Government). The ability to speak freely under minimal legal boundaries is a right known as Freedom of speech. This is one of the most protected liberties since it gives leeway for individuals to communicate their ideas. These ideas can be delivered through the various platforms described in earlier content. Prior to the construction of this amendment there was a limit to freedom of speech which suppressed people from becoming informed and spreading their ideas and involving their opinions in politics. â€Å"It was until the 18th century that freedom of speech was recognized in America as a shield against despotic government† (Germani). This was a step towards the right direction and a perfect example of freedom to petition. This includes the United States â€Å"ethics reform† bill which was intended to enable â€Å"grassroots lobbying†. This generally means a movement to enable members of the general public to communicate on matters dealing with the government or inspire and influence the other members of the general public to do the same. Mass media is playing a great role to bring about fulfillment of freedom of petition as a First Amendment. It achieves this by enabling citizens to focus government attention on unresolved issues in society; provide information through appropriate media channels about common policies, expose corruption, misconduct, incompetence and popular frustrations without harming the public order (Newton). This was the era mass media had established itself and it is evident when colonial newspaper publisher, John Peter Zenger, used his journalism to speak against the oppressive New York governor William Cosby (Germani). The First Amendment and freedom of speech has become imperative not only to the political world today but also to non-profit or third sector organizations because they allow people to prepare, speak freely and operate within wide limits. Hillary Clinton uses media to express her freedom of speech and appeal to many people especially the youth. The media helps her display her agenda to the public. A video released on Youtube Sunday 12, 2015, reveals Clinton’s plans to bring about new improvements in America involving the middle class portraying a positive image to her viewers. The Youtube video featured a black couple expecting a child, a young American-Asian woman and two men claiming to be getting married. This media platform in relation to freedom of speech helped her to bring about her main agenda. These individual rights come together to express, pursue, and defend our ideas. Mass media plays a great role in bringing about freedom of assembly through social media, television and radio. If we take a closer look at the political world in America, we see just how influential the media can be in creating awareness and perception that lead to critical evaluations by the public for public figures such as Hillary Clinton. In continuation, this freedom applies to all not only public figures, in which it could be manipulated into the reputable comedic parodies created by John Stewart and The Daily Show and their ability to portray Kate McKinnon as Hillary Clinton without punishable action or consequence, for example, or Tina Fey as Sarah Palin. These are the same rights that enable an individual to make complaints or have the sovereignty to deliver such a message without fear of reprisals. In Hillary Clinton’s recent presidential campaign, she addressed all group of people regardless of their religion. Some societies find it difficult to appeal to voters across different religious lines but this is completely different in America where it includes all people in political process, whether they are members of large. Powerful religious groups, religious minority or subscribe to no religion. Therefore through media, voters are encouraged to make their decisions based on their personal assessment, integrity and ability of an individual to lead people in an appropriate manner across the nation without bias based on religion. The candidate for election plays a great role in setting a great tone and example to be a leader of America through non biased religious campaign. History displays a restriction of freedom of assembly that limited people to be able to pursue and influence ranging groups of people; but with constant pursuit of the constitution and liberties covering mass media, there has been a significant change allowing individuals to gather and associate with any group of interest. Additionally, according to the records of colonial assemblies, there were no freedoms of petition until the period when mass media was reformed to address the issue. In the past, petitioning was in form of public dialogue but with the development of the constitution and media; the First Amendment has been adopted to enhance public views. In her current political campaign, Hillary Clinton addressed the rights of lesbian, gay, bisexual and transgender people around the world. She had also addressed the same issue in her â€Å"Free and equal in dignity and rights† speech during the international human rights day at the United Nation’s premises in Geneva on December 6th, 2011. Therefore she will be running the presidency as a pro-LGBT rights candidate. In this attempt to be the face of this new, up and coming era in gay rights, the public will provide analytical feedback through todays modern technology like never seen before (Chahal). The inevitable accumulation of analytical data serves as a representation of how far media has taken us in politics and how social media has fortified Hillary Clinton’s popularity in her current presidential campaign. In less than 24 hours after launching her Facebook page, on Sunday, 12 2015, she was able to accumulate more than 600,000 page views and 2 million video views. This is one of her campaign strategies used since she had earlier mentioned on the importance of social media and data in the 2016 general elections. According to observations made over time, social media and its massive interconnected sources, also known as â€Å"big data†, influence election decisions. For instance, â€Å"social data drove the 2008 general election and big data drove 2012 general election† (Chahal). Therefore, the â€Å"marriage† of the two data is expected to be the drive of 2016 general election (Chahal). To conclude, mass media plays a very important role in the election process, since most candidates who embrace technology and mass media, especially in a presidential campaign, normally have high chances of winning the election. There is a great change in the society with the innovative advancement of mass media to give rise to social Medias like Facebook, Twitter and YouTube which provide great platform for freedom of speech and assembly. Actually, politicians running for any kind of election no matter locally, statewide or nationally should plan their campaign properly by setting appropriate media devices to disseminate information and reach all people across different social classes and religion. As well, media plays an essential role in communication with voters; therefore, the media should represent standards by which people can evaluate political candidates. Finally, the First Amendment plays a great role in enhancing the freedom of press and media in the process of distributio n of information. It has opened a way for people to understand how the political world works hence election of sound and competent leaders. Whether Hillary Clinton successfully wins her presidential campaign relies heavily on her preparation before the public eye – media being the sensory vehicle used to connect with her it’s the closest thing one has to shaking hands. Works Cited American Government. Liberty and civil rights. 1 June 2014.  ushistory.  16 April 2015 www.ushistory.org/gov/10.asp>. Baker, Gerard. The Clinton Affair: Gerard Baker Explains Why the Allegations over Monica Lewinsky Present Such a Threat to the US Presidency:: [London Edition].  Http://search.proquest.com/. 17 Jan. 1998. Web. 23 Apr. 2015. http://search.proquest.com/pqcentral/docview/248541187/328F64E34D024E06PQ/8?accountid=9715>. Baran, Stanley J.  Introduction to Mass Communication: Media Literacy and Culture.  New York, NY: McGraw Hill, 2014. Print. Chahal, Gurbaksh. Election 2016: How Big Data Social Data Will Determine the Next President.  Election 2016: How Big Data Social Data Will Determine the Next President. 26 June 2013. Web. 23 Apr. 2015. https://www.benton.org/node/154506>. First Lady Biography: Hillary Clinton.  Hillary Clinton Biography. The National First Ladies Library. Web. 23 Apr. 2015. http://www.firstladies.org/biographies/firstladies.aspx?biography=43>. Former Secretary of State Hillary Rodham Clinton to Deliver Keynote Address at BIO International Convention.  Former Secretary of State Hillary Rodham Clinton to Deliver Keynote Address at BIO International Convention. 14 May 2014. Web. 23 Apr. 2015. https://www.bio.org/media/press-release/former-secretary-state-hillary-rodham-clinton-deliver-keynote-address-bio-intern>. Germani, Steve. Learning to Give, Philanthropy Education Resources That Teach Giving and Civic Engagement.  Learning to Give. Web. 22 Apr. 2015. http://learningtogive.org/papers/paper28.html>. Hillary Clinton To Announce Presidential Bid On Sunday.  NPR. NPR, 10 Apr. 2015. Web. 22 Apr. 2015. http://www.npr.org/blogs/thetwo-way/2015/04/10/398729997/hillary-clinton-to-announce-presidential-bid-on-sunday>. Internet Society Global Internet Report. 1 Jan. 2014. Web. 23 Apr. 2015. https://www.internetsociety.org/sites/default/files/Global_Internet_Report_2014_0.pdf>. Kluwer, Wolters. The First Amendment.  The First Amendment. Fourth ed. NY: Wolters Kluwer Law and Business in New York, 2012. 799. Print. Matthews, Christopher. GREAT DEBATE NIXON AND KENNEDY STAGED THE FIRST TV PRESIDENTIAL CAMPAIGN DEBATE IN 1960 AND CHANGED POLITICS FOREVER.  San Francisco Examiner April  28 1996.  ProQuest.  Web. 21 Apr. 2015 . Newton, Adam. FREEDOM OF PETITION,PETITION RESEARCH. 10 October 2002.  firstamendmentcenter.  17 April 2015 www.firstamendmentcenter.org/petition-overview>. Thomas, Ken. Hillary Clinton Announces Her Second Run for the White House.  PBS. PBS, 12 Apr. 2015. Web. 22 Apr. 2015. http://www.pbs.org/newshour/rundown/hillary-clinton-announce-official-run-president/>.

Wednesday, November 13, 2019

General Motors Essay -- Auto Industry

US automobile industry began at the end of the 1800’s and by the 1890’s one out of seven jobs and one out of six businesses owed their existence to the automobile. Also this industry was the largest single customer for many raw materials but now With analysts debating whether or not the American economy is already in a recession, the big three automakers in the US especially General Motors are sharply scaling back production. The facts described by Danny Hakim in an article (G.M. Sees a Loss Near $1 Billion; Stock Falls 14%) published in NYtimes on March 17, 2005 say that announcement by GM about losses of almost a billion dollars for last six month dropped its share to the lowest level in more than a decade. Also it is considered to be ever biggest single day loss since 1987, as GM’s share lost 35 points on Dow Jones. GM once considered as strongest among big three is now way behind in the race with the plans to cut off 10% production of cars in North America. Investors have lost their confidence in GM. Market researchers and analysts are also waving red flags. Main reasons for GM crisis are crucial home industry and increasing health care cost, as company is providing health coverage to almost 1.1 million people in America. Despite all these facts, company’s chief executive Mr. Wagoner has neither yet announced any serious plans to overcome this situation nor has he shown any intention to change their corporate strategy.   Ã‚  Ã‚  Ã‚  Ã‚  Globalization is the first concept which c...

Monday, November 11, 2019

Paranormal Existences

Paranormal Existence Is someone or something else among us at this moment, in this room, something we can’t even see? Have you ever wondered what else is really out there? Unexplained happenings occur every day. Spirits or ghosts are thought of just being people that have passed away but there has to be more to it. Paranormal activity is defined as experiences that lie outside the range of normal experience or scientific explanation.At some point in everyone’s life they will experience some kind of unexplained activity. Many people ask the question if it actually exists or if it’s all in their head. Scientists often say that these so called â€Å"spirits† do not exist. Only personal experiences can interpret your own feelings about paranormal existences. My story is about a spirit that lived on past their death. One night a couple months ago me and my friends were playing on her wigi board. Her dad had died 5 years earlier due to a horrific car crash.Her f amily had always seen balls roll across the room and other strange things happen without explanation; they always assumed it was him. When we started playing around with the board the first letter of the girl’s dads name showed up and her eyes instantly filled up with tears, like a helpless child left all alone, the second letter was the second letter to his name, the same with the third. By this time my friend was balling, she of course knew it was her father. We continued playing until the last letter of his name showed up.At this moment we heard a vase upstairs shatter into a million pieces, just like the car windshield had done when his helpless body had gone through it, instantly killed. We ran upstairs to find the vase and its contents of flowers spread all over the floor. Then we replaced it with a new vase and reassembled the flowers to how they were. The next morning her mother walked downstairs with a flower in her hand and asked, â€Å"Why did you put a flower nex t to my bed? † That night changed the way I thought about spirits forever.I never thought anything like that could ever happen to me. Anyone who experienced that kind of activity and the intensity in that room could easily say they felt a presence surrounding them. In the moment of that glass shattering was the one of the scariest moments of my life. I will always remember the terror racing through me, my heart pounding, sounding of horse’s strong hooves beating against the track, like thunder rolling in and the suspense leading up to the storm.Saying spirits like this don’t exist is outrageous considering how many people actually experience real activity. Some people don’t want to believe this is real simply because they are scared of it. Many others find it very interesting to study about and explore the possibilities of what else could potentially be out there with us in our everyday lives and something you aren’t even able to see. Everyone has d ifferent views on if paranormal existences are actually real. Mysterious things could happen at any time, and when they do, be prepared.

Friday, November 8, 2019

The Pearl Essays - The Pearl, Literature, Film, Cinema Of Mexico

The Pearl Essays - The Pearl, Literature, Film, Cinema Of Mexico The Pearl Character Analysis of Kino from The Pearl Kino, a character from the story The Pearl, is a prime example of a developing character. From the start through to the end, he develops drastically. At the beginning, he was thought out to be a good loyal husband but as time went on he became a selfish, greedy person who would do anything for money. When the story began Kino seemed to be a good husband who wanted nothing more than to be able to support his family. After a scorpion had stung Coyotito, Kino prayed that he would find a pearl not to become a rich man but so that he could pay the doctor to heal the baby, as he would not work free. After Kino had spent long hard hours searching the ocean floor, he finally found the pearl he had worked for. At first when he found it, he only wanted to pay the doctor to cure Coyotito. However as time passed he began to think of all the things that he could acquire with the money form the pearl and began to develop greed and selfishness. When people asked him what he would buy now that he was a rich man, he was quick to list several items that came to his mind. One of these items was a rifle. Kino wanted a rifle because he wanted to show power over the rest of his village. When Kino took the pearl to the pearl buyers to sell, he was offered one thousand pesos. Kino declined that offer claiming that his pearl was The Pearl of the World. By reacting in such a manner he yet again demonstrates his greed. It is not about saving Coyotito anymore, for he is already feeling well, it is now about the money. Although one thousand pesos was more money than Kino had ever seen he demanded that he would get fifty thousand pesos. Later in the text, Kino discovers Juana trying to destroy the pearl, causing Kino to become very angry, and resulted in him beating her. Although Juana was in very much pain she accepted the beating as if it were a punishment and stayed with Kino. A while later Kino was attacked by another man who wanted the pearl for himself and defended his pearl by killing the man. It is around this point in the story where Kino displays his greatest point of greed and selfishness. When Kino gets ready to attack the trackers Coyotito lets out a cry awakening one of the sleeping trackers. The tracker on watch described the cry as being the cry of a baby, however, the tracker who had just awaked described it as being a coyote. The tracker on guard then lifted his rifle and shot in the direction of the sound. This sparked the deadliest of fuses in Kino, which turned him from a normal man into a fearsome, uncontrollable, machinelike man killing everything in it's path. When Kino returned to the village he looked at the pearl and began to realize the effect it had on him, his family, and his village, and decided to throw it back into the ocean where it came from. Kino has paid a large price to learn such a valuable lesson, that we should not let greed and our want for something to overcome us and let us lose sight of the important things in life such as family, health, and life itself.

Wednesday, November 6, 2019

Are People Obedient Essays - Social Psychology, Conformity

Are People Obedient Essays - Social Psychology, Conformity Are People Obedient ARE PEOPLE OBEDIENT? By Queron Thompson Does everyone in society go against what they believe in merely to satisfy an authority figure? Stanley Milgrams Perils Of Obedience expresses that most of society supports the authority figure regardless of their own personal ideals. Milgram says to the reader, For many people, obedience is a deeply ingrained behavioral tendency, indeed a potent impulse overriding training in ethics, sympathy, and moral conduct (Milgram 606). Is Milgrams statement telling us obedience is an unparalleled force in todays society? Two authors, George Orwell and Langston Hughes, provide us with incidents that support Milgrams findings. George Orwells work, Shooting an Elephant, can be used as an example of Milgrams discoveries. He recalls an account of himself as a British policeman called upon to take action against a belligerent elephant rampaging through a small Burmese Village. Orwell makes it a point to show that the natives of the village, who at any other time would have looked upon the him in disfavor, are now backing him in hopes of the animals destruction. Orwell realizes it is quite unnecessary to kill the animal, yet does it anyway. Why might you ask? Milgrims findings on peoples obedience to authority can be seen as an answer to this question. In the reading Orwell says, And suddenly I realized that I should have to shoot the elephant after all. The people expected it of me and I had got to do it: I could feel their two thousand wills pressing me forward, irresistibly.(Orwell 771). With this statement, we can easily determine the role the villagers take on. Suddenly, they have taken on the role of the authority figure and Orwell the conforming citizen. In Milgrams Perils Of Obedience, the test subjects or teachers follow the experimenters authority and inflict punishment upon the actors or learners without any regard to their own feelings. In Orwells writings, he has also put the natives or authority ahead of his own personal convictions and has proven Milgram an astute judge of human character. Langston Hughes, author of Salvation offers us a different perspective on Milgrams findings, obedience before morality. Mr. Hughes paints a picture of himself as a little boy, whose decisions at a church revival, directly reflect mans own instinctive behavioral tendencies for obedience. A young Langston, whos congregation wants him to go up and get saved, gives into obedience and ventures to the altar as if he has seen the light of the Holy Spirit. Can he really see it or is this just a decision to give into the congregation, or what we consider the authority? Milgrams deeply ingrained human impulses are evident at this point. Hughes goes on to say, So I decided that maybe to save further trouble, Id better lie, too, and say that Jesus had come, and get up and be saved; So I did (Hughes 32). In saying this, Young Langston has obviously overlooked his personal belief of a visual Holy Spirit to meet the level of obedience laid out by the congregation. Once again, Stanley Milgrams theor ies are correct. His discoveries bind us to the fact that people may believe strongly in an idea or thought but, will overlook that belief to be obedient. In conclusion, what does this leave the reader to think? Do people conform to authority? Is society holding back its views inorder to meet a level of obedience? Stanley Milgram has pointed out a human characteristic that may very well be in each and every one of us. George Orwell and Langston Hughes have both given us two examples that support and defend this theory. With all this evidence compounded, we the reader can make a justified assumption that everyone in society has, at one time or another, overlooked his or her personal feelings to conform. This occurrence, whether it is instinctive or judgmental is one that each individual deals with a personal level.

Monday, November 4, 2019

HU300 unit 6 DB topic 1 Research Paper Example | Topics and Well Written Essays - 250 words

HU300 unit 6 DB topic 1 - Research Paper Example zierka was able to effectively add a universal appeal to this piece of literature and create a strong link to the audience through the use of pathos as the rhetorical appeal. By making the audience feel the emotions being described to be felt by the main character, the audience empathized and sympathized with her. There were mixed emotions that were apparently exhibited by Hanneh: from being proud and jubilant after she successfully painted her kitchen white; to being anxious and worried after her landlord raised her rent for the first time; and to eventually being enraged, vengeful and distraught after the landlord raised her rent for the second time; and finally, being remorseful, distraught, almost at the verge of losing her mind when she furiously destroyed the beautifulness that apparently caused her misery. In Janaro & Altshuler’s (2012) book, epiphany was explicitly noted as providing an â€Å"insight into life or human nature† (97). In Hanneh’s story, epiphany, which also means a sudden realization, was demonstrated at the climax of the story when she realized that ironically, the cause of all her misery is her desire to emulate the possession of beauty and elegance from the white kitchen she envied from Mrs. Preston and to hope for democracy as she was expectantly made to believe that she could be capable of

Saturday, November 2, 2019

Human resource strategy Essay Example | Topics and Well Written Essays - 2500 words

Human resource strategy - Essay Example Based on the new developments in the business world, HRM strategies are also undergoing drastic changes at present. Earlier, HRM functions were labeled as personnel management. Later, it acquired the form of human resource management. Now instead of HRM, Strategic human resource management (SHRM) is gaining grounds in organizations of the modern world. The core of SHRM is to prepare the employees in accordance with the strategies of the organization. The integration of the employees in to the main streams of organizational activities is a modern day business strategy. Along with the expansion of human resource management or strategic human resource management, lots of ethical problems are also arising. When organizations move into foreign markets, they must adapt to communication, culture and human resource issues. Domestic business and international businesses have more differences than similarities. Moreover, ethical dimensions of HRM would be more significant in cross cultural bus inesses than in domestic businesses because of the huge differences in cultures between countries. â€Å"Education, social standing, religion, personality, belief structure, past experience, affection shown in the home, and a myriad of other factors will affect human behaviour and culture† (Encina, 2007). Most of the current organizations have extremely diverse workforce and hence the interests of these diverse workforce may often been clash each other. Strategic HRM policies should be formulated in such a way that all the employees working in an organization get equal opportunities and fair treatments. â€Å"Ethical conventions should be fully addressed by the HRM profession and ethics be integrated into the strategic HRM process† (Carey, 2011) Business ethics was not much interested in the issues relating to the ethical management of employees till recent times. â€Å"Apart from the development of ethical awareness among managers and the ethical dimension of change management processes, there has been little debate around the ethical basis of much HR policy and practice† (Winstanley & Woodall, 2000, p.1). However, current business Gurus are aware of the necessities of managing employees in an ethical way for the sustainment of their business. This paper briefly analyses the ethical dimensions of strategic HRM in future Ethical dimensions of strategic HRM in future The work culture in different countries are different and hence while employing diverse workforce, an organization may face clashes between the interests of diverse employees. For example, Americans like to work under a stress free environment because of the immense freedom they are enjoying in their country because of democracy. However, Chinese may not enjoy such freedom in the work places of their country because of the tight communist administration. An American working in China may face extreme difficult situations in China because of the contrasting business management ph ilosophies he may face in China. Strategic HRM should give more focus in such areas in order to reduce the stress levels of the diverse employees. â€Å"There is a powerful argument that the wider economic system and ultimately the business organisations within it exist to serve human and societal needs rather than the opposite†