ontemporary Thinkers Plato, Aristotle, Augustine, Aguinas...

Contemporary Thinkers: Plato, Aristotle, Augustine, Aguinas Question #1 : Please discuss the political organization of the Greek city- states, particularly Athenian democracy at the time of Pericles, Plato, and Aristotle. Also discuss the backgrounds of Socrates, Plato and Aristotle and the fate of the Greek city-states historically. nbsp;nbsp;nbsp;nbsp;nbsp;During the time of Pericles, Plato, and Aristotle, Greece was divided into city-states with a wide variety of constitutions, ranging from Spartas military dictatorship to Athens direct democracy. nbsp;nbsp;nbsp;nbsp;nbsp;Most city-states had about 300,000 people, each divided into one of three classes : citizens, metics, or slaves. The citizens represented a total of†¦show more content†¦After peace was declared, he tightened Athenian control of the empire. â€Å"He crushed major rebellions, imposed democratic government, dispatched colonies of Athenian citizens to strategic areas, and made tribute collection (the main source of Athenian wealth) more efficient. Convinced of the inevitability of war with Sparta and the Peloponnesians, Pericles made an alliance with Corinths enemy, Corcyra , knowing that it could lead to armed hostilities. He refused Spartas demand that he revoke the Megarian decree, which denied Megara access to the harbors of the empire. These actions led to the Peloponnesian War . Pericles, who was relying on the fleet and the empires resources, planned to avoid a pitched battle with the Peloponnesians and to abandon the countryside to them. He fell victim to the plague, however, never to know that the war he initiated would result in the disastrous defeat of Athens. â€Å"(GME â€Å"PERICLES†) nbsp;nbsp;nbsp;nbsp;nbsp;Socrates, was a Greek thinker whose work marked a decisive turning point in the history of philosophy. He invented a method of teaching by asking questions (the Socratic method), pioneered the search for definitions, and turned philosophy away from a study of the way things are toward a consideration of virtue and the health of the human soul. Socrates believed that to do wrong is to damage ones soul, and that this is the worst thing one can do. From this it

The Beginning Of Rock Music - 1088 Words

â€Å"Little† Richard Wayne Penniman, one of the first rock musicians, once said, The blues had an illegitimate baby and we named it rock n roll. Rock and Roll initially began setting its roots around 1950, with a strong connection to audiences who were under an oppressing thumb at the time. If African American music is unique, it is largely due to the foundation of blues, a form of music that emerged in the early 20th century. Establishing the sounds of African American culture, these styles inspired revolutionary genres of the century: jazz, blues, rock, and hip hop. They are well known and appreciated around the world and throughout the U.S. It would be virtually impossible to imagine American music without these corner stones. The beginning of rock music is also the tale of the never-ending social struggles of American history. Blues and jazz, the expressive and meaningful songs of everyday black Americans, are deeply rooted in regret, loss, despair, hope, love, strength, and dreams. While upholding the originality over many decades, the spirit and musical theory of these styles have influenced much of the American music that is produced to this day. The â€Å"blue notes†, a term for notes that are much lower and flatter than usual that are the major factors of the form became prominent in country music, rock and roll and jazz (Merwe, 1989). The simple yet untraditional form of blues became the model for the first rock and roll songs, such as â€Å"Good Rockin’ Tonight†,Show MoreRelatedThe Rock Of Rock And Roll1062 Words   |  5 PagesSince the beginning of time there has always been music in the world. The Native Americans had their tribal music, which was used for healing, ceremoni es, and ancient rituals. Ever since the beginning of the 20th century there has been rock and roll. 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From its beginnings in the late 1950s and early 1960s until the present day, rock has changed styles seemingly every decade as new bands become popular because of their unique style of music. ThroughoutRead MorePink Floyd s Impact On British Culture1458 Words   |  6 Pages Pink Floyd’s Impact on British Culture Pink Floyd is one of the most known Psychedelic Rock bands to ever exist. They were a game changer within the music business and appeared countless times on British’s top 100 list. Most of their music including the album â€Å"The Dark Side of the Moon† had important political subject to talk about. They were apart of the British Invasion (although the band itself originated from Cambridge London, England). Their name, roles within the band, and even theRead MoreThe Rock Of Pop Rock1199 Words   |  5 PagesDue to pop music s popularity, rock experienced a diminished presence on the top 40 music chart by the end of the decade, though the genre still sold well. In the early 2000s, there was an astounding resurgence of interest in  pop rock. This began in the year 2000 with the success of  Blink-182 s song All the Small Things and  Nine Days s song Absolutely (Story of a Girl), both of which peaked at #6 on the  Billboard  Hot 100. Pop rock is a genre that mixes catchy pop lyrics with rock-based instrumentationRead MoreA Brief History Of Rock And Roll And The Woodstock Music Festival Of 19691382 Words   |  6 PagesA Brief History of Rock and Roll and The Woodstock Music Festival of 1969 Throughout history, major social transformations have taken place that has changed how people perceive themselves and the world around them. With each social reformation, cultural forms and institutions also change as well as their meanings. For Example, the development of recording and electronic communication within United States capitalism spurred the unique coming together of music traditions in twentieth century UnitedRead More Multiculturalism In Music Essay1450 Words   |  6 Pages Visualize in your head a rock band, and a rapper. What kind of clothes are they wearing. What lyric styles are they singing in? And what color are they? Ongoing stereotypes suggest that the rock band is a group of white musicians and the rapper would be black. However, examples from the past and present shows that these stereotypes are untrue. Music is defined as â€Å"The art of organizing tones to produce a coherent sequence of sounds to elicit an aesthetic response in a listener† (Morris, 864). ThisRead MoreEssay about Music throughout Society961 Words   |  4 PagesMusic throughout Society Weve been talking a lot about social rituals. Well, just what exactly is a social ritual? 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The Geology of Seattle Free Essays

The Geology of Seattle Seattle is located in the state of Washington in the Pacific Northwest. Seattle is metropolitan and has a population of nearly 3. 5 million. We will write a custom essay sample on The Geology of Seattle or any similar topic only for you Order Now Seattle’s climate changes from wet and cold during the winter months to dry and hot during the summer months. The coast of Seattle is responsible for the growth of its economy, due to the large number of commercial ports. Seattle is in the destructive range of several volcanos within Washington, most prominently, Mt. Rainier. Topography Seattle is surrounded by large bodies of water and mountainous terrain. The city itself lies on top of several hills, which include; Capitol Hill, Second Hill, Denny Hill, Beacon Hill, and Queen Anne Hill. From the center of Seattle you can find shoreline to the north, Bainbridge Island to the north-west, The Puget Sound to the west, Vashon Island to the south-west, Tukwila to the south, Renton to the south-east, Lake Mercer to the East, and Lake Forest Park to the north-east. Past the Puget Sound lie the Olympic Mountains. Seattle owes its specific structure due to glacial scouring and deposition and tectonic activity, subsequently modified by landsliding, stream erosion and deposition, and human activity. Geological hazards Seattle is threatened by several geological hazards, such as earthquakes, flooding, volcanos and landslides and shore erosion. Perhaps one of the most prominent hazards to Seattle is the Massive volcano, MT. Rainier, which lies 54 miles southeast of Seattle. MT. Rainier stands at an elevation of 14,411  feet and is very topographically prominent. Rainier is considered one of the world’s most dangerous volcanos. The composition of Rainier is very andesitic and upon it eruption could cause a violent explosion. The glacial ice that sits atop the mountain can also cause massive lahars that could cause major damage to Seattle’s infrastructure as well as its economy. Although MT. Rainier displays no signs of imminent eruption, it has gone through several major eruptions in the past 3000 years. These eruptions include the Twin Creek eruptive episode 1,500 years ago, the Fryingpan Creek eruptive period 1000 year ago, the Electron Mudflow 500 years ago, and several small eruption plumes in the 1800’s which caused black smoke to be seen to the early pioneers of the area. It is projected that the potential damage to Seattle and the surrounding area would be catastrophic if MT. Rainer were to erupt. Geoff Clayton, a geologist working for a company called RH2 Engineering, was asked by Seattle Weekly to estimate the damages to the Settle area. By using a computer program, he reached a conclusion that the result of Mt. Rainer spawning lahars would be a devastating natural disaster. Clayton then quoted that,† Before approaching Seattle, a lahar, he says, would have â€Å"wiped out Enumclaw, Kent, Auburn, and most of Renton, if not all of it. Clayton went on to say that if such a massive lahar could potentially cause tsunamis in Lake Washington and the Puget Sound, effectively flooding the port of Seattle. It is needless to say that if Seattle were to lose its commercial ports, the economic consequences would be dire. Another geological hazard that presents itself in Seattle is the risk of Earthquakes. Seattle lies within the ring of fire and is at r isk of experiencing a crippling earthquake. The Seattle area has experienced several significant earthquakes in the past. The most recent notable quake was in February 28, 2001 when a magnitude 6. 8 earthquake ravaged Pioneer Square. The quake caused significant property damage but no fatalities. More powerful earthquakes have occurred farther in the past. On  January 26, 1700 the area was struck with a staggering 9. 0 magnitude quake, and on December 14, 1872 Seattle was struck again with a 7. 3 magnitude quake. A few more semi-powerful quakes occurred between 1940 to the present day, however, fatalities were minimal. To predict the potential loss cause by another 9. earthquake hitting modern day Seattle, FEMA used â€Å"Hazus† (a computer program used by FEMA) and found that such an earthquake would cause billions of dollars of property damage, thousands of deaths and even more injuries to the population. The aftereffects of the earthquake would be equally devastating. The earthquake would trigger tsunamis form the surrounding water bodies, as well as fires and landslides. Effects such as the se would be devastating and would take decades to repair. Seattle has hundreds of miles of waterfront surrounding the city. With such a large amount of water around the city, flooding is a major concern to the residents of Seattle. Although tidal flooding from the Puget Sound and Lake Washington is a concern, the real threat of flooding comes from the system of undeveloped creeks and river that run through the city. These floods most often occur in the fall and winter due to the increased rainfall. Thornton Creek in northwest Seattle and Longfellow Creek in west Seattle are two creeks that are notorious for flooding during the winter months. Thornton Creek has caused major water damage urban areas that border the creek when it has flooded in 1967 and again in 2003. Another flood of importance occurred in 2006 when record rainfall caused flash floods that swept through the city during rush-hour. Although the floods in the Seattle are wide spread and intense, they cause few deaths. Landslides are another geological hazard that is common to the Seattle area. Landslides in Seattle can be caused by any number of factors, either natural or manmade. Landslides occur in areas that exhibit clay-sand contact or any other adverse soil and groundwater conditions. Seattle has a large database containing many of the landslides it has experienced since the 1800’s. Using this data, the city has compiled a list of areas that are the most prone to landslides, the list is as follows: Northwest Seattle * Burke-Gilman Trail * Inverness * Laurelhurst * Southwest Magnolia * Southwest Queen Anne * East Queen Anne * Northwest Queen Anne * North Capitol Hill * Lakeview Boulevard * Interlaken * Madrona * Rainier Avenue S. E. * West Beacon Hill (I-5) * West Marginal Way * Alki * Admiral Way * Beach Drive S. W. * 47th Avenue S. W. Seola Beach * Pigeon Point * Cheasty Boulevard S. Here is the corresponding map: The most notable series of landslides in recent history occurred in January of 1997. Over 100 landslides were reported throughout the Seattle area within several days and caused hundreds of thousands of dollars in damages. A study showed several factors that contributed to the incident. During the spring of 1997, the Seattle area experienced much more precipitation that usual. A cold spell in the spring caused ice crystals to form and melt in the soil, increasing its porosity. The several day of intense rainfall between late January and early March are what triggered the series subsequent landslides. Geologically economic activities Present day Seattle relies in its ports for economic growth, however, in the 1800’s coal was Seattle’s main export. Coal was discovered in the Seattle area in 1833. The development of the railroads in Washington spurred the growth of the coal market. At the time, locomotives primary fuel was coal, and coal required the use of the railways to be exported. The coal market continued to grow in Seattle. In 1918 Seattle was delivering 4. million tons to California each day. The coal market began to fail when locomotives started switching from coal to petroleum and natural gas. Coal mines began to shut down as the demand for coal diminished until the last active coal mine closed down on November 27, 2006. â€Å"Live-ability of Seattle† At a glance, Seattle seems as good as a place as any to live. However, there a re several factors to consider for anyone looking to take up residence in the Seattle area. To the human perspective, hazardous geological incidents seem too far and few between to see as a threat. If one were to look at all of the geological disasters in the Seattle area on a geological timescale, they would see just how prone to disasters Seattle is. Approximately every five hundred years Seattle experiences a 9. 0 earthquake. Any seismic activity on that scale would also cause tsunamis to devastate the area. Seattle is also under the constant threat of MT. Rainier erupting and spawning a massive lahar that would destroy downtown Seattle. Seasonal floods are a major threat to the residents of the Seattle regardless of the lengths the city has gone to prevent flood damages. All of these geological hazards are especially dangerous due to the fact that Seattle is a large metropolitan area. With all this in mind, I consider Seattle a dangerous place to live. Bibliography * http://www. seattleweekly. com/2005-10-19/news/the-super-flood. php/ * â€Å"Geological Hazards In Seattle† by Donald W. Tubbs and Thomas Dunne * †Landslides In Seattle† by Donald W. Tubbs Prepared in cooperation with United States Geological Survey 1974 * â€Å"Coal In The Puget Sound Region† HistoryLink. org Essay 5158 * http://www. nps. gov/mora/faqs. htm How to cite The Geology of Seattle, Essay examples

Benefits Of Sustainability Initiatives SABIC Free Solution

Question: Discuss about the Benefits of Sustainability Initiatives SABIC. Answer: Introduction In the recent past, Saudi Arabia experienced economic success. These developments have offered numerous opportunities for the government and investors to establish a healthy and strong ground for incorporating investments and relevant policies thus helps in achieving a sustainable economic growth. Robertson (2014) affirms that sustainable development and strategies have boosted Saudi Arabian economic expansion. Undeniably, the Saudi government has recently established healthy and stiff competitive environment thus making it a global destination for planning and investment. Besides, the Kingdom of Saudi Arabia has benefited from the international foundation to achieve its output gains through efficient planning (Hertog Luciani, 2012). To show the significance of the regulatory requirements on various sustainability initiatives, the article has opted to focus on SABIC Company that has become a leading organization in the world. In fact, the study surveys the companys sustainability in itiatives and explains some of the achievements this organization has realized through the sustainable initiatives and how it has benefited based on the overall success as determined by Traversa and Idriss (2012). In the modern world, multinational bodies, governments, and other enterprises have used business regulations in drafting their laws and demands regarding people and enterprise as part of their legal enactments. Without a doubt, the source of regulation can be private regulatory bodies or non-governmental organizations granted such powers by the government of the day as highlighted by Jacob (2013). In fact, sustainability has emerged as the best innovations, techniques, and strategies that companies and governments have used to develop their operational performances and how such activities affect the economy. Many people are aware of the various sustainable regulations including ISO Standards that have encouraged stakeholders to recognize their corporate obligations in implementing sustainable schemes. In Saudi Arabia, the government has established the Presidency of Meteorological and Environment (PME) body that is mandated to outline the relevant environmental standards that companies and other organizations must meet to avoid cessation (Alyami, Regzgui, Kwan, 2015). To this effect, many companies and businesses have been compelled to adopt the sustainable policies thus meet the set standards and improve their competitiveness. It has also emerged that many companies that have adopted the sustainable requirements have become more appealing and persuasive thus benefit from acceptations in the society. Company Background Saudi Arabia Industries Cooperation (SABIC) is an organization that was founded in 1976 with a vision to transform the natural gas into a valuable petrochemical commodity. Previously, many people damaged the environment and underutilized the natural gas. But with SABIC, this perception was changed as it turned the natural resource into a beneficial petrochemical product that has enhanced the supply of energy thus meeting the needs of the society. Since its inception, SABIC has achieved significant contributions in carbon storage and capture through initiatives (Arab News, 2015). For example, the corporation has used the largest carbon dioxide purification plant because it recognizes the continued concerns regarding climate change. The company has confirmed through its efforts that it is a part of the solution as its products and services reduce CO2 emissions thus meets the customers sustainable goals. The company has also recognized that these effects would never bear fruits without engaging other stakeholders (Hertog Luciani, 2012). To this effect, SABIC has collaborated with the Ministry of Petroleum and Mineral Resources and Saudi Aramco in hosting several forums such as the Carbon Sequestration Leadership Forum where various stakeholders engage on how they can make business sense by adopting operational resource and energy efficiency approach to minimize the operating costs (Arab News, 2015). SABIC has continuously encouraged governmental policies and support that have accelerated technology innovation and development thus allowing stakeholders to share the best practices. In fact, the organization engages the international players to justify its leadership position in the Middle East. It continuously participates in the forums that advocate for sustainability and encourage collaboration (McCullough, 2014). It has also supported efforts and mechanisms that reduce CO2 emission and fits its business model. Given these efforts, it is important to study how the organization has benefited from the sustainable initiatives. Recognition and Awards The American Chemistry Council recently recognized the efforts of SABIC in its innovative plastic business. The company has established extensive world-class programs that have improved energy efficiency. To this effect, the Saudi company earned responsible care energy efficiency (Staff, 2015). The accomplishment confirmed the companys sustainability initiatives thus attracting the honor from the American Chemistry Council. The company has also used a holistic approach to achieving a sustainable performance and help it to reduce environmental impact using transportation network, manufacturing process and infrastructure. SABIC has strengthened its operational excellence thus benefiting its customers nationwide (Staff, 2015). SABIC engages in the manufacture of plastics for different industries including medical services, consumer electronics, and automotive. These products confirmed the company striving to improve the manufacturing process and managing resources efficiently. Benefits of Sustainability Initiative The company was founded on the promise to create value that would allow the country to flourish and grow. SABIC pledged to extend the sustainability initiatives beyond Saudi Arabia. According to Brebbia (2016), the companys financial goal was to generate an economic value for its shareholders. The organization was linked to socio-economic and environmental success. For an organization to meet the economic needs and expectations of stakeholders, it needed to invest in customers, people, and communities. SABIC devoted its resources to environmental and energy improvements for various manufacturing facilities. It focused on helping these companies to build advanced technology center (Wyman, 2014). The investments have made the company more efficient thus reducing the overhead costs. SABIC continue to focus on value creation through innovation as it forms the basis of economic values. The company also believes that developing an efficient manufacturing process to establish sustainable ma rket solutions. SABIC believes that integrating a sustainable criterion is necessary for improving innovation processes at all levels of development. SABIC works closely with stakeholders to align its sustainability strategy with its goals (SABIC, 2014). This has ensured the company has benefited from sustainability initiatives to provide the solutions to facilitate success. The company has embedded sustainability into SABICs strategy to maximize economic benefits thus maximize value in its value chain (Traversa Idriss, 2012). Delivering financial value confirms the companys long-term health of its business beyond the economic capital. The firm believes that the management of social, human, and natural capital. To meet its long-term goal, SABIC has created 2025 strategy that has recognized the interconnectivity between the value it creates for customers and other stakeholders in the society. With these connections, the company has managed to be accountable for its performance by creating a strategy addresses sustainable value for its future. SABIC has expanded its patent portfolio by about 8.7 percent as reported by the company (SABIC, 2014). In fact, it increased its expenditure on research and development by 16 percent as reported by SABIC (2012). Creating value SABIC has incorporated sustainability initiatives into its product development and processes by taking a robust approach thus create economic value. ICSPD and Brebbia (2009) maintain that it invested in the emerging technologies to benefit the economy, society, and the environment. SABIC has managed to deliver operational efficiency and productivity gains. For example, in all the manufacturing assets of SABIC, the firm continues to design and operate for maximum efficiency and minimize environmental impacts. According to Brebbia (2016), operational efficiency projects show it expected a significant impact on its operating costs and revenues. Besides, the sustainability initiatives had helped it reduce CO2 emissions such as introducing flaring mechanism has enabled SABIC to reduce the emissions by over 48 percent and cut energy intensity by over 7 percent. It anticipated that the economic benefits of this project stand at $100 million annually. The new initiatives have further ensured the company reduces differentiated technologies (Tietenberg Lewis, 2010). For example, it had to respond to the gas feedstock constraints by exploring the development of differentiated and new technologies including Oil to Chemicals (OIC) project (SABIC, 2014). Without a doubt, the project will encompass unique configuration of operational units so that it can generate the highest yield conversion of chemicals from oil. According to Abubakar and Aina (2016), the sustainability initiatives have brought improved material and chemical solutions to its customer segments. Based on 2025 strategy, SABIC has identified priority customer market segments to improve its performance. Hence, the company is striving to improve its sustainability impacts thus create cost savings through the material, resource, and energy efficiency gains (Hasmi, Abdulghaffar, Edinat, 2015). SABIC has improved transportation following the adoption of robust sustainability initiatives by offering different innovative materials that have ensured it meets the safety standards and offers low weight in the transportation sector. Through these processes, SABIC has improved fuel efficiency. For instance, in 2014, the Saudi-based company introduced new and high performing polypropylene copolymer with superior processing qualities. At the same time, the company maintained the best resistance to its mechanical impacts (SABIC, 2012). These inventions have allowed the company to design new vehicle components and help the auto manufacturers to reduce the weight thus maximize resources. For instance, the companys materials have been used to make car seats to accommodate children. The company also has conducted the life-cycle assessment that has justified the reduction in energy consumption and emission of CO2. Supply chain optimization The supply chain team has acknowledged the significance of SABIC in the society as it helps in creating environmental value through the optimization of logistics and networks (SABIC, 2014). This organization has health the global supply chain team to cut the lead time thus boosting its competitiveness in the market. Consequently, these initiatives have made SABIC strengthen its customer services and stakeholder relationship using collaborative operations to achieve shipping, packaging, and delivery of solutions. According to SABIC (2012), SABIC can maximize its supply chain through the Portal Logistics Facility that has facilitated the establishment of considerable value to the firm. The move ensured the company reduced the lead time to the countrys ports. In fact, the organization cut the overflow warehouse requirements at different levels including manufacturing point (Wyman, 2014). The completion of the PLF, the companys Polymers business made successful tests in configuring its l ogistics leading to a cost saving goal that it predicted at 15 percent (SABIC, 2012). To this effect, the customers of SABIC in Asia accessed competitive services. Given the success of its products in Asia, the company intends to extend to Africa that will lead to an annual saving of about $7.3 million. Cost minimization Sustainability initiatives have become one of the most valued strategies to achieve a cost-effective objective. According to ICSPD and Brebbia (2009), companies that have implemented these initiatives have reduced their production costs beyond reproach. Although setting a company or sustainable initiatives are expensive in the short-term, the long-run effects confirm the cost effectiveness. Innovative plastics, polymers, and metals have registered a twelve percent reduction in cost because SABIC has invested in improving sustainability products as reported by SABIC (2014). With reduced production costs, the company gets in the pole position to overcome its competitors that have for several years given it a run for its money. This investment has benefited SABIC by helping it attain the world leader status. Conclusion Sustainability remains an essential and a necessity for the future of human and it further offers numerous benefits for different companies. Based on this article, the sustainability initiatives focus on sustainable product improvements thus defines the companys service, products, and success. The case study that is a leading Saudi Arabias company forms an example of a company that has reported substantial growth and profits by implementing the sustainability initiatives as listed in this article. SABIC is not only a leader in Saudi Arabia but a global player that has made sustainability the core of its business strategy. With this central focus, the company has ensured its customers benefits from innovative products and services and further meets the companys long-term objectives. The sustainability initiatives of SABIC have given it a competitive advantage beyond its competitors because it uses them to provide value for its stakeholders. References Abubakar, I. R. Aina, Y. A. (2016). Achieving sustainable cities in Saudi Arabia: Juggling the competing urbanization challenges. In U.G. Benna S.B. Garba (Eds), Population Growth and Rapid Urbanization in the Developing World (pp. 42-63). Hershey, PA: IGI Global. Alyami, S.H., Regzgui, Y., Kwan, A. (2015). The development of sustainable assessment method for Saudi Arabia built environment: Weighing systems: Sustainability Science, 10(1), 167-178. Arab News. (2015, Nov 5). SABIC initiatives promote sustainability. Corporate News. Retrieved from https://www.arabnews.com/corporate-news/news/830646 Brebbia, C.A. (2016). Sustainability development. Southampton: WIT Press. Hasmi, M. A., Abdulghaffar, N., Edinat, I. (2015). Sustainability commitment in Saudi Arabia and need for educational reforms for the jobs of the future. International Business Economics Research Journal, 14(1), 47-54. Retrieved from https://www.cluteinstitute.com/ojs/index.php/IBER/article/download/9031/9024 Hertog, S. Luciani, G. (2012). Energy and sustainability policies in the Gulf States. The Transformation of the Gulf: Politics, Economics, and the Global Order, 236-257. International Conference on Sustainable Planning and Development (ICSPD), Brebbia, C. A. (2009). Sustainable development and planning IV. Southampton: WIT Press. Jacob, A. (2013). Sustainability drives innovation at DSM composite resins. Reinforced Plastics, 57(4), 44-46. McCullough, D.G. (2014, May 12). Saudi Arabias green decree brings hopes of sustainability. Guardian. Retrieved from https://www.theguardian.com/sustainable-business/saudi-arabia-green-construction-oil-sustainability-environment Robertson, M. (2014). Sustainability principles and practice. Hoboken, NJ: Taylor Francis. SABIC. (2012). Sustainability report 2012. Retrieved from https://www.sabic.com/corporate/en/images/2012%20%20SABIC%20Sustainability%20Report%20-%20English_tcm12-5846.pdf SABIC. (2014). Foundation for the future. Sustainability Report 2014. Retrieved from https://www.sabic.com/me/en/images/sabic_sustainability-report_2014_tcm14-15473.pdf Staff, E. (2015, May 19). SABIC wins five ACC responsible care awards. Retrieved from https://www.seacoastecho.com/article_8822.shtml#.WF3-9X2Qp_k Tietenberg, T., Lewis, L. (2010). Environmental economics policy, (6th Ed.). Upper Saddle, NJ: Pearson Education, Inc. Traversa, E. Idriss, H. (2012). Materials for renewable and sustainable energy provide the connection between materials, energy, and sustainability. Materials for Renewable and Sustainable Energy, 1(1), 1-2. Wyman, O. (2014). Energy sustainability index. World Energy Council. Retrieved from https://www.worldenergy.org/data/sustainability-index

History Of Punk Rock Essays - Culture Of New York City, Punk Rock

History of Punk Rock Did you know that the first commercially successful punk band was the Sex Pistols? Then came groups like Black Flag, Husker Du, and Bad Brains. Punk was invented in Britain in the mid Seventies. The first American punk started in a New York club called CBGB's. CBGB's would attract a crowd of about 500 with its Sunday-afternoon hard-core matinees. The concerts would be over by a reasonable time so kids could get home to eat dinner with their parents. In this paper we will take a look at some history and aspects of punk rock over the years. Slam Dancing Slam dancing has been popular through the history of punk. You may have heard of called "mashing" or "stage diving." Mashing is just a big game of bumper cars like you played when you were a kid. I think Natalie Jacobson who is dating the lead singer of "Murphy's Law" describes stage diving best when says, "It's like diving into a human carpet. Something like the old kids' trust game. Just my way of getting into it. Gospel people got their thing, I got mine."1 Politics Some punks consider themselves Nazis', or are concerned with issues like peace, racism, and nuclear war. Most punk is against parental, musical, and political authorities. On the other hand some isn't. Bob Mould of Husker Du talks about politics quite frequently in his songs. I don't write about politics because I'm not an expert. Some bands find it very necessary to claim they're politically relevant when in actuality they don't know shit about politics. Not informing people is much better than misinforming people. We're sort of like reporters in a way. Reporters of our own mental state. Reporters of the state of the air. Consciousness. Of the day. We make personal statements.2 Friends Most punks that live in small towns have trouble making friends. They find it hard to relate to most people. Sixteen- year-old Becca Levine finds it hard to make friends in her small town. She comes from a family of divorced parents that never have understood her. Her mother thinks it's just a phase she's going through. As Becca Quotes, "Parents around here treat me like I'm kind of weird."3 She has met someone from New York City that understands her. She meets with him at concerts at clubs like the Ritz or CBGB's. She met someone else also. Someone about 20 minutes away from her hometown who wrote an ad in a national magazine looking for someone to associate with that would understand him. He got a lot of responses, but when he saw the letter from Becca he called her right up. They met for the first time at a Hard-Core show in New York City. But still no one in her hometown understands her. Fitting in with the New York hard-core scene is one of her goals. Clothing Punk has its very own unique style. Although punk sports hard edges, bright colors, shaved heads, leather jackets, Mohawks, and army boots. You can't really tell if a person is a punk by the way they dress or do their hair. Wanda Draper, professor of psychiatry and behavioral sciences at the University of Oklahoma says, "We need to look at their reactions and responses to what goes on around them in everyday life. When we know that this is a fad-that it is an effort to be a part of the 'group'-we can usually relax."4 Development of Punk Through the years some punk has had influences from country to the Grateful Dead. Some of this may not even be punk at all. Take Rancid's song "Time Bomb" off their latest album, "...And Out Come the Wolves"5 for instance. It is their rendition of Reggae. Most punk groups don't make much money at all. Once in a while a punk group will hit it big time but that is very rare. Paul Westerbert, lead singer of the Replacements quotes, "We are the hungriest band I've ever seen. We get in the van and drive to a town, play, stay at a friend's house. Wake up when they throw us out. Drive the rest of the day. Play the next night. We get fifteen dollars a day. And when we're home, we don't get nothing. We're way in debt. We own a van, it breaks down, and you know when you play that the gig money goes to pay for the broken- down van. We're used to it.6 Relation Punk is also related to Hard-Core and Ska. Hard-Core is usually heavier and more upbeat the regular punk. Ska History Of Punk Rock Essays - Culture Of New York City, Punk Rock History of Punk Rock Did you know that the first commercially successful punk band was the Sex Pistols? Then came groups like Black Flag, Husker Du, and Bad Brains. Punk was invented in Britain in the mid Seventies. The first American punk started in a New York club called CBGB's. CBGB's would attract a crowd of about 500 with its Sunday-afternoon hard-core matinees. The concerts would be over by a reasonable time so kids could get home to eat dinner with their parents. In this paper we will take a look at some history and aspects of punk rock over the years. Slam Dancing Slam dancing has been popular through the history of punk. You may have heard of called "mashing" or "stage diving." Mashing is just a big game of bumper cars like you played when you were a kid. I think Natalie Jacobson who is dating the lead singer of "Murphy's Law" describes stage diving best when says, "It's like diving into a human carpet. Something like the old kids' trust game. Just my way of getting into it. Gospel people got their thing, I got mine."1 Politics Some punks consider themselves Nazis', or are concerned with issues like peace, racism, and nuclear war. Most punk is against parental, musical, and political authorities. On the other hand some isn't. Bob Mould of Husker Du talks about politics quite frequently in his songs. I don't write about politics because I'm not an expert. Some bands find it very necessary to claim they're politically relevant when in actuality they don't know shit about politics. Not informing people is much better than misinforming people. We're sort of like reporters in a way. Reporters of our own mental state. Reporters of the state of the air. Consciousness. Of the day. We make personal statements.2 Friends Most punks that live in small towns have trouble making friends. They find it hard to relate to most people. Sixteen- year-old Becca Levine finds it hard to make friends in her small town. She comes from a family of divorced parents that never have understood her. Her mother thinks it's just a phase she's going through. As Becca Quotes, "Parents around here treat me like I'm kind of weird."3 She has met someone from New York City that understands her. She meets with him at concerts at clubs like the Ritz or CBGB's. She met someone else also. Someone about 20 minutes away from her hometown who wrote an ad in a national magazine looking for someone to associate with that would understand him. He got a lot of responses, but when he saw the letter from Becca he called her right up. They met for the first time at a Hard-Core show in New York City. But still no one in her hometown understands her. Fitting in with the New York hard-core scene is one of her goals. Clothing Punk has its very own unique style. Although punk sports hard edges, bright colors, shaved heads, leather jackets, Mohawks, and army boots. You can't really tell if a person is a punk by the way they dress or do their hair. Wanda Draper, professor of psychiatry and behavioral sciences at the University of Oklahoma says, "We need to look at their reactions and responses to what goes on around them in everyday life. When we know that this is a fad-that it is an effort to be a part of the 'group'-we can usually relax."4 Development of Punk Through the years some punk has had influences from country to the Grateful Dead. Some of this may not even be punk at all. Take Rancid's song "Time Bomb" off their latest album, "...And Out Come the Wolves"5 for instance. It is their rendition of Reggae. Most punk groups don't make much money at all. Once in a while a punk group will hit it big time but that is very rare. Paul Westerbert, lead singer of the Replacements quotes, "We are the hungriest band I've ever seen. We get in the van and drive to a town, play, stay at a friend's house. Wake up when they throw us out. Drive the rest of the day. Play the next night. We get fifteen dollars a day. And when we're home, we don't get nothing. We're way in debt. We own a van, it breaks down, and you know when you play that the gig money goes to pay for the broken- down van. We're used to it.6 Relation Punk is also related to Hard-Core and Ska. Hard-Core is usually heavier and more upbeat the regular punk. Ska

The Power of the Declaration essays

The Power of the Declaration essays Power and The Declaration of Independence There are many abstractions in the Declaration of Independence. These abstractions such as: rights, freedom, liberty and happiness have become the foundations of American society and have helped to shape the American Identity. Power, another abstraction that reoccurs in all the major parts of the Declaration of Independence plays an equally important role in shaping American Identity. One forgets the abstraction of power, because it appears in relation to other institutions: the legislature, the King, the earth, and the military. The abstraction of power sets the tone of the Declaration, and shapes the colonists conception of government and society. Power in the Declaration of Independence flows from distinct bodies within society such as the King, the legislature, the military, and the colonists. The English Dictionary defines power as, the ability to do or effect something or anything, or to act upon a person or thing. Throughout the ages according to the dictionary the word power has connoted similar meanings. In 1470 the word power meant to have strength and the ability to do something. Nearly three hundred years later in 1785 the word power carried the same meaning of control, strength, and force, power to produce an effect, supposes power not to produce it; otherwise it is not power but necessity. This definition explains how the power of government and social institutions rests in their ability to command people, rocks, colonies to do something they otherwise would not do. To make people pay taxes. To make the rocks form into a fence. To make the colonists honor the king. The colonialists adopt this interpretation of power. They see power as a cruel force that has wedded them to a king who has a history of repeated injuries and usurpations. The framers of t he Declaration of Independence also believe that po...

Supply Chain Managment Essay Example | Topics and Well Written Essays - 1000 words

Supply Chain Managment - Essay Example The environmental changes have given rise to problems such as uncertain climatic changes that threaten the existence of all life forms. The Mileage calculator introduced a new parameter of monitoring the addition of pollution in the environment. In the mean time, by utilizing an unbroken supply chain with quality and cost effectiveness, the supermarket suppliers develop new supply chains from farm lands to the supermarket with innovation and new strategic allies. These supply lines some times use airplanes, some times trains and of course all of them use the road routes. For example, The Netherlands is the fourth biggest European Union exporter of fresh fruits. The largest export includes grapes 16%, apple 15% and orange 9% (CBI, 2005), Recommendations to Corporate Strategists As a consultant to the corporate strategists of the fruit and vegetable supermarket I recommend that the corporate should not compromise on the quality of the products at any cost. Secondly, it has to take step s to offer the best price to their customers. Thirdly, the environment sustainability issue should also be a major concern for the corporate. The quality of the product should be maintained within the over all cost, no matter from where the products get imported. As far as the millage calculator is concerned, most of the time there are no other solutions to use means of transportation like buses, trains, and air planes to transport fresh products to the customers. The cost (in terms of cash, environmental sustainability, labor and sometimes the quality) does not rely upon the nearest available products in comparison to fresh products from far places. Here the question arises that how to maintain the affordable cost for the customers... This paper approves that the earth is facing new challenges in the form of global warming, toxic rains, earthquakes, floods, melting of icebergs and big typhoons as well as cyclones and hurricanes. The environmental changes have given rise to problems such as uncertain climatic changes that threaten the existence of all life forms. The Mileage calculator introduced a new parameter of monitoring the addition of pollution in the environment. In the mean time, by utilizing an unbroken supply chain with quality and cost effectiveness, the supermarket suppliers develop new supply chains from farm lands to the supermarket with innovation and new strategic allies. The quality of the product should be maintained within the over all cost, no matter from where the products get imported. As far as the millage calculator is concerned, most of the time there are no other solutions to use means of transportation like buses, trains, and air planes to transport fresh products to the customers. The c ost does not rely upon the nearest available products in comparison to fresh products from far places. This essay comes to the conclusion that according to the corporate strategy the corporation should take care about the performance in terms of 'ethical' and 'cost' bases. The corporation should be very clear about their target customers with respect to their choice. If customers do not compromise on cost and compromise on quality then definitely it should not be your target.

Play, Games, and Sport Assignment Example | Topics and Well Written Essays - 500 words

Play, Games, and Sport - Assignment Example Some games were restricted to men other to women while others were open to all genders which included the young and the old in the society (Greenough, 45-67). Traditionally, history suggests that Native American games were inseparable from their religions according to history of their religion they create stories which mostly involved contests between two opposing twin gods which were armed with clubs bow and arrows. Hence they used these games as a replay of the stories told that offered recreation and also gambling opportunity. These games were divided into two categories where there existed chance and skills games or dexterity the community used this games not only for the young generation’s amusement but also a venue where they could learn, gain improve skills and also sharpen their senses. The winners who won these games were highly respected in the tribe. Traditionally, Native Americans are believed to the inventors of most games and sports which included lacrosse. Team games, which the young played always taught cooperation and also encouraged social interaction within tribes and also with other tribes (Krech,107-110). Among those games played by the Native Americans was lacrosse also called tewaarathon, the little brother of war or even be gateway depending on the given tribe. However, these games have seen some improvements, but it is still played even today. Lacrosse developed from AD1100 WHICH WAS played by 100- 1,000 men on a field that stretched from 500 meters to 3kilometrles long it lasted from sunrise to sundown which would even take two to three days this game was invented and played as part of ceremonial ritual that was used to symbolize warfare to give gratitude and thanks to the creator (Krech, 107-110). The players who took part were informed of warriors with the aim of bringing glory and honor to the tribes as well as

Art History Essay Example | Topics and Well Written Essays - 1000 words - 8

Art History - Essay Example He incorporated classical elements such as round arches instead of the common pointed ones resulting to fully-scaled figures. These figures were relied in formation of compositions in Roman. Later, Glovanni, Pisano’s son, introduced a contrasting version of art by arranging figures loosely and dynamically creating excitement in the evolving art motion (Kleiner, 23-30). Painting architecture during ancient Italy patronage system was the influence by the fall of Constantinople in 1204. One of the leading painters, Bonaventura used oil to paint on wood focusing on church figures such as saints. Biblical narratives were a great source of influence in painting which led to the construction of churches in the 13th century. This led to development of laypersons in the 14th and 15th century who dedicated themselves to strict religious observance (Kleiner, 37-40). Between 14th and 16th century training to become a formal artist became a necessity through which an individual acquired membership in the appropriate guild. Humanist and artist Leon Battista Alberti set the rules governing the art of painting. Pietro Lorenzetti contribution pictorial realism in 14th century incepted a new feature in arts. Flemish painters were evolving new methods in oil painting that permitted them to paint human beings and substance in amazingly life like way, using palettes of vivacious descriptions. Prior to this, arts were religious in character. Structural innovation, involving careful inspection of what lay directly before an artist eye started taking place. Artists introduced illusionistic representation in fashion and visual form all societal concerns (Kleiner, 43-57). Inclusion of secular them in art work was a reflection of the evolving societal. With seclusion of laymen and women strictly following religious doctrines, other societal members relied on artwork to express their views on religion and the world (Kleiner, 60-77). Throughout the fourteenth,

What Constitutes True Friendship Philosophy Essay

What Constitutes True Friendship Philosophy Essay Why, according to Aristotle, is the true friend such a rare area and abiding benefit. What constitutes true friendship and how is it distinguished from other forms. Why is the true friend necessary for the good life? Why is true happiness impossible without the true friend? Evaluate Aristotles argument: does his ideal of friendship continue a measure, or, if it is an impossible standard, should we toss it out as unrealistic? What then, in your view, constitutes a true friend? How does Aristotelian phillia differ from (and is similar to) Platonic eros? In his book, Aristotle has conceived an ethical theory which aims towards providing a better and more improved way of life. Like Socrates and Plato, Aristotle too believes that virtues play an essential role in order to achieve the goal of a well-lived life. However, while acknowledging this claim, Aristotle differs from the pre-requisite that of training in the sciences and meta-physics as suggested by both Socrates and Plato. Aristotle instead believes that the virtues are a product of rational, social and emotional skills. He further states that aspects such as friendship, virtue, honour, wealth and pleasure are essential for this purpose. Thus comes into play the factor of a virtuous character, who according to him aims and seeks for the good by which he refers to the highest good of happiness. Thus we desire for the best in order to live well. Living well and happiness are synonymous concepts for him. For Aristotle, human being is different from all other creatures present on this planet, and is the smartest among them all since he is the only creature that possesses the ability to reason his thoughts and hence is rational in nature. Thus he is compelled to exercise his reason with virtue so as to achieve the state of happiness. For him to be able to exercise this reason with virtue, Aristotle points out the necessity to discipline eros present within man. This disciplining begins at a young age with the acquisition of good habits. Yet the exercise of virtue in the right amount that is by means of securing the golden mean can only be achieved with the help of a true friend. Aristotle then undertakes the job of describing and defining the types of friendships that exist. He thus classified them into three categories: (1) friendship of utility: under this form of friendship, the basis is laid down on account of the utility to be derived by each individual. Thus here, the whole relation is based on sort of a precondition where a person is to be used only for the benefit of oneself. Thus one remains friends for just as long as they continue to derive their benefits from engaging in this kind of a relationship. Any individual at any point of time is not capable of managing everything on his own throughout his life. At this point he does feel the need for someone that could help him out in situations which if were to be handled alone, would turn out to be complete dead-ends. If we go to see, most of the relationships in todays world have such kind definitely present at any given point in time. Well in defence of such relationships, I would like to say that no t every individual is capable of handling everything by himself. He most certainly is not a perfect individual. He will need the help of some other individual, a person who makes up for the qualities that he lacks and thus is able to fulfil his needs. So obviously at such times, he cannot go up to a stranger to ask him for help. At such points it is absolutely necessary to have some contacts, these contacts usually are more similar to acquaintances, yet they do stand up for you. And as Aristotle has defined, the longevity of this kind of a friendship is very short as when we finish seeking utility, we no longer have any interest or rather any incentive left that provokes us to continue with this relationship. This to some extent is true because a certain individual is capable of providing only so much utility that after a point he can do nothing more. Also, it is very easy to be replaced by someone else for the same purposes, for the seeker has no real personal attachment to the per son who fulfils his utility. Hence the duration of this kind of a friendship is not long since it exists on nothing more than a give and take relationship. (2) Friendship of pleasure: this kind of friendship as well is not really different from the one that we have discussed above. The differences lie in the factors such as it (friendship) is seen to develop during the young days of any individuals life span since as we can observe, with the process of aging, one cannot derive the same pleasure that was attained at an earlier date. When we observe old people, their friendships usually have the possibility of changing their nature from that of a friendship of pleasure to friendship of utility as they have nothing to gain at their age. They are concerned about the company and help required with carrying out day to day activities as they cannot perform them the same way as before. When concerned with lovers, their pleasure is usually constrained to the youth of the body, once that has been taken away, there is nothing more that remains. Unless the people involved have grown fond of each others company, otherwise, even this kind of friendsh ip does not have a great longevity. (3) Friendship of character: This is the type of friendship that Aristotle is interested in. While talking about the friends that will help any man achieve his golden mean that would in turn lead him towards the acquisition of happiness by means of living well, he refers to the true friends who will help him in this process. He describes them as nothing like what has been described in the above two categories. In fact, the true friends maintain this relationship with each other because they enjoy each others company in the truest sense. They aim for the well-being of each other. For whatever they intend to do, their actions always aim for the best interests of their friend. He thus describes such a friendship as rare as it is permanent in nature, they are always in close proximity, and there are no selfish purposes included on part of any friend in such a friendship. He also states that there exists this very important feature of reciprocal good will that is very distinct and is spec ific only to the third category of friendship. In discussing the characteristics that help define this type of friendship, Aristotle does not deny the fact that among the other things that are fulfilled by such friends, it is very much possible that they can derive some utility in such a relationship and that the occurrence of such an event is foreseeable but he further goes on to specify that this event is justifiable only as long as while seeking utility, the friends continue to enjoy each others company. Thus according to Aristotle, all these aspects of such a friend distinguish them from the other categories. According to Aristotle, it is this friend that helps you to make the distinction between a lot of things and helps you to reason with virtue and act in accordance with it. It is this friend that helps you to obtain the clarity of thought that is required while making any decisions. Thus as Aristotle has mentioned earlier that in order to lead a well-lived life which leads us towards happiness, mans eros needs to be disciplined. This friend helps in the disciplining after the first task of acquisition of good habits has been achieved. We often find our elders mentioning quotes like one rotten apple spoils the whole barrel and advising us on the importance of keeping good friends by our side always. I think that this has a great deal of significance because once we step out of the protected boundaries of our homes, leave the ever caring and nurturing warmth of our loved ones to face the real world, our primary socializing group does not hold the same effect on the way we go on to shape our selves after this point. There is no denying that they do continue to influence us in the way we think but the level of influence begins to diminish with the growth in the amount of exposure that we continually gain with time. As human beings, we can never really run away from the influence of the people around us and hence at such a point, it becomes very crucial to stay in good company. Hence I feel Aristotle emphasises so much on the need to have a true friend in ones life. Because after all, we are constantly being groomed and guided by the people in our company and in a way we allow them to shape us and guide us in our future endeavours. I believe that every person must have noticed the change in himself over a period of time. As with time, a lot of things change around us, the most important factor among which is the situation that we are in. In this process, we do gain and lose the company of the friends that we have around us resulting from which we realise, in the abse nce of the certain people in our life, we end up reacting differently each time. Thus with this change in the people around us, we constantly allow ourselves to be motivated or affected by somebodys presence and their influence on us. I assume that as a result of this facet of life, which is a common factor for every human being despite the differences that they are born with, that Aristotle stresses on the need for this one true friend. The true friend in ones life will continue to be the one steady factor that will continue to stay constant despite all the changes and this is something that is essential. The one true friend who loves our company and believes in doing what is best for you. Part of being a part of a friendship that is true is that the two friends involved, are both good people. Thus all that they do together is virtuous in nature this why their friendship is pleasant and beneficial. And since virtue is something that is stable, this friendship can stand strong against the tides of time. For bad company has often lead people down the wrong path and looking at the fact that how easy it is to find friends that belong in the first two categories, the true friend is very much rare and an abiding benefi t. Also to add to the reasons why true friendship is rare, it takes time and effort to build a relationship and maintain it at the same time. This is not something which is possible to do with a lot of people. It is only with the selected few that such a bond can be established. Apart from the characteristics of the types of friendships that have been discussed before, there are a few more things that help distinguish true friendship from that of the other two types. One of the most obvious reasons is that the bad or the evil people cannot participate in a friendship that is long lasting owning to their nature. As according to Aristotle, the necessary component of a true friendship is that it requires the two people involved to be virtuous in nature. These bad individuals are then found to be indulging in a friendship that is based on the utility or pleasure aspect. Whereas true friends continue to maintain their bond because they are a part of it for the sake of each other and that their friendship is not obligated to any sort of qualifications or pre requisites. True friendship does not subject itself to the inequality among the two friends for it mainly rests on liking the other and not on being liked. Being liked is a pre requisite that is in place for t he other types of friendships described by Aristotle as these friendships cannot possibly tolerate any form of inequality between the friends (inequality with regards to wealth, status, virtues, etc.) as such friendships basically concentrate on being liked than liking the other. Hence friendship between such individuals is unlikely to develop or last for that matter. They mainly thrive on being liked by the one who is in the inferior position, as most individuals prefer being flattered by someone and they often regard this flattery as the confirmation of their own opinion about themselves. Thus they enjoy being liked for the sake of themselves and not for that of someone else. True friends, according to Aristotle can never engage in erroneous activities as they have each other. Whereas the bad friends only enjoy each others company as long as they can benefit from the evil habits of their friends. The friendship between such people is based on the utility of their contrary interest s and these are some more aspects that distinguish the true friends from the other types. The true friends believe in loving unconditionally rather than being loved since it is the virtue that characterizes them and as a result of this very reason that the friendship between two unequal individuals can be successful. The whole aspect of loving unconditionally added with reciprocal desire is what helps eliminate the inequality between them and helps them to become equal. They indulge in sort of a competition which is healthy in nature. Since true friends always indulge in doing things that result in acts of good will, this competition is certainly healthy in nature also for other reasons such as when friends indulge in such competitions, they do not do so for the sake of winning rather they indulge in it so as to compel their friend to succeed and excel beyond their capacities with a view to perfect themselves. They engage themselves in an act of pushing each other to their respective limits, which is reciprocal in nature, as they desire for the well-being of one another. Thus this resultant perfection gets them closer towards the ultimate goal of happiness and it is only a true friend who helps one proceed towards it. Hence the need for the true friend is advocated by Aristotle in leading a good life. To conclude, I would like to say that though Aristotle conceptions may be too idealistic in certain aspects, yet they are not completely inapplicable. Even today, in a world that is drastically different from what existed back then, the rules, characteristics and the basic mechanism put forth by him still is righteously applicable to all in some form of the other. Putting in my personal opinion, I think this text has helped me gain certain insights regarding situations in my life and I must admit that I have found answers and peace of mind that none of the other people who tried to counsel me, could provide me with.

ONE ATTEMPT :: Essays Papers

ONE ATTEMPT 1. Every one of us strives to be better, accomplish more, and do it faster. Some of us may be occasionally disappointed, but it is whether or not we choose to try again that determines our success. John Steinbeck gives us one example of this in â€Å"Chrysanthemums†. [."] The theme of this story is that although most people are eager to do more and try different things with their life, not everyone will succeed with this attempt. [This is not a very fruitful thesis -- the story deals primarily with a problem of just women, not "most people."] 2. To characterize Elisa’s lifestyle, one would conclude that she wants more out of her life than what she has now. For example, she wants more responsibility and wishes to help with the orchard, and she tries to prove this to her husband by saying, â€Å"Maybe I could do it, too†. She also finds the peddler’s traveling lifestyle appealing. She states this by saying more than once, â€Å"That would be a nice way to live†. 3. Elisa also wants more love than what she has now. The first example of her need for more love is her sexual advances [hmmm] toward the peddler. Elisa is explaining the night sky, but she is also being very sexual by stating: â€Å"I’ve never lived as you do, but I know what you mean. When the night is dark-why, the stars are sharp-pointed, and there’s quiet. Why, you rise up and up! Every pointed star gets driven into your body. It’s like that. Hot and sharp and–lovely.† [The preceding quotation should be analyzed in more detail. It is certainly interesting, but why, if she is, is she being so sexual in her comments to an old peddlar?] Elisa is also sexual towards the peddler by saying; â€Å"I could show you what a woman might do†. [She doesn't mean it that way -- she means that a woman can do more than men think they can do.] 4. A second example of her need for love is she near nagging her husband for a polite compliment. She does this by asking several times, â€Å"What do you mean by ‘nice’?

Media corruption †other side of the coin Essay

‘Whoever controls the media, controls the mind† In today’s world, the media has become a necessity just like food, clothing, and shelter. The media was ideally designed to be impartial and unbiased – to provide information, news, and knowledge that is objective and socially constructive. Unfortunately, in recent times, because of its money making approach the media has adopted a biased approach that is benefitting politicians and the corporate leaders. Sadly, the media is known to be resorting to â€Å"Paid News† – news that is published or broadcasted to benefit a certain class of people who have huge economic power and who wield that economic power to buy â€Å"The News† in their favor. The viewer’s/readers of such â€Å"Paid News† are at such a loss with this information that lacks integrity and they can be easily misled. Actually the readers/viewers are deceived in to believing â€Å"Paid News† which is indeed misrepresentation of the truth.. Article 19 of the Constitution of India â€Å"Reach to the public† – states the right to freedom of speech and expression to media .When this freedom is misused by the media, it becomes a prime reason for media corruption, and more or less the willingness of Indian Govt. to eradicate this problem. The objective of this paper is to highlight the roots and remedies of media-corruption in India and to create awareness about the general public about the distortion of news/information by the media – to enable viewers to discern, and not be uninformed consumers of the news. Key words: necessary, money making approach, freedom.

Tarjeta NEXUS para frontera Estados Unidos y Canadá

Tarjeta NEXUS para frontera Estados Unidos y Canad Nexus es una tarjeta que permite el trnsito acelerado de control migratorio y aduanero entre Estados Unidos y Canad. Forma parte de un grupo de alternativas de cruce de aduanas conocido como Programa de Viajeros de Confianza. La tarjeta NEXUS es vlida en todas las fronteras terrestres entre Estados Unidos y Canad, pero adems, tiene  otras ventajas. Por ejemplo, puede ser utilizada en  vuelos domà ©sticos dentro de los Estados Unidos e incluso algunos  internacionales que se especifican ms abajo. e incluso en el pase de la frontera terrestre entre los Estados Unidos y Mà ©xico. En este artà ­culo se informa sobre quià ©n puede beneficiarse de NEXUS, cà ³mo se solicita y cules son sus ventajas. Quià ©nes pueden solicitar la tarjeta NEXUS Ciudadanos americanosCanadiensesResidentes permanentes legales de USA o de Canad siempre y cuando lleven residiendo en dichos paà ­ses por un mà ­nimo de tres aà ±os. Cà ³mo se solicita la tarjeta NEXUS En Estados Unidos, aplicar por internet en la pgina oficial del Servicio de Proteccià ³n de Fronteras y Aduanas (CBP, por sus siglas en inglà ©s). Se trata de una pgina que se llama GOES, que son las iniciales del programa Global Online Enrollment System. La pgina, que puede elegirse en los idiomas inglà ©s, espaà ±ol, o francà ©s, da la opcià ³n de enrolarse en cualquiera de los Programas de Viajeros de Confianza, es decir, no solo para NEXUS sino tambià ©n para Global Entry (avià ³n), FAST o SENTRI (terrestre en frontera con Mà ©xico). Debe elegirse y hacer click sobre el icono del programa de interà ©s, en este caso NEXUS. Sin embargo, si es la primera vez que se ingresa al sistema, es necesario crear una cuenta. Para ello, mover el cursor de la pgina hacia abajo y proceder a donde dice Inscripcià ³n de Nuevos Usuarios al GOES. En el caso de familias, debe crearse una cuenta por cada persona. Es decir, incluso los nià ±os pequeà ±os deben tener su propia cuenta. Adems, pagar la cuota de $50 (excepto los menores de 18 aà ±os, para los que es gratis) y enviar copia de los documentos que se solicitan. Durante el proceso de llenado del formulario es posible editar las respuestas. Sin embargo, una vez certificadas ya no ser posible realizar ningà ºn cambio. En estos casos, en el momento de la entrevista es cuando se debe notificar todo tipo de errores que pueda contener el formulario. Ser necesario pasar un examen de historial delictivo y una entrevista en persona. La aplicacià ³n deber ser aprobada conjuntamente por las autoridades de Canad y de los Estados Unidos. Ser rechazada si la persona ha sido condenada por algà ºn delito o ha cometido alguna infraccià ³n migratoria o aduanera en viajes anteriores o si por cualquier razà ³n la persona no es elegible y/o admisible a los Estados Unidos. Si la solicitud es aprobada condicionalmente, el solicitante deber proceder a cerrar una cita. En el caso de familias, debe cerrarse una cita por cada miembro de la unidad familiar que est pidiendo la tarjeta NEXUS. Si despuà ©s de la entrevista la tarjeta es aprobada, se recibir por correo en unos pocos dà ­as. Es vlida por cinco aà ±os y debe renovarse seis meses antes de su expiracià ³n.   Cules son los beneficios de tener una tarjeta NEXUS Un pase ms rpido en los controles de aduanas. Las reglas son distintas segà ºn los casos: Frontera terrestre entre Estados Unidos y Canad: Los titulares de una tarjeta NEXUS pueden utilizar las filas asà ­ expresamente seà ±aladas pero sà ³lo si se dan dos condiciones: Todos los ocupantes del auto, incluidos los nià ±os, deben tener su propia tarjeta.No ingresar ningà ºn artà ­culo prohibido para traer o que obligue a una declaracià ³n de bienes en Estados Unidos, por ejemplo, una cantidad elevada de dinero sin declarar. Por el contrario, sà ­ que se pueden traer mascotas e, incluso, piezas de caza. Pero es necesario respetar las reglas. Los residentes permanentes legales deben llevar con ellos, adems de la tarjeta NEXUS, la de residencia (green card) y sus pasaportes ya que se puede pedir que los muestre. Frontera terrestre entre Estados Unidos y Mà ©xico: Los titulares de una tarjeta NEXUS que viajan en un auto registrado y aprobado pueden ingresar a USA desde Mà ©xico utilizando las là ­neas seà ±aladas como SENTRI, disminuyendo asà ­ los tiempos de espera para los cruces por los controles migratorios internacionales. Si el auto no est aprobado, los ciudadanos americanos pueden ingresar de regreso al paà ­s utilizando la tarjeta NEXUS y colocndose en cualquiera de las filas que no es SENTRI. Ingreso a Estados Unidos por aeropuerto: Los ciudadanos americanos que tienen una tarjeta NEXUS pueden acelerar su ingreso al paà ­s dirigià ©ndose en el aeropuerto a los kioskos del programa Global Entry. Tienen que llevar sus pasaportes estadounidenses (y tambià ©n es aconsejable que lleven la tarjeta). Adems los ciudadanos americanos pueden ingresar por un aeropuerto a Estados Unidos utilizando la NEXUS como su à ºnica identificacià ³n cuando el punto de origen del vuelo sea un o de los siguientes aeropuertos canadienses: Robert L. Stanfield (Halifax)Pierre Elliott Trudeau (Montreal)Macdonald-Carter (Ottawa)Pearson (Toronton)James Armstrong Richardson (Winnipeg)Calgary International AirportEdmonton International AirportVancouver International Airport Vuelos domà ©sticos dentro de Estados Unidos Los titulares de la NEXUS pueden utilizar el programa TSA PreCheck.  Su fin es acelerar el paso por control de seguridad. Para ello antes de volar deben introducir su Pass ID Custom and Border Protection/trusted traveler number que aparece en su tarjeta en la reserva de su vuelo. Y si tienen una cuenta de viajero frecuente, en la misma.   De interà ©s y recomendacià ³n Por à ºltimo, la tarjeta Nexus puede ser realmente à ºtil a los estudiantes canadienses que cursan sus estudios en los Estados Unidos en instituciones cercanas a la frontera y continà ºan teniendo su residencia en Canad. Seà ±alar, adems, que para estos casos especà ­ficos existe la visa F-3, que es poco conocida, pero existe y ofrece sus ventajas frente a la tà ­pica F-1. Este artà ­culo es meramente informativo. No es asistencia legal.

ASTHMA PREVALENCE AND INCIDENCE Essay Example

ASTHMA PREVALENCE AND INCIDENCE Essay Example ASTHMA PREVALENCE AND INCIDENCE Essay ASTHMA PREVALENCE AND INCIDENCE Essay This brief critically considers the empirical literature on asthma attention. Emphasis is on UK surveies although research from the USA ( and other states ) is besides considered. It is argued that both environmental and familial factors are implicated in asthma oncoming, based on epidemiological grounds. Deficits in attention proviso persist: these spreads in attention may be attributable to a broad scope of modifiable factors, including unsatisfactory wellness professional ( GP, nurses ) input, limited usage of attention programs, and patient unknowingness. Overall, nevertheless, conclusive illations about asthma attention proviso are hampered by: A preponderance of retrospective/correlational surveies, and a dearth of randomised control tests, which demonstrate causality ; A dearth of research on peculiar spreads in asthma attention ; Failure to account for third-variable moderator effects. The Office for National Statistics ( 2004 ) publishes comprehensive statistics on asthma-related mortality, morbidity, intervention, and attention, collapsed by demographic classs. Data is collected from the General Practice Research Database ( GPRD ) . Issues addressed include mortality, prevalence, clip tendencies, patients confer withing general pattern, incidence of acute asthma, and hospital inmate admittances. Research suggests that wellness attention suppliers frequently fail to hold on the precise standards for naming asthma, whether mild or terrible ( e.g. Buford, 2005 ) . Severe asthma is frequently defined based on pneumonic map measurings, such as forced expiratory volume in 1 2nd, and hospitalization. However, neither of these indexs faithfully predicts asthma badness ( Eisner et al, 2005 ) . Eisner et Al ( 2005 ) evaluated the efficaciousness of a method for placing a cohort of grownups with terrible asthma based on recent admittances to an intensive attention unit ( ICU ) for asthma. Four hundred grownups with terrible asthma enrolled at 17 Northern Carolina infirmaries were surveyed. A control group of patients hospitalised without ICU unit admittance was besides recruited. The survey examined whether admittance to an ICU unit is in itself a dependable index of asthma badness. Asthma patients with a recent ICU admittance generated higher asthma tonss ( based on the frequence of current asthma symptoms, usage of steroids and other medicines, and history of hospitalisations/intubations ) , and poorer quality of life, were more likely to hold been hospitalised, visited an asthma specializer in the old 12 months, been in an asthma-related exigency section, and received inhaled corticoids in the past twelvemonth. Data analysis controlled cardinal background variables ( e.g. demographic factors ) , increasing assurance in the dependability of the findings. However, this survey was based on quasi-experimental design and hence may be confounded by trying prejudice. Tendencies in one-year rates of primary attention audiences, mortality, and hospital visits/admissions were monitored for kids under 5 old ages and 5-14 twelvemonth olds. For kids aged lt ; 5, hebdomadally general pattern audiences rose during the early 1990s, peaked around 1993 ( circa 150/100,000 kids ) , so began to worsen. This lessening persisted through the 1990s, falling to about 70/100,000 by 2000. Annual infirmary admittances have besides declined through the 1990s, falling from circa 100/10,000 in 1990 to about 50/10,000 by 2000. By contrast the figure of patients treated for asthma has increased marginally albeit year-to-year alteration may be undistinguished. Mortality rates decreased steadily, from around 10 million in the sixtiess to about 2 million the twelvemonth 2000. For 5-14 twelvemonth olds, hebdomadal general pattern visits rose in the early 1990s ( circa 70/100,000 in 1990 ) , showed a fluctuating form through the mid 1990s, but has declined steadily since 1997 ( about 50/100,000 by 2000 ) . The figure of patients treated yearly for asthma has risen easy but steadily, although this addition seemed to level out by the mid/late1990s. Both mortality rates have dropped steadily since the early 1990s, from about 14 million in 1990 to circa 2 million by 2000. Annual infirmary admittances has besides fallen steadily, from merely under 30/10,000 in 1990 to about 15/10,000 by 2000. These forms suggest an addition in self-management ( e.g. action programs ) that obviates the demand to see a general pattern, and that asthma attention overall is holding the coveted consequence on mortality. The prevalence of wheezing and asthma in kids has by and large increased during the last 40 old ages. Although there is a dearth of dependable national statistics, informations is available from specific parts of the UK, notably Leicester, Sheffield, and Aberdeen ( see Figure 1 ) . Figure 1Prevalence of Wheezing and Asthma in Children The prevalence of wheezing increased from 12 % ( 1990 ) to 26 % ( 1998 ) in Leicester, and from 17 % ( 1991 ) to 19 % ( 1999 ) in Sheffield. The prevalence of asthma showed a similar form in both metropoliss, lifting from 11 % ( 1990 ) to 18 % ( 1998 ) in Leicester, and from 18 % ( 1991 ) to 30 % ( 1999 ) in Sheffield. Wheezing incidence rates for Aberdeen increased from 10 % ( 1964 ) , to 20 % ( 1989 ) , 25 % ( 1994 ) , and 28 % ( 1991 ) . Datas from national birth cohorts suggests a crisp addition in the mean hebdomadal GP audiences for hay fever/allergic coryza from 1991 to 1992. The rates rose from circa 13/100,000 ( 0-4 twelvemonth olds ) and 40/100,000 ( 5-14 old ages olds ) in 1991 to about 25/100,000 ( 0-4 twelvemonth olds ) and 76/100,000 ( 5-14 twelvemonth olds ) as 1992 approached. Trends later dropped off somewhat but so started to demo an addition once more around 1998. By the twelvemonth 2000 the figures were approximately 20/100,000 ( 0-4 twelvemonth olds ) , and 56/100,000 ( 5-14 twelvemonth olds ) . Datas from a nationally representative sample of schools across the state suggests that the prevalence of asthma was reasonably even across different parts. However, Data for England suggests a higher prevalence outside large metropoliss. The greatest proportions of wheezing was found in the South West, while the highest proportion of asthma instances was found in East Anglia and Oxford ( see Figure 2 ) . Figure 2Regions with Highest Proportions ( % ) of Children Reporting Wheezing and Asthma In a recent Annual Report, Asthma UK ( 2003/2004 ) noted that one kid in 10 has asthma and a kid is admitted to hospital every 18 proceedingss due to an asthma onslaught. Over 600 transcripts ofAsthma in the Under Fivessare downloaded from the UK Asthma website monthly and on mean every schoolroom in the UK has at least 3 kids with asthma. The impact of acute asthma can be enfeebling. Around 5.2 million people in Britain are soon being treated for asthma, and asthma prevention/care costs the NHS on mean about ?900 ( i.e. ?889 ) million per twelvemonth. GPs across the state dainty over 14,000 new episodes of asthma each hebdomad, and UK Asthma met about 25,000 petitions for wellness publicity paperss and other stuffs. Approximately 40 % of workers who have asthma find that working really exacerbates their asthma, and 1 in 5 wheezing people feel excluded from countries of the workplace in which people smoke. Over 12.7 million on the job yearss in the UK are lost as a consequence of asthma, and it is estimated that the one-year cost of asthma to the economic system is ?2.3 billion. Asthma UK besides states that 82 % of people who are wheezing find that inactive smoke triggers their asthma, and 19 % of people with asthma indicate that their medical status makes it hard for them to play with kids in their household. One in 3 kids has had their everyday day-to-day activities disrupted due to asthma and 39 % of wheezing people are severely affected by traffic exhausts ( which halt them exerting ) . About 500,000 people have asthma that is really hard to command. In 2003/2004 over 90 research workers worked on Asthma UK-funded undertakings and, Asthma UK spent ?2.5 million on asthma-related research. The group funded/is funding 63 research undertakings. These statistics paint a instead black image of asthma prevalence, incidence, and the effects on people’s lives. Numerous epidemiological surveies have been published that reference the etiology of asthma in population groups ( International Archives of Allergy A ; Immunology, 2000 ; Kitch et Al, 2000 ; Schweigert et Al, 2000 ; Tan, 2001 ; Court et al, 2002 ; Smyth, 2002 ; Weissman, 2002 ; Tan et Al, 2003 ; Wenzel, 2003 ; Gibson A ; Powell, 2004 ; Barnes, 2005 ; Pinto A ; Almeida, 2005 ) . Barnes ( 2005 ) considered grounds on the function of familial factors in opposition to atopic asthma, Studies which focus on the function of familial factors in opposition to tropical/parasitic diseases ( e.g. malaria ) convergence with familial associations found for asthma. It was concluded that familial factors might be implicated in the development of allergic unwellnesss. Pregnancy is thought to increase the chance of asthma onslaughts in approximately 4 % of all pregnant adult females. Beckmann ( 2006 ) assessed 18 pregnant adult females with asthma. The survey was based on a longitudinal design. Participants were recruited from local prenatal clinics and private endeavors, and enrolled during the first trimester. Patients kept a day-to-day log entering peak expiratory flow informations until bringing. Three peak-flow appraisals were recorded after which the best value was entered into the log. Asthma was diagnosed by a wellness professional. Participants were besides required to enter asthma symptoms, aggravations, medicines, and coffin nail usage. To increase engagement, topics were reminded by telephone to finish their log. Data analysis showed that peak expiratory flow ( PEF ) was variable as a map of peculiar trimesters. Peak air flow was highest during the 2nd trimester, with a statistically dependable difference between the 2nd and 3rd trimester. Unfortunately, the little sample size limits the generalisability of the findings. However, the survey was based on a longitudinal design, leting probationary causal illations. Schweigert et Al ( 2000 ) reviewed the literature on the function of industrial enzymes in occupational asthma and allergic reaction. Enzymes used by detersive fabrication companies ( e.g. amylases, cellulases ) are toxicologically benign, with mild annoyance effects on the organic structure. However, these enzymes do affected asthma and allergic reaction. Therefore, the industry is required to adhere to exposure guidelines for these enzymes. Kitch et Al ( 2000 ) considered literature on the histopathology of late oncoming of asthma ( i.e. onset in maturity ) , and whether allergic exposure and sensitiveness have the same impact on asthma development in maturity as they do in kids. Epidemiologic surveies suggest that the prevalence of asthma in older grownups aged 65years or more is between 4 % and 8 % . The unwellness appears to be more common in adult females, particularly those with a long history of smoke, and with respiratory symptoms ( e.g. cough, wheeze, shortness of breath ) . Asthma in maturity frequently developed before the age of 40, with maximal incidence happening about early childhood. Beyond the age of 20 old ages the incidence of asthma tends to stay stable through immature, middle-aged, and older maturity. Death rates in grownups are by and large lower than figures for kids ; â€Å"Mortality rates attributable to asthma among those aged between 55 and 59 old ages of age and 60 and 64 old ages of age were 2.8 and 4.2 severally, per 100,000 people, the highest rates among all age groups† ( p.387 ) . However, as grownups get older asthma is less and less likely to be identified as the chief cause of decease due to the increased incidence of other pathology. Epidemiologic research in Japan highlights a nexus with air pollution ( International Archives of Allergy A ; Immunology, 2000 ) . The prevalence of asthma among kindergarten and simple school kids has increased steadily since the early 1960s, lifting from 0.5-1.2 % between 1960 and 1969, to 1.2-4.5 % ( 1970-1979 ) , 1.7 % -6.8 % ( 1980-1989 ) , and 3.9-8.2 % ( 1990 onwards ) . By contrast, informations indicates small or no alteration in asthma prevalence amongst grownups. Figures range from 1.2 % in 1950-1959 to 1.2-4.0 % ( 1960-1969 ) , 0.9-5.0 % ( 1970-1979 ) , 0.5-3.1 % ( 1980-1989 ) the 1960s to 1.6-2.9 % ( 1990 onwards ) ( see Figure 3 ) . Figure 3Tendencies in Asthma Prevalence in Nipponese Children and Adults Asthma in Nipponese kids is more common amongst male childs than misss although this gender difference has diminished perceptibly since the sixtiess. Asthma normally appears in babyhood or early in childhood but has been known to get down across all age groups. Inherited ( familial ) temperaments to allergic reactions have been implicated in the oncoming of asthma. There is usually a strong correlativity between asthma oncoming and a household history of asthma. Overall, asthma-related mortality in Japan has decreased since the mid 1990s. Delaies in seeking intervention and rapid aggravation of symptoms have been strongly implicated in asthma mortality. Unfortunately, this article offers small information about the designs of surveies reviewed. Inferences sing the possible causes of asthma morbidity and mortality may be inconclusive if much of the grounds is derived from cohort surveies, instead than instance control surveies that more efficaciously extinguish alternate causes. The premenstrual period in adult females has been implicated in asthma aggravation. Tan ( 2001 ) reviews epidemiological literature proposing that female sex-steroid endocrines may be important in understanding the premenstrual-asthma nexus, albeit the available grounds is tenuous. The luteal stage of the catamenial rhythm is associated with airway redness and hyper-responsiveness, and hence may explicate asthma aggravation during the premenstrual stage. However, this addition in asthma badness can still be treated efficaciously utilizing the normal drugs. Surveies suggest that premenstrual asthma affects the rate of infirmary admittances – the bulk of grownups admitted are adult females, bespeaking that hormonal factors play an of import function. Other grounds suggested that exigency presentations increased before ovulation. It is suggested that unwritten prophylactic pills or gonadotrophin let go ofing endocrine parallels may be particularly effectual interventions. However, premenstrual asthma was seldom associated with serious mortality. Unfortunately, most of the surveies reviewed were retrospective and questionnaire based, and therefore capable to response prejudice. There was a dearth of randomised control tests, or imposter experiments that may allow causal illations. Court et Al ( 2002 ) considered the differentiation between atopic ( extrinsic ) asthma, common in younger people, and non-atopic ( intrinsic ) asthma, found largely in older groups. Additionally, they besides considered whether designation of asthma instances in epidemiological research should be based on a doctor’s diagnosing or self-reported asthma symptoms. About 25,000 people in England were surveyed. Data was collected sing whether participants had experienced wheezing in the past 12 months and/or had been diagnosed as wheezing by a physician. Peoples with atopic asthma were more likely to hold experienced wheeze and been diagnosed as wheezing in the yesteryear, compared with the non-atopic group. Logistic arrested development analysis showed that gender, societal category, smoking position, populating in an urban/rural country, and house dust mice ( HDM ) , were all hazard factors for the presence of wheeze both with ( age non important ) and without ( urban/rural country non important ) a diagnosing of asthma. Wheeze/asthma was more prevailing in adult females, younger people, lower societal categories, previous/current smoke, life in an urban country, and greater HDM IgE degrees. Smoking position, societal category, and age were all hazard factors for wheeze in both atopic and non-atopic instances. Gender was besides a hazard factor for atopic topics, and urban life for non-atopics. Other research has considered the epidemiology of terrible or ‘refractory’ asthma, which is instead less good understood compared with milder signifiers of asthma. Wenzel ( 2003 ) reviews grounds bespeaking that terrible asthma ( defined as asthmatics necessitating uninterrupted high-dose inhaled corticoids or unwritten corticoids for over half of the predating twelvemonth ) may account for circa ? 5 % of asthma instances. Datas from a big Australian-based survey, which has followed a big cohort of asthmatics for over three decennaries, implicates childhood pneumonic jobs with decreased lung map in maturity. Data suggests that over two-thirds of terrible asthmatics were afflicted with asthma in childhood. Other hazard factors implicated include familial mutants ( in the IL-4 cistron and IL-4 receptor ) , and environmental factors ( e.g. allergen, baccy exposure, house dust touch, cockroach and alternaria exposures ) , respiratory infections ( e.g. pathogens like chlamydia ) , fleshiness, gastroesophageal reflux disease, increased organic structure mass index, deficiency of attachment to corticosteroid governments, and hapless physiological response to medicine. Physiological factors are besides implicated, notably structural alterations in air passage responsiveness, redness of the peripheral parts of the lungs. Steroids are the chief signifier of intervention. Tan et Al ( 2003 ) demonstrated the function of respiratory infection in patients with terrible ( i.e. near fatal ) asthma, acute aggravations, or chronic clogging pneumonic unwellness ( COPD ) . Participants had all been diagnosed as wheezing by a doctor and were undergoing intervention. All showed grounds of forced expiratory volume in 1 2nd ( FEV1) addition of 200mL. COPD patients were enduring from chronic cough and dyspnoea, with a predicted FEV1% 50 % , with no ?-agonist reversibility. Near fatal instances were patients undergoing ventilatory support in the intensive attention unit of a infirmary ( National University Hospital and Alexandria Hospital, Singapore ) as a consequence of a terrible aggravation. Acute asthma topics were characterised by non-improvement following disposal of ?-agonists, and/or terrible aggravation judging from clinical/blood informations. Analysis showed that near-fatal instances were the least likely to hold the grippe A + grippe B virus, but the most prone to hold adenovirus and picornavirus, compared with the other two groups ( see Figure 4 ) . This suggests that viral infection may be a hazard factor for terrible asthma. However, due to trying size/bias ( n= 68 ) , and failure to command for cardinal background variables ( e.g. asthma history, smoking history, anterior medicine usage, and outpatient spirometry ) , the findings can be considered probationary. Figure 4Spectrum of Virus Infection Across Patient Groups Smyth ( 2002 ) reviewed epidemiological surveies on asthma in the UK, and worldwide. The figure of new asthma instances seen by GPs has increased perceptibly since the mid 1970s. However, asthma incidence has tended to diminish since the early 1990s, consistent with informations from the Office for National Statistics ( 2004 ) . By the twelvemonth 2000 circa 60-70, 40-50, 20-25 new instances ( per 100,000 of a given age group ) were reported amongst, severally, preschool kids, 5-14 twelvemonth olds, and people older than 15 old ages. Significant cultural differences have been reported, with high asthma prevalence in Afro-Caribbean kids. Since 1962, the figure of preschool kids hospitalised for asthma rose steadily, so peaked in the late 80s and early 90s, and has begun to worsen since. The hospitalization rates in 1989 were 90/10,000 ( preschool kids ) , 30/10,000 ( 5-14 twelvemonth olds ) , and 10/10,000 ( 15 old ages or older ) . By comparing the rates for 1999 were 60/10,000, 20/1 0,000, and 10/10,000 severally ( see Figure 5 ) . Figure 5UK Asthma Hospitalisation Rates ( per 10,000 ) in 1989 and 1999 The British Thoracic Society identifies specific benchmarks or ‘best practice’ which wellness professionals are required to run into when caring for asthma patients ( BTS, 2004 ) . These recommendations are largely based on scientific grounds from RCTs, epidemiological surveies ( cohort and case-control ) , meta-analytic reappraisals, and other good quality research. The recommendations related specifically to the undermentioned subjects: Diagnosis and appraisal in kids and grownups( e.g. key symptoms, entering standards which justified diagnosing of asthma ) ; Pharmacological direction( e.g. usage of drugs [ inhaled steroids, ?2agonist ] to command symptoms, prevent aggravation, extinguishing side effects, using a ‘stepwise’ protocol for intervention ) ; Use of inhalator devices( technique and preparation for patients, agonist bringing, inhaled steroids, CFC vs. HFA propellent inhalators, suggestions on ordering devices ) ; Non-pharmacological direction( e.g. chest eating and modified milk expression for primary bar, and allergen turning away for secondary bar, alternate medical specialties ) ; Management of ague asthma( initial appraisal, clinical characteristics, chest X raies, O, steroid intervention, referral to intensive attention ) Asthma in gestation( drug therapy, direction during labor, drug intervention in suckling female parents ) ; Administration and bringing of attention( e.g. entree to primary attention delivered by trained clinicians, regular reappraisals of people with asthma, audit tools for supervising patient attention after diagnosing ) ; Patient instruction( e.g. action programs, self-management, conformity with intervention governments ) . Overall, despite these guidelines, recent research suggests that patients’ intervention demands are non being met. For illustration, Hyland and Elisabeth ( 2004 ) study informations on the unmet demands of patients. Focus groups were organised between parents, patients, and clinicians. Patients and parents reported assorted demands that weren’t been met including frequent aggravations, and a penchant for less complex drug regimens ( i.e. with fewer drugs ) . Many persons had concerns sing intervention and experienced asthma symptoms 3 or more yearss per hebdomad. As Levy ( 2004 ) suggests, there is a demand for wellness professionals to turn to these concerns, particularly in relation to the BTS guidelines. Levy, a GP and Research Fellow in Community Health, identified current lacks in the attention of asthma victims. These comprised: Higher than expected aggravations ( 42/1000 patients per twelvemonth ) ; Under-diagnosis: more patients showing for intervention with unmanageable asthma, who had non been diagnosed antecedently ; Lacks in intervention consumption: many patients fail to roll up their prescriptions ; Many patients with symptoms delay showing for intervention, until their medical state of affairs becomes critical ; Health attention professionals are neglecting to measure patients objectively ( PEF, oximetry ) , both pre- and post-treatment ; Failure to adhere to national guidelines for the attention of ague asthma ( e.g. non adequate unwritten steroids and ?-agonists are prescribed for patients showing with asthma onslaughts. Considerable fluctuations across GPs, NHS Trusts, clinics, and other beginnings of attention proviso: patient follow-up assignments range from a few yearss to six months, in direct misdemeanor of criterions set by the British Thoracic Society ( BTS, 2004 ) . Levy suggests assorted schemes for bettering asthma attention including diagnosing standards ( e.g. â€Å"any patient with repeating or respiratory symptoms [ cough, wheeze, or shortness of breath ] , or who has been prescribed anti-asthma intervention should be considered to hold asthma† ( p.44 ) ) , usage of computerised templets, holding systems or triggers in topographic point for remembering patients ( e.g. patients bespeaking more medicine, or who have been seen out of hours ) , presenting more effectual protocols for monitoring and informing asthma patients ( e.g. utilizing a checklist to determine assorted cardinal information on patients position, such as effects of asthma on patients life, recent aggravations ) , supplying written self-management programs ( e.g. how to observe uncontrolled asthma, utilizing PFM charts ) , and holding an in agreement process for pull offing acute asthma onslaughts ( e.g. choosing a low threshold for utilizing unwritten steroids ) . Presently there is a deficiency of research proving the value of these recommendations on asthma wellness results. However assorted schemes are continually being implemented in assorted parts of the state to better the quality of asthma attention. For illustration, Holt ( 2004 ) describes the effects of implementing the RAISE enterprise, launched by the National Respiratory Training Centre, in a primary attention puting. This strategy is designed to raise consciousness of bing fluctuations in criterions of attention, better criterions of attention through instruction, support, and feedback, addition consciousness and apprehension of respiratory disease, usage asthma as platform to show the value of shared experiences across different agencies/professionals, and augment the profile of primary attention scenes as the chief beginning of asthma attention and invention. The RAISE led to assorted betterments, such as: The usage of ‘active’ and ‘inactive’ asthma registries, to separate patients who presently have asthma symptoms from those who don’t. Introduction of computerised templets to better truth and dependability of informations entering during audiences ( e.g. come oning consecutive from appraisal of symptoms, to top out flow, inhalator, and advice phases ) . Use of symptom questionnaires ( e.g. handed out with repetition prescriptions ) that help patients with well-managed asthma decide whether they can choose for a telephone audience, instead than taking the problem to see the pattern for a face-to-face audience. Haggerty ( 2005 ) identifies several factors paramount to effectual attention and direction of asthma in UK patients. These comprise adequate patient instruction about the nature of asthma ( e.g. figure of asthma episodes, usage of speedy alleviation medical specialties, long term symptoms, limitations on day-to-day activities, and exigency visits ) , usage of asthma action programs, and customised intervention programs ( to accomplish early control ) , and turn toing patients ain concerns and perceptual experience. Treatment for asthma is normally in the signifier of regular inhaled corticoids ( ICS ) , unwritten corticoids ( OCS ) , and ? agonists. These interventions are normally administered by a wellness professional when symptoms manifest and/or become terrible. However, since asthma can frequently worsen quickly, before an person can seek medical aid, it is critical that asthma patients receive the necessary attention from wellness professionals, and besides self-management accomplishments. GPs and nurses play a critical function. Griffiths et Al ( 2004 ) conducted a randomised control test to measure the consequence of a specializer nurse intercession on the frequence of unscheduled asthma attention in an interior metropolis multiethnic clinic in London. The function of specializer nurses in asthma attention has been unsure. Interventions in which specializer nurses educate patients about asthma, after hospital attending with acute asthma, were shown to hold inconsistent effects on unscheduled attention. However, outreach enterprises to educate medical staff had shown no consequence. Thus, an intercession was designed that combined patient instruction with educational outreach for physicians and pattern nurses. It was suspected that such an incorporate attack would profit cultural minority groups, particularly given their higher infirmary admittance rates and decreased entree to care during asthma aggravation. The cardinal research inquiry was whether specializer nurses could better wellness results in cultur al minority groups. Result variables were the per centum of patients having unscheduled intervention for acute asthma during a 12 month period, and clip to first unscheduled attending with acute asthma. The survey was based on 44 patterns in two east London boroughs. Participants comprised over 300 patients ( aged 6 to 60 ) who were admitted to or go toing the infirmary, or the out of hours GP service with acute asthma. Half the sample were classified as South Asians, 34 % were Caucasic, while 16 % were Caucasic. The intercession was based on a liaison theoretical account. Practices were assigned to either a intervention or control status. Practices randomised to the intervention status ran a nurse led clinic affecting affair with GPs and pattern nurses, integrating instruction, raising the profile of guidelines for the direction of ague asthma, and supplying ongoing clinical support. In pattern these patterns received two one-hour visits from a specialist nurse who discussed guidelines for pull offing patients with acute asthma. Discussions were based on relevant empirical grounds. A computing machine templet was provided to arouse patient information on assorted intervention issues, such as inhalator technique and peak expiratory flow, and offer self-management advice. By contrast, control patterns received a visit advancing standard asthma attention guidelines. Data analysis showed that the intercession lengthened the clip to first attending ( average 194 yearss for intercession patterns, and 126 yearss for control patterns ) , and besides reduced the proportion of patients showing with acute asthma ( 58 % intervention patterns versus 68 % in control patterns ( see Figure 6 ) . These effects were non moderated by single differences in ethnicity, albeit Caucasians seemed to profit more from the intercession compared with minority cultural groups. Figure 6Time to First Attendance ( Median ) and Percentage of Patients Showing with Acute Asthma O’Connor ( 2006 ) noted that asthma attention in the UK remains below the needed criterions. The bulk of the 69,000 infirmary admittances and circa 1400 deceases yearly are attributable to hapless patient attachment to intervention regimens. Nurses, it is argued, play an of import function in advancing attachment. Additionally, usage of a new inhaled corticoids – circlesonide – may besides assist increase attachment. Circlesonide is much easier to utilize than more constituted asthma drugs ( e.g. it has a once-daily dosing ) . Evidence is reviewed proposing that peak expiratory flow remains stable when patients are given circlesonide compared with a placebo. Tsuyuki et Al ( 2005 ) assessed the quality of asthma attention delivered by community-based GPs in Alberta, Canada. They reviewed clinical charts for over 3000 patients from 45 primary attention GPs. Of this figure 20 % had of all time visited an exigency section or infirmary, 25 % had grounds that a spirometry had been performed, 55 % showed no grounds of holding received any asthma instruction, 68 % were prescribed an inhaled corticoid within the past 6 months, while a really little minority ( 2 % ) had received a written action program. Figure 6 shows per centum of participants having medicine. Figure 7Prescribed Medication and Pulmonary Trials in Asthma Patients Sixty-eight per centum were prescribed an inhaled corticoid, 11 % were given an unwritten corticoid, and 80 % received a short moving ?-agonist, while 8 % were prescribed a long acting ?-agonist. Participants with an exigency room/hospital event were ( marginally ) more likely to be prescribed medicine ( no group differences in usage of short moving ?-agonists ) . Sing pneumonic testing, 25 % had grounds of a pneumonic map trial ( non top out flow ) , 46 % had peak flow monitored, 34 % showed no grounds of pneumonic map trials, while 26 % had an x-ray. Again persons with an exigency room/hospital event were more likely to be tested ( see Figure 7 ) . Datas about instruction received by patients was besides evaluated. Twenty-two per centum received information about environmental triggers, 20 % on inhalator usage, 10 % on how to execute a place PEF trial, 2 % on written action programs, while 55 % received no instruction at all. Those with an exigency room/hospital event were more likely to have instruction. Receiving asthma instruction, usage of spirometry, and prescription of inhaled corticoids, were all predicted by figure of asthma-related clinic visits ( 4 or more ) and holding an exigency room/hospital event. Additionally, asthma instruction was predicted by cormorbidities, and absence of certification sing asthma triggers, while usage of spirometry was predicted by being a non-smoker, and symptoms or triggers. Finally, usage of inhaled steroids was predicted by symptoms. Overall, this survey highlights legion spreads in the attention provided by GPs, partially repeating unfavorable judgments of GPs in the UK ( Levy, 2004 ) . For illustration, Levy ( 2004 ) cited ‘under-treatment’ as one of several spreads in asthma attention. However, Tsuyuki et al’s ( 2005 ) survey is limited by its retrospective design and possible doctor prejudice. Since GPs peculiarly interested in asthma may hold been more likely to take part ( e.g. necessary records etc ) , it is possible that the degree of attention was slightly overestimated. Patterson et Al ( 2005 ) tested the effectivity of a programme of asthma nines on clinical results ( e.g. inhalator usage ) and quality of life in 173 wheezing kids. Participants attended asthma nines at school on a hebdomadal footing over a 2-month period. Outcome steps comprised spirometry and inhalator method, and tonss on the Paediatric Quality of Life Questionnaire. The programme produced fringy but undistinguished alterations in quality of life tonss, and inhalator technique ( at 16 hebdomads ) . However, there was no consequence on spirometry. Action/Care Plans Research suggests that the usage of written action programs â€Å"facilitates the early sensing and intervention of an aggravation and is hence an indispensable facet of the self-management of exacerbations† ( Gibson A ; Powell, 2004 ) . An action program is a written protocol prescribed to an asthma patient for usage in pull offing an asthma onslaught or intensifying symptomatology. The program is written specifically to run into the demands of an single patient, so in consequence, no two action programs will be precisely the same. The program provides counsel on when and how to self-administer medicines, how to entree medical services in the event of aggravation. Gibson and Powell ( 2004 ) place the undermentioned constituents of a ‘complete’ action program: When to increase intervention ( i.e. the action point what degree of symptoms or peak expiratory flow ( PEF ) are required to trip the action program ) ; How to increase intervention ( e.g. corticoid inhalators, combined with unwritten consumption ) ; For how long ( e.g. , until symptoms subside ) ; When to seek aid from wellness professionals. Gibson and Powell ( 2004 ) specify an action program as uncomplete if the usage of ICS is non prescribed. A program was considered non-specific if it provided general instead than tailored information about asthma direction. They reviewed 26s randomised control tests which assessed the effects of action program constituents on asthma wellness results. Action programs were by and large based on PEF values, and intervention instructions specified additions in both OCS and ICS. Compared with usual asthma attention complete action programs reduced hospital admittances ( 46 % discrepancy predicted ) , although lone ‘personal best’ programs based on PEF reduced exigency room visits and improved air passage capacity. Action programs were recommended as ‘traffic light’ systems in some surveies. Evidence besides suggested that symptom based action programs were by and large similar to PEF based programs. Sing intervention instructions, additions in ICS and OCS doses significantly improved wellness results. Finally, the wellness value of uncomplete or non-specific action programs was unsure due to limited research grounds. The undermentioned key points were highlighted ( see Figure 8 ) ; Action programs improve wellness results when based on personal best ( instead than predicted ) PEF ; Action programs with multiple ( e.g. four ) action points are non significantly better than programs with fewer points ; Action plans based on symptoms ( instead than PEF values ) are no less effectual ; Complete action programs utilizing ICS and OCS are extremely effectual in pull offing terrible aggravations. Figure 8Effectss of Action Plan Constituents on Mean Peak Expiratory Flow Burns ( 2005 ) reviewed the UK literature on the value of action programs in asthma direction. Surveies confirm that action programs may cut down aggravations and unwritten corticorsteroids, better control of asthma symptoms, and cut down audience times. However, consumption of programs has been limited – merely 6 % of asthma patients are issued with an action program, partially due to hapless committedness by wellness professionals. Critiques argue that action programs may deter hospital/clinic visits, even when such attending is overriding to guarantee patient endurance. Furthermore, patients frequently view action programs as something for ‘other’ people and some GPs suspect that patients may hold problem groking action programs. However, much of the grounds reviewed is inconclusive due to the deficiency of a placebo group in some surveies. Therefore, it is non clear whether group differences observed were induced by action programs specifically, or patientsâ⠂¬â„¢ perceptual experience of being ‘treated’ . Carroll ( 2005 ) discusses the value of attention programs ( or ‘integrated attention pathways’ , ‘anticipated recovery pathways’ , or ‘care maps’ ) , which describe indispensable intervention and direction protocols for asthma ( and other conditions ) . Presently, there remains a dearth of UK research on the effectivity of attention maps on wellness results for asthma patients. Nevertheless, available grounds suggests that attention programs can hold several benefits, for illustration by increasing attachment to medicine, cut downing admittance times, bettering communicating across subjects, and easing the execution of national criterions for asthma attention. Therefore, attention maps are presently recognised by the Department of Health ( 1998 ) . However, it is noted that attention maps can halter personal enterprise. An asthma attention tract was developed and implemented at the exigency section of the Southport and Ormskirk Hospital NHS Trust. This development was based on a comprehensive literature reappraisal, which highlighted considerable fluctuations in asthma attention across doctors, clinics, and infirmaries. The attention program was designed to better conformity with criterions set out by the British Thoracic Society, and incorporated several phases: initial appraisal ( e.g. PEF values, and counsel on placing mild, moderate, and terrible asthma ) ; drug therapy ( e.g. inhaler corticoids ) , ongoing clinical appraisals ( e.g. monitoring critical marks, PEFs ) ; and dispatch planning ( e.g. specific standards for dispatching patients, guaranting inhalator method is right etc ) . Hospital direction approved the attention tract in November 2004. Both nurses and doctors were trained consequently. An audit procedure assessed whether the attention program was decently documented and easy to read. Findingss highlighted several jobs including: duplicate of activities/documentation ; failure to conform to BTS guidelines ( e.g. ordering nebulised ipratropium as the first phase of intervention for patients with moderate asthma ) ; and failure to look into and rectify inhalator technique before patients are discharged. Execution of the attention program continues to be audited and improved consequently. Unfortunately, given the restrictions of audits, it is non clear the extent to which issues originating here would generalize to other NHS trusts. Dinakar et Al ( 2004 ) assessed the effectivity of an asthma action program in pull offing aggravations. Participants were caretakers of wheezing kids who were go toing a general pattern clinic in an inner-city infirmary. They completed a questionnaire measuring assorted asthma-related factors including asthma badness, frequence of aggravations, and possession/utility of an asthma action program ( e.g. ‘if your kid has an asthma action program, do you experience it helps in the yellow and ruddy zones? ’ ) . The xanthous zone refers to symptoms that require Ventolin ? three times a twenty-four hours, gt ; two darks in sequence, while the ruddy zone was defined by symptoms that necessitate unwritten steroids/urgent visit. The bulk of participants had an asthma action program, and most of these found the program utile in pull offing aggravations. However, these findings are constrained by the little sample size and deficiency of statistical analysis. Therefore, it is non c lear whether the ascertained forms are dependable. Chen et Al ( 2004 ) developed and evaluated a attention program for kids with asthma in a randomized control test. The attention program was developed on the footing of in-depth interviews with the parents of kids with asthma. Parents were indiscriminately assigned to either an experimental or control group in an allergic clinic of a children’s infirmary in China. The experimental group received a attention program in add-on to the usual attention. The attention map incorporated an algorithm turn toing appraisal and intervention issues ( e.g. acknowledgment of asthma symptoms, day-to-day medicine governments, reading of extremum flow metre rates, dietetic demands, the demand for follow-up, and exigency action programs for ague asthma onslaughts ) . Findingss showed that those in the experimental group were less likely to go to the exigency room ( over a 6 month period ) , and had more positive attitudes towards asthma. By contrast, those in the control group had irregular followups by a physician and inconsistent usage of medicine. It was concluded that a attention program could better the quality of life for asthma kids and their parents. Unfortunately, this survey did non integrate a placebo group. Therefore, it is non clear whether the ascertained group differences resulted from the action program, or simply the perceptual experience of ‘receiving a treatment’ , which in bend could take to a self-fulfilling prophesy. The findings would hold been more conclusive given a group administered with a ‘fake’ intervention ( e.g. similar attention program, but on something else ) . Some grounds suggests that deficiency of instruction amongst asthma patients can hinder their satisfaction with and engagement in asthma attention. Mancuso et Al ( 2006 ) considered this issue, by measuring the relationship between patient literacy and their ratings of wellness attention proviso and willingness to be involved in doing determinations about their attention. Patients from a primary attention pattern in New York completed the Test of Functional Health Literacy in Adults ( TOFHLA ) , a well-established index of basic numeral and literacy accomplishments as related to wellness attention. Patients besides provided information about asthma features, such as badness ( whether patients needed to be hospitalised ) , asthma control ( how frequently patients had aggravations ) , and their perceptual experience of asthma and wellness attention experiences, entree to care, and the quality of attention received. Datas from 175 patients who came for follow-up visits was analysed. Multivariate analysis showed that marginal/inadequate wellness literacy was associated with lower satisfaction with asthma position, poorer wellness results from asthma attention, more hard entree to care, and an unwillingness to partake in doing determinations about intervention. These findings highlighted the demand for doctors to educate patients more efficaciously sing asthma and asthma attention. However, since this was a cross-sectional study, the way of possible causality is questionable. For illustration, it is possible that an involuntariness to be involved in intervention determinations may further ignorance of assorted facets of attention. A similar statement can be made about the impact of decreased entree to care and miss of cognition about wellness issues. Some grounds suggests kids rely to a great extent on their parents for information about their status. Parents in bend frequently look to wellness attention suppliers for related information. Finally, wellness attention suppliers are expected to be knowing about assorted facets of asthma attention, so that they can pass on efficaciously and fruitfully with parents and kids. Buford ( 2005 ) interviewed parents and kids sing their perceptual experiences of wellness attention suppliers and their engagement in assisting kids cope with asthma. Parents â€Å"voiced the demand for ongoing instruction about asthma by their wellness attention providers† ( p.159 ) , and felt it was indispensable that wellness suppliers communicate straight with the kids. Parents besides felt that wellness suppliers themselves may halter asthma attention, notably through holds in naming asthma, and incompatibilities in the advice given by different suppliers. Overall, this survey highlighted the importance of educating wellness suppliers about asthma attention and parent outlooks. It is besides pertinent to educate parents on asthma and how best to convey this information to their kids. However, this survey utilised a little ad-hoc sample, so the generalization of the findings to the wider population may be questionable. Research suggests that these guidelines are non ever implemented by clinicians, despite the benefits for the quality of patient attention. Health Resource Utilisation Asthma patients frequently delay seeking intervention, particularly persons with mild/moderate asthma symptoms. Therefore placing the correlatives of attention use has been the focal point of research ( e.g. Buetow et Al, 2004 ; Davies et Al, 2004 ; Silver et Al, 2005 ) . Diagnosis of allergic coryza morbidity may be implicated in UK wellness attention use. Price et Al ( 2005 ) noted that allergic coryza and asthma tend to coexist, and although coryza does non add significantly to intervention costs, it has epidemiological, pathological, and curative links with asthma. Both conditions are likely different symptoms of the same implicit in pathology air passage redness, although coryza tends to develop before asthma symptoms manifest. An epidemiological cohort survey was conducted to measure incremental impact of coryza on wellness resource use of asthma patients. Data for 27,303 grownups ( average age 34 old ages ) was collected from the UK MediPlus ® database, which contains information for over one million patients from a representative pool of ?500 GPs. Patients were considered eligible for the survey if they had one or more asthma-related visits to their GP during a 12 month follow-up stage. Patients were considered to hold coryza if there was a record that coryza was diagnosed and/ or relevant drugs prescribed. Measures of age, gender, oral/inhaled corticoid, and short-acting b-agonist prescriptions, were treated as covariates. Overall, 83.1 % of patients had asthma, while 16.6 % had both conditions. Figure 9 shows that patients with coryza visited their GP for asthma more frequently than patients who had asthma entirely, even after seting for covariates. Furthermore coryza patients were significantly more prone to be hospitalised for asthma. Logistic arrested development analysis revealed that the chance of asthma related hospitalization was predicted by allergic coryza, every bit good as being female, presently smoking, figure of short-acting ?-agonists, and oral/inhaled corticoid usage. Overall, this survey confirms that added respiratory symptomatology increases wellness service use. However, findings should be interpreted with cautiousness. Due to the big sample size even undependable and delicate associations between variables may be important. It may be appropriate to see lone findings important at really rigorous significance degree ( e.g. P lt ; .0001 ) . Figure 9Differences between Asthma-only and Asthma + Rhinitis Patients in Health Care Use Other grounds suggests that patient’s intervention demands and penchants are non ever adequately addressed. Hyland and hectoliter ( 2004 ) argued that â€Å"the pattern of medical specialty is frequently most successful when the doctor understands the patient’s perceptual experiences non merely of unwellness but besides of treatment† ( p.2142 ) . Doctors may concentrate excessively much on the clinical direction of asthma, and therefore neglect to appreciate patients existent demands. They conducted focal point groups with patients, parents, and clinicians. Additionally, questionnaire studies were conducted in the UK, Germany, and Spain. The purpose was to place unmet patient demands. The focal point groups highlighted differences in perceptual experiences of intervention between clinicians and patients/parents. Patients reported good asthma direction but besides frequent aggravations. The bulk of patients preferable simpler drug regimens ( i.e. fewer drugs ) and were worried about their intervention. Furthermore most patients tended to trust on stand-in medicines, and some patients who reported their asthma as being under control besides experienced asthma symptoms more than three yearss a hebdomad, visited the exigency section, or reaching a GP for place a place visit during the last few months. It was concluded that patients and GPs might construe asthma and related nomenclature ( e.g. ‘well-controlled’ ) otherwise. Furthermore, it is suggested that patient anxiousness about their intervention may sabotage attachment to intervention governments. However, the survey does non really show a nexus between patient-clinician perceptual disagreements and intervention attachment. Indeed, such an association may be tenuous particularly in the context of cardinal covariates such as the presence of other pathology ( e.g. coryza ) and holding a attention program. Cultural differences may be implicated in disparities in children’s entree to/utilisation of attention. Grecian et Al ( 2006 ) assessed cultural differences in household perceptual experiences of the usual beginning of attention ( USC ) for kids with asthma. Of peculiar involvement were ( a ) household studies of the presence and nature of the USC for kids, and ( B ) differences in the USC for kids from different cultural groups. Datas from the 1996-2000 Medical Expenditure Panel Survey ( MEPS ) Household Component was analysed. The MEPS is a national study of the US families that provides information on wellness resource use and other factors. Adults with cognition of a family’s wellness attention usage provided information about whether a kid was wheezing and the family’s use of wellness attention. For illustration â€Å"whether there is a peculiar doctor’s office, clinic, wellness Centre, or other topographic point that the single normally goes if he/she is ill or needs advice about his/her health† and whether the USC â€Å"was a specific medical individual or a facility† ( p.62 ) . Logistic arrested development highlighted important cultural differences in USC. For illustration, among wheezing kids aged 10-17 old ages, Spanish-speaking Hispanics and inkinesss were less likely than Caucasians to hold a USC. Minority groups were besides more likely to stipulate their USC as a infirmary or outpatient section, and experience entree barriers related to assignments. Davies et Al ( 2004 ) assessed the value of asthma accountant therapy ( montelukast ) on wellness resource use in kids with asthma. Participants were kids who had participated in randomized clinical tests comparing montelukast and placebo groups. They were asked to partake in an extra survey comparing montelukast and usual intervention groups. Use of unwritten corticorsteroids, figure of visits to the physician and exigency sections, and figure of hospitalizations, were treated as outcome steps. Level of use was the same in patients who had received montelukast and those administered cromolyn or inhaled corticoids. However, this survey focused on kids with mild to chair asthma, therefore it is non clear whether the findings would generalize to patients with terrible asthma, who have more to free by non sing a doctor, exigency section or infirmary, or taking steroids. Buetow et Al ( 2004 ) investigated barriers to attendance for GP asthma attention. Participants were over 400 kids with suspected take a breathing troubles from 26 schools in Auckland New Zealand. Data was collected via questionnaires, which was administered to parents/guardians. Multivariate analysis revealed that expected visits to the GP were heightened by sensed demand, wellness jobs, badness of asthma symptoms, and ethnicity ( Maori and Pacific, as opposed to Caucasian ) . Silver et Al ( 2005 ) assessed the impact of anxiousness in caretakers for interior metropolis kids with asthma on asthma badness ( based on twenty-four hours and dark symptomatology ) and use of ague attention services ( the figure of primary attention visits [ GP ] , exigency section visits, and asthma-related hospitalization during the predating 6 months ) . Care use was positively related to asthma badness but non caretaker anxiousness. However, the analysis failed to command for of import covariates, such as parental input and bing intervention government. Some grounds suggests that holding allergic coryza may impact use of attention resources. Thomas et Al ( 2005 ) investigated this relationship in a retrospective cohort survey utilizing informations ( collected between 1998 to 2001 ) from a UK MediPlus general pattern database. The database contains records for circa 2 million patient visits to over 500 GPs. Records of diagnosed allergic coryza ( or prescriptions proposing coryza ) covering the period from October 1998 to April 2001 were extracted. Outcome information was established for the period October 2000 to September 2001. Data was recovered for 9522 asthma-related GP visits ( 1879 and 7643 with and without allergic coryza, severally ) out of more than 14,000 asthma patients. Analysis showed that coryza independently predicted greater hospital use, figure of asthma-related GP visits, and costs of prescriptions. These findings indicate that kids with asthma and coryza may necessitate more medical attention ( both exigency and nonemergency ) . However, the correlational consequences negate conclusive illations about cause and consequence. Follow-up Sin et Al ( 2004 ) assessed the efficaciousness of an intercession on the rate of follow-up visits with a primary attention doctor. Asthma patients ( n=125 ) from the exigency section of a community infirmary were assigned to a usual attention or enhanced attention status. Both groups received the usual attention. However, the enhanced attention group had a coordinator wellness professional who made follow-up assignments with the patients GP, together with one or more reminder phone calls to the patient. Outcome information was assessed at 6 months of followup: the enhanced attention group had higher quality of life tonss, more follow-up visits to the GP, were more likely to use written action programs, and reported fewer asthma symptoms. This survey suggests that minimum inputs from a wellness professional can breed follow-up visits in wheezing patients. However, this consequence was ephemeral, and the absence of a placebo group renders the findings inconclusive. Chapter FOUR Decision It became clear early in this literature reappraisal that there are spreads in asthma attention proviso, surely in the UK ( Levy, 2004 ) . Therefore, unsurprisingly, legion surveies have sort to place important correlatives of assorted attention lacks, such as hapless followers, limited usage of attention programs, and the frequence of hospital/emergency room visits. Factors implicated in the quality of asthma attention proviso are more frequently than non moderated by assorted background variables, including ethnicity, gender, and age. Therefore, for illustration, trying to understand the function that nurse can play in promoting follow-up assignments requires an apprehension of the possible interactions between nurse input and cardinal background factors, such as gender or parent/patient literacy degrees. In kernel, the determiners of the quality of asthma attention are multiple and interdependent. However, conclusive illations about the effects of GPs, nurses, and other factors on asthma attention proviso arenonpossible based on the bing literature. There are several grounds for this ( see Figure 10 ) . One ground for this is that there is a dearth of randomised control tests, which are the gilded criterion for set uping cause and consequence relationships in wellness attention. Most of the surveies found were based on questionnaire studies, or relied on retrospective designs affecting the usage of preexistent informations archives. Some surveies employed longitudinal designs, but these rely chiefly on temporal sequence to show causality. Therefore, A preceded B, so hence B could non hold caused A. Although A could hold caused B longitudinal grounds doesnondemonstrate this causal nexus. Nevertheless, in position of the ethical restraints that limit the range of randomised control tests, it is indispensable to to the full see the deductions of bing retrospective and cross-sectional surveies. Figure 10Some Constraints that Negate Conclusive Inferences from the Asthma Care Literature Another ground is the limited research on certain spreads in asthma attention identified by Levy ( 2000 ) . First, the issue of under-diagnosis: why are patients with milder symptoms non diagnosed as wheezing, until they present with an acute aggravation? Weissman ( 2002 ) notes, â€Å"Unfortunately, physicians’ diagnosing of asthma and BHR [ bronchial hyper-reactivity ] are non peculiarly good â€Å"gold standards† for designation of asthma. It is likely that a physician’s diagnosing of asthma under-detects sub-clinical mild asthma† ( p.6 ) . Concerns have besides been expressed about under-treatment ( patients non roll uping prescriptions ) and wellness professionals neglecting to measure patients objectively, utilizing peak expiratory flow and oximetry. Small is known about GP, nurse, and patient features that predict these weaknesss. Finally, bing research frequently fails to account for the moderating effects of assorted background, clinical, and other variables that may measure up reported relationships. Significant associations reported in the literature ( e.g. between developing coryza symptoms and hospitalization ) may be moderated by other variables, such as age, gender, and even actions of the primary attention supplier [ 1 ] . Even randomised control tests by and large fail to prove for interactions, for illustration, utilizing a multi-factorial analysis of discrepancy design ( Field, 2000 ) . However, one salient characteristic that has emerged from the present reappraisal is the value of care/action programs for easing the direction of asthma onslaughts. Randomised clinical tests have shown that attention programs significantly improve wellness results, across multiple standards ( e.g. PEF, bettering conformity with BTS criterions, cut downing hospital admittances ) . Furthermore, care/action programs appear to be pulling considerable involvement amongst wellness professionals, particularly those working with asthma patients. Despite all this, uptake amongst patients remains highly low, every bit small as 6 % by some estimations ( Burns, 2005 ; Haggerty, 2005 ) . Evidence suggests that GPs are loath to supply programs to patients partially because of uncertainties about the ability of some patients to to the full understand a attention program. Indeed, it is possible that patient misunderstanding/confusion can take to evitable mortality following an acute asthma aggravation. However, there appears to be no grounds confirming this position of patients. While kids may be excessively immature to grok a attention program, no grounds was found that parents are unable to hold on attention program protocols, particularly given equal and regular support from their wellness supplier. Furthermore, there is a more indispensable point to be made. Give the accent on evidence-based pattern in wellness attention proviso ( Thompson et al, 2004 ) , it is indispensable that attention programs are implemented given the grounds verifying their effectivity. Overall, asthma attention is a many-sided proviso that requires close coactions between different wellness attention staff ( Holt, 2004 ) , working to back up patients through appropriate attention, while at the same time accounting for single differences between patient groups ( e.g. pregnant adult females, cultural minorities, kids ) that may chair the attempts of wellness professionals. There is room for betterment. There is a demand for farther ( largely randomised control ) research designed to turn to specific spreads in attention ( Holt, 2004 ; Levy, 2004 ; Wilkinson A ; Finch, 2004 ; Finch, 2005 ) , particularly those countries that do non look to hold attracted sufficient research activity. For illustration, under-diagnosis of patients, under-treatment, wellness professionals neglecting to measure patients objectively before and after intervention. Randomised control tests can be used to set up causality one time cardinal correlatives have been identified. The present reappraisal permits some probationary recommendations: Retrospective and correlational designs have been the chief attack to analyzing facets of asthma attention, in both the UK and the USA. Therefore, there is a demand for more randomized control tests, to set up cause-effect relationships ; More research is needed that identifies correlatives of under-diagnosis ( GPs neglecting to name milder asthma instances ) , under-treatment ( patients non roll uping prescriptions ) , and wellness professionals neglecting to measure patients objectively. This list is non thorough. Future surveies should try to verify bing literature on the value of attention programs, correlatives of successful followup, frequence of hospitalisation/emergency events, and