Why Tuberculosis is a Public Health issue

This essay will undertake chiefly about the wellness topic that was assigned to the writer s group which is Tuberculosis, this so accounts for the mortality of several million people each twelvemonth chiefly, in the 3rd universe states. Health appraisal and background Introduction M. TB has been a plague for the human race for centuries. There is grounds to propose that it has perchance been endemic since at least 10, 000 BC. ( Suarez et al. , 2001 ) . At the present twenty-four hours, it is a disease which is increasing on a planetary graduated table ( WHO 2006 ) . Prevalence The WHO has been cardinal in the coordination of a figure of strategies which are targeted at guaranting that quality-assured TB programmes are rolled out in countries which are perceived to be at greatest demand ( WHO 2006 ) . These enterprises have resulted in a state of affairs globally, where 53 % of all people who are diagnosed with extremely morbific TB received intervention in conformity with the internationally recommended TB control scheme in 2004. This compares with 10 % in 1995 as an exemplifying illustration. The WHO reports that 84 % of this group were treated successfully ( WHO 2006 ) . The push of this determination is that, despite the fact that the incidence of TB in the United Kingdom is relatively low, easiness of modern travel allows exposure of the United Kingdom population to some populations where the incidence is well higher ( Scriven & A ; Garman, 2005 ) . The bulk of long term migrators, and many visitants travel from the states where there is a high incidence of active TB ( & gt ; 40 per 100,000 ) and enter states where the incidence is relatively low ( & lt ; 25 per 100,000 ) ( Joint Tuberculosis Committee of the British Thoracic Society, 2005 ) . To set this in position, the incidence of active TB in the native UK population is in the part of 4.4 per 100,000, and this contrasts with 121 210 per 100,000 in certain nonnative populations. The increased hazard of infectivity of foreign born subjects has been demonstrated to go on for up to 20 old ages after migration ( Baudette & A ; Ellis, 2004 ) . It clearly follows that, in low incidence states such as the UK, the nonnative population are responsible for the bulk of new instances of active TB. Studies put the existent incidence between 35 – 70 % of all new instances. ( Euro TB 2007 ) . Current showing and control steps In Western Europe, and North America, presently more than half of all new active TB instances diagnosed occur among nonnative recent migrators. ( Borgdorff, Nagelkerke, new wave Soolingen, de Haas, Veen & A ; van Embden 2008 ) Despite the high proportion of active instances now being found in usually low-incidence states which are attributable to nonnative occupants, the impact on the public wellness is comparatively low. A figure of recent surveies ( viz. ITA 2005 ) have demonstrated that the current thorax radiogram testing programmes in topographic point in the UK have small impact and are non cost-efficient. Screening of immigrants with sputum civilization has been demonstrated to better cost-effectiveness marginally. The intervention of latent infection which can be detected through testing with either tuberculin tegument proving or chest radiogram may necessitate the infliction of coercive steps for the mark populations to maximize impact and cost-effectiveness. ( Dahle, Sandve n, Heldal & A ; Caugant 2003 ) Some governments ( viz. Vernon 2010 ) nevertheless, suggest that, in contrast, contact tracing, peculiarly within cultural communities, appears to be more cost-effective and less intrusive. Taken in overview, in low-incidence states such as the United Kingdom, showing of immigrants at the point of entry appears to hold small overall impact and does non look to be a really cost-efficient TB control scheme. More effectual options have been suggested and these include contact following which is delivered through the primary attention substructure and, on a planetary graduated table, increased investing in planetary TB control ( Davies & A ; Macdowall 2006 ) . Rationale and mark group There are a immense figure of possible wellness promotion-related activities in this context. It is clearly beyond the range of a short reappraisal to see more than one facet in any grade of item. This reappraisal will therefore curtail its consideration to wellness publicity mechanisms which can be used to observe, hint and dainty immigrants to the United Kingdom from high TB incidence states. Evaluation of such steps can be from a figure of positions, in the current economic clime of the NHS, which is basically a rationed service, an appropriate appraising tool would be cost-effectiveness. ( Pender, Murdaugh & A ; Parsons 2002 ) . Clearly there are other positions, including acceptableness to the immigrant population ( which may be reflected in issues of conformity ) or the existent impact of a relatively little figure of instances of active TB in the community which could be dealt with by trust on the natural herd unsusceptibility of the population and contact tracing as suggested by Ewles ( Ewles 2005 ) The importance of such wellness publicity activities can be gauged from the fact that the bulk of new instances of TB amongst the immigrant population are attributed to a reactivation of a antecedently latent infection. This is most likely to happen within the 2 – 5 year following migration. ( 10 Asbroek, Borgdorff, Nagelkerke, et al. , 2006 ) . Molecular epidemiological surveies have besides shown that a little proportion of new instances can be acquired after migration, with the Chin survey proposing that this would be in the part of 20 – 30 % ( Chin, De Riemer & A ; Small 2006 ) . In the UK it has been demonstrated that the kids of nonnative occupants have higher degrees of active TB than the general population and this incidence is increased if regular visits are made to their state of beginning. ( Ormerod, Green & A ; Gray 2001 ) Policies: In the UK, specific consideration of the in-migration policy shows that the demand for testing is non cosmopolitan. Immigrants who are meaning to remain longer than 6 months either have to be screened for TB ( and some other complaints ) before come ining the UK or to be screened on reaching. Those who do non be after to remain more than 6 months or are merely tourers are non capable to showing, even those who are coming from a high hazard states. It is considered that it is impractical to test all in these classs and the primary wellness attention installations are expected to pick up sporadic instances opportunistically as they present in the population. If this is contrasted with the wellness publicity policy in the Philippines, one can observe that the scheme in the Phillipines has changed well in the last decennary. It has been noted that the incidence of drug-resistant TB is at its greatest in those with HIV, the urban hapless and the prison populations. The decrease in prevalence is greatest in these groups and the Government has reported that it has achieved a 34 % decrease in notified instances in the last decennary. The National Stop TB Partnership was introduced in 1994 and increasingly expanded. It combined with the National Interagency Coordination Strategy for TB in 2003. In bend, this was superseded with the National Strategic Plan in 2006 which has aimed to cut down the incidence of TB. It would look that the steps to test for TB in immigrants to the Philippines are limited with no demand for short term travelers to be screened. Consideration of the broad image of TB control in the Philippines suggests that the state has been fighting with the issue for many old ages. This has been hampered by considerable economic demands on authorities installations from other need-areas against an increasing incidence of HIV/AIDS, which is a major predisposing factor for the development of TB in this peculiar hazard group. Funding for TB control comes non merely from Philippine national resources but besides from international resources such as the Global Fund On a planetary graduated table the steps reported, and mostly instigated by the WHO, showed that the incidence of planetary TB peaked in 2004 and that the end of cut downing the 1990 mortality rate by half by 2015 appears to be on path, chiefly through the coordination of the DOTS programme. In specific consideration of footings of Health Promotion activity, testing for a peculiar disease is by and large considered justified if, in the frequently quoted analysis of Sackett et al. , the disease is comparatively common and treatable. The ideal screening trial should be cheap, easy to administrate, do no uncomfortableness to the patient, and offer both high sensitiveness and specificity. ( Sackett, Haynes & A ; Tugwell 1985 Pg 21 ) . Why Tuberculosis is a Public Health issue: Tuberculosis is said to be a high hazard catching type of disease that could endanger the wellness of the public one time this has non been traced, treated, and isolated. This, holding said can be fatal but most decidedly curable. It can be transmitted through a simple sneezing or cough by person who has been infected by this disease, the bacteriums can so be spread through the air and anyone nearby who can inhale it can acquire infected. The bacteriums normally dwell in the lungs, where it normally grows. It might remain and the organic structure s natural defence might discontinue the bacteriums from turning and become hibernating but one time the organic structure s immune system is at below par, this is where the danger sinks in ( WHO, 2007 ) . The manner of transmittal is undeniably effortless and giving therefore should be considered a menace to every person most particularly to the vulnerable groups ( the elderly, the babies, the pregnant adult females and those whose immune s ystem is depressed ) . Bradshaw s demands If one considers the wellness publicity issues from a theoretical point of view, one can observe that Bradshaw attempted to specify demands. Taking a social position Bradshaw categorised demands as normative ( distinguished by professionals, such as inoculation ) , felt ( wants, wants and desires ) , expressed ( vocalised demands or how people use services ) and comparative demands, which indicates that needs originating in one location may be similar for people with similar socio-demographic features populating in another location ( Bradshaw 1972 Pg 22 ) . This probe will be normative in this context as it will chiefly see the issue from the population needs as defined by health care professionals. ( Downie, Tannahill & A ; Tannahill 2002 ) . Need for testing Further accent for the demand for good wellness publicity activities comes from consideration of the economic effects of TB infection. In the USA ( where it is easier to quantify health-related disbursement ) the entire one-year outgo on TB was in surplus of $ 700 million even a few old ages ago. It is believed that a similar figure ( proportionate to the population ) is incurred in the UK. ( Brown, Miller & A ; Taylor 2005 ) Methodology The methodological analysis for this reappraisal has been to analyze and critically analyze the peer-reviewed literature on the topic and to deduce decisions from the grounds base thereby established Analysis of the activity Screening processs Screening programmes in the UK historically ( after WWII ) consisted of compulsory CXRs for all new immigrants. As the incidence of TB in the general population diminished, the cosmopolitan CXR was finally abandoned. It was besides the instance that it was discovered that the impact on the public wellness, in footings of a decrease of sputum-positive instances, overall morbidity or mortality, was negligible. ( Toman 1999 ) . The current policy in the UK is for immigrants to undergo CXR on reaching and so are later referred to the wellness authorization where they will later shack. Value of CXR The trouble here is that merely a really little proportion of immigrants who are screened with CXR are found to hold antecedently undiagnosed active pneumonic TB. Even from the high-incidence states it is & lt ; 1 % ( Blum, Polish, Tapy, Catlin & A ; Cohn 2003 ) . Paradoxically, it has been shown that the prevalence of instances of latent infection which are associated with CXR abnormalcies ( that is inactive TB and/or apical fibronodular disease ) is instead higher with Comstock et al. seting it at 3 – 5 % ( Comstock, Edwards & A ; , Livesay 2004 ) . From the public wellness point of view, one has to see that it is rather possible to hold latent TB infection with no CXR abnormalcies at all and between 35 – 42 % of instances fall into this class. ( Nolan & A ; Elarth 2005 ) Combination testing A more common and rational attack utilises a CXR to observe active tubercular disease and the tuberculin skin trial ( TST ) to observe any grade of latent infection. This method nevertheless, has non significantly reduced the incidence of TB in the community and hence one has top consider other methods of sensing such as phlegm civilizations, acid-fast staining and nucleic elaboration trials which are presently available. A figure of sero-assays and trials of cell-mediated unsusceptibility are being developed but should be considered under development at the present clip in this context. ( Wright, Walley, Philip, Petros & A ; Ford 2010 ) If one considers the wellness publicity deductions of showing of immigrants so one has to see the comparative virtues of each of these activities. It is normal pattern in the literature to compare each process to the gilded criterion of a positive phlegm civilization. As has already been outlined, the CXR has a low positive predictive value and this is found to be even lower in instances of HIV/AIDS infection. Schoch et Al. hold pointed out that the huge bulk of positive CXRs are really false positive consequences. ( Schoch, Rieder, Tueller, Altpeter, Zellweger, Rieder, Krause & A ; Turnheer 2007 ) Although sputum civilization is frequently referred to as the gilded criterion for diagnostic truth, one should observe that a individual civilization is no more sensitive than a CXR. It appears to be by and large accepted that a microbiological civilization of three to six phlegm samples is needed to be extremely sensitive for active pneumonic TB. The specificity of a TB civilization is really high and there are really few false positives and these by and large occur as a consequence of cross-contamination during research lab handling. ( Bothamley, Ditiu, Migliori & A ; Lange 2008 ) Some Centres presently use acid-fast staining as a mechanism to increase the effectual choice up rate. This proves to be more specific but less sensitive than a CXR. ( Bothamley, et Al. 2008 Smart analysis If one considers this wellness publicity attack from the position of a SMART analysis. It is surely specific as it is designed to aim TB instances from abroad. It is manageable to a grade as, within the targeted population, it is manageable by the presently bing health care mechanisms, either by direct showing of some of those persons perceived to be at hazard, or reach following if the initial showing is neither done or has a false negative result.. It is provably accomplishable as it is already in topographic point, there is a bigger inquiry as to whether cosmopolitan showing of all reachings in the UK is accomplishable and the current policy is dictated on the premise that it is non. ( Lalvani & A ; Pareek 2010 ) Relevance to the general Public Health is clear, as steps to curtail the spread of TB through the general population, peculiarly the drug immune strains, are clearly relevant. Time relation is more hard to measure as the policy is different for different immigrant groups. Those going on a short term clip graduated table ( less than six months ) are merely non screened. Some immigrants ( non all ) geting with the purpose of remaining longer than six months are screened. It would look that, in footings of clip consideration, some are screened prior to arrival and others after reaching in the UK so there is non a clearly defined reply to this inquiry. If considered from a strengths and failing point of view. The strengths are that the policy tends to aim long term immigrants, peculiarly from high hazard countries, which are the population group that are most likely to present a hazard to the general population. Clearly, holding identified those with active or latent TB, the mechanisms are available and active within the UK to adequately handle those who are identified and besides to reach hint and dainty any instances which may hold arisen through community contact with an identified septic person. The failings are that the current United kingdom policy allows in short term visitants, who may good be infected, unscreened, and relies on mechanisms of contact tracing and timeserving clinical intercession for new instances which arise periodically in the population. The short term ends for this current scheme appears to be to place those persons, chiefly from high hazard communities, who wish to shack long term in the UK and to either garbage admittance or to guarantee that they are on appropriate intervention prior to admittance to the UK. The longer term ends appear to be to cut down the exposure of the general UK population to instances of active and perchance drug-resistant TB from the immigrant population. This attack seems to be appropriate for the wellness publicity job which confronts the UK. It clearly is non perfect, as there is the possible for instances of TB to come into the state without any grade of medical showing, if they intend to be in the UK for less than six months. Although the official line is that TB requires prolonged contact in order to be a wellness hazard to another person, this is non purely true as there is no reputable grounds base to propose that contact has to be a lower limit of six months for transportation of TB between persons. ( Mack, Migliori, Sester, Reider, Ehklers & A ; Goletti et Al. 2009 ) Evaluation Cost effectivity When Dasgupta et Al. studied the comparative cost-effectiveness of these assorted mechanisms for sensing of TB they found that the costs of testing utilizing a sputum civilization method were really higher per capita, the cost per instance of active TB found would be lower when compared to CXR. This is besides reflected in the other methods which, although their costs may really be lower in footings of showing costs, because of their decreased specificity, the overall costs would be much higher. From a Health Promotion point of view nevertheless, this is non the whole narrative as the cost of testing is non overriding. This is because testing carried out with a trial with greater specificity, such as sputum civilization, would necessarily ensue in fewer false-positive trials. In bend, this would ensue in lower costs for the clinical probe of persons who had false-positive trials. The importance of this remark is that the 2nd phase of a medical probe is more expensive than all screening trials. ( Dasgupta & A ; Menzies 2005 ) Latent disease sensing Although the obvious impact of wellness publicity would be directed at the sensing and appropriate intervention of active TB. If one is sing the immigrant population of the UK, so latent signifiers of the disease processes are merely every bit of import to observe. As has already been discussed, phlegm trials are of no value and CXRs are of merely minimum value in this status. The TST is a trial which depends on the development of cell-mediated immune responses which merely occurs at some clip after exposure to the TB being. It is carried out by injection and is demonstrated to be positive with the development of skin sclerosis within 48 – 72 hours. Although this trial is considered to be the most effectual for the sensing of latent infection, in the presence of active infection between 10 47 % of patients will hold a falsely negative trial. ( Erkens, Slump, Kamphorst, Keizer, new wave Gerven, Bwire, Berkel & A ; Borgdorff 2008 ) Health publicity benefits Health publicity considerations suggest that, in the USA at least, the TST trial is given to all immigrants who have come from a state of high TB incidence. The presence of latent infection amongst immigrants to the UK is presently about 30 75 % depending on state of beginning. A positive trial is normally followed up with a class of INH which will cut down the hazard of farther spread through the population. It should be noted that false positive consequences can happen with a past history of BCG inoculation every bit good as exposure to non-tuberculous mycobacterium, both contingencies being common among appliers from developing states. In a unusually elaborate survey, once more carried out in the USA ( chiefly for grounds of finding costs ) Saraiya et Al. calculated the cost-effectiveness of a Health Promotion enterprise which offered TNT testing to all new immigrants to the state. The inside informations of the survey are highly complex but, in kernel, the writers found that, in the twelvemonth 2002, without TST showing, 13,933 instances of active TB instances could be predicted, but, if a TNT showing programme together with isoniazid intervention was instituted, so 4,342 instances would be expected. The computations suggested that the net cost to the state without TST testing would be estimated at $ 338 million, and this compares to the cost with TST testing in the part of $ 258 million. ( Saraiya, Cookson & A ; Tribble et Al. 2002 ) . These costings, although taking into history a immense figure of factors, do hold some defects such as there is no accounting of the set up costs of such a Health Promotion programme. The writers translated these figures into a net economy of $ 8,320 per instance of TB prevented. Any wellness publicity strategy has besides to take note of the fact that this is non an ideal universe which can be absolutely mathematically modelled and the Saraiya et Al. survey did non do allowances for factors such as any immigrant refusing to undergo TST proving or failure of those who did prove positive with TST to describe for subsequent medical rating. There is besides the possibility that the immigrants my garbage to get down the therapy if it is deemed to be appropriate. ( Naidoo & A ; Wills 2005 ) Conformity Unfortunately such factors are non merely theoretical, they appear to interpret into pattern with surveies such as Cain et Al. showing that jobs such as these were responsible for a really significant decrease in the overall effectivity of the Health Promotion programme, as merely between 11 30 % of immigrants who had a positive TST trial were found to hold successfully completed an appropriate class of antimycobacterial therapy. ( Cain, Haley, Armstrong, Garman, Wells, Iademarco, Castro & A ; Laserson 2007 ) . From a clinical point of view there is a farther complication nevertheless, and that appears to be that there is a sub-group of persons with latent TB who have unnatural CXRs and who are at an increased hazard of reactivation. Cain et Al. point out that hence CXR followed by TST showing may be a more effectual Health Promotion scheme and may be more cost effectual if it consequences in the eventual intervention of fewer immigrants who have latent infection, but who are at a greater hazard of reactivation. This protocol was investigated by Shwartzmann et Al. and, utilizing a Markov theoretical account, the writers attempted to work out the costings involved. Although the methodological analysis was non every bit rigorous as that employed by Saraiya et al. , they were able to reason that, in those immigrants who had latent tubercular disease with abnormalcies found on the CXR, a important figure could be targeted and prevented from reactivation. ( Schwartz adult male & A ; Menzies 2004 ) . Education and conformity In the context of patient instruction, one can observe that this survey besides found that of the 353 patients who constituted the entry cohort, merely 145 really completed the preventive therapy class. It is non clear from the survey whether this group merely was lost to follow up or the health care professionals merely did non acquire over the message of the importance of taking the medicine, which may look counterintuitive to an immigrant who really has no obvious symptoms. Hazard issues If these wellness publicity steps were translated into the likely scenario of an immigrant coming to the UK from a high TB prevalence state, so Kik et Al. suggest that if the premise is made that the prevalence of latent TB was 50 % of all TB instances, so merely supplying CXR would be probably to forestall 1.2 active instances per 1,000 immigrants screened and the usage of the TST trial would be probably to forestall 2.9 instances per 1,000 immigrants screened. ( Kik, Franken, Mensen, Coblens, Kamphorst, Arend & A ; Erkens 2010 ) . The TST government would be more expensive, non least because it would be expected to place a larger figure of low-risk persons every bit good as the group of as false-positive reactors who would all hence be considered campaigners for chemoprophylaxis. Contact following as wellness publicity activity Although this reappraisal has considered the wellness publicity effects of testing at immigrant entry to the UK, there is besides the mechanism of contact following which, a figure of surveies ( viz. Hardy, Varma, Collyns, Moffitt, Mullarkey & A ; Watson 2010 ) have concluded, is besides a cost-efficient manner of restricting TB spread. The set up of the primary wellness attention construction in the UK is suited for such steps as community based contact following squads can be geographically positioned. Some of the early surveies ( viz Omerod 1993 ) estimated that 1 % of all immigrant contacts had active TB at the clip of the initial showing process and, at least at the clip of the survey, 10 % of all active TB instances which were later treated were identified entirely through the mechanism of following the contacts of those who were found to be positive. Such a mechanism is besides cost-efficient with Grzybowski et Al. showing that, in an entry cohort of 244 immigrants, 103 contac ts were traced and 6 were found to hold active disease. ( Grzybowski, Fishaut, Rowe & A ; Brown 2001 ) . The writers besides found that, because of the personal intercession of the health care professionals, there was a high conformity and intervention completion rate amongst this group. The big Underwood et Al. survey, which was completed in the UK, in a badly economically deprived country with chiefly Bangladeshi immigrants, went farther and demonstrated that contact following really proved to be more efficient than testing of new entrants at the point of entry. Using contact following entirely, the writers found 13 instances of active TB from contacts of 322 new immigrants. ( Underwood, White, Baker, Law & A ; Moore-Gillon 2003 ) Decisions In decision, it is clear that wellness publicity requires designation of those immigrants who have active or latent TB and who arrive in the UK in appreciable Numberss. It is clear that there is no 1 showing technique which will adequately cover with all contingencies. Assessment and rating of the assorted techniques described demonstrate that each has peculiar strengths and failings. A considered combination of CXR and TST together with appropriate contact following appears to offer the most effectual mechanism for aiming intervention for those in demand and to understate the likeliness of farther disease transmittal. It is clearly problematic whether a showing programme which considers all immigrants ( peculiarly those from high hazard states ) is either executable of economically practical or whether the combination attack outlined above is a matter-of-fact via media which keeps the bulk of the active instances out of the UK with maximal cost effectivity

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FISHER v. UNIVERSITY OF TEXAS - Case Study Example In the year 2008, the plaintiff applied for admission to the UT for further studies after finishing their secondary education. In their case filing, the two students stated that the University failed to grant them admission chances citing the reason to be their color. The plaintiff quoted the clause on Civil Rights Act and title VI Act of 1964 (Kent College of Law 2010). The first ruling was in 2009, and during this time, the court sided with the defense made by the University. The ruling did not impress the plaintiff and; therefore, they decided to appeal against the judgment. The UT was a renowned university, which was among the dream choice for many young people. In order to recruit students in the institution in an orderly manner, the university management has set guidelines. The university internal admission criteria was superior and was necessary comply procedure. Historically, the University used Academic index that based the selection on students’ high school ranking (Kent College of Law 2010). Academic index formula gave a room for unallowable levels of diversity and, therefore, the University started considering the applicant’s race. This criterion took place up to around 1996 when the government made changes to the law to diversify the admission in all institutions (Kent College of Law 2010). The first hearing of the case against admission of the plaintiff was at the District Court. The plaintiff had questioned whether the action by the UT in considering the applicants’ race before admission was in fulfillment of the government’s interest. In its ruling, the court referred to guidelines in Grutter and sided with the University criteria of considering the students races. The court reviewed all the circumstances that led to the university’s option of putting races into admission procedures. Court ascertained that the decision was in good will. The

You may pick a good one Essay Example | Topics and Well Written Essays - 500 words

You may pick a good one - Essay Example The two cultural groups exhibits differences as described in the following paragraphs. African American has traditions, values and customs concerning death. This is drawn from the various ethnic, culture and religious backgrounds they exhibit. Some of the common practices exhibited by African Americans in their values include: African Americans also have distinct patterns of language. Some of the developed languages among the communities here include; Gullah popular with the Sea Islands and Creole common to the Louisiana. The African American culture is also associated with academic legitimate dialect due to its logical structure; however other people consider this as slang because of the poor Standard American English command (Hudgens 57). The African Americans also practice a variety of religions ranging from Protestant Christianity to Muslims. On the other hand, Hispanic Americans possess diverse cultural and custom background. They include people from Puerto Rico, Cuba, Dominican Republic, Spain, central and South America, and Mexico. Some of the common cultural values and customs they exhibit in relation to death include: Hispanic Americans are often united by language, customs, values and religion. However, an extensive diversity exists among them in their traits. Some of these values include; family commitment, belief on the child behavior reflecting the family honor, a strong system of support to the family, duty to care and hierarchical order in the family siblings (Dunn 239). Hispanic Americans are hence different from the African Americans in language, religion, customs, values and beliefs as mentioned in the

Importance of Contract Formation Term Paper Example | Topics and Well Written Essays - 1250 words

Importance of Contract Formation - Term Paper Example Any offer, forming these elements, is legally binding. The right of the contracting parties is to get the contract fulfilled in their favor, and to perform only those acts as obligations, which are mentioned in a contract, and not more or less than that. That is how, the formation of a contract, with its essential elements, becomes very significant. Simply defined in law, ‘a contract is an agreement or a promise, enforceable by law, which has the power and capacity to be legally binding’. It is between two or more parties. It could be oral, in writing, through electronic means, or a combination of one or more of these means of a contract. Contract law is based on the principle that is expressed in the Latin phrase, ‘pacta stunt servanda’, which means, ‘agreements are to be kept’. There could be many kinds of contracts such as a sales contract, a partnership contract, a mortgage contract, a rental contract or a marriage contract. Business contracts are considered to be in writing, essentially, to be legally valid. â€Å"Social contracts have long been characterized as appealing to either actual consent or Ideas for legitimacy. Jean-Jacques Rousseau, however, appeals to both, hence gaining the benefits of two approaches.†. Contracts have been used to shape and regularize personal and family matters also, since long. â€Å"Contract has long been used to shape and facilitate non-commercial, personal or family relations. Casebooks are replete with examples of ‘bait promises’.†   Intention to create a legal relationship, which means that both or all the parties to contract must have an intention to enter into a legal relationship. This intention could be express or through conduct but it is considered better if the intention is mentioned expressly in the contract.  

Solution Paper Essay Example | Topics and Well Written Essays - 500 words

Solution Paper - Essay Example Expectant women are advised to avoid any drugs not prescribed to protect the unborn child (Kozlowski, Henningfield & Brigham, 2001). Tobacco smoking is addictive with users being unable to quit. Tobacco contains many harmful chemicals that enter the mother’s bloodstream. The nutrients are passed from mother to child through the placenta. The harmful chemicals pass to the child through the placenta that may cause cancer. The mother’s blood also provides oxygen to the unborn child. Excessive smoking by the mother cuts off the child’s oxygen supply. Low oxygen supply may result to malformation of child, stillbirth or premature delivery. Women should avoid tobacco to ensure increase the chances of giving birth to healthy children. Chemicals in tobacco may also be passed to the newborn child through breast milk or secondary smoking. Educating women on the harmful effect of cigarettes is important to improve on infant mortality. Information should be provided to women at a young age to ensure that they make informed decisions when choosing cigarettes. For addicted women, the user can use remedies to overcome nicotine addiction. It is difficult to quit smoking due to the addictive nature of the drug. The nicotine problem can be countered using nicotine patches. Women who are addicted to tobacco can use the nicotine patches to reduce the withdrawal effects. Nicotine patches are effective over a long time despite their slow mode of action. Gum and lozenges can also be used to reduce the harmful effects of nicotine. Gum and lozenges are fast acting but the user should reduce their use over time (Kozlowski, Henningfield & Brigham, 2001). Behaviour modification therapy will help reduce the problem of nicotine addiction. The user talks to other addicts or a counselor on ways to reduce dependency on nicotine. Behaviour modification therapy may be accompanied by medication prescribed to reduce the effects on nicotine on the user. The user should

High School Education Essay Example for Free

High School Education Essay Education is perhaps the most important endeavor a person can attempt in their life. Studies show those who have a post high school degree of some kind will earn considerably more during their working years than those who don’t. Therefore the many young adults who don’t have a high school degree will be crippled in becoming successful in our workforce. In today’s society this has become a major problem in creating a better country as a whole. The ‘hard times’ that many people may have could be prevented by more preparation and education for the future simply because more education leads to greater success. Our schooling system needs to be confronted in providing a better education so that our children will bloom and create a better, more intelligent nation than today. Dropping out of high school puts people in a extenuating circumstance for the rest of their life. Without a high school education it basically cripples you in achieving success for yourself in the future. This widespread of dropouts and failures not only effects themselves but also the world around them by decreasing economic growth. â€Å"Conclusions shows that economic growth is directly related to education in each country. Investing in education rapidly grows economies and raises the average level of employment. † (Breton) Though many classes may seem inapplicable to the work force or a future career, there are skills developed such as group work, critical thinking, and exposure to disciplines that one would not otherwise study offers the potential for personal growth not found in everyday life and experience. This personal growth that is developed only through school proves that everyone must have a high school education. To create a better workforce and way of life I propose to enact federal policies and requirements for our schooling system. These policies would include more financial aid, and imply less inflexibility for high school students. â€Å"The federal role in education is limited. Because of the Tenth amendment, most education policy is decided at the state and local levels. † (Policy Overview) Changing from state to federal would be the first part of my solution. With the change in rule there would also be the policies enacted to ensure a better education. More financial aid would go to the school and students to provide a better education. From this financial you can expect higher teacher salaries, more teaching jobs, and a better learning environment. Implying less inflexibility for high school students could be many things. One would be having no states test to graduate, and instead have comprehensive exams by the school to test the knowledge and skills of their students. Also have the school to use teachers and counselors to be more involved in each students life for the struggles they may be having concerning necessities and school. Our high school education system is clearing not working and needs to be refined. The amount of people being able graduate needs to improve so that our nation as a whole can grow. By using my solution to this problem you can see a much better education system. The State role would be changed, and there would be a completely different education system to ensure everyone people graduate from high school. There would be no student failures, and dropouts from the policies enacted by a federal not state rule. From this you can see higher graduation rates leading to more economic growth for our country. â€Å"America found its growth hormone after the Second World War in the incredible educational success of the GI Bill. †(Bencini) Studies in education have proven that more education and reform leads to economic success and growth. My proposal to this problem would reform and create our society better as a whole, and make a more intelligent or sufficient world than today. Education is perhaps the most important endeavor a person can attempt, and dropping out of high school puts people in a extenuating circumstance for the rest of their life. This leads to less economic growth and higher unemployment rates that deprave our economy. To create a better workforce and way of life I propose to enact federal policies and requirements for our schooling system. This include more financial aid, and more inflexibility towards our school systems. We need to call for our politicians to improve our schooling system because the cause and effects of students not completing school leads to failure and less success. From more education leads to greater success so the key role in our nations future is our youths education. Works Cited

Revolution(s) in Latin America from Bolivia to Chile Essay Example for Free

Revolution(s) in Latin America from Bolivia to Chile Essay This paper will deal briefly with the revolutionary movement in Latin America in the mid 20th Century. It will compare and contrast Bolivia, Cuba, Chile and Argentina and seek to draw lessons for today. Ultimately, Peron proved the most successful model of revolution, and this only because of his strong ability to mobilize disparate elements of the population often left out of more doctrinaire Marxist movements. I. This paper will briefly deal with four related but distinct elements: first, the revolution in Bolivia in 1952, the revolution in Cuba a short time later, and the failed revolution in Chile after the 1970 elections. After this, it will deal with the Peron regime in Argentina. Given all this, this paper will attempt to compare and contrast these movements, looking at US as well as Soviet policy relative to them, and see what modern policymakers can take from these immensely important events. The Bolivian revolution of 1952 was one of the first major earthshaking events in post World War II Latin America. Bolivia was an economic disaster since the war (and before) dependent largely on tin exports and a small amount of coffee for economic survival (Cockcroft, 1997). Like all three revolutions dealt within this section, the big issue was the ownership of land. In countries largely made up of peasants, this was the greatest issue. In all three of these states, the land was owned in large parcels, by a small oligarchy that had connections with the government. This was the key in all three revolutions (Kohl, 1978). One issue that sets Bolivia apart was the fact that the army was rather uninterested in pursuing a battle against the revolutionaries, who, unlike the Chilean case, were far from â€Å"Marxist† in ideological orientation (Kohl, 1978, 239). The revolutionary movement (MNR) was both nationalist and socialist in orientation, seeking an independent and prosperous Bolivia independent of both USSR and USA. The basic platform of the Nationalist Revolutionary Movement was land reform first of all, the nationalization of the tin industry and free elections. The connection with the USA was seen by the MNR as a link between to so-called â€Å"tin barons† and the army through US aid. This was a similar view in Cuba. After a brief period of fighting, roughly the middle of April in 1952, the main urban centers fell to the revolutionary movement with the help of miners and other urban workers (the farmers took little part) who were armed by the MNR (Kohl, 1978). The army had no stomach for a fight, and put up token resistance. It was not long before the founder of the MNR, Victor Paz Estemssono, took power as president, and immediately purged the army and engaged in land reform. Universal suffrage was quickly instituted by the new government, and the tin mines were brought under state control. It is clear in hindsight that military personnel were involved in the initial uprising in early April in 1952, the army saw no threat in the nationalist movement and was loathe to fight it. This was to make the Bolivian revolution different from the revolutions in Cuba and Chile (cf. Gerassi, 1965, esp ch 16). In Cuba, 1953, the economic situation was the same for the peasants, but not for the economy as a whole. Unlike the depressed Bolivian situation, the Cuban economy was booming in 1953, except for the fact that the boom did not affect the middle and lower sectors of the peasantry. The economic boom was based on several things: the endless American demand for sugar, the investment of the Batista government in tourism and gambling (similar to Lebanon at the same time), and the presence of a substantial Jewish and Italian organized crime who ran drugs out of the island (Blasier, 1967). Nevertheless, the peasants were largely illiterate and suffering from hunger and disease, similar to that of Bolivia. Like all the revolutions dealt with here, land imbalance was the key. Here, the sugar plantations were in the hands of domestic and foreign oligarchs, Like Tin in Bolivia or Copper in Chile, in Cuba, the revolutionary movement, modeled after that of the MNR in Bolivia (that is, both nationalist and socialist), sought land reform and free elections. The Batista government had rigged elections for some time to make sure him and his military cronies were placed in power regularly (Cockcroft, 1997). Unlike the Bolivian case, the Cuban army was basically loyal to Batista and fought the revolutionaries for some time. The US government did place some pressure on the Cuban leader to hold free elections, which he largely refused to do, leading the CIA to offer some limited financial support to Castro early on (Blasier, 1967). Ultimately, the revolutionaries forced Batista to flee to the US, and the army took over more fully, leading to a protracted war. Hidden in the mountains and fields of southeastern Cuba, the revolutionaries defeated Batista’s small and poorly coordinated offensive. The US posture was uncertain until substantial aid developed from the USSR, and, after Castro’s victory, nationalization of sugar plantations and other assets deprived Cubans and Americans of their former fortunes (Marfelli, 1998). Unlike the Bolivian case, free elections were never held. Chile paints a similar picture. Like the other two states dealt with here, Chile was also a one resource exporter, in her case, copper. The revolution, which did not succeed, begins at the elections of 1970, where the semi-Marxist Salvador Allende received roughly 36% of the vote in a tightly contested three way race. Hardly a ringing endorsement, the KGB as well as the CIA back differing parties in this contest. Both intelligence agencies saw Chile and its copper as a major strategic asset, and both wanted to see Chile in their sphere of influence. The difference being that the CIA spent money to defeat Allende (in general), the Soviets spent money to elect Allende (specifically), even giving him a private salary while on the campaign trail. Allende will never get more than 40% of the vote, and hence, more radical measures were necessary (Leonov, 2005). Allende’s victory was a blow to US interests, and Richard Nixon set his face against the new government, who quickly permitted a substantial KGB presence in the country and allied himself with Castro. Even more, the Allende government nationalized the copper mines and engaged in some limited land reform, like all the above. Allende’s policies, however, created substantial economic downturns in Chile: while attempting to raise wages, he increased inflation. Price fixing brought shortages of necessary items to Santiago and other important urban areas. Unemployment went up, and copper exports fell. Soon, the army and many citizens were opposed to the government that was seen to be artificially propped up by Soviet subsidies. The fact that the opposition parties were contesting the election did not help matters, and in the two elections before Allende’s death, he received no more than 40% of the vote in tight races. The famous coup that brought General Pinochet to power was the result. (Leonov, 2005). These three revolutionary movements, briefly sketched above, contain many important similarities to one another. In all cases, the governments that preceded the revolutions were basically oligarchic: a small number of wealthy controlling a substantially disproportionate share of wealth. Each of these governments was largely militarized and the military was seen as basically supporting the state (with some hesitation in Bolivia). Each of the governments before the revolutionaries seem rather a-ideological, more or less existing to collect taxes and keep a certain group in power. In each case, the armies were basically autonomous forces, making decisions more or less apart from the states that allegedly controlled them. All three states were basically single-resource dependent which harms the sovereignty of the state. Decisions cannot be made autonomously when the entire state’s economy is based on copper markets (for example) that exist far outside the country. The revolutionary movements also have substantial similarities. Both were ideologically nationalist as well as socialist, both in the broad sense of the terms. They sought a redistribution of land and nationalization of the main source of national income: tin, sugar, copper. All of these movements sought violent measures to take power. Even the Allende government used his â€Å"red guards† to confiscate the goods of the people they considered â€Å"rich,† to harm the black market. But as the Leonov lectures prove, all of these movements, legitimate or not, were hijacked by KGB forces and used to increase Soviet power in the area. Hence, whatever sympathy the US may have had with these movements (such as it had to the early Castro) quickly evaporated once the KGB moved in, putting the US in a bad position, having to appear as the â€Å"defender of the oligarchy† against the â€Å"apostles of equality. † It seems that the Soviets forced the American hand in these matters. There are also several differences within these movements. The posture of the army was important: in Chile and Cuba, the army was loyal, in Bolivia, they seemed to have no stomach for a fight. In all cases, the army was relatively small and poorly equipped. A well financed revolutionary movement could easily be a march for these rather unprofessional military forces. The results of the revolution differed wildly. In Chile, the economy tanked. In Cuba, free elections were never held, and Castro held the country in an iron grip under Soviet subsidies. In Bolivia, the economy improved and land distribution was a fact. This is the greatest lesson of these movements: there is no guarantee of success. There is a guarantee that an old oligarchy is to replace a new one the unfortunate results of revolution. All the revolutionaries, with varying degrees of success, sought to improve the role of women in society and in the economy. To a large extent, the revolutionaries had a substantial share of women among their members. In Chile, the Allende government creates subsidy plans for free milk distribution to poor families, a policy difficult to argue with. However, when his price fixing scheme appeared early into his presidency, these milk distributions dried up, and families were forced to buy on the black market at inflated prices. Here, the female side fo the revolution was a complete failure, and mothers were worse off than before. It seems clear that the price fixing scheme was a failure and might well have been the main reason the revolution failed: shortages occurred and the black market sprang up. Allende’s violent methods of dealing with these alienated many people. It is hard to see any real alterative (in 1973) in Chile for women than to support the coup and the freeing of prices for milk and other necessaries. II. Juan Peron is one of the most celebrated Latin American personalities. He contained within himself the true ethical content of the Latin American revolutionaries without being a revolutionary. Nonviolent and patriotic, he offered Argentina everything it needed politically. The Perons were part of Argentinian politics through the World War II era, and Juan’s position in the military government (as vice president under General Eldomiro Farrell) permitted him a platform to argue in favor of unionization and nationalism, in speeches and policies that made him wildly popular. Combining nationalism, patriotism and socialism, this set of ingredients was all that was necessary to bring a coalition of left and right into being over questions of economic nationalism and equality. The fact that he married a woman of lowborn status, Eva, the real power behind Juan (Van Dine, 1998) who used her popularity to engage in serious welfare programs and mobilization of the â€Å"shirtless ones† to her and her husband’s side created a duo that has not been seen since. Peron was a man of his word. In his first term as president (until 1952) he engaged in a flurry of domestic policies that went beyond the socialist rhetoric of the revolutions described above. In the seminal work on Latin American revolutions by Gerassi (1965, esp. ch 3), he provides a provision list of the major areas of concern and policy for the Peron duo. Peron’s list of accomplishments is stunning: social security was made mandatory for each citizen. He was behind the creation of trade unions in every major Argentinian industry. He made certain that elections were free and that universal suffrage was the norm. Insofar as the treatment of women were concerned, he insisted on paid maternity leave, free medical care (especially prenatal care) and paid time off for all new mothers. He built recreation centers for all major industries, and made sure that paid vacations were the norm for all workers in Argentina. And this was only the beginning (cf. Gerassi for more details). Just as important, he sought the development of Argentina’s economic diversification. This is a substantial difference between Peron and the other movements dealt with above. The other movements did not have a substantial plan for diversification and were basically content to be one crop country. Argentina was not like this, there were too many resources to be mobilized, and such diversification became a major project of the Argentinian first couple in the 1950s. Peron was an amateur philosopher of sorts, and saw political ideology as more of a barrier than an impetus to economic performance and equality. His basic philosophical position was called Justicalisimo, or the â€Å"third way† between socialism and capitalism that attempted to combine the positive contributions of both. This approach will be imitated by Nasser in Egypt and the Bolivian MNR. But it is precisely this approach to political things that makes sense out of his popularity: there was no prepackaged ideology to oppose. His was a mixture of the best of the left with the best of capitalism. Both of these were blended with an appeal to nationalism, patriotism and Argentinian sovereignty that was immensely popular. He was able, through his own personality as well as that of his wife, to mobilize both left and right over questions of economic nationalism and equality. Most certainly, his policies were not typical for Latin America or anywhere else. There are few people who can claim his mantle. This paper mentioned Nasser of Egypt, and is likely the only one who can claim this. Peron did not seek a violent revolution. He sought a revolution based in patriotism and national consent, a nation rebuilt around the â€Å"first couple,† who were iconic in their times and ours. This is a rare chemistry that cannot be imitated by professional guerillas or politicians of the typical stripe. The fact that he put his promises immediately into action and fought the wealthy of society made him more and more popular, and this popularity, ths ability to mobilize the population, is what made the oligarchy fear him, yet there was little they could do. The Eva Peron Foundation, a huge semi-official charitable trust, built thousands of schools and hospitals around the country. The government of Argentina was truly a family affair, mirroring the actual Argentinian family itself, it was iconic almost literally, in that they were ruled not by a junta, or a general, or a rich man, but a family. In this writer’s opinion, Peron’s popularity was based on what he physically accomplished. But more than this, it was the mixture of patriotism and economic nationalism and equality. Since cliche Marxism is anti-patriotic and internationalist as well as anti-Christian, they naturally alienate many of these types of people. Peron did not do this, since he was nationalist and did not repress the church as did Castro. Hence, he was able to mobilize these people as well, adding to his popularity in a way that a Castro or Allende could not. There is so much material on this Argentinean leader that this brief description cannot do it justice. III. This paper has sought to deal with the question of Latin American Revolution in brief. It is clear by this time that this writer is partial to Peron, and sees his model as superior to the others dealt with above, and offers quite a bit of material for the future of Latin America. The revolutions of Cuba, Bolivia and Chile were, when all is said and done, failures. While correctly addressing many important issues, these revolutionaries simply became another oligarchy, or fell apart altogether (such as Allende). These states are still poor and underdeveloped, and only Chile has been able to control infant mortality with any success. The problems in all these countries were the same: one crop dependency, oligarchy, land hunger and poor infrastructure. Only Peron performed substantial moves to remedy this situation, but his later overthrow proved these abortive. Argentina was back where it had started. Cuba today is an economic disaster and a dictatorship, while Bolivia is no better off than in 1952. Nationalism, patriotism, autarky and economic equality are the wave of the future, while internationalist socialism(as well as border-less capitalism) is a relic of the past. Bibliography Kohl, James. (1978) â€Å"Peasant and Revolution in Bolivia, April 9, 1952-August 2, 1953. † The American Historical Review. 58: 238-259 Blasier, Cole (1967). â€Å"Studies of Social revolution: Origins in Mexico, Bolivia and Cuba. † Latin American Research Review. 2: 28-64 Perez, Marfelli. (1998) The Cuban Revolution. Oxford University Press. Leonov, Aledander (2005) â€Å"Soviet Intelligence in Latin America During the Cold War. † Lectures. The Center for Academic Publications. (http://www. cepchile. cl/dms/lang_2/doc_1140. html) Van Dine, Robert. (1998) â€Å"Evita Peron: Saint or Coutesan. † Vandine Publishing. (http://www. vandine. com/peron. htm; Van Dine is a career DC diplomat) Gerassi, John. (1965) The Great Fear in Latin America. Macmillan, 1965. (This work acted as background material for all the information above) Cockcroft, James D. (1997) Latin America: History, Politics, and U. S. Policy. Nelson Hall Publishers.

Liver Function Tests And Bilirubin Biology Essay

Liver Function Tests And Bilirubin Biology Essay The human body is made up of various organs and one of the most important homeostatic organs is the liver. However, despite its very active role, is mostly underemphasised and although most of its functions are not as regulatory as the brain, the liver is involved in important processes. These include biochemical, excretory and synthetic functions, therefore, to detect deviations in its function, several tests must be carried out. These test are referred to as Liver function tests. They provide clues on the liver function and help to evaluate the level or amount of liver damage. Hence, they are used in the diagnosis of liver disease. And since early diagnosis and therapeutic intervention plays a large role in the treatment of liver diseases, liver function tests are important. Liver function tests The liver is the largest visceral organ in the body. It weighs about 1.3kg (3lb) in an adult (patho book ref). It has about 500 individual functions. To ensure that the liver continues to carry out these functions, there are several tests which are carried out on the liver when investigating a patient with liver disease. These tests are carried out on the bllod, each of them checking the amounts or levels of various constituents in the blood. Liver function tests include tests depict cholestasis (alkaline phosphatase, gamma glutamyl transpeptidase), tests reflecting the synthetic function of the liver tests (albumin and prothrombin time),tests portraying excretion (bilirubin, alkaline phosphatase and gamma glutamyl transpeptidase) and tests monitoring the amount of cell damage or liver injury (Aspartate aminotransferase and alanine aminotransferase). Bilirubin This is a yellow compound or pigment formed by the breakdown of haemoglobin. This originates from the breakdown of worn out, old or damaged red blood cells. The senescent blood cells are taken up and destroyed macrophages (Kupffer cells) of the phagocytic system (which are located primarily in the spleen and in the liver. During the breakdown of haemoglobin into heme and globin, the globin is further degraded to form new proteins and the heme part forms bilverdin. In the Kupffer cells, the bilverdin is converted to bilirubin by the use of enzymes. The bilirubin is then released into the plasma where it binds to albumin and becomes an unconjugated bilirubin. The unconjugated or free bilirubin enters the hepatocytes and after mixing with glucuronic acid, it becomes a conjugated bilirubin. This conjugated bilirubin is water soluble and hence, soluble in bile, therefore if the outflow of bile is interrupted, conjugated bilirubin will affect the colour of the urine, it becomes darker. Conjugated bilirubin enters into the small intestines through the bile ducts and there, it is deconjugated into urobilinogen by bacteria. The urobilinogin formed could either be reabsorbed into circulation by the hepatic portal vein into the liver to be re-excreted into the bile or excreted in faeces. This process is known as the enterohepatic circulation. The urobilinogen excreted in faeces or urine is oxidized to urobilin which is responsible for the colour of faeces. There are two tests which are carried out for bilirubin. They are direct-reacting (which is carried out for conjugated bilirubin) and indirect-reacting (which is carried out for unconjugated bilirubin). Various conditions can lead to an elevation in the amount of bilirubin in the blood, such as blockage of the bile ducts, excess production of bilirubin, reduced conjugation, reduced secretion and reduced uptake by the liver. Increased levels of indirect bilirubin are usually caused by liver cell disorder. An example is in hepatitis where the damaged biliary excretion leads to the presence of excess faecal urobilinogen in the urine. This gives the urine a darker colour and can be used as an indication of early cell injury. And an increase of direct bilirubin characteristically results from an obstruction which could either be located within or outside the liver (e.g.  a blockage in the bile ducts or gallstones). When the bile duct is obstructed, the concentration of urinary urobilino gen reduces because the stoppage in the excretion of bile into the gut does not lead to synthesis of the faecal urobilinogen. Albumin. Albumin is a major protein which is synthesised by the liver cells and secreted into the blood. The capacity of the synthetic function of the liver can be measured with the use of albumin. The serum albumin test, therefore, is carried out in order to measure the amount of protein in the serum. Albumin has a comparatively long half life of twenty one days, therefore, liver damage must persist (be long term) before reduced levels of serum can be noticed. Inability to maintain the serum levels between the reference value of 35- 50 g/L leads to a low reading of albumin, referred to as hypoalbuminaemia, which signifies impending liver failure. Apart from liver failure, there are other conditions which can result in low serum albumin. Examples include urinary loss, hypercatabolism and also severe malnutrition. Alkaline Phosphatase: Alkaline phosphatase is an isoenzyme which is present in the liver canalicular plasma membrane of hepatocytes, in the placenta, intestine and in the bone for bone building. The normal amount of alkaline phosphates is less 100 IU/L. Increase in alkaline phosphatase is mostly due to increase in enzyme production in areas close to an obstruction and also due to the molecular weight of the biliary isoenzyme. This can be detected with the used of serum electrophoresis. Increase in alkaline phosphatase can be caused by disorders such as cholestasis within the liver (intrahepatic) or outside the live (extrahepatic), space occupying lesions (such as abscesses, cysts and tumours) and hepatitis. During pregnancy, the isoenzyme located in the placenta is released and the isoenzyme in the bone is also released in children and adolescents during growth. These are known as physiological increases in serum alkaline phosphatase. In disorders such as rickets, the serum alkaline phosphatase level is i ncreased. This type of increase is called a pathological increase. And although bilirubin levels increase alongside alkaline phosphatase levels, sometimes the bilirubin value can remain normal regardless of an increased alkaline phosphatase level. Gamma Glutamyl transpeptidase Gamma-glutamyltraferse, gGT, is a glycoprotein which is found in many tissues such as the prostate, liver, intestine, pancreas, and kidneys. It has a normal range which is 20 times (1000U/L), it is considered severe and the raised ALT level can lead to severe viral hepatitis , circulatory shock and drug or toxin induced necrosis. The levels of AST and ALT are reasonably increased (2 30 times) in hepatitis (e.g. alcoholic hepatitis). An increased level of AST normally indicates acute abnormality of liver, heart and/or skeletal muscles.

Importance of the Telemachy in Developing Major Themes of Odyssey Essay

The Importance of the Telemachy in Developing Major Themes of Odyssey      Ã‚  Ã‚   As we begin to read the Odyssey, one of the surprising facts is that we do not meet the famed hero until we are well into Book V, on Calypso's island of Ogygia. However, during these introductory four books, we learn of the situation in Ithaca, Odysseus' plight, some of the most important themes of the story and of course Odysseus' son Telemachus. Homer keeps us in suspense, building the reputation of Odysseus by the stories of Menelaus, Helen, Nestor and all Odysseus' friends in Ithaca. Also, by building up the character and heroism of Telemachus, we are impressed by him, and as Athene says "your father's manly vigour has descended upon you". We would expect Odysseus to actually be better than Telemachus, due to his kleos ('undying fame on the lips of men') and experience ("Few sons, indeed, are like their fathers. Generally they are worse" Athene). So we learn of our main hero through words and inference, but this section of the book is key for our understanding as to the rules and practices of the Greek world in this story, and how the rest of the Odyssey will be carried out. Homer does this by bringing in all the themes that we will encounter time and again as we read on.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Even in the first part of Book I, in Homer's appeal to the Muse and also the introductory meeting of the Olympian Gods, one of the most important themes is brought in. This is the theme that transgressions, especially non-pious ones, lead to punishment. Examples given here are Odysseus' men eating the Sun God's (Hyperion's) cattle, resulting in the destruction of their ship. Homer even comments on it - "their own transgression that brought them to their doom". As... ...seashore", indicating his mood of despair. The link here is between the seashore and despair. When a hero feels an emotion it can be expressed in the book by their location. Thus when we meet Odysseus for the first time he is crying on the beach of Ogygia. When the crew leave the land of the Cicones, they come ashore for a short while away from there to weep on the beach or shore for their lost comrades. They do the same thing when they arrive at the island of Circe.    Now we can leave the Telemachy with these ideas, narrative tools and themes in our mind of how the story will continue and according to what rules. We also have a good idea as to what our hero will be like when we meet him, as we do in Book V. Work Cited: Homer (Translated by Robert Fagles. Preface by Bernard Knox). 1996. The Odyssey. New York: Viking Penguin, div. of Penguin Books, Ltd. Importance of the Telemachy in Developing Major Themes of Odyssey Essay The Importance of the Telemachy in Developing Major Themes of Odyssey      Ã‚  Ã‚   As we begin to read the Odyssey, one of the surprising facts is that we do not meet the famed hero until we are well into Book V, on Calypso's island of Ogygia. However, during these introductory four books, we learn of the situation in Ithaca, Odysseus' plight, some of the most important themes of the story and of course Odysseus' son Telemachus. Homer keeps us in suspense, building the reputation of Odysseus by the stories of Menelaus, Helen, Nestor and all Odysseus' friends in Ithaca. Also, by building up the character and heroism of Telemachus, we are impressed by him, and as Athene says "your father's manly vigour has descended upon you". We would expect Odysseus to actually be better than Telemachus, due to his kleos ('undying fame on the lips of men') and experience ("Few sons, indeed, are like their fathers. Generally they are worse" Athene). So we learn of our main hero through words and inference, but this section of the book is key for our understanding as to the rules and practices of the Greek world in this story, and how the rest of the Odyssey will be carried out. Homer does this by bringing in all the themes that we will encounter time and again as we read on.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Even in the first part of Book I, in Homer's appeal to the Muse and also the introductory meeting of the Olympian Gods, one of the most important themes is brought in. This is the theme that transgressions, especially non-pious ones, lead to punishment. Examples given here are Odysseus' men eating the Sun God's (Hyperion's) cattle, resulting in the destruction of their ship. Homer even comments on it - "their own transgression that brought them to their doom". As... ...seashore", indicating his mood of despair. The link here is between the seashore and despair. When a hero feels an emotion it can be expressed in the book by their location. Thus when we meet Odysseus for the first time he is crying on the beach of Ogygia. When the crew leave the land of the Cicones, they come ashore for a short while away from there to weep on the beach or shore for their lost comrades. They do the same thing when they arrive at the island of Circe.    Now we can leave the Telemachy with these ideas, narrative tools and themes in our mind of how the story will continue and according to what rules. We also have a good idea as to what our hero will be like when we meet him, as we do in Book V. Work Cited: Homer (Translated by Robert Fagles. Preface by Bernard Knox). 1996. The Odyssey. New York: Viking Penguin, div. of Penguin Books, Ltd.

Mother of Three Earns Six-Figures with eCommerce Website :: Sell Websites Buy Websites

Mother of Three Earns Six-Figures with eCommerce Website Reprinted with permission of VotanWeb.com In January, Sarah Kline bought an old watch for three dollars at a small thrift store she stumbled upon in a tiny town near her home in Florida . She went home and listed it for sale on her website. Several days later it sold for $14,200. She'd recognized the watch as the signature style of a designer famous for his unusual creations. A sharp eye for authentic vintage watches -- watches no longer being made -- and the ability to connect with customers who want it are Ms. Kline’s secrets to success on the internet. The 36-year-old housewife has been selling to jewelry stores for years. In early 2002, a computer-savvy store owner and friend suggested she turn to the internet to widen her market. By selling directly to customers online, she could cut out the middleman. Ms. Kline wasn't an experienced Internet user, but she found an existing website listed for sale on VotanWeb. She bought the website when the owner agreed to help her until she had a thorough grasp of the website. His instructions were easy to follow. "It was all new to me, but I learned quickly," she says. "I also did a lot of research by looking at how successful websites set up their auctions -- the categories they listed their products in and the descriptions they used." Ms. Kline began holding auctions. Within weeks, her online sales exceeded those of her off-line business, and she decided to commit entirely to the internet. She now runs about 75 auctions a week, and her annual sales have doubled in the past year to about $420,000. The watch, for example, sold on the internet for about 20 times the amount she estimates it would have gone for had she solicited a local retailer. She's also no longer dependent on local buyers' tastes, since over 90% of her sales are to out-of-state customers. "I couldn't sell everything I had to stores because a lot were particular about what they wanted," she says. For example, most wouldn't buy large quantities of high-end vintage watches. "I found a lot of nice vintage watches from the estates of all the old people who move to Florida to die," she says. "But the stores I sold to wouldn't buy them." Ms. Kline fell in love with vintage watches in the early 1990s while working as a clerk at the local jewelry store. Mother of Three Earns Six-Figures with eCommerce Website :: Sell Websites Buy Websites Mother of Three Earns Six-Figures with eCommerce Website Reprinted with permission of VotanWeb.com In January, Sarah Kline bought an old watch for three dollars at a small thrift store she stumbled upon in a tiny town near her home in Florida . She went home and listed it for sale on her website. Several days later it sold for $14,200. She'd recognized the watch as the signature style of a designer famous for his unusual creations. A sharp eye for authentic vintage watches -- watches no longer being made -- and the ability to connect with customers who want it are Ms. Kline’s secrets to success on the internet. The 36-year-old housewife has been selling to jewelry stores for years. In early 2002, a computer-savvy store owner and friend suggested she turn to the internet to widen her market. By selling directly to customers online, she could cut out the middleman. Ms. Kline wasn't an experienced Internet user, but she found an existing website listed for sale on VotanWeb. She bought the website when the owner agreed to help her until she had a thorough grasp of the website. His instructions were easy to follow. "It was all new to me, but I learned quickly," she says. "I also did a lot of research by looking at how successful websites set up their auctions -- the categories they listed their products in and the descriptions they used." Ms. Kline began holding auctions. Within weeks, her online sales exceeded those of her off-line business, and she decided to commit entirely to the internet. She now runs about 75 auctions a week, and her annual sales have doubled in the past year to about $420,000. The watch, for example, sold on the internet for about 20 times the amount she estimates it would have gone for had she solicited a local retailer. She's also no longer dependent on local buyers' tastes, since over 90% of her sales are to out-of-state customers. "I couldn't sell everything I had to stores because a lot were particular about what they wanted," she says. For example, most wouldn't buy large quantities of high-end vintage watches. "I found a lot of nice vintage watches from the estates of all the old people who move to Florida to die," she says. "But the stores I sold to wouldn't buy them." Ms. Kline fell in love with vintage watches in the early 1990s while working as a clerk at the local jewelry store.

Social Contradictions in Fyodor Dostoyevskys Notes from the Underground :: Notes from the Underground Essays

Social Contradictions in Fyodor Dostoyevsky's Notes from the Underground Notes from the Underground, by Fyodor Dostoyevsky is a truly remarkable novel. Dostoyevsky's novels probe the cause of human action. They questioned conventional wisdom of what drove humans and offered insight into the inner workings and torments of the human soul. In Notes from Underground, Dostoyevsky relates the viewpoints and doings of a very peculiar man. The man is peculiar because of his lack of self-respect, his sadistic and masochistic tendencies, and his horrible delight in inflicting emotional pain on himself and others. Almost instantly the reader is forced to hate this man. He has no redeeming values, all of his insights into human nature are ghastly, and once he begins the narrative of his life, the reader begins to actively hate and pity him. The reader is forced to ask why Dostoyevsky would bother writing about this troubling man and his problems. The answer is that Dostoyevsky does not believe in the norms society sets for people. This man is the absolute opposite of everything society holds to be acceptable. Here is a man, with intelligent insight, lucid perception, who is a self-admitted to be sick, depraved, and hateful. A man who at every turn is determined to thwart every chance fate offers him to be happy and content. A man who actively seeks to punish and humiliate himself. Dostoyevsky is showing the reader that man is not governed by values which society holds to be all important. The point of Notes from Underground more than anything else is that humans actions cannot be calculated. Dostoyevsky implies that in society everyone acts in their own self-interest. They act to gain advantages which are in their own self-interest. He asks the reader to take that as a given. Society sees happiness, freedom, prosperity, etc. as distinct advantages. These things should be in ones self-interest, society says. If someone say, rapes another person, they are not acting in their own self interest. They are running the risk of feeling guilty, guilt is not conducive to happiness. They run the risk of being thrown into jail. Jail is not a place where one can be prosperous or free. Therefore going to jail or feeling guilty are not in ones self interest, according to society's values. A person who conforms to these values, logically, would not rape anyone.

Chuck Taylors All Stars Essay

A.) Marketing Channel Converse uses a distribution channel when marketing the Chuck Taylor All Stars basketball shoes; they have two distribution centers in Ontario, California that uses an automation system to get the shoes into their reserved racks and shipped out to their destinations. These distribution centers handle both Converse and Hurley products as a multi-channel distribution in retail, wholesale, and e-commerce processing. Through this the company has increased the speed of their production by taking two days off the retail order processing timeline and reducing the CPU of apparel by 20 percent. They follow the APCD format which stands for Act, Plan, Check, and Do. The company â€Å"acts† by deciding on the changes needed to improve processing, â€Å"plan† by designing or revising business process components to improve results, â€Å"check† by assessing the measurements and reporting the results to decision makers, and â€Å"do† by implementing the plan and measurin g its performance (Webstoryteller, 2012). B.) Type of Distribution Converse is an intensive distributor because their products and footwear are aimed at maximum market coverage; they try to have the shoes available in every outlet where potential consumers are willing to buy them. The strategy is to sell a large percentage of their products to wholesalers and retailers that are trying to stock their own products. (Lamb, Hair, McDaniel, 2012) C.) Maintaining Channel Cooperation For the most part, Converse has no problem maintaining their distribution channel since they follow the APCD guidelines. The distribution centers’ warehouse management and control systems manages the daily order requirements due to the coordination of their employees, processes, and systems all working together. The company operates a 2 shift/5 day schedule that allows them to receive over 20,000 cases per day, stored over 9 million units of footwear, replenish their orders within 48 hours, and perform dynamic routing (Webstoryteller, 2012). D.) Physical Distribution In footwear, Converse has 12 automated value add and 5 case sealing stations that print of RDIF tickets that are required by client contract services. The shoes are packaged and then shipped off to retailing stores like Target, Kohls, Journeys, Journeys Kids, Macys, Nordstrom, Foot Locker, Champs, Finish Line, JC Penny, Lord & Taylor, Converse Outlet, Nordstrom Rack, Famous Footwear, Foot Action, Amazon, eBay, Sears, Sports Authority, Dicks Sporting Goods, and Zappos (Webstoryteller, 2012).

Is Single Life or Married Life Better Essay

In my culture, you used to be required to be matrimonial in order to be treated as a large up or an adult. That concept had been in my culture for to a greater extent than a yard years. As sentence c bented, that concept has sensibly changed too. Nowadays, universe married in an option. umteen deal prefer to stay superstar and be living happily with their choices, b bely umteen otherwises disagree. They think that you invite to be married to achieve ultimate happiness. So, what ar the differences between world married and being exclusive? The three most popular arguments between a married demeanor and a hit feeling be freedom, social ife and finance.Lets expire with the first difference freedom, since it is the first liaison you give up when you marry to someone. culmination along with marriage is responsibilities, it means that you set pop to take care of your provide, your children, you privynot dependable check to do anything on your own any much. Yo u baset take off and do anything you wishing anymore, because most of your time impart be dedicated to your family. So, whenever you want to go out with your friends, you need to ask your quisling for permission. Things are iffe assume when you are single. When you are single, you nominate full control over your life, you are not bound to any debt instrument provided your own. If you need to take a break from the stress from your work, you can just take off by yourself.When you want to go out with your friends, you wear offt need to ask anyones permissions. In contrast, you arouse busy life fetching care of you parent and your children, and you fatiguet get enough time to go out and enjoy yourself. If youre married, you dont have to fill somewhat your social life. It wont be a hassle if you ecide to go out or need someone to hang out with because your accomplice will ceaselessly be in that location. Since you and your parent have occasion a package, your amount of f riends will receive double concluding your partners source of friends. You get to meet more hoi polloi with more choices of drill. provided, things are more more difficult for a single person than a married yoke in social life. People who are single always have to worry about their companion whenever they are out. They dont have such a stable friend or partner each time they go out.Instead, they need to call many friends before they keep a suitable partner for the night, or they need to spend more time making new friends. Also their choices of use are limited and predictable since there are however some activity for single person. So in comparison, people who are married will come through time in finding a partner for their social activity with a lot more choices. Last but not least, finance. It is very controversy study whether you will save more specie staying single or earn more money being a married suspender.According to Tom Van Riper on Forbes. com, married coupl es have the advantage in the short term compared to single life, where only 9. 3% of monthly gross income goes for rent compared with 23% for single, 5. 6% vs. 8. 3% for food, 1% vs. 1. 8% for cable television, and 1. 2% vs. 2. 8% for telephone bill. In addition, auto insurers role married couple in a lower risk class, saving them money on car insurance. On the other hand, once the children enter the picture, which can take up a married couple in financial trouble, a childs cost can goes up to $4000 per onth locomote in ages. Despite the expenses, single people actually do better in buying houses. Annually, standard deduction for a single person is $4,750 per year, where married couple stands at $7,950 per year. Moreover, married couple hightail it to start saving for retirement primeval on, while singles generally bide until theyre 40, which means singles have more free cash in their pocket than married couple.As I stated in the introduction, nowadays, being single or married is a choice, which many eople choose differently according to the perks they encountered. But beyond the perks, you need to choose sagely with another point of view where you can acknowledge advantage and disadvantage of being single or married. Married life comes with responsibility, where you need make the correct decisions every day and taking care of your partner and your children while single life offers freedom, pull from the burden of responsibilities, but lonely in the late years of your life. It has been always a tough decision.