The National Cardiac Surgery Database Of The Overweight...

In recent decades, improved socioeconomic conditions have led to the expansion of the overweight population worldwide. Obesity is well known to be a risk factor for the development of diabetes mellitus, hypertension and coronary artery disease [1] and is also thought to increase the risk of perioperative morbidity and mortality with cardiac surgery, as evidenced by its inclusion into the Parsonnet system for the stratification of risk for perioperative death [2]. The analysis of the National Cardiac Surgery Database of the Society of Thoracic Surgeons, based on data from CABG, indicated that morbid obesity remains an independent predictor of increased operative mortality in patients undergoing CABG [3] Most studies assessing the effect of†¦show more content†¦Understanding the intraoperative transfusion requirements will streamline blood bank usage and facilitate patient-specific interventions. Preoperative parameters that predict usage are varied, with clinical assessment tools already in place for many operative indications, such as trauma patients requiring massive transfusions [8]. Cardiac surgery in particular routinely utilizes red blood cells, and research to evaluate those patients who will require blood, and how much they will need, is ongoing [9-11]. As with transfusions, a tool to evaluate patients preoperatively for their estimated blood loss postoperatively would facilitate the provision of better patient-specific care. The aim of this study is to investigate the effect of varying BMI on early clinical outcomes in patients undergoing CABG. We retrospectively evaluated the effects of BMI on bleeding, transfusion and in hospital outcomes among Chinese patients who underwent isolated, primary CABG [12-14]. We also collected the results from their clinically available coagulation test to investigate the variations in different BMI classifications. METHODS STUDY POPULATION The study was approved by the ethics committee of Fuwai Hospital. Patient records/information was made anonymous and de-identified prior to analysis. From January 1, 2013 to December 30, 2013, 1007 patients

Risk Management Process Is Risk - 1436 Words

Risk management is developed in order to reduce the likelihood of possible events that have negative effects for patients, staffs and the organization; to reduce the risk of death and injury or disease for patients, staffs, and others as result of services provided; to improve patient outcomes; to manage resources effectively; and to support legislative compliance and to ensure organizational viability and development. In order to achieve these goals, risk management teams should follow the four steps process of risk management. The first step is risk identifications. Risk identification involves the collection of information about current and past patient are occurrences and other events that represent potential losses to the organization. Such risks can be identified as antitrust, violations, breach of contract, casualty exposure, defamation, embezzlement, environmental damage, fraud and abuse, general liability, hazardous substance exposure, professional malpractice, securities vi olations, transportation liability, and worker’s compensation. The second step in risk management process is risk analysis. Risk analysis entails the evaluation of past experience and current exposure to eliminate or limit substantially the impact of risk on cash flow, community image, and employee and medical staff morale. The third step in risk management process is Risk Control/Treatment. Risk Control/Treatment is the organization’s response to significant areas, as well as its rejoinder toShow MoreRelatedRisks Of A Risk Management Process1208 Words   |  5 PagesEvery day businesses face the challenge of being exposed to potential risks. Whether these risks are internal to the company financially, damaged caused to the interior or exterior of the building itself, or lawsuits due to liability losses, businesses have a responsibility to be prepared. There are numerous ways for businesses to protect themselves from possible risks resulting from a loss. Risks may als o vary depending on the type of business and operations it conducts. Not all companies will beRead MoreRisk Management Process : Identifying The Risk1234 Words   |  5 PagesThere are five steps of the risk management process: identifying the risk, analyzing the risk, evaluate the risk, treat the risk, and monitor or review the risk (â€Å"What Are the 5 Risk Management Process Steps?†). Step one would be to identify the risk. This step involves finding all the possible potential losses. There are some major issues that can cause a risk in risk management, such as, worker compensation, climate change, and increasing cost. 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Other highlights of the Research Industry are revision to the â€Å"Common Rule† â€Å"to reduce burden, delay and ambiguity for investigators†, the Food and Drug administration (FDA) encouragingRead MoreTechnology And Risk Management Process1299 Words   |  6 PagesIntroduction Innovation and the â€Å"Change† process have gripped the clinical research Industry in the last few years. Evolution in technology and Risk Management processes consequently lead to release of the latest International Council of Harmonization (ICH) Good Clinical Practice (GCP) E6 R2 step 4 in Nov 2016. Change in the Clinical Research landscape also lead to revisions towards modernization and reinforcement of the â€Å"Common Rule† in Jan 2017 besides the Food and Drug administration’s (FDA)Read MoreRisk Assessment : An Essential Part Of A Risk Management Process1046 Words   |  5 PagesIntroduction The risk assessment is an essential part of a risk management process designed to provide appropriate levels of security for information systems. The assessment approach analyzes the relationships among assets, threats, vulnerabilities and other elements. Security risk assessment should be a continuous activity. Thus, a comprehensive enterprise security risk assessment should be conducted at least once every two years to explore the risks associated with the organization’s informationRead MoreEssay on Risk Management Process1603 Words   |  7 Pages Purpose The purpose of this Risk Management Process document is: †¢ To provide a framework to track and monitor project risks throughout the project lifecycle †¢ Establish roles and responsibilities of all participants in the process Scope This process will be used by the entire project team. As such, this document defines the Risk Management process and flow for a project. Description A risk is any factor that may potentially interfere with a successful completion of a project by having

6 elements to a contract Essay Example For Students

6 elements to a contract Essay A contract is a binding agreement made between two competent parties that can be written verbal or implied. The purpose of a contract is to create an agreement that can be supported by the law (Wests Encyclopedia). As we enter the new millenium, and with the increase in the number of businesses (including e-commerce), we need to know more and more about contract law. Knowledge of contract law can also protect consumers and businesses from misunderstandings. The six elements of a contract are: binding agreement, competent parties, form required by law, legal in purpose, consideration, and genuine assent. A binding agreement is a contract, verbal or written, between parties that is bound by law. When two competent parties make an agreement, it is considered binding. A binding agreement must have an offer and an acceptance. An example of a binding agreement would be if Kelly told Jamie that she would buy her car for $6,000 and they both agreed to it. This agreement is legal in purpose, supported by consideration, is in the form required by law and is made by two competent parties who gave genuine assent. To make an agreement a legal contract, both parties have to be competent. All adults are assumed to be competent. Its important for people who are making contracts to be of sound mind. This means that the people involved cannot be under the influence of any substances or be mentally ill. Convicts and enemy aliens are also considered to lack capacity. Capacity means the ability to understand ones actions and the effects of those actions. It is legal for minors to enter into contracts, but they cannot be bound by law because younger people have limited experience and are more vulnerable than adults (Mietus 163). The purpose of competency is so people dont take advantage of those who are not competent when entering into contracts. When an adult makes a contract with a minor, the minor is the only one who can disaffirm the contract. The adult is bound by law (Mietus 163). An example of a contract that cannot legally be bound would be if John wanted to buy Ryans car for $2000 and Ryan refused. Later that day, John took Ryan out to a bar and offered him several drinks. John offered to buy Ryans car again and Ryan agreed because he was under the influence of alcohol. Due to Ryans lack of competency, this contract is void. Consideration is the promise or action that one person (the promisor) gives in exchange for the promise or action of the promisee (Mietus 198). A promise of giving without receiving is not a legal contract and would be called lack of consideration. An example of lack of consideration would be if grandpa said he would pay for your college tuition if you get straight As in high school and then decides not to do it. That promise would not be legally binding because he is not getting anything in return. Both parties must get something in return for the contact to be legal. An example of consideration is if two competent parties traded a pen for a watch. Each party is giving and receiving something of value, which is called consideration.One of the exceptions to consideration is promissory estoppel. An example of this would be if your dad said he would buy you a brand new car if you paid your way through law school. Because you suffered an economic loss to hold up your end of the bargain, the other party could be legally bound by promissory estoppel. Another exception to consideration are charitable contributions. For example, if I told Red Cross that I was going to donate $500 per year, then I could be legally bound to do so. .u3f2b06bc679e8c88c17a344ea3cc362f , .u3f2b06bc679e8c88c17a344ea3cc362f .postImageUrl , .u3f2b06bc679e8c88c17a344ea3cc362f .centered-text-area { min-height: 80px; position: relative; } .u3f2b06bc679e8c88c17a344ea3cc362f , .u3f2b06bc679e8c88c17a344ea3cc362f:hover , .u3f2b06bc679e8c88c17a344ea3cc362f:visited , .u3f2b06bc679e8c88c17a344ea3cc362f:active { border:0!important; } .u3f2b06bc679e8c88c17a344ea3cc362f .clearfix:after { content: ""; display: table; clear: both; } .u3f2b06bc679e8c88c17a344ea3cc362f { display: block; transition: background-color 250ms; webkit-transition: background-color 250ms; width: 100%; opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #95A5A6; } .u3f2b06bc679e8c88c17a344ea3cc362f:active , .u3f2b06bc679e8c88c17a344ea3cc362f:hover { opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #2C3E50; } .u3f2b06bc679e8c88c17a344ea3cc362f .centered-text-area { width: 100%; position: relative ; } .u3f2b06bc679e8c88c17a344ea3cc362f .ctaText { border-bottom: 0 solid #fff; color: #2980B9; font-size: 16px; font-weight: bold; margin: 0; padding: 0; text-decoration: underline; } .u3f2b06bc679e8c88c17a344ea3cc362f .postTitle { color: #FFFFFF; font-size: 16px; font-weight: 600; margin: 0; padding: 0; width: 100%; } .u3f2b06bc679e8c88c17a344ea3cc362f .ctaButton { background-color: #7F8C8D!important; color: #2980B9; border: none; border-radius: 3px; box-shadow: none; font-size: 14px; font-weight: bold; line-height: 26px; moz-border-radius: 3px; text-align: center; text-decoration: none; text-shadow: none; width: 80px; min-height: 80px; background: url(https://artscolumbia.org/wp-content/plugins/intelly-related-posts/assets/images/simple-arrow.png)no-repeat; position: absolute; right: 0; top: 0; } .u3f2b06bc679e8c88c17a344ea3cc362f:hover .ctaButton { background-color: #34495E!important; } .u3f2b06bc679e8c88c17a344ea3cc362f .centered-text { display: table; height: 80px; padding-left : 18px; top: 0; } .u3f2b06bc679e8c88c17a344ea3cc362f .u3f2b06bc679e8c88c17a344ea3cc362f-content { display: table-cell; margin: 0; padding: 0; padding-right: 108px; position: relative; vertical-align: middle; width: 100%; } .u3f2b06bc679e8c88c17a344ea3cc362f:after { content: ""; display: block; clear: both; } READ: Socrates: Psychic Harmony Is The Greatest Good EssayGenuine assent exists when consent is not clouded by fraud, duress, undo influence or mistake (Mietus 212). For example, if Billy pulled out a gun and got Ed to agree to sell his bike for $5, Ed is under duress and is not giving genuine assent to sell the bike. Genuine assent must be communicated clearly in some way (written, verbal or strongly implied). An example of not giving genuine assent would be

Titanic Movie Poster Essay Research Paper The free essay sample

Titanic Movie Poster Essay, Research Paper The screen box for Titanic reveals two different significances to the audience. The first is an expressed significance, of which is clearly presented through the assorted images on the screen. The 2nd significance, the inexplicit significance, is nuance suggested amongst the images and requires some idea to hold on. Through the usage of implicit and expressed significance, the film box creates involvement and machination. The screen is composed of images that tell the audience right off what they can anticipate from the film. Initially catching the audience s eyes is Leonardo DiCaprio and Kate Winslet pictured at the top of the box. DiCaprio s arm is around Kate Winstlet, proposing that the film is about these two being lovers. The character of Kate Winslet is have oning diamond earrings, which shows that character is from a rich or good off background. The histrions names appear above them in a little, difficult to read fount, likely because the histrions are celebrated plenty that they are recognizable to the public by merely their faces. We will write a custom essay sample on Titanic Movie Poster Essay Research Paper The or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Next, the big image of the bow of a big ship tells the audience the scene of the film is placed on a ship. The ship is evidently the celebrated Titanic as suggested by the bold rubric across it. The manager # 8217 ; s name, James Cameron is above the rubric, possibly to pull involvement from the manager s fans. Under the rubric states the movie has won eleven academy awards including best image. The intent of saying this fact is to inform the audience how critically acclaimed the film is, and possibly making more involvement than compared to non holding the claim on the box at all. By analyzing the screen a little more closely, several impli cit significances can be made out. The first is how the histrions are confronting. Kate Winslet s back is towards DiCaprio. This suggests that even though they are in love something might be keeping her dorsum from to the full encompassing him. Their eyes are lowered, giving the feeling that they are deep in idea as if they are seeking to calculate things out. The ship seems to typify their love ; which is huge, strong and continually hammering forth. The manner the word Titanic is presented besides signifies their love. The words look like they are of steel ; which is strong and solid, like the love for each other. If looked closely, one can see that the characters are shown utilizing really soft and bleached colors giving a wispy feel and the ship is really crisp with the colorss bold. The inexplicit significance behind the contrast is to mean how the ship is the key to to the full understanding the narrative of these two lovers. Possibly a secret between so is locked within the sh ip. In making this inquiry, the audience is intrigued into sing this film to happen out what significance the ship has with the two characters. The film box uses expressed messages to catch the audiences oculus. Right off it reveals that this is a narrative of two immature lovers likely on a ship. In province the manager # 8217 ; s name, James Cameron, and the academy awards with the intended intent of converting that this is a worthwhile film to watch. If the possible spectator is still non wholly convinced in leasing or purchasing, so this is when the inexplicit significances come in to play. By showing elusive messages and raising wonder, the inexplicit messages are used to give the audience that small push over the fencing in make up ones minding to see the film or non.

Husserl Phenomenology

Husserl Phenomenology Free Online Research Papers Husserl was a German Jewish philosopher. Being Jewish put him at a disadvantage due to the times and the place. After gaining his Ph.D in mathematics at Berlin university, he lectured at the universities of Gà ¶ttingen and Freiburg. The Nazis had him relocated in favor of his previous apprentice, Heidegger. Husserl believed that the political and social crisis followed from an intellectual crisis. Modern science was unsuccessful to provide its promised answers. Husserl wanted to produce a philosophy that would offer a firm establishment of certain understanding upon which all other sciences would rest. His phenomenology was to be a philosophy of drastic rejuvenation through which mankind would learn to see the world anew. All prejudices would be eliminated; all simplistic answers to fundamental questions would be balanced, all taken for granted attitudes abandoned. The result a Europe founded on truth. Only one need absorbs me: I must win clarity else I cannot live; I cannot bear life unless I can believe that I will achieve it. (H. Spielberg The Phenomenological Movement Vol. 1 1865 p. 76 n.1, p. 82.) Husserl dedicated himself to a search for the very foundation of human knowledge. His first passion had been mathematics and he became gripped by a vision of a philosophy that provided the surefire certainty found in mathematics. He wanted to create a philosophy that was a rigorous science. Yet his focus was not on the so-called objective truths of empirical science, but on the subjective process of human thinking; not on so-called facts but on phenomena, things as they appear to the mind. Edmund Husserl saw modern science in crisis. Its claims to objectivity failed to recognize the active role of consciousness in developing human understanding. He developed phenomenology, a methodology designed to examine the contents of ones own consciousness. The examination of pure phenomena is seen as a means to return to the fundaments of knowledge and how the world first appears to the consciousness. The focus is on the subjective process of thinking rather than on what others would consider the objective facts of empirical science. His method of phenomenological reduction requires the suspension of all assumptions about the external causes and results of the contents of consciousness. The aim is to distinguish the essential nature of mental acts and thus the truths that are the sources of human knowledge. Thinking is always intentional, aimed at a specific object. But the difference between thinking and acting is that the intentional object, what the mind is thinking about, need not be present. It may not even exist. The difference between mental acts and other acts is that the objects of mental acts may be intentionally inexistent. This does not, however, mean they have no reality. The act of thinking gives them a meaning and significance; they become objects of our consciousness. It is these objects of consciousness, phenomena, that are the focus of Husserls philosophy. Husserl saw modern science in crisis precisely because its claims to objectivity had failed to recognize the active role of consciousness in developing human understanding. Any theory of knowledge must be based on an understanding of the workings of the human consciousness. The natural sciences give the appearance of rational, objective knowledge. But the natural attitude of the scientific method fails to acknowledge the role of consciousness in constituting meaning. It denies the essential status of objects of consciousness as living intentional experiences. The mind and only the mind is a being in itself and for itself; it is autonomous and capable of being handled in a rational, genuinely and thoroughly scientific way Thus the science of nature presupposes the science of the mind. (Philosophy and the Crisis of European Man) Phenomenology claims to be absolutely original and scientific in a genuine sense. It abandons the tentative notions that science mistakes for reality and the pseudo-scientific pretenses of naturalism. Husserl is not denying a legitimate role for natural science. He is simply arguing that its very legitimacy assumes a phenomenological investigation of the intentional origins of knowledge. A solid foundation for knowledge can only be secured by a meticulous method that returns to the intuitive evidence of the immediate experience of consciousness. Phenomenology is therefore a science of science. Attempts by Franz Brentano to establish psychology as an empirical science inspired an interest in mental phenomena. It was Brentano who first stressed the intentionality of consciousness. Brentano realized that it was impossible to study behavior without recognizing that behavior constitutes acts of consciousness. It involved interaction between the subjective conscious self and the objective outside world. Empirical psychology, he concluded, must first seek to understand the subjective experience by way of intuition. Brentano appears to have had greater influence on the phenomenologists than on the world of experimental psychology. Heidegger was at one time pupil of Husserl, a pupil who succeeded his master as professor at Freiburg University, not so much because of his philosophical genius but because of his political affiliation. Heideggers commitment to National Socialism saw his promotion to rector of the university in 1933. Meanwhile, Husserl was subjected to harassment and his career inhibited because of his Jewish background. The influence of both Husserl and Heidegger on existentialists like Sartre is undeniable. Later phenomenologists failed to follow Husserls thinking in its entirety. They make the more modest claim to explore the many ways in which consciousness itself provides the structure and the feeling of being in the world. Still the existentialists focus on the life-world of the conscious being finds its origins here. Husserl envisioned a process of exploring the intentionality of pure consciousness and hence producing universally valid knowledge free from corruption by individual and communal experiences and understanding. This would involve a number of stages. Bracketing suspension of all empirical and metaphysical presuppositions Reduction allowing a return to a presuppositionless world Free variation imaginary variation of the reduced thing to a common variation or essence (eidos) Intuition an awareness of the essence as it emerges passively from the overlap of the varying acts of intentionality Description of the essential structures of of both the intended thing (noema) and the intending consciousness (noesis). The descriptive phase includes all the stages and renders essential intuitions permanent and hence communicable to others in the universal pursuit of knowledge. Phenomenology is in search of a pure or reduced object or process, its very essence. It seeks to strip individual objects of all that makes them particular, seeking the pure essence what they share with other objects of the same sort. This requires putting to one side all beliefs characteristic of common sense and science, a process called bracketing. Bracketing concentrates our awareness on the ways in which meanings appear to us as pure phenomena regardless of whether they exist as empirical entities outside of our consciousness. The mind is thus freed from the literal reality we normally take for granted and comes to know its own intentionality more intimately and more accurately. From the outset, Husserl argued that the main purpose of phenomenology is a return to the fundaments of knowledge. Its aim is to relocate the primary point of contact between man and the world, to redirect philosophical attention to the primordial ways we perceive the world. Phenomenology works to recover the forgotten origins of scientific knowledge, to retrace a pre-objective intuition of things themselves in their flesh and blood presence in the life-world. It asks us to rediscover the hidden â€Å"intentionalities† of consciousness, to examine their essential structures in a new manner without presuppositions. Phenomenology places much importance on imagination and intuition. After bracketing, there occurs free variation where meaning unfolds in a free play of pure possibilities. In the unregulated horizon of our imagination, we can liberally vary or modify anything until an invariant structure is revealed. This is the essence of the thing intended. It emerges passively from the overlap of the multiple acts of our freely varying intentionality. In a single intuitive act of recognition we are taken back to the interface between consciousness and its intended object. In this way, phenomenology arranges to repeat the pre-reflective acts of our intentional experience in a reflective fashion. Husserls analysis focuses not just on the objects of consciousness but also on the acts of consciousness perception, imagination, signification etc. which intend the object. The method culminates in a description of the essential structures of both the intended thing (noema) and intending consciousness (noesis), as these essences emerge from the free variation of imagination into the grasp of a united intuition. Through the process of phenomenological reduction, Husserl believed that one can also discover ones own transcendental ego. This ego, as pure consciousness, is quite distinct from the psychical self that is of interest to psychology. Husserl believed that his phenomenological method overcame the difficulties that Kant had identified in coming to know either things-in-themselves or the transcendental self. By means of phenomenological reduction, Husserl believed that we could regain access to a presuppositionless world of transcendental immediacy where being becomes identical with its manifestation to consciousness. Being becomes reduced in a non-reductive sense of being retrieved and opened up to the meaning of being . Husserls analysis focuses not just on the objects of consciousness but also on the acts of consciousness perception, imagination, signification etc. which intend the object. The method culminates in a description of the essential structures of both the intended thing (noema) and intending consciousness (noesis), as these essences emerge from the free variation of imagination into the grasp of a united intuition. Through the process of phenomenological reduction, Husserl believed that one can also discover ones own transcendental ego. This ego, as pure consciousness, is quite distinct from the psychical self that is of interest to psychology. Husserl believed that his phenomenological method overcame the difficulties that Kant had identified in coming to know either things-in-themselves or the transcendental self. By means of phenomenological reduction, Husserl believed that we could regain access to a presuppositionless world of transcendental immediacy where being becomes identical with its manifestation to consciousness. Being becomes reduced in a non-reductive sense of being retrieved and opened up to the meaning of being. Husserl was fixed that a new scientific philosophy would not treat consciousness from the natural viewpoint, as object. Truth lies, not in the mind, nor in the natural objects of perception, but in the interaction between the two. As soon as we encounter the world, we, as conscious subjects, start to give it meaning. A solid foundation for knowledge can only be secured by a scrupulous method that returns us to the immediate experience of consciousness. We can only hope to know the things themselves by interrogating the life of the consciousness which intends these things that transcendental self which alone is capable of producing valid universal knowledge. Research Papers on Husserl PhenomenologyThree Concepts of PsychodynamicRelationship between Media Coverage and Social andComparison: Letter from Birmingham and CritoAnalysis Of A Cosmetics AdvertisementQuebec and CanadaIncorporating Risk and Uncertainty Factor in CapitalAppeasement Policy Towards the Outbreak of World War 2Capital PunishmentBook Review on The Autobiography of Malcolm XInfluences of Socio-Economic Status of Married Males

4 Google Searches to Boost Interview Success

4 Google Searches to Boost Interview Success When a company has contacted you about an interview, you might think your work (getting your resume in order, pulling together your application package) is over. After all, ball’s in their court, right? Not so much. The legwork you do between the initial outreach from the company and the day of your interview can make the difference between getting the job and going through this process again with a different company and job. Preparation is essential ahead of the interview, and thanks to the wonders of Google (or your preferred web search engine), you can set yourself up nicely.Find as much information as you can on the company.Check for news alerts in particular, as these can tell you what the company’s public face is. Are they constantly on the defensive for financial shenanigans? Are they always at the forefront of raising money for your favorite charity? Good or bad, this research can give you a baseline of information about the company in general.The good things (s trong financial success, major philanthropy efforts) can be casually worked into the conversation during your interview to show that you’ve been paying attention to the company’s fortunes. The bad stuff, well, that’s for your own reference. It won’t endear you to that company’s employees if you open with, â€Å"Jeez, you guys had a heck of a bad quarter, huh?†Do a little digging into the company’s key people.This can include the person who will be interviewing you. A quick check of LinkedIn can tell you if you have any shared school or business connections. When you do this bit of research, though, tread carefully. Remember that on networks like LinkedIn, you  can see who’s been looking at your  profile, and how many times. So while natural curiosity can seem proactive, definitely be wary of seeming stalker-y.That same policy applies in the interview itself, too. If you and the interviewer both went to the same school, grea t! You have an in to talk about the football team during the small-talk portion. But if you just recite personal facts you gleaned from social networks, it may make you look aggressive or obsessive.Research your potential job title at the company.Even if you don’t have specific names from the place where you’re interviewing, you can easily search for more generic information. Try typing in â€Å"[company name] + [job title]† to see if there’s any information floating around about the specific job- that might turn up information at sites like Salary.com and similar review websites. This could also help later, if you receive a job offer: it can give you a frame of reference for salary or benefit negotiations.Know the company’s mission.This type of information is often readily available on the company’s own website. Knowing their stated core values puts an answer in your back pocket if the interviewer asks, â€Å"What drew you to this company? † or â€Å"What do you already know about this company?† If you can smoothly say, â€Å"Like Company X, I also fully support providing organic snacks to baby seals,† without missing a beat, it’ll emphasize you can fit well in the company’s culture.The more information you have before you ever set foot in the interview, the better off you’ll be. After all, they’re not just evaluating you and your specific skills, but also you as a potential team member and ambassador for the company.

An environmental accident for which a company was liable. It can also Term Paper

An environmental accident for which a company was liable. It can also be a deliberate environmental incident for which a compan - Term Paper Example Sea water breached the tsunami walls protecting the facility after a tsunami that followed the earthquake. The tsunami wave was 13 meters while the tsunami walls protecting the facility were only 10 meters high. TEPCO had predicted a possibility of a tsunami wave breaching the wall in case of an earthquake of a high magnitude. The paper seeks to establish the liability of the company in regard to the Fukushima Daiichi nuclear disaster. Table of contents 1. Introduction†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.†¦4 1.1 Fukushima I nuclear power plant†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.†¦.†¦Ã¢â‚¬ ¦..4 2. Causes of the Fukushima I nuclear plant disaster†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.†¦...5 3. Safety issues r elating to the Fukushima nuclear plant prior to the disaster.†¦Ã¢â‚¬ ¦..†¦..6 3.1 Changed layout of the emergency cooling system†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 6 3.2 Falsified safety records by TEPCO†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.†¦..†¦6 3.3 Prior failure of the backup generator †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦6 3.4 Ignored tsunami warning†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.†¦Ã¢â‚¬ ¦..7 3.5 Location of the reactor†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.†¦Ã¢â‚¬ ¦..7 4. ... Unit 3†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦..9 4.4 Issues in Unit 4†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.†¦.10 5 Release of radioactive substances into the environment†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦...10 6. Liability for the Fukushima nuclear disaster†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦11 6.1 Assessing TEPCO’S liability†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.†¦...12 Work cited †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦14 1. Introduction The Great East Japan Earthquake with magnitude of 9.0 did a substantial damage to Japan and its environs. The gigantic tsunami that followed the quake resulted in more damage. The earthquake was complex and unusual double quake with a severe period of around 3 minutes. As a result of the earthquake Japan shifted a few meters east and the country's coastline sank half a meter. The death toll from the earthquake is recorded at 19,000, and much of the coastal area was destroyed. 1.1 Fukushima I nuclear power plant The Fukushima I Nuclear Power Plant comprised of six boiling water reactors. These reactors were designed by General Electric. During its activity, the plant produced a total power of 4.7 gigawatts. The plant was among the largest nuclear plants around the world. It was run by TEPCO (Tokyo Electric Power Company). At the time of the earthquake unit 1, 2 and 3 of the plant were operational while unit 4 had been de-fueled and both unit 5 and 6 had been shut down for maintenance. After the earthquake the functioning units in all nuclear plants, including unit 1, 2 and 3 in the Fukushima I plant were shut down following government regulations (Ohnishi, 12). A 13

American Civil War High School Essay Example | Topics and Well Written Essays - 500 words

American Civil War High School - Essay Example Another reason why the south lost is that the troops faced major problems in battle. These problems were as a result of lack of a good communication channel, communication barriers led to a lack of information and in the case where a group attacked it were difficult to get help and enforcement from the other troops. The southern troops also lacked unity and many were not confident in winning the battle and this eventually gave the north an opportunity to win the battle. Therefore the south lost due to lack of unity, lack of communication channels, poor organization and lack of experience in battle. In my own view there is no way that the south would have won with all the disadvantages they had compared to the north, they took these opportunity and won the battle. The north won the battle due to the fact that they had more soldiers compared to the south, also the soldiers were experienced, well trained and well armed then the south, transport and communication networks were better than those of the south region and this made it easier for transportation of arms and reinforcing battle fronts.

The Bridge at Argenteuil Essay Example for Free

The Bridge at Argenteuil Essay The Bridge at Argenteuil by Alfred Sisley is a landscape painted during the French Impressionism period. This painting is located at the Memphis Brooks Museum of Art in the European to 1900 collection. The Memphis Brooks Museum of Art is the oldest fine arts museum in Tennessee and displays art from antiquity to contemporary. I chose this museum because it has art from different time periods. This museum, upon first impression, was well organized, and the different collections were relatively easy to find. I chose The Bridge at Argenteuil because Alfred Sisleys work is rarely studied. Alfred Sisleys The Bridge at Argenteuil is a landscape painting. It is oil on canvas and 15 ? by 24 inches. Painted in 1872, The Bridge at Argenteuil depicts a quiet, country scene. Toward the right of the painting, there are warm-colored houses on top of a small hill, while toward the left of the painting is a river, in which is a small sail boat. The grass in the foreground is reminiscent of wheat fields. There is a path that runs from the foreground of the painting out to the river, ending at a small dock, perhaps for fishing. There is a bridge in the background, seemingly tying the entire painting together. Because there is no action in the painting, this work seems to be a study in quiet and calm country life. Every object in this landscape seems to be connected. For example, the path in the foreground leads to the dock that connects with the river. The bridge in the background stretches from the land where the artist painted from, over the river, and to the shore on the other side of the river toward the left of the frame, connecting the two pieces of land. This painting clarifies that the countryside is peaceful and calm. Many artists choose to paint people, animals, and urban scapes. However, a few, like Alfred Sisley, choose to paint landscapes. Sisley recognized that country landscapes show the softer side of life. Sisley chose to look at the bigger picture instead of focusing on one thing in particular. By having the freedom that comes with not focusing on a particular subject, Sisley captured the essence of the natural world, a world that is peaceful, calm, and ever-changing. I believe this is what he wanted to show the world. The Bridge at Argenteuil is a study in the wonders of nature and how man and nature can exist in harmony. This work does meet the standards of perfection, inexhaustibility, and insight. Every object in the painting works with the others to create a scene that is calm and peaceful. Sisley painted in great detail, showing the perfection that exists in nature. For example, Sisley included different shades of blue in the river; the further I looked into the background at the water, the whiter it seemed to become. The white clouds seem to be moving from right to left, slowly covering a light blue sky. Sisley added these details to capture the ever-changing essence of nature. The work is insightful. This painting made me take a slower, second look at nature and how everything does balance out. For example, in this painting, every aspect of nature the sky, the water, and the land seem to have an equal part of the frame, they seem to be balanced. I could envision a triangle while looking at these aspects, with the sky being the top point, and the land and water being the bottom points. The Bridge at Argenteuil resists monotony because nature is always changing. For instance, the water seems clear, like it would be during the summer, but the grass is becoming brown, indicating that the season is moving toward winter. The sky is becoming overcast; this could be indicative of a colder breeze moving in. Because of these elements, it seems as though the season is in transition. This painting has and has not withstood the test of time. For instance, it has withstood the test of time because it was painted in 1872 and is still on display along with other famous and important works of art. It depicts a nature scene that is always changing and evolving, a scene that never becomes outdated. However, Alfred Sisley, as well as this painting, has not been studied extensively and is rarely analyzed, unlike other works of art of the late nineteenth century, such as Monet and Renoir. This gives the impression that this painting has not withstood the test of time. The bridge at Argenteuil has not only been painted by Alfred Sisley. Claude Monet, another impressionist painter, painted this bridge as well. However, there one major difference between the two paintings, although they share the same title. Sisleys The Bridge at Argenteuil depicts the bridge from afar, focusing more on the land and the water in the foreground. Monets The Bridge at Argenteuil focuses more on the water and a couple of sail boats, with the bridge off to the right side of the frame. Another important detail is that Monets painting of the bridge was created two years after Sisley painted the bridge. Therefore, Sisleys The Bridge at Argenteuil can be determined to be unique and original. Also because of the aforementioned reasons, it can be said that this painting could have influenced Monets painting of the bridge. Sisley also depicted a sail boat in his painting, like Monet did, although Sisleys sail boat was small and relatively insignificant, while Monets sail boats were the focus of the painting. This painting possesses not only international appeal because Sisley was a French painter, but universal appeal because people from around the world can relate to nature. This painting depicts elements in nature that can be found in any rural area. For example, it is a scene that focuses on a grassy knoll and a body of water. While looking at this painting, it seems as though it can be found in the United States, when actually, this scene was painted in France. This scene has universal appeal because people of all ages and cultures can relate to it. I chose Alfred Sisleys The Bridge at Argenteuil because it is an under-appreciated painting. It seemed calm and comforting, two feelings that most do not take the time to enjoy. The grass in the foreground and how it seemed to be swaying in the breeze sticks in my mind the most. The analysis of this work of art taught me how to appreciate the seemingly insignificant aspects of life. For most, including myself, life rushes by. Getting to work or school and finishing daily tasks keeps one so busy that no one ever has the time anymore to slow down and appreciate nature. Most take these aspects of life for granted. Analyzing this painting forced me to slow down and appreciate the beauty of nature.

The idea of facades across a range of texts Essay -- essays research p

The poem ‘The Ballad of Calvary Street’ by James Baxter, the film ‘American Beauty’ (directed by Sam Mendes and released in 1999), and the play ‘An Inspector Calls’ written by J.B. Priestley and performed at Circa Theatre in 2005, are all texts that share a similar theme. Although these three texts are different in terms of authorship and the medium through which the significant messages are communicated, what the texts do have in common is that they all convey ideas about how facades and superficial images of family life only lead to soullessness and domestic disorder. The unique approach that each text takes to this issue heightens the impact of the texts in every case, and allows the discussion of facades to become more pertinent in a time when domestic problems still mar our society. Baxter’s poem, ‘The Ballad of Calvary Street’, satirises the concept of facades and fake family life by ironically using religious imagery, and by utilising figurative language and clever diction to develop a rounded depiction of the sad characters at the heart of the poem. The poem discusses firstly the trellises that line Calvary Street (an image which conventionally would symbolise happy domestic life), and mentions the flowers that bloom â€Å"as bright as blood†. In addition to being an insidious suggestion that there is violence beneath the veneer of this seemingly respectable society, this phrase also alludes to the crucifixion of Christ. This is confirmed by the line that later describes the house as â€Å"an empty tomb†. This evocative metaphor hints that the house is a place of depression and emotional soullessness, and again links this home to the story of Christ; however, Baxter is comparing this house to Christ’s story only ironic ally. Through the use of religious language, Baxter is able to sardonically indicate that the values of forgiveness and compassion so often connected to The Bible and religion are nowhere to be found in this unhappy home. To emphasise that religion plays no role in this distorted version of family life, Baxter intersperses the religious language with mundane descriptions (for instance, he writes, â€Å"the afternoon goes, goes by, while angels harp above a cloud †¦Ã¢â‚¬ ) to show that spirituality – and indeed, all ideas of ethics and morality – are forsaken in this barren location. Baxter tells in the poem of how â€Å"two old souls go slowly mad†, and const... ...ley play ‘An Inspector Calls’ all scrutinise the nature of domestic life, and the facades that are developed to hide the true problems of our society. ‘The Ballad of Calvary Street’ looks at the manner in which individuality and excitement are suppressed by the maintenance of such a faà §ade, and emphasises that domestic relationships are devoid of any spirituality or ethical framework. ‘American Beauty’ focuses on the advantages of breaking free from the constraints of the faà §ade, and emphasises the freedom and openness that can be achieved once the duties of the faà §ade are forgone. ‘An Inspector Calls’ analyses the way a faà §ade can crumble when there is pressure and confusion to reveal people who are not as respectable as they seem. The issue of facades is very relevant to our society, at a time when, in New Zealand at least, domestic abuse and divorce are still pernicious problems. The issue is often explored across a range of texts and could even be argued to be a clichà © in current times. However, the uncompromising and honest manner in which these texts address the issue makes the concept of facades so intriguing and fresh, and causes these texts to gain added power and impact.

Process Centered Organizations Essay

Process Centered Organizations are planned to create maximum value, innovation and development. A Process Centered Organization can sustain its processes at a high level. A process centered organizational design sorts out the best blend of structure and process. By carrying out a process-centered cycle, healthcare organizations can achieve their goals by changing the way workflow is defined and the way the people working in these organizations perceive their roles. In all healthcare organizations, the focal point is the patient. From a patient’s perspective, how much he or she is valued is important. Healthcare organizations around the globe are making efforts to satisfy their customers in the best possible ways. But modern times require these organizations to engage in the use of knowledge, skills, tools, techniques and systems to improve and direct processes towards creating value for the patient. One such example of a healthcare organization is Eastern Maine Medical Center (EMMC), Bangor, Maine. The organization in fact received the 2008 HIMSS Davies Award. This prestigious award is given to selected hospitals in the United States for effectively using information technology to improve the safety and quality of patient care. EMMC represents an immaculate example of how to apply and make use of electronic health records (EHR) along with other technologies in order to ensure delivery of quality and evidence based healthcare. The EHR system was installed as part of EMMC’s Patient First Initiatives Program. This was an effort to provide high quality patient care by changing care delivery, adopting a patient-focused culture and implementing a technology plan to support the care delivery process. EMMC’s use of data derived from its healthcare IT systems is a shining example of how to drive performance improvement, quality and improve care in response to state and national reporting requirements. †(HIMMS news, 2008) Eric Hartz, MD, EMMC chief medical information officer, says this award is a crowning achievement for EMMC’s employees. He emphasized that in the end, it is the patients of the region who will benefit from EMMC. The organizations staff worked hard for nearly a decade to implement the most advanced computer systems on the market to allow instantaneous sharing of health information among all healthcare providers involved in a patient’s care. â€Å"When the software that was currently available wasn’t doing the job we wanted, we challenged our vendors to work with us to build something better. It has been a tremendous collaboration†, said MR. Hartz. The services offered by these new systems are incredible. For example they improved ratio from electronic to hand written orders from 5:1 to 14:1. It eliminated 160 minutes from order writing to pharmacy receipt of orders, plus the average time for pharmacist review decreased 52 percent, from 50. 8 minutes to 24. 3 minutes. It also decreased overall medication incidents by 27 percent etc. (Cerner, 2008) The new systems in EMMC offer decision-support to help guarantee that patients receive the safest and best care achievable. EMMC’s providers and staff spent numerous hours working on the clinical systems to continuously make them better. They involved themselves and participated with the organizations experts in the information systems department and this allowed them to streamline all their processes and improve employee productivity. After several years of preparation, improvement, and execution, the nurses, physicians, and other healthcare professionals adopted advancements in information technology. They are now helping to bring the latest advancements and technology in patient care to the people who arrive at the doorstep of their hospital from any side of Maine. In process centering, processes are not newly created by organizations; in fact existing processes are modernized to meet the organization’s goals. What process centering does is to modify the perception and bring the process into focus. And this is exactly what EMMC did in order to provide higher levels of satisfactions to their patients and customers.

Computer Systems Essay

1. Introduction The purpose of this report is to survey the current state of scanner technology and to briefly discuss predicted advancements in the field. By examining a range of recently published journal articles, magazine articles and internet sites on the topic of scanners this report describes the main types of scanners in common use today and examines their performance in relation to four criteria: resolution, bit-depth, dynamic range and software. The report then considers the effect of further technological advances in these four areas, as well as the deployment of new sensor technology on the future development of scanners. The first scanner, initially referred to as a ‘reading machine’, was developed in 1960 by Jacob Rabinow, a Russian born engineer. The device could scan printed material and then compare each character to a set of standards in a matrix using, for the first time, the â€Å"best match principle† to determine the original message (Blatner, Fleishman and Roth 1998, p.3). This reading machine was to form the basis for the development of current scanning, sorting and processing machines. An early improvement on the reading machine was the drum scanner. These scanners used a type of scanning technology called photomultiplier tubes (PMT). Drum scanners are still used in industry today because of the high quality images they produce. The development of smaller, more economical scanners such as desktop scanners and scanners for domestic use followed the drum scanner as the number of computer users increased and computer technology advanced. Scanners can now capture images from a wide variety of two and three  dimensional sources. These images are converted to digitised computer files that can be stored on a hard-drive or floppy disk. With the aid of specific software, these images can then be manipulated and enhanced by the user. It is now possible to deploy electronic acquisition to create an entire layout (including all graphic elements) from the same computer. This means manual stripping is no longer required (Scanners, digital cameras and photo CDs 2000). Scanners are considered an invaluable tool for adding graphics and text to documents and have been readily adopted by both business and domestic users. 2. How scanners work A scanner is a device that uses a light source to electronically convert an image into binary data (0s and 1s). This binary data can then be used to store the scanned image on a computer. A scanner recreates an image by using small electronic components referred to as the scanner’s ‘eyes’ (Scanner tips 2000). The type of ‘eyes’ used in today’s scanners are charge-coupled devices (CCD) and photomultiplier tubes (PMT). These electronic eyes measure the amount of light reflected from individual points on the page and translate it to digital signals that correspond to the brightness of each point (Englander 2000). To create a file on the computer that represents a colour image, the scanner divides the image into a grid with many individual points called pixels or picture elements (Scanner tips 2000). A scanning head, termed a row of ‘eyes’, reads over the grid and assigns a number to each pixel based on the main colour in that pixel, u sing green, blue and red. For example an aqua pixel would be saved as a number to represent the proportion of blue, green and red which represents the colour aqua (Scanners, digital cameras and photo CDs 2000). 3. Types of scanners There are five main types of scanners in common use today: drum scanners, flatbed scanners, sheet-fed scanners, slide scanners, and hand held scanners. 3.1 Drum scanners Drum scanners were widely used in the past, however they are much less commonly used today due to advances in scanner technology. As a result of their expense, these machines are primarily used by professionals in industry, where they are considered important due to the high-end quality image they produce and because they use PMT technology which is more  sophisticated than charge-coupled devices (CCDs) and contact image sensor’s (CISs). Drum scanners are difficult to operate and technicians operate these scanners by placing the item to be scanned on a glass cylinder rotating at high speeds around the sensor (Sullivan 1996). 3.2 Flatbed scanners The most popular scanners for general use are flatbed scanners. This type of scanner is highly versatile because it is able to scan flat objects as well as small three dimensional objects. Flat-bed scanners operate by placing the item to be scanned on a glass window while scanning heads move underneath it. A transparency adapter is used to scan transparent originals such as slides or x-rays, and an automatic document feeder is available for scanning large numbers of documents (Scanner tips 2000). 3.3 Sheet-fed scanners Sheet-fed scanners have grown in popularity in recent years, particularly for small office or domestic use as they are reasonably priced, can scan full-sized documents and are compact, requiring limited desk space (Scanner tips 2000). Most models of sheet-fed scanners have an inbuilt document feeder to overcome the problem of manually feeding one sheet of paper at a time. However the actual process or scanning with a sheet-fed scanner may result in distortion as the image to be scanned moves over the scanning heads (Scanner tips 2000). A further limitation of sheet-fed scanners is that they are unable to scan three dimensional objects. 3.4 Slide scanners This type of scanner is used to scan items such as slides that need careful handling during scanning. Unlike other scanners, the scanning heads in slide scanners do not reflect light from the image, but rather pass light through it. This enables these scanners to produce superior results without distortions caused by reflective light. To be able to scan small and detailed items, these scanners have a large number of eyes on the scanning head which produces a high quality result. Slide scanners tend to be more expensive and less versatile than flatbed and sheet-fed scanners as they are limited to only scanning slides and film. These scanners, however, are well suited to users requiring high quality scans of large numbers of slides (Scanner tips 2000). 3.5 Hand held scanners Hand held scanners are compact, portable scanners which are simply dragged across a page manually to capture an image. These scanners are easy to use and economical to purchase; however, their use is limited to text of up to four inches in diameter that does not require a high resolution. For this reason, hand held scanners are unsuitable for colour images. A further disadvantage of hand held scanners is that the user must have a steady hand when scanning or the resulting image will be distorted (Scanner tips 2000). 4. Scanner specifications The performance of a scanner can be examined in relation to four main criteria: resolution, bit-depth, dynamic range and software. 4.1 Resolution Resolution is a measure of how many pixels a scanner can sample in a given image. It is used to describe the amount of detail in an image (Figeiredo, McIllree and Thomas 1996). Higher resolution scanners are generally more expensive and produce superior results as they have a greater capacity to capture detail. Scanners have two types of resolutions: optical resolution and interpolated resolution. Optical resolution, or hardware resolution, is a measure of how many pixels a scanner can actually read. A current model desktop scanner typically has a resolution of 300 x 300 dots per inch (dpi) (Anderson 1999). This means that this scanner has a scanning head with 300 sensors per inch, so it can sample 300 dpi in one direction and 300 dpi in the other direction by stopping the scanning head 300 times per inch in both directions. Some scanners stop the scanning head more frequently as it moves down the page, giving an optical resolution of 300 x 600 dpi; however, scanning more frequently in one direction does not improve the result of the scan. The basic requirement for scanning detailed images and line art from photos or other printed originals is an optical resolution of 600 dpi. When scanning slides and negatives the minimum optical resolution is 1200 dpi. Interpolated resolution measures the number of pixels a scanner is able to predict. A scanner can turn a 300 x 300 dpi scan into a 600 x 600 dpi scan by looking in-between scanned pixels and guessing what that spot would have  looked like if it had been scanned. This prediction is then used to insert new pixels in between the actual ones scanned. This technique is less precise than optical resolution; however it assists in improving the enlargement of scanned images. 4.2 Bit depth Bit depth refers to the amount of information that a scanner records for each pixel when converting an image to digital form. Scanners differ in the amount of data they record for each pixel within an image. The simplest kinds of scanners only record data related to black and white details and have a bit depth of 1 (Anderson 1999). The minimum bit depth required for scanning photographs and documents is 24-bits, while slides, negatives or transparencies need a scanner with at least 30-bits. Thus for a scanner to produce a high quality scan with colour, a higher bit depth is required. In general, current scanners have a bit depth of 24, which means that 8 bits of information can be collected for the three primary colours used in scanning; blue, red and green (Anderson 1999). This high resolution allows scanners to produce images close to photographic quality. 4.3 Dynamic range Dynamic range refers to the measurement of the range of tones a scanner can record on a scale of 0.0 to 4.0, with 0.0 being perfect white and 4.0 being perfect black. Colour flat-bed scanners usually have a dynamic range of 2.4. A range of this measurement is unable to provide high quality colour scans. A dynamic range of 2.8 and 3.2 is suited to professional purposes and can be found in high-end scanners. An even higher dynamic range of 3.0 to 3.8 can be provided by drum scanners. 4.4 Software A scanner, like any type of hardware, requires software. Typically the two most common pieces of software provided with scanners include optical character recognition (OCR) and image editing software. Optical character recognition software translates the information recorded in a scan, tiny dots, into a text file which can be edited. Image editing software allows the tones and colours of an image to be manipulated for better printing and display. Image editing also gives filters to apply special effects to scanned images 5. Future developments The quality of scanned images is constantly improving as characteristics such as resolution, bit-depth and dynamic range are enhanced and further developed. More sophisticated image editing and optical character recognition software development is also resulting in superior quality scans. Future advances are expected to result in the incorporation of specialized scanners into other types of technology such as the recently developed digital camera. This device allows the user to take pictures of three-dimensional objects much like a regular camera, except that instead of using film, the objects are scanned by the camera in a similar process to the functioning of a flatbed scanner. The relatively new area of sensor technology in the form of a contact image sensor (CIS) (see Appendix 1) is expected to improve the functionality of scanners and the quality of images as it â€Å"replaces the cumbersome optical reduction technique with a single row of sensors† (Grotta and Wiener 1998, p. 1). Developers have already been able to produce a CIS scanner which is thinner, lighter, more energy efficient and cheaper to manufacture than a traditional CCD base device. However, the quality of the scan is not as good as its counterparts. Further development of CIS technology is needed to improve image quality and colour, and to address the problem of a limited 300 or 600 dpi. 6. Conclusion This report has identified five types of scanners currently available. Some are primarily used for professional purposes such as the drum scanner; others are used more broadly in the workplace and home such as flatbed scanners and to a lesser extent sheetfed scanners. Scanners for specialized purposes have also been identified such as slide and handheld scanners. The performance of these scanners is dependent upon their resolution, bit-depth, dynamic range and software. Scanners have improved significantly in recent years in terms of weight, size, price and speed, and the replacement of CCD technology with CIS technology is anticipated to produce further benefits to these areas as well as to scan quality. The impact of these improvements is expected to increase the accessibility of scanner technology to a wider range of users and its suitability for a wider range of purposes. In  relation to this, the future of scanner technology seems to point to the convergence of different techn ologies. Specialized scanners are currently being incorporated into other types of technologies such as digital cameras, printers, and photocopiers. This can be expected to continue with other forms of technology in conjunction with further improvements to image quality, speed, price, size and weight. 7. Reference list Anderson, D. The PC Guide. [http:www.pctechguide.com/18scanners.htm]. Blatner, D., Fleishman, G. Roth, G. (1998) Real world scanning and halftones 2nd edition, Peachpit Press, USA. Englander, I (2000). The Architecture of computer hardware and systems software. John Wiley, USA, p272. Figeiredo, J. McIllree, J. Thomas, N. (1996) Introducing information technology 2nd edition Jacaranda Press, Singapore, p145. Grotta, D. and Weiner, S. What’s now †¦What’s next. [http://www.zdnet.com/pcmag/features/scanners98/intro.html] PC Magazines 20 October 1998. 8/4/00 Prepress, scanners, digital cameras and photoCDs. [http://www.prepress.pps.com/mem/lib/ptr/scanners.html] 1998. 6/4/00 Scansoft scanner tips [http://www.scannercentral.com/scanners/tips/tips1.asp] 2000.6/4/00 Sullivan. M. Types of scanners. [http://hsdesign.com/scanning/types/types.html] 1996. 8/4/00

Free Essays on Tivo Corporate Governance

Corporate Governance and Control Measures Tivo has nine members on its board of directors. Michael Ramsey serves as Tivo’s CEO and chairman of the board. This dual title/function could create a conflict of interest within the board of directors, especially with the two other insiders on the board David Courtney (Executive VP) and Mark Perry (CFO). With these two insiders on the board, it makes it very difficult for them to take a position that is in opposition to their boss’s. Another weakness that could be perceived of this board is with the partner groups, which are represented by three board members. These partners that are represented are Coca-Cola (Chief Marketing Officer), Virtual Inc. (CEO), and NBC Cable (President). These partner representatives could get caught up in making decisions that are best for their respected companies rather than the good of Tivo. While Tivo’s corporate governance composition could be questioned, they have some qualities that would be desired by other companies. All of the board members own at least $200,000 worth of Tivo stock. In theory this stock ownership would mean that the directors would want to do anything necessary to increase this value. Another aspect of Tivo’s governance is that there are no board members associated with its auditor, KPMG. This separation should ensure that there is no â€Å"creative bookkeeping†. Tivo’s board has also implemented several policies as a preventative/remedial measure. These policies include: board compensation committee, nominating and governance committee, board audit committee, and code of ethics and conduct (Tivo Governance). The board compensation committee deals with all the forms of compensation to the board members. These compensations include bonuses, stock options, and fees. The nominating and governance committee is used to identify and recruit quality and honest board members. This committee is also in charge of deve... Free Essays on Tivo Corporate Governance Free Essays on Tivo Corporate Governance Corporate Governance and Control Measures Tivo has nine members on its board of directors. Michael Ramsey serves as Tivo’s CEO and chairman of the board. This dual title/function could create a conflict of interest within the board of directors, especially with the two other insiders on the board David Courtney (Executive VP) and Mark Perry (CFO). With these two insiders on the board, it makes it very difficult for them to take a position that is in opposition to their boss’s. Another weakness that could be perceived of this board is with the partner groups, which are represented by three board members. These partners that are represented are Coca-Cola (Chief Marketing Officer), Virtual Inc. (CEO), and NBC Cable (President). These partner representatives could get caught up in making decisions that are best for their respected companies rather than the good of Tivo. While Tivo’s corporate governance composition could be questioned, they have some qualities that would be desired by other companies. All of the board members own at least $200,000 worth of Tivo stock. In theory this stock ownership would mean that the directors would want to do anything necessary to increase this value. Another aspect of Tivo’s governance is that there are no board members associated with its auditor, KPMG. This separation should ensure that there is no â€Å"creative bookkeeping†. Tivo’s board has also implemented several policies as a preventative/remedial measure. These policies include: board compensation committee, nominating and governance committee, board audit committee, and code of ethics and conduct (Tivo Governance). The board compensation committee deals with all the forms of compensation to the board members. These compensations include bonuses, stock options, and fees. The nominating and governance committee is used to identify and recruit quality and honest board members. This committee is also in charge of deve...

Learn the Conjugates of Peser (to Weigh) in French

Learn the Conjugates of Peser (to Weigh) in French Meaning to weigh, the French verb  peser  is used for measurements, but it can also be used to say to ponder, as in to weigh the consequences. Its an interesting verb and the conjugations require a stem change, which does make it a little trickier than others. Dont worry, though, a quick lesson in  pesers most useful forms will explain everything. The Basic Conjugations of  Peser Peser is a stem-changing verb. Not only do you have to concern yourself with adding the correct ending, theres also a difference in spelling to watch for. This change comes primarily in the present and future tenses of the indicative mood, though it will appear elsewhere as well. As you can see in the chart, there are times in which the  e  of the verb stem is accented  Ãƒ ¨. This happens often in verbs that end in  -e_er. Other than that,  peser  is conjugated much like any regular -er  verb.  Youll apply the same endings as you would for words like  tomber  (to fall) and that does make this a little easier for experienced French students. Beginning with the verb stem (or radical), which is  pes-, match the subject pronoun and the tense in the chart. This will help you learn that  je pà ¨se  means I am weighing and that  nous pesions  means we weighed. Present Future Imperfect je pse pserai pesais tu pses pseras pesais il pse psera pesait nous pesons pserons pesions vous pesez pserez pesiez ils psent pseront pesaient The Present Participle of  Peser The present participle of peser does not require the stem change. Instead, youll simply add -ant to the verb stem to create the word pesant. Peser  in the Compound Past Tense Passà © composà ©Ã‚  is the French compound past tense and it is used frequently. To form it, youll need to conjugate the auxiliary verb  avoir  to the present tense and follow it with the  past participle  pesà ©.  The results are phrases such as  jai pesà ©Ã‚  for I weighed and  nous avons pesà ©Ã‚  for we weighed. More Simple Conjugations of  Peser Peser  can also be useful in a few other simple conjugations. For instance, if youre uncertain if something is being weighed, you can use  the subjunctive. On the other hand, if the weighing is dependent on certain conditions,  the conditional  is used.   The passà © simple  and  the imperfect subjunctive  are literary tenses and youll encounter these most often in formal French writing. Subjunctive Conditional Pass Simple Imperfect Subjunctive je pse pserais pesai pesasse tu pses pserais pesas pesasses il pse pserait pesa pest nous pesions pserions pesmes pesassions vous pesiez pseriez pestes pesassiez ils psent pseraient pesrent pesassent The  only time when its okay to drop the subject pronoun is when youre using  peser  in  the imperative.  This is for short statements that get to the point, so use  pà ¨se  rather than tu pà ¨se. Imperative (tu) pse (nous) pesons (vous) pesez

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CJM 321 CRIMINOLOGICAL THEORIES - Essay Example because computers, mobile technologies, and the Internet are now being used to conduct cybercrimes, not to mention, deviant behaviors, such as cyberbullying, which can also lead to criminal activities. Clearly, the sources of criminality have spread and diversified to touch various aspects of human society which is why law enforcement is trying to find ways to respond to them using limited people, budget, and resources. Ensuring and preserving public safety is one of the top priorities of local governments and law enforcement agencies. People’s safety and the security of their properties are perceived as basic human rights and important to the community’s total quality of life (Plant & Scott, 2009, p.8). The main concern of the paper is to understand how law enforcement can provide the essentials for today’s communities. These essentials include crime-fighting though the police also performs other functions, such as aiding the movement of people and vehicles, helping those who cannot take care of themselves, such as the mentally ill, children, and the homeless, and resolving conflicts between individuals or groups. The paper explores the issues that have to be addressed to ensure â€Å"safety† for all, including discussing their obstacles and existing and potential solutions. The main issues to be addressed to ensure safety are crime prevention strategies that include pr evention of substance abuse that leads to crimes and accidents, gang crimes and organized ctimes, hate crimes, and terrorism. The selling, distribution, and use of drugs, including related drug crimes continue to create social problems for society. It does not help that, due to the globalization of technology and transportation, illegal drug business has expanded and become more resourceful in evading the detection of law enforcement. In 2007, law enforcement agencies across the U.S. made 1.8 million drug-related arrests (McElreath et al., 2013, p.11). In 2008, almost 100,000 inmates in

Compare and contrast the possible biological risks and hazards when Essay - 1

Compare and contrast the possible biological risks and hazards when using Computed Tomography (CT), Magnetic Resonance Imaging (MRI) and Ultrasound (US) when imaging a pregnant patient - Essay Example In the process recommendations of how to reduce and ameliorate these risks are critiqued and examined A computed tomography (CT) scan utilises x-rays to provide detailed pictures of structured inside the body of pregnant women (WebMD, 2013). The process is done by getting a pregnant woman to lie on a table that is attached to a CT scanner which is round with an inner-hollow (Romans, 2010; Prokop & Galanski, 2013). The scanner sends x-rays throughout the body and the pictures are studied appropriately (Kalender, 2011). The rotation comes with pictures that are captured and saved on a computer that can be retrieved or printed. CT Scans present more detailed and thorough pictures and images of the area of interest in a medical study or examination (Patient UK, 2014). The system uses conventional radiology and as such, it opens a patient up to the risks of other x-ray systems and processes (DeMaio, 2010; Buzug, 2008). CT Scans opens up a pregnant woman to various risks of radiation during the process, however, the amount of radiation that a pregnant woman will be exposed to varies. Some authorities identify that a patient taking a pregnancy related scan will be exposed to 6.6mSv of radiation which is approximately three years’ worth of background radiation (NHS Choices, 2013). This is obviously very high and could expose a pregnant woman and a foetus to some dangerous levels of radiation. There are various levels of risks that foetuses are directly exposed to during CT scans. The level is examined in a study by Marx et al on the Uterine Radiation Dose (MRAD). The head is exposed to under 50 MRAD, the Thorax is exposed to 10-590 MRADs, the Abdomen, 2800 – 4,600 MRADs whilst the Pelvis is exposed to 1,940-5,000 MRADs (Marx, Lockberger, Walls, & Adams, 2013). However, the inherent benefit is that it is quick and accurate and it is often the best way to check a patient

Paraphrasing of PCR methodology Essay Example | Topics and Well Written Essays - 1000 words

Paraphrasing of PCR methodology - Essay Example This was followed by further addition of one volume of phenol into the tube before centrifuging at 5000 rpm at room temperature. The phenol was obtained by saturating it with NTE of pH 8.5. The next step involved removal of the upper phase and putting into a separate microcentrifuge tube and adding one volume of chloroform:isoamyl alcohol mixed at a ratio of 24:1. The mixture was then centrifuged for 10 minutes at 5000rpm. The last three procedures were conducted (X4) making certain that no material remained at the interphase. The preparation was then removed and 2 volumes of 100% ice cold ethanol added following a previous addition of 1/20 volume of 3M sodium acetate. This was then centrifuged again at 3000 rpm for 5 minutes to obtain DNA pellets that were left to dry. Later, they were suspended in a 50Â µl TE buffer such as 10mM EDTA. This allowed for quantification and assessment of the purity of the DNA using a nanodrop spectrophometer 2000C series. The first step involved calibration of the Eppendorf and Sartorius Biohit pipettes. This was done to ensure that they provide accurate readings. The actual preparation of the mixture entailed adding 2.5ul of 10X ionic buffer, 0.5ul dNTPs, 0.75ul MgCl2, 0.5ul GAPDH forward primer, 0.5ul GAPDH reverse primer, 0.1 Taq, 18.15ul molecular water and 2ul of DNA Template designated THP1. Each 0.2ml PCR tube was filled with 25ul of the supermix. The supermix, DNA template and the primer values of the consecutive experiments 2, 3,4,5,6 and 7 will be changed to obtain the optimal condition of the PCR detection of the PTEN gene. Similarly, in the other experiments, PTEN and GAPDH will be the primers, which will use different cell lines such as HACAT, MM6, Hela, Caski and THP1. The PTEN and GAPDH primers are product of the SIGMA-ALDRRICH company, whereas the cell lines were obtained from the American type culture

Comparison of Beta Blockers Use

Comparison of Beta Blockers Use 1.1 Background Beta-blockers are a medication used to treat high blood pressure and heart problems. They are used by millions of people around the world everyday. In 2004, they were the fifth most widely prescribed class of medicine. Beta-blockers are effective, life-saving medicines with more than 25 years of widespread and generally safe use. There are fourteen beta-blockers are currently available. These included Acebutolol, Atenolol, Betaxolol, Bisoprolol, Carvedilol, Esmolol, Labetalol, Metoprolol, Nadolol, Penbutolol, Pindolol, Propranolol, and Timolol. Beta-blockers are just one class of prescription medicine used to treat high blood pressure and heart disease. Four other classes are commonly used to treat high blood pressure, for example. These include the diuretics, calcium channel blockers, ACE inhibitors, and angiotensin-receptor blockers. These four plus beta blockers are often used in combination, two or more at a time. Indeed, many people with high blood pressure will require two or more high blood pressure medicines to bring their blood pressure down to a normal and healthy range. Although they are used primarily to treat people with high blood pressure, they are also used to treat other heart conditions. These include angina (heart or chest pain), abnormal heart rhythms, coronary artery blockages, and heart failure. They are also used, along with other treatments, to help prevent repeat heart attacks in people who have already had one, to prevent migraine headaches, and to treat performance or stage-fright anxiety. High blood pressure is one of the most significantly and persistently under-diagnosed and under-treated medical conditions. It raises your risk of heart disease, heart attack, heart failure, stroke, dementia, vision loss, and kidney failure. In most who have high blood pressure, it is a lifelong condition. Yet studies show that only 30% of people with high blood pressure getting the medicines, care, and blood pressure control they need. Uncontrolled high blood pressure is a leading cause of death. Because it has no symptoms and often goes undetected, high blood pressure is often called the nations leading silent killer. Beta-blockers work by blocking adrenaline in the heart and blood vessels. Adrenaline speeds up the heart rate, makes the heart muscle contract more strongly, and constricts arteries throughout the body. All these raise blood pressure. In blocking adrenaline, beta-blockers slow down the heart and reduce its workload. That helps to decrease blood pressure. Choosing a beta-blocker, and its dose, depends on what people need it for. Studies show that some beta blockers are more effective and safer than others for certain conditions. People respond to the various beta-blockers differently. There are important differences in how the various beta-blockers work that will affect the use of them. In effect, beta blockers differ in the type of beta receptors they block (ÃŽÂ ²1, ÃŽÂ ²2, and ÃŽÂ ±) and, therefore, their effects. Non-selective beta blockers, for example, propranolol, block ÃŽÂ ²1 and ÃŽÂ ²2 receptors and, therefore, affect the heart, blood vessels, and air passages. Selective beta blockers, for example, metoprolol primarily block ÃŽÂ ²1 receptors and, therefore, mostly affect the heart and do not affect air passages. Labetalol and carvedilol block beta and alpha-1 receptors. Blocking alpha receptors adds to the blood vessel dilating effect of labetalol and carvedilol. Beta-blockers are generally safe medicines. They have not been shown to cause any serious long-term or irreversible negative consequences, even after many years of use. But side effects are common among people taking beta-blockers. The majority of people can expect to experience at least one. These include fatigue or drowsiness, dizziness or lightheadedness, slow heartbeat, low blood pressure, difficulty breathing, numbness, tinkling or coldness of fingers, toes or skin, weight gain, mental depression, disturbing dreams, reduced libido, erectile dysfunction in men, or ability to reach orgasm in both men and women. Most side effects can be avoided or minimized by starting with a low dose and increasing it gradually. Also, some of these adverse effects go away or diminish in time, after body gets used to the drug. Overall, the strongest evidence on beta-blockers links them to a lower risk of repeat heart attack and early death in the aftermath of a heart attack. More than 60 studies have examined this, and all have found a marked benefit for the pills. There is also compelling evidence that some beta blockers lower the risk of death in people with heart failure, preventing 3.8 deaths per 100 patients in the first year of treatment. Therefore, everyone who has had a heart attack should be taking a beta-blocker. Below are the list of beta-blockers that use in Klinik Kesihatan Greentown: No:  1. Generic Name:  Atenolol Trade Name:  TENORMIN ® Dosage Form:  Tablet Strength:  100mg No:  2. Generic Name:  Bisoprolol Trade Name:  CONCOR ® Dosage Form:  Tablet Strength:  2.5mg , 5mg No:  3. Generic Name:  Carvedilol Trade Name:  DILATREND ®, CASLOT ® Dosage Form:  Tablet Strength:  6.25mg , 25mg No:  4. Generic Name:  Labetalol Trade Name:  TRANDATE ® Dosage Form:  Tablet Strength:  100mg No:  5. Generic Name:  Metoprolol Trade Name:  BETALOC ® Dosage Form:  Tablet Strength:  100mg No:  6. Generic Name:  Propranolol Trade Name:  INDERAL ® Dosage Form:  Tablet Strength:  40mg 1.2 Objectives 1.2.1 To list down types of beta-blockers in Klinik Kesihatan Greentown. 1.2.2 To analyze the usage of each beta-blockers in Kinik Kesihatan Greentown. 1.2.3 To compare the most commonly used beta-blockers in Klinik Kesihatan  Greentown based on the results. CHAPTER 2:  LITERATURE REVIEW From the past, beta blockers is widely use for the treatment of hypertension besides treatment such as stable and unstable angina, arrhythmias, bleeding esophageal varices, coronary artery disease, asymptomatic and symptomatic heart failure, hypertension migraine, and secondary prevention post-myocardial infarction (Mark Helfand, MD, et al., 2007). Although some study shows that beta-blockers are not first-line drugs in the treatment of hypertension (Wiysonge CS, et al., 2007) but when initiating a beta-blocker, it is proven to be as effective and safe as initiating an ACE-inhibitor first (Ferenc Follath, 2006). Besides, beta blockers provide similar clinical outcomes and are associated with fewer adverse events than calcium antagonists in randomized trials of patients who have stable angina. (Paul A. Heidenreich, MD, et.al., 1999) There is also evidence that suggest B-blockers are useful in managing angina and reducing mortality after myocardial infarction and in heart failure (H T Ong, consultant cardiologist, 2007) but beta blockers appear to be less effective when used as monotherapy in black hypertensives (Walter Flamenbaum, MD, 1985). Additionally, beta-blockers may be considered as a first-line option in women of child-bearing potential because of concern about foetal renal maldevelopment with ACE inhibitors or angiotensin receptor blockers (British Hypertension Society, 2008). When starting beta blockers, it should be started at the lowest dose, with the dose increased every two to four weeks until the target dose or highest tolerated dose is reached because beta-blockers showed little evidence of useful antiarrhythmic action in the dosage used (J M Roland, et.al., 1979). It also should reconsider in the treatment of hypertension since doses smaller than those recommended are almost as effective and much cheaper. (A K Scott, et al., 1982) On the other side, when beta blocker treatment given as secondary prophylaxis after myocardial infarction it is highly cost effective (G Olsson, L A Levin, N Rehnqvist, 1987). Among all the beta-blockers, atenolol had the most widely used in Klinik Kesihatan Greentown because study proven atenolol is more effective than placebo in lowering blood pressure but does not appear to reduce the rates of cardiovascular morbidity or mortality (Carlberg B., et al., 2004). One of the studies also shown that the use of atenolol (started 72 h before operation) is effective in reducing the incidence of supraventricular arrhythmias following elective coronary artery bypass operations in patients with good left ventricular function (R. K. Lamb, et al., 1988). When compare between atenolol versus nifedipine versus the combination, atenolol was slightly better than nifedipine on exercise time, but the combination was slightly better for decreasing the number of attacks (El-Tamimi, H. Davies, G.J., 1992). Anyway, atenolol should be avoided in the early stages of pregnancy and given with caution at the later stages, as it is associated with fetal growth retardation, which is related to duration of treatment. (Lydakis C., et al., 1999) Metoprolol, which shows the second higher usage in Klinik Kesihatan Greentown, is an effective drug for treatment of stable exercise-induced angina pectoris (Arnman K Rydà ©n L. 1993) where metoprolol also can reduce total mortality, sudden death, and death due to progressive heart failure and improved quality of life (Mark Helfand, MD, et al., 2007). There is also a study about 62 patients taking metoprolol 100 mg twice daily, nifedipine 10 mg three times daily and the combination in a randomised double blind crossover study, metoprolol was better than nifedipine; the combination was better again (Uusitalo, A, et.al, 1986). On the other side, both carvedilol and metoprolol also showed parallel beneficial effects on symptoms, exercise, ejection fraction, and oxidative stress in heart failure (Marrick L. Kukin, MD, et. al, 1999). Treatment with metoprolol will resulted in lower all-cause mortality than treatment with a thiazide diuretic (Mark Helfand, MD, et al., 2007) but metoprolol did not benefit mortality or ischemic events in a longer-term (Mark Helfand, MD, et al., 2007). Although carvedilol and immediate release metoprolol had similar effects on quality of life, but metoprolol improved exercise capacity more (Mark Helfand, MD, et al., 2007). Yet, the chronic use of the more selective beta-1 selective blockers such as atenolol and metaprotenol has been shown in several studies to not significantly increase asthma or worsen pulmonary function (J Respir, 2003). Among all the beta blockers, labetalol is among the physicians choice because the efficient hypotensive action, together with apparent freedom from maternal and fetal side-effects, and consequent improved perinatal mortality, suggest that it is a suitable drug for use in pregnancy complicated by hypertension (C A Michael, 1979). Besides, labetalol appears to be better able to prevent the appearance of fetal growth retardation compare to atenolol (Lardoux H, et al., 1983). The most significant effect is when comparing side-effect liabilities, it is clear that quantitatively labetalol produces no greater burden of side-effects than drugs of the ÃŽÂ ²-adrenoceptor-blocking group (B. N. C. Prichard D. A. Richards 1982). It also may be considered relatively safer then pure non-selective beta-adrenoceptor blocking drugs in patients with airways obstruction (S H Jackson D G Beevers 1983). Among the incidence of side-effects, was similar with atenolol, metoprolol and pindolol but was slightly less with labetalol (J J McNeil W J Louis 1979). Of all this reason, labetalol become one f the common prescribe drug for pregnant women. For the next drug, propranolol, it should be used with care in patients with known vascular disease (P D McSorley D J Warren 1978). Carvedilol which is other beta blockers has a powerful antiarrhythmic effect, where a study shows after AMI, even in patients already treated with an ACE inhibitor, carvedilol suppresses atrial as well as ventricular arrhythmias in these patients (McMurray, J., et al., 2005). It also may adversely affect recovery from severe hemorrhagic shock (Taniguchi T., et al., 2009). Next, carvedilol is the only beta blocker shown to reduce mortality in post-MI patients who are already taking an ACE inhibitor (Mark Helfand, MD, et al., 2007). In one of the study also shown that administering carvedilol in addition to conventional therapy reduces mortality and attenuates myocardial remodelling in patients with left ventricular dysfunction following acute MI. Mortality was significantly lower with carvedilol than with metoprolol in patients with mild to severe CHF, suggesting that carvedilol may be the preferred beta-blocker (Keating GM Jarvis B. 2003). However, patients with CHF and asthma tolerated carvedilol poorly and because of that asthma still remain a contraindication to beta-blockade (Kotlyar E, et al., 2002). For bisoprolol, neither dose of bisoprolol showed any obvious influence on reducing attack duration or severity (Mark Helfand, MD, et al., 2007). CHAPTER 3:  METHODOLOGY 3.1 Study Design A case control study is conducted from 1st Mac 2009 till 8th May 2009. We will identify the usage of Beta Blocker drugs in Klinik Kesihatan Greentown. Inclusion criteria for this study are based on the date noted on the cupon. Exclusion criteria is the date for the part supply prescriptions which we will take the last date the patient comes to collect the their medication. A total of 3 months prescription (October 2008 till December 2008) will be taken to be analyzed. Comparison between all beta blockers is then done when all data has been analyzed. 3.2 Data Collection Each month of prescription is divided among us group members to evaluate and count the frequency usage of those Beta Blocker drugs. Time that given to finished the evaluation of the prescription is 1 month from the date the prescription is given. The Beta Blocker drugs that has be taken count for this study is between Metoprolol Tartrate, Atenolol, Carvedilol, Propanolol HCL, Bisoprolol Fumarate, and Labetolol HCL. 3.3 Statistical Methods/Data Analysis Data has been analysis using Microsoft Excel which the results is shown through bar and pai chart. 3.4 Ethical Consideration Permission to conduct this study is obtained from the chief pharmacist and our local preceptor of Hospital Raja Permaisuri Bainun and Klinik Kesihatan Greentown. CHAPTER 4:  RESULTS Graph 1 show the total usage of each type of Beta-blockers used in October 2008 at Klinik Kesihatan Greentown. From the graph, we found that atenolol is among the most frequently used Beta-blocker drug used by Klinik Kesihatan Greentown on October 2008 which is 449 patients, followed by metoprolol, 404 patients, propranolol, 20 patients, labetalol and carvedilol, 1 patient each, while no patient was prescribed with Bisoprolol. Graph 2 shows the total usage of each type of beta-blockers in November 2008 at Klinik Kesihatan Greentown. The graph indicates that atenolol is the most highly used if compared with other Beta-blockers which have 358 patients, followed by metoprolol, 324 patients, propranolol, 35 patients, bisoprolol, 4 patients, labetalol, 2 patients and carvedilol, have 1 patient only. Graph 3 shows the total usage of each type of Beta-blockers in December 2008. From the graph we can conclude that atenolol rated as the most widely used where there are 377 patients, followed by metoprolol, 303 patients, then propranolol, 27 patients, bisoprolol, 14 patients, labetalol, 3 patients and carvedilol, 8 patients. Graph 4 shows the overall usage of each beta-blocker used in Klinik Kesihatan Greentown based on total amount of prescriptions prescribed on October, November and December 2008. From types of beta-blocker, we can conclude that atenolol is the most widely used which have 1184 patients compared with other beta-blocker drugs. While metoprolol is the second beta-blocker drug that commonly used which have 1034 patients, followed by propranolol, 82 patients, bisoprolol, 18 patients, carvedilol, 10 patients and labetalol, 6 patients. Graph 5 displays the total usage of beta-blockers based from October, November and December in year 2008 at Klinik Kesihatan Greentown. From the overall, the month of October 2008 shows the highest percentage of beta-blockers used in Klinik Kesihatan Greentown which are 38% or total usage are 875, followed by December 2008 which are 31% or total usage are 732 and November 2008 are 31% or total usage are 724. CHAPTER 5:  DISCUSSION 5.1 Atenolol Beta-blockers work by blocking adrenaline in the heart and blood vessels. Adrenaline speeds up the heart rate, makes the heart muscle contract more strongly, and constricts arteries throughout the body. All these raise blood pressure. In blocking adrenaline, beta-blockers slow down the heart and reduce its workload. That helps to decrease blood pressure (Houghton T, Fremantle N, Cleland JG. 2002). Atenolol in this case is a beta blocker used not only to treat hypertension but also is the primary medication treatment for angina and after an heart attack (American Academy of Family Physician, 2000). Based on our study, at Klinik Kesihatan Greentown the most used beta blocker from October 2008 till December 2008 was atenolol. This could be due to many factors; one of it to be the effective treatment towards treating hypertension. It is also widely use because doctors nationwide has been prescribing this drug for a long time and it is shown by patient age on the prescription studied, geriatric patients prefer sticking to atenolol than changing to other beta blockers as they safe and satisfied with the treatment of atenolol. Atenolol also has very less adverse effects compared to other beta blockers .It is also known to effectively lower blood pressure to its normal range by decreasing the heart rate. It easy to consume as the daily dosing is usually 1 tablet a day(100mg) or half a tablet a day(50mg) ( Shekelle, P. G., et al., 2003 ). According to a study it has chosen four of the five indicated beta blockers as Best Buy drugs for people with angina, based on price. They are atenolol, metoprolol tartrate, and propranolol. Generic acebutolol is substantially more expensive than these four and no more effective. Taking a beta-blocker after a heart attack lowers the risk of a repeat attack and death by 15% to 25%. Five beta-blockers -atenolol, carvedilol , metoprolol tartrate, propranolol, and timolol- have been proven in studies to reduce deaths in people whove had heart attacks. The evidence is somewhat stronger for atenolol, however. On that basis, and because they are available at lower cost than carvedilol (Coreg) and timolol, atenolol is chosen as one of the best buys around. Studies of carvedilol are complicated by its use therefore atenolol is a much suitable drug to be considered alongside its market price (Houghton T, Fremantle N, Cleland JG. 2002). 5.2 Metoprolol Metoprolol is the second commonly used in Klinik Kesihatan Greentown after atenolol. It is a first-line therapy for hypertension, angina, congestive heart failure, coronary artery disease, secondary prevention of heart attack (Bradley HA, et al., 2006). Besides that, metoprolol is also used to treat migraine headaches, panic disorder, anxiety and hyperthyroidism (Cleland JGF, et al., 2002). It is a selective beta-1-blocking agents which do not significantly affect respiratory function or antagonize salbutamol effects in patients with COPD (Fogari R, et al., 2001). Metoprolol does not significantly affect FEV1 or FVC at a dose of 200 mg daily when compared with placebo in patients with moderately severe COPD and significant reversible component (Fenster PE, et al., 1990). Metoprolol is used to decrease symptoms such as rapid heart rate, sweating and tremor which are associated with thyrotoxicosis. It is also used to prevent migraine, although it is not fully understood how metoprolol works in this area (Erdmann E, et al., 2005). At low doses, cardioselective beta blockers such as metoprolol selectively block the beta receptors found in the heart and are less likely to cause side effects. These medications may be better than nonselective beta blockers for people with obstructive lung disease, asthma, poor circulation, diabetes, and depression (Torp-Pedersen C, et al., 2007). Based on the analysis of the COMET (Carvedilol Or Metoprolol European Trial) study, metoprolol patients had a 34% lower risk of death than placebo patients. Metoprolol reduced mortality and all-cause hospitalization by 19%. All-cause mortality plus hospitalization for heart failure went down 31%. All-cause hospitalization alone was lowered by 13%, hospitalization for all heart-related causes by 20%, and hospitalization for worsening CHF by 32% ( Woolfenden J,et al, 2003). Selective beta-1-adrenergic blockade is routinely preferred to non-selective blockade in patients with coexistent COPD and CHF to minimize the risk of inducing bronchoconstriction (Abraham T, et al, 1983). Compared to metoprolol tartrate, carvedilol reduced the total days lost. This effect was mostly due to increased longevity. Metoprolol tartrate has been shown to improve well-being after myocardial infarction (Olsson G, et al,1993). Beneficial effects of metoprolol in idiopathic dilated cardiomyopathy, indicating that the effect of carvedilol was in addition to that of an active control (Waagstein F, Bristow MR, Swedberg K, et al, 1993). 5.3 Propranolol From the graph, propranolol is one of the least used in Klinik Kesihatan Greentown. Propranolol is used most often for the treatment of high blood pressure, angina, and abnormal heart rhythms. It is also used to treat the symptoms of anxiety. Propranolol was the first beta-blocker available in the United States. Beta-blockers are drugs that interfere with nerve signals transmitted by the chemical norepinephrine. They reduce the force and speed of the heartbeat and prevent dilation of certain blood vessels. These actions reduce the work load on the heart, relieve the muscle tremors that often accompany anxiety, and reduce the blood pressure in the brain to prevent migraines.  ( Division of Simon and Schuster 1230, avenue of the Americans New York, NY 10020). Because of the risk of side effects, propranolol should be used with caution in people with impaired kidney or liver function (Division of Simon and Schuster 1230, avenue of the Americans New York, NY 10020). It works by affecting the response to nerve impulses in certain parts of the body, like the heart. As a result, the heart beats slower and decreases the blood pressure. When the blood pressure is lowered, the amount of blood and oxygen is increased to the heart. Propranolol is also affects the bodys sugar metabolism, it should be used with caution in people with diabetes or hypoglycemia (low blood sugar). Propranolol may mask certain clinical signs of thyroid disease and interfere with thyroid-function tests. Similarly, propranolol may interfere with tests for glaucoma  ( Division of Simon and Schuster 1230, avenue of the Americans New York, NY 10020).   Propranolol is thus used for the symptomatic relief of thyrotoxicosis (hyperthyroidism). It has no direct effect on the cause, namely overproduction of thyroid hormones, which requires to be treated concurrently. This is clearly shown at Klinik Kesihatan Greentown because most of propanolol usage was to treat thyrotoxicosis. Scores on various subjective rating scales showed that propranolol had a larger mood elevating effect than atenolol. Heart rate and blood pressure were significantly reduced 24 h after atenolol medication; these effects were absent or reduced after propranolol had been given (A.  A.  Landauer, et al., 1978  ). 5.4 Bisoprolol From the graph we know that the total usage of bisoprolol is only 6 patients out of the 3 month that we have evaluated. It shows that bisoprolol is also less than one of the least used in Klinik Greentown Ipoh. This is due to the price of the medicine. As in a journal, the greatest absolute cost discrepancy for both groups was under-estimation of linezolid ($800 and $400) and over-estimation of clopidogrel ($60) and bisoprolol therapy ($62) by residents and pharmacists, respectively (Wilbur K., 2009). It shows that bisoprolol is one of the expensive Beta blocker drugs compared to the others of Beta blocker drugs. Perhaps it cant give the same effect of atenolol which the most used Beta blocker. Based on a journal, serious adverse effects (e.g. serious bradycardia or hypotension) occurred in 3.1% of patients switching from metoprolol tartrate to carvedilol, and 2.3% experienced worsening heart failure. In the metoprolol to bisoprolol group, worsening heart failure occurred in about 2% of patients. Serious adverse effects also occurred in about 2% of the metoprolol to bisoprolol patients. Adverse effects were higher in patients switched to the equivalent dose rather than half the equivalent dose. (Pharmacists Letter / Prescribers Letter, 2009) Other than that, bisoprolol is also difficult to get the stock of drugs because it is the List A drug and have its own procedures to make the ordering from the company. 5.5 Carvedilol From the graph we can conclude that carvedilol have the least favorable number of usage compare to others beta blockers but then its still a preferable drug for physician to prescribe due to its beneficial effect. First of all, carvedilol is proven to lower mortality in patients with mild to severe congestive heart failure (Keating GM, 2003), besides it also suppresses atrial as well as ventricular arrhythmias (McMurray et. al 2005) and it is the only beta blocker shown to reduce mortality in post-MI (Mark Helfand et. al, 2007). But then on the other side, when compare to metoprolol, it is lack in improved exercise capacity (Mark Helfand et.all 2007) and it may adversely affect recovery from severe hemorrhagic shock (Taniguchi T et.all 2009). Between, patients with CHF and asthma tolerated carvedilol poorly and yet, asthma still remains a contraindication to beta-blockade. All the prescribing for beta blockers in Klinik Kesihatan Greentown also mostly due to the restriction of cost w here carvedilol is listed as A list drug therefore it needs a specialist to start and indirectly reduce A listed drug. 5.6 Labetalol From the graph, we can see that labetalol shows the least usage in Klinik Kesihatan Greentown. This is because the main indication of labetalol is for use in pregnancy complicated by hypertension with apparent freedom from maternal and fetal side-effects, and consequent improved perinatal mortality (C A Michael, 1979). Beside that, labetalol should be avoided in asthmatic patient because it produced more bronchial blockade than atenolol (A D Mackay, et al., 1981) and reduced the effect of inhaled salbutamol on FEV1 (S H Jackson D G Beevers, 1983). Furthermore, labetalol was associated with a significant less reduction or increase in cardiac output than on pure beta blockers (Lund-Johansen P, 1983) and probably induced SLE syndrome (R. C. Brown, et al., 1981). Lastly, considerable differences in dose (atenolol 138 +/- 13 mg daily; labetalol 308 +/- 34 mg daily; metoprolol 234 +/- 22 mg daily), labetalol will required a higher dose to produce similar antihypertensive effects (J J McNe il W J Louis, 1979) and the cost for labetalol is higher than atenolol and metoprolol. CHAPTER 6:  CONCLUSIONS Finally, we can conclude that atenolol have the highest usage among beta-blockers in Klinik Kesihatan Greentown followed by metoprolol, propranolol, bisoprolol, carvedilol and the least usage which is labetalol. Commencing from this study, we found that further studies is needed so that physician can prescribe more convincingly and led to a better life for patients.