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.

I Versus We Theory is Hidden Everywhere :: Sociology Sociological Essays

I Versus We Theory is Hidden Everywhere Although each author gives him- or herself the goal to write a very unique piece of work, we the readers can see similarities amongst writings stretched over decades. Created characters, settings, and circumstances tend to change from one piece of work to the next, but themes, more often than not, all deal with the same everyday problems. These repeated themes are not by accident. Writers analyze what the public likes to read about. In fact, probably one of the most common themes is the I vs. We theory, which is simply the idea that people can change from being selfish into looking out for the whole group, such as a certain race, family, friends, or age group. Because the theme is so intense, it is usually found in novels, where there is plenty of room to express numerous examples to totally convince the readers that the main character has truly changed. By looking at J.D. Salinger’s The Catcher in the Rye and John Steinbeck’s The Grapes of Wrath, we can show how they, too, write about this transition, as does Sam Greenlee in The Spook Who Sat By the Door. Although these three novels were published over the span of three decades with varying cultural groups, they all illustrate the exact same issue. The Spook Who Sat by the Door by Sam Greenlee shows the I vs. We theory by establishing the problem of one man, Dan Freeman, who is only concerned with his well-being, but unfair treatment of others turns him into a military hero. At first, in chapter two, Freeman concentrates primarily on his acceptance into the CIA. This selfish attitude is still portrayed in chapter five when the Dahomey Queen, a nearby hooker, is used for pleasure purposes only. In this same chapter, Joy, Freeman’s girlfriend, shows up and asks him to quit the CIA. Although he loves her, he refuses to give up his dream to be the only black employee in the CIA. The transition to the "We" phenomenon occurs in chapter eight when Freeman chooses to leave the CIA and decides to work as a social worker. The pay, as well as his social climbing, takes a fall, but his hunger to help others does an about-face. A local gang keeps Freeman eager and energetic to fight for all blacks, not just for a few kids.

Kafka and the Dramatisation of the Guilty

Kafka†¦ draws the reader into the dramatization of the (guilty) failure to arrive, to communicate, to understand. And it is this movement which he describes again and again, not only on the level of rational discourse, but on a great many levels. -Heller Heller's statement is at best a rather enigmatic one: riddled with unanswered questions and uncertainties. The reader of Heller's statement would first ask himself how Kafka†¦ draws the reader into the dramatization, then would question the failure to arrive, to communicate, to understand: arrive, communicate, understand what? Thirdly, one asks oneself what is the movement he describes again and again: drawing the reader into the dramatization or the failure to arrive, communicate, understand. And lastly, one wonders what the â€Å"many levels† are that Kafka uses to communicate the rather ambiguous â€Å"movement†. The failure to arrive is a recurrent theme throughout the novel. Probably the best example of it is the failure to arrive at a judgement. K is on trial for the entirety of the novel, and never is judgement passed on him. He is waiting for the court to arrive at a judgement during the course of the novel, yet at the end he is only punished: the court never arrives at a judgement. This can be applied to most of the book: for instance K's failure to arrive at the first hearing on time and the failure of his case to arrive at the highest courts. It is if events are placed in suspense, their conclusion shimmering ever so faintly in the distance and the reader, like Tantalus, attempts to attain the unattainable. Failure to arrive may indicate that in â€Å"The Trial† the journey or process is more important than its conclusion; was the original German manuscript not actually called â€Å"Der Prozess†? However, whatever be the meaning of the failure to arrive, it is instrument al in creating tension as the conclusion continues to be elusive. The failure to arrive can possibly be linked with the failure to communicate in that if one is still in the process of thinking and has not yet arrived at a conclusion, one would find it difficult to accurately describe the thought process to another, hence the failure to communicate. I believe that the most accurate way to define the failure to communicate can be found in Brink's interpretation of the novel. Brink sees language in â€Å"The Trial† as being unable to communicate anything. Take, for example, the advocate's speeches. They are entirely superfluous: Huld turns endlessly around the point with out actually addressing it. Whether this is due to the inadequacy of language or to whether there actually is a point or not one is not sure, but there is clearly a failure to communicate. I believe that the concept of failure to communicate in The Trial is perhaps partly created by the language used in the novel, most of which convey only abstracted logical concepts. The lang uage used has no substance and therefore it is completely detached from reality: the syntax is correct but it makes no sense at all. Failure to understand also plays an extremely important rà ¯Ã‚ ¿Ã‚ ½le in the novel. It can be seen to follow on directly from the failure to communicate: if one person cannot communicate, the other cannot understand. Perhaps the most important instance of failure to understand is K's failure to understand the court system. He never seems to develop an adequate understanding of it from those who have or claim to have an understanding of it. They are unable to communicate their understanding to K, thus keeping K from arriving at an understanding or conclusion. This of course brings us back to the failure to arrive (at a conclusion) which in turns leads to the failure to communicate, and so on. According to Heller, Kafka dramatizes these failures by creating forms in which they can interact with each other, i.e. characters. It is into this dramatization that Kafka draws us by a rather clever usage of basic trait of human nature. Human nature is rather curious by definition, and Kafka uses this facet of human nature to entice the reader into a complete immersion in the world of â€Å"The Trial†. The failure to arrive at any conclusion or judgement is rather intriguing in that it creates a permanent sense of tension: a menace hanging over one's head in suspended animation and the goal almost visible in the distance. One does not know whether it will remain suspended, spring to life, or whether it is there at all. Indeed, one does not know if there really is a point or conclusion. This uncertainty, however, does not stop our pursuit of the glittering conclusion. The sight of it makes the state of uncertainty even more unbearable and the elusive conclusion yet more desir able. One is enticed into entering deeper into a tangle of uncertainties by this lure. The failure to communicate supports this. By using extremely ambiguous language, devoid of any substance and meaning, one is constantly held in a state of uncertainty. Bathed in this uncertainty, we feel the need to understand, to resolve the uncertainties. The failure to understand throughout the novel is echoed in the mind of the reader: if the narrator and/or the text know nothing and/or communicate nothing it is natural that the reader is maintained in a situation where he understands nothing and his curiosity is aroused. Eventually the reader to becomes part of the drama. His failures to understand, communicate and arrive echo those in the novel and reinforce them, plunging the reader yet deeper into the labyrinth without a center. This movement is a downward cycle in which confusion begets confusion, drawing the reader deeper and deeper into the text in a downward spiral. Heller declares that it is this movement which is described and communicated again and again throughout the text. It is indeed correct that this movement is repeated again and again: it is a chain reaction in which some begets more of the same and so on and so forth. However, one wonders how Kafka manages to communicate this to the reader. It is certainly almost impossible to explain it through the medium of language since it has been explained in the text that language is ambiguous and only confounds and obfuscates. Yet by it's own definition then, it is perfectly suited to describe this movement and feeling in the novel. Kafka uses the container, and not the content, in order to communicate the movement to his readers. Yet in a sense the content, or rather the lack of it, also helps to communicate the movement. One expects that a container contains. It is logical that and object should fulfill its definition. In ascribing to this logic, one falls even deeper into the text as one searches for meaning and substance. One becomes lost and confused wading through all the superfluous packaging searching for the content. But there is no center; there is no content. We echo K in his search for the high court, the nub of the court system. He fails because there is no nub; there is no high court.

Hubspot Case Essay

The problem in this case is that Hubspot needed to make a transition from its initial start-up structure (organizational structure, target customers and pricing strategy) in order grow, and the dilemma was how to best approach this change. Hubspot faced three main issues for this: a) identify target customers, b) modify their pricing model and c) how to develop the growth strategy. Hubspot was good at building a community, e.g. over 300000 unique visitor in 2008, and thousands of freeware subscriptions in 2009. Nonetheless they had a diverse universe of customers, from small business owners (Ollies) to marketing professionals (Marys), different type of business ranging B2B or B2C, and size (over or under 25 employees). Table C shows there was a potential market evenly distributed among B2B and B2C. For Hubsport, the decision to identify a target customer was difficult. This is seen when contrasting exhibits 6 where 73% of customers were Ollies and exhibit 5 which indicated that Marys accounted for 68% of new customers from Sep-Dec 2008. Although the B2B customers were important for Ollies and Marys, there was an interesting growth of Marys in B2C. Thus a segmentation of customer was required to better assess their different needs. At the end of 2008, Hubspots’s products responded to the main two customers (Ollies and Marys), still its pricing model was similar for both, where Marys paid a slightly higher monthly amount as its software package included more features (exhibit 7). This was something Hubspot needed to analyze as Ollie and Marys had various pros and cons as customers. Ollies represented a lower cost to acquire ($1000) and where quick to sign in, but cancel subscription early, while Marys cost more to acquire ($5000) and took longer to sign in, by stayed for longer using the product. Assuming no churn rate an Ollie had to maintain subscription for 2 months and Marys had to maintain subscription for 9 months, to pay off their acquiring cost. The previous  scenario meant that HubSpot’s 2008 projections including the 100 paying customers from 2007 made the current pricing model not viable to support the high cost of Marys (see appendix 1). Another issued faced was the Hubsport was still a small company, seen in that it only had few engineers to build the software therefore it was hard to catch up with the sales team. Thus the product vs customer vs pricing situation presented an optimization and planning issue to keep the company growing. The previous two points require a growth strategy. At the same time it made the owners question their vision, i.e. to inbound or outbound. The strategy for growth had to clarify which customer to target, how to roll-out the respective products, whether to keep it a SaaS, and the transition into a new pricing structure to maintain current customer and capture more value from new ones. The objective of our proposed solutions is to keep Hubspot as the software-to-have for inbound marketing and grow financially from a start-up to an established business. For this we set out the following actions: Hubspot’s culture and vision should be maintained. Web 2.0 is continuing evolving as more businesses are using the various channels and HubSpot can differentiate itself as the inbound marketing which weighs more than outbound marketing (inbound represents 37% marketing budget while outbound 30%). HubSpot has the expertise to create traffic and analyze and qualify leads filling the respective demand of Ollies and Marys. At the same time we differentiate from our two main competitors by proving a lower price (Eloqua is more expensive) and focusing on inbound marketing (Marketo is a mix of inbound and outbound). Our conclusions are founded by overlaying HubSpot’s competitive field (exhibit 3) with customers’ needs a) traffic creation and b) leads analysis and qualifications, in line with HubSpot’s main strengths, as seen in appendix 2. Thus the company should not consider outbound as an alternative. As showed in appendix 4, our two segmented customers have showed different needs in terms of product features and consumption behavior. Based on the current churn out rate, we can estimate consumer lifetime value of Ollies is $4,750 and Marys $10,500 (see calculation in appendix 3). Therefore, according to our segmentation strategy, we propose following product bundles by differentiating product price and product features: 1) Product pricing: As Ollies have a shorter customer life and less marketing budget, we suggest keeping current up-front fee and a lower monthly fee. As suggestion, up-front $500 and monthly fee in the range of $150 to $250. As Marys have a longer customer life and lower price sensitivity we suggest increasing both up-front and monthly fee. As suggestion up-front $600 and monthly fee in the range of $600 to $750. Meanwhile, Marys are interested in deeper analytics, we suggest additional fee for each service of deeper analytics. As CMS system helps lower churn rate, we suggest initial fee of $300 covering 6 hours consulting to encourage both of them to use such service. 2) Product features: As Ollies prefer quick and simple solutions, we suggest tailor-made product focusing on generating leads. As Marys have a high demand of analytics, we suggest tailor-made product with more sophisticated tools to meet the needs of deeper analytics. As frequent log-in helps lower churn rate, we suggest to provide service update on a regular basis to encourage a continuous use of our service. After clearly identifying the segmentation of consumer and differentiation of products, we need ensure market-centered organizations that are capable of translating strategy into actions: 1) Engineering: To invest on product development and innovation to continuously provide with relevant service to enhance our competitive advantage of generating leads as well as analytics . 2) Sales force: To divide sales force to separately serve Maryer & Ollies by providing Maryer with long-term, more sophisticated support, providing Ollies with quick & simple service. 3) Marketing: To continue make a buzz for inbound marketing to create inbound marketing community rather than a simple business Finally the strategy has to be sensitive to our current customers, Appendix 5 indicates a tentative layout of the plan. Starting with the internal reorganization, then gradually change the product offering for consumers.

Recipe to Make Your Own Natural Insect Repellent

Recipe to Make Your Own Natural Insect Repellent You can make natural insect repellent yourself. The insect repellent is safe and effective, plus it costs much less to make it than to buy it. Natural Insect Repellent Safety There are a few different formulations you can make for your natural insect repellent. These repellents involve diluting essential oils that the insects find distasteful or which confuses them. The oils dont mix with water, so youll need to add them to other oils or to alcohol. Its important to use an oil or alcohol that is safe for your skin. Also, dont go overboard with the essential oils. The oils are potent and could cause skin irritation or another reaction if you use too much. If you are pregnant or nursing, do not apply an insect repellent, natural or otherwise, until after youve gotten it cleared by your physician. Natural Insect Repellent Ingredients Different insects are repelled by different chemicals, so youll get a more effective repellent if you combine a few different insect-repelling natural oils. If you are making large amounts of insect repellent, a good rule of thumb is to mix the repellent so its 5-10% essential oil, so mix 1 part essential oil with 10-20 parts carrier oil or alcohol. For a smaller batch use: 10 to 25 drops (total) of essential oils2 tablespoons of a carrier oil or alcohol The essential oils that work well against biting insects (mosquitoes, flies, ticks, fleas) are: cinnamon oil (mosquitoes)lemon eucalyptus or regular eucalyptus oil (mosquitoes, ticks, and lice)citronella oil (mosquitoes and biting flies)castor oil (mosquitoes)orange oil (fleas)rose geranium (ticks and lice) Safe carrier oils and alcohols include: olive oilsunflower oilany other cooking oilwitch hazelvodka Natural Insect Repellent Recipe Mix the essential oil with the carrier oil or alcohol. Rub or spray the natural insect repellent onto skin or clothing, using care to avoid the sensitive eye area. Youll need to re-apply the natural product after about an hour or after swimming or exercise. Unused natural insect repellent may be stored in a dark bottle, away from heat or sunlight. If you wish, you may combine the oil with aloe vera gel to change the consistency of the product.

The History of Life on Earth

The History of Life on Earth The Carboniferous Period is a geologic time period that took place between 360 to 286 million years ago. The Carboniferous Period is named after the rich coal deposits that are present in rock layers from this time period. The Age of Amphibians The Carboniferous Period is also known as the Age of Amphibians. It is the fifth of six geologic periods that together make up the Paleozoic Era. The Carboniferous Period is preceded by the Devonian Period and followed by the Permian Period. The climate of the Carboniferous Period was quite uniform (there were no distinct seasons) and it was more humid and tropical than our present-day climate. The plant life of the Carboniferous Period resembled modern tropical plants. The Carboniferous Period was a time when the first of many animal groups evolved: the first true bony fishes, the first sharks, the first amphibians, and the first amniotes. The appearance of the amniotes is evolutionarily significant because of the amniotic egg, the defining characteristic of amniotes, enabled the ancestors of modern reptiles, birds, and mammals to reproduce on land and colonize terrestrial habitats that were previously uninhabited by vertebrates.   Mountain Building The Carboniferous Period was a time of mountain building when the collision of the Laurussian and Gondwanaland land masses formed the supercontinent Pangea. This collision resulted in the uplifting of mountain ranges such as the Appalachian Mountains, the Hercynian Mountains, and the Ural Mountains. During the Carboniferous Period, the vast oceans that covered the earth often flooded the continents, creating warm, shallow seas. It was during this time that the armored fish that had been abundant in the Devonian Period became extinct and were replaced by more modern fishes. As the Carboniferous Period progressed, the uplifting of landmasses resulted in an increase in erosion and the building of floodplains and river deltas. The increased freshwater habitat meant that some marine organisms such as corals and crinoids died out. New species that were adapted to the reduced salinity of these waters evolved, such as freshwater clams, gastropods, sharks, and bony fish. Vast Swamp Forests Freshwater wetlands increased and formed vast swamp forests. Fossil remains show that air-breathing insects, arachnids, and myriapods were present during the Late Carboniferous. The seas were dominated by sharks and their relatives and it was during this period that sharks underwent much diversification. Arid Environments   Land snails first appeared and dragonflies and mayflies diversified. As the land habitats dried, animals evolved ways of adapting to the arid environments. The amniotic egg enabled early tetrapods to break free of the bonds to aquatic habitats for reproduction. The earliest known amniote is Hylonomus, a lizard-like creature with a strong jaw and slender limbs. Early tetrapods diversified significantly during the Carboniferous Period. These included the temnospondyls and the anthracosaurs. Finally, the first diapsids and synapsids evolved during the Carboniferous. By the middle the Carboniferous Period, tetrapods were common and quite diverse. The varied in size (some measuring up to 20 feet in length). As the climate grew cooler and drier, the evolution of amphibians slowed and the appearance of amniotes lead to a new evolutionary path.

Sources of Titles Drawn from Shakespeare

Sources of Titles Drawn from Shakespeare Sources of Titles Drawn from Shakespeare Sources of Titles Drawn from Shakespeare By Maeve Maddox Today is April 23. HAPPY BIRTHDAY, SHAKESPEARE! Here are the sources of the titles given in yesterdays post. 1. The Moon Is Down, John Steinbeck BANQUO: How goes the night, boy? FLEANCE: The moon is down. I have not heard the clock. Macbeth, II.i The remark adds to a sense of evil foreboding; Macbeth is on his way to murder Duncan. 2. Gaudy Night, Dorothy Sayers ANTONY: †¦Come, Lets have one other gaudy night: call to me All my sad captains; fill our bowls once more; Lets mock the midnight bell. Antony and Cleopatra, III.xiii Antony is speaking to Cleopatra. Their end is nigh, but theyre going to party. 3. Under the Greenwood Tree, Thomas Hardy AMIENS: Under the greenwood tree Who loves to lie with me, And turn his merry note Unto the sweet birds throat, Come hither, come hither, come hither: Here shall he see No enemy But winter and rough weather. As You Like It, II.v Jaques and the other forest dwellers listen to Amiens sing about their idyllic life. 4. And Be a Villain, Rex Stout HAMLET: O villain, villain, smiling, damnà ¨d villain! My tablesmeet it is I set it down That one may smile, and smile, and be a villain At least I am sure it may be so in Denmark. Hamlet, I.v Hamlet is talking about his uncle/stepfather Claudius, the murderer of his father. 5. Something Wicked This Way Comes. Ray Bradbury SECOND WITCH: By the pricking of my thumbs, Something wicked this way comes. [Knocking] Open locks, Whoever knocks! [Enter Macbeth] Macbeth, IV, i This is the second scene with the witches. The first time, they accosted Macbeth. This time he is seeking them out. He has begun the downward path into evil. 6. Pale Fire, Vladimir Nabokov TIMON: The suns a thief, and with his great attraction Robs the vast sea: the moons an arrant thief And her pale fire she snatches from the sun. Timon of Athens IV, iii Misanthrope Timon is discoursing on his view that everyones a crook. Nabokovs story is about the creative fire of the poet. An echo of the pale fire from the Timon of Athens quotation is in a line spoken by the ghost of Hamlets father. Morning is approaching and he must return to Purgatory: GHOST: Fare thee well at once! The glow-worm shows the matin to be near, And gins to pale his uneffectual fire: Adieu, adieu! Hamlet, remember me. [Exit] Hamlet, I,v 7. Band of Brothers, Stephen Ambrose HENRY V: This story [of Agincourt] shall the good man teach his son; And Crispin Crispian shall neer go by, From this day to the ending of the world, But we in it shall be rememberd; We few, we happy few, we band of brothers Henry V, IV.iii Henry is giving his discouraged men a pep talk before a last desperate assault on the French. 8. The Dogs of War, Frederick Forsyth ANTONY: And Caesars spirit, ranging for revenge, With Ate by his side come hot from hell, Shall in these confines with a monarchs voice Cry Havoc, and let slip the dogs of war Julius Caesar, III.i Antony, speaking at Caesars funeral, desires to stir up the populace against the assassins. After describing the horrors of civil war, he depicts the ghost of Julius Caesar leading the attack. 9. There is a Tide, Agatha Christie CASSIUS: There is a tide in the affairs of men, Which, taken at the flood, leads on to fortune; Omitted, all the voyage of their life Is bound in shallows and in miseries. On such a full sea re we now afloat; And we must take the current when it serves, Or lose our ventures. Julius Caesar, IV, iii Cassius is trying to persuade Brutus that they must fight at Philippi. 10. By the Pricking of My Thumbs, Agatha Chrstie See Number 5 above. 11. Not in Our Stars, M. M. Marshall CASSIUS: The fault, dear Brutus, is not in our stars, But in ourselves, that we are underlings. Julius Caesar, I,ii Cassius is urging Brutus to act against Julius Caesar. 12. Chimes at Midnight, Terence White SHALLOW: Ha, cousin Silence, that thou hadst seen that that this knight and I have seen! Ha, Sir John, said I well? FALSTAFF: We have heard the chimes at midnight, Master Shallow. Henry IV part 2, III,ii Falstaff and Shallow, in the company of Silence, are reminiscing about their youth. Only rowdies and people up to no good would have stayed out late enough to hear the clock strike midnight. 13. The Mousetrap, Agatha Christie CLAUDIUS: Have you heard the argument? Is there no offence in t? HAMLET: No, no, they do but jest, poison in jest; no offence i the world. CLAUDIUS: What do you call the play? HAMLET: The Mouse-trap. Hamlet, III, ii Hamlet has hired actors to present a play with which he hopes to catch the conscience of the king. Uncomfortable as the play proceeds, Claudius asks Hamlet for more information. 14. Twice-Told Tales, Nathaniel Hawthorne LEWIS (Louis, Dauphin of France)†¨Ã¢â‚¬ ¨Ã‚  Theres nothing in this world can make me joy: †¨Ã‚  Ã‚  Ã‚  Ã‚   Life is as tedious as a twice-told tale †¨Ã‚  Ã‚  Ã‚  Ã‚   Vexing the dull ear of a drowsy man; †¨Ã‚  Ã‚  Ã‚  Ã‚   And bitter shame hath spoild the sweet worlds taste †¨Ã‚  Ã‚  Ã‚  Ã‚   That it yields nought but shame and bitterness. King John, III,iv Lewis is depressed because the fortunes of war have turned against France. His meaning is that a twice-told tale is boring and tedious. Hawthorne and other writers used twice-told tales in another sense: old stories retold for modern readers. 15. A Muse of Fire, A.D. Harvey PROLOGUE: O for a Muse of fire, that would ascend The brightest heaven of invention, A kingdom for a stage, princes to act And monarchs to behold the swelling scene! Then should the warlike Harry, like himself, Assume the port of Mars and at his heels, Leashd in like hounds, should famine, sword and fire Crouch for employment†¦ †¦can this cockpit hold The vasty fields of France? or may we cram Within this wooden O the very casques That did affright the air at Agincourt? Henry V, Prologue Kenneth Branagh opens his film version of the play with an actor declaiming these lines on an Elizabethan stage. Then the scene opens out into the vasty fields of France and the realistic action that movies excel in. Shakespeare had to do it all with words and a few stage props. 16. Strange Snow, Steve Metcalfe PHILOSTRATE [reading]: A tedious brief scene of young Pyramus and his love Thisbe; very tragical mirth. THESEUS: Merry and tragical! Tedious and brief! That is, hot ice and wondrous strange snow. How shall we find the concord of this discord? Midsummer Nights Dream, V, i Theseus is reacting to the comical, contradictory description of the play of Pyramus and Thisbe offered as wedding entertainment by Bottom the weaver and the other mechanicals. 17. Walk the Night, Robert C. Reinhart GHOST: I am thy fathers spirit, Doomd for a certain term to walk the night, And for the day confined to fast in fires, Till the foul crimes done in my days of nature Are burnt and purged away. Hamlet, I,v 18. A Plague on Both Your Houses. Robert. W. Whitaker MERCUTIO: I am hurt. A plague o both your houses! I am sped. Is he gone, and hath nothing? Romeo and Juliet, III, i Romeos friend Mercutio has been in a fight with Tybalt, a Capulet. Tybalt has escaped without a scratch, but Mercutio is fatally wounded. With his dying breath he curses the senseless hostility between the Montagues and the Capulets that has ended his life. 19. The Sound and the Fury, William Faulkner MACBETH: To-morrow, and to-morrow, and to-morrow, Creeps in this petty pace from day to day To the last syllable of recorded time, And all our yesterdays have lighted fools The way to dusty death. Out, out, brief candle! Lifes but a walking shadow, a poor player That struts and frets his hour upon the stage And then is heard no more: it is a tale Told by an idiot, full of sound and fury, Signifying nothing. Macbeth V,v Macbeth has come to the end of the road. Lady Macbeth is dead, and MacDuff is at the gates of Dunsinane Castle. All his scheming and criminal behavior amount to a pile of ashes. 20. Dagger of the Mind, Star Trek episode MACBETH: Is this a dagger which I see before me, The handle toward my hand? Come, let me clutch thee. I have thee not, and yet I see thee still. Art thou not, fatal vision*, sensible To feeling as to sight? or art thou but A dagger of the mind, a false creation, Proceeding from the heat-oppressed brain? Macbeth, II,i Macbeth is on his way to murder King Duncan. Hes hallucinating because of the guilt he feels. *Fatal Vision, true crime book by Joe McGiniss; Fatal Vision, TV miniseries starring Karl Malden Want to improve your English in five minutes a day? Get a subscription and start receiving our writing tips and exercises daily! Keep learning! Browse the Expressions category, check our popular posts, or choose a related post below:75 Synonyms for â€Å"Angry†What is the Difference Between Metaphor and Simile?May Have vs. Might Have

What is nursing Essay Example | Topics and Well Written Essays - 750 words

What is nursing - Essay Example lling a vital role within a given industry or business, the definition of nursing that has been laid out above strictly differs from the definition or â€Å"scope† that many jobs may have (Azuri et al., 2014). As a means of understanding this and delineating what the specific responsibilities and expectations are for nurses, the following analysis will seek to engage the reader with a more profound and nuanced interpretation of what the nurse actually does and how they are expected to fulfill their unique role within the medical community. Through such a discussion, it is the further hope of this student that the reader will be able to come to a more informed understanding of the role of the nurse and how this vital position serves to strengthen the outreach and scope that the medical community has. A discussion of what defines a nurse would not be complete without briefly discussing some of the roles and responsibilities that nurses have. Although the following will not be an exhaustive list, as such a list might require a dissertation length response, the core responsibilities that will be defined are generally shared amongst most nurses. Firstly, the nurse is required to directly interact with the patient and gather information that the medical professional, whether a doctor, PA, or other professional, can utilize as a means of addressing issues relating to the health of the patient and their future prognosis. In such a way, the nurse is oftentimes required to engage in a physical exam or a discussion with the patient; as a means of categorizing and seeking to provide actionable information to the doctor or PA (Christiansen et al., 2013). In a more direct sense, nurses are oftentimes required to provide health counseling and education. Although this is sometimes overlooked, in lieu of the fact that this is an expectation of a doctor, the fact of the matter is that a nurse’s extensive medical training prepares him/her to counsel patients with regard to

How does the promotion strategy effect the customer purchase Literature review

How does the promotion strategy effect the customer purchase - Literature review Example Mela, Gupta and Lehmann (1997) discussed the long-term impact of promotions on brand performance. Even though, this article takes dependent variable as brand performance instead of customer purchase, it has been chosen because brand performance is, after all, a determinant of customer purchase. Mela, Gupta and Lehmann (1997) investigated the long-term impact of advertising and promotion on customer’s brand choice behavior. Customer’s brand choice behavior depended upon two decisive factors. i. Is there any response of customers on the variables of marketing mix such as product, price, place and promotion? ii. If so, are these changes related to the promotional policies of retailers and manufacturers? The results of the study revealed that in long run, price promotion makes both types of customers; loyal and non-loyal. In addition to that, Mela, Gupta and Lehmann (1997) concluded that advertising has good affect on consumers’ brand choice behavior whereas promotions have bad affect on the brand choice behavior of consumers (Mela, Gupta and Lehmann, 1997). Personalization, also known as customization, is the popular concept of marketing. It has become a necessity for many organizations. Savadkoohi (2012) conducted a study to investigate advantages and disadvantages of customization for companies as well as customers. The paper emphasized upon the personalized online promotions and its impact on consumers’ buying behavior. Savadkoohi (2012) concluded that the successful online personalization strategies can increase the buying behavior of the customers and thereby, can affect the companies’ profitability. Nowadays, online marketing, selling and promotion have become very common. Companies utilize the platform of internet in order to attract more customers. Ye, Haohong and Fei (2010) conducted a study to investigate the impact of sales promotion on C2C online shopping behavior of consumer. In order to examine the relationship between these variables, Ye, Haohong and Fei (2010) used an empirical method. The results of the st udy revealed that online promotion has direct influence on the attitude of customers but the intention of purchase is not significant. However, it might help in building a brand perception in minds of customers. Therefore, online promotion can be effective in increasing the brand awareness (Ye, Haohong and Fei, 2010). Modi and Jhulka (2012) conducted a study in order to measure the impact of promotional schemes on the buying behavior of consumers. Modi and Jhulka (2012) examined five types of promotional schemes, which included Festival Season Offers, Special Gift, Exchange Offer, Product Warranties and Contest Prizes. A questionnaire was constructed in order to perform the research and gather the relevant data. Chi square test was performed to test the null hypotheses. The results of the study revealed that promotional schemes can be proved as effective tool to organizations for selling their products. The authors further stated that promotional schemes can be very useful especiall y in the car purchasing decision of consumers (Modi and Jhulka, 2012). Costa, Epperson, Huang and McKissick (2002) conducted a study to determine the impact of advertising and promotion on the scanned purchases of Vidalia onion. Another aim of the study was to examine the expected return on expenditure of promotion. In order to gather the data of Vidalia onion, scanned copies from the supermarket were collected. Vidalia Onion Marketing Order generates the promotion expenditure. In order to carry out the research, Costa, Epperson, Huang and McKissick (2002) utilized error component model for 10 different markets for the period of 1996 to 2001. Results of the study revealed that advertising and promotion expenditures influenced the demand of Vidalia onion substantially over the research period. Keeping in mind the seasonality of Vidalia onion, more promotional activities can be done in order to increase the

Personal Views regarding Socializing with Superiors and with Essay

Personal Views regarding Socializing with Superiors and with Subordinates - Essay Example This will translate to less efficiency by the superiors in running of the organization. This is evident where a subordinate to whom there is a close relationship with a superior cannot be terminated from employment, given a pay cut or reduced responsibilities for whatever reason, as this will negatively affect the social relationship (Rue et al, 2013). The other disadvantage of subordinate-superior social relationship is that it results in a loss of respect for the manager, as they will treat each other as friends affecting the ability for quality job performance. Socializing will not allow for constructive judgment and performance appraisal that is required of each employee by the superiors leading to unfairness and injustice in job performance (Rue et al, 2013). However, there is a need for some social interaction between subordinates and superiors and between subordinates their selves. These include taking drinks together and parties but there has to be professionalism where the superior leaves first and the conversations based on non-work issues. Subordinates can have social relationships at the work place as they have the same characteristics including having the same experience, same level of skills and education, and the performance of duties at the same level. These social relations aid in the development of teamwork, development of trust between employees, and the creation of a bond between the

Determinants Of The Use Of Financial Incentives Essay

Determinants Of The Use Of Financial Incentives - Essay Example Bankers had anticipated a continuous growth in the property market, and loans had been disbursed to people with low creditworthiness to show a growth in the business. Financial products called mortgage-backed securities had enabled financial institutions and investors around the world to invest in the U.S. housing market. Major banks and financial institutions reported losses of approximately US$435 billion as of 17 July 2008, as these securities derived their value from mortgage payments and housing prices. As a result of this crisis, the most revered names on Wall Street have had to eat humble pie. In September 2008, Merrill Lynch agreed to sell itself on Sunday to Bank of America for roughly $50 billion to avert a deepening financial crisis. At almost the same time, while another prominent securities firm, Lehman Brothers, filed for bankruptcy protection, shocking the whole world. The collapse of Bear Sterns hedge funds is another example of the short-sightedness of investment banking. Controlling for CEO pay-performance sensitivity (delta) and the feedback effects of firm policy and risk on the managerial compensation scheme, it is observed that higher sensitivity of CEO wealth to stock volatility (vega) implements riskier policy choices, including relatively more investment in R&D, less investment in PPE, more focus, and higher leverage. We also find that riskier policy choices generally lead to compensation structures with higher vega and lower delta. Stock-return volatility has a positive effect on both vega and delta. C. How investment banks use and report executive compensation schemes Quantitative analysis of a detailed industry-wide survey validates the hypothesis that those occupations where the output is easily identifiable receive higher bonus pay. The proximity of an occupation to the revenue generating activity within the organization is also found to be significant in determining bonus levels, as is job grade within the organization.

Theory of Strength and Conditioning and Vertical Jump Essay

Theory of Strength and Conditioning and Vertical Jump - Essay Example Young (2006, p. 74) reported that exercises involving bilateral contractions of leg muscles for vertical movements, like squats and jump squats, are not effective in improving performance. In contrast, according to Young (2006, p. 74), plyometric training can lead to â€Å"significant increases in sprint acceleration performance, thus highlighting the importance of movement pattern and contraction velocity specificity.† Further, Harris et al. (2008, p. 691) reported that based on an experiment they conducted among thirty elite rugby athletes, the correlation between sprint ability and jumping ability is generally positive and of moderate to strong magnitude. Adopting the definitions reported by earlier works, Ploeg et al. (2010, p. 39) explained that plyometric exercises or plyometrics are exercises in phases that begins with intense eccentric muscular contractions followed by rapid concentric muscular contraction. Drawing on various works, Ploeg et al. (2010, p. 39) explained that when muscle is stretched, the muscle stores elastic energy briefly and plyometric exercises use the stored energy to assist the concentric contraction to produce more force than what can be provided by a plain concentric action or a concentric contraction.... (2010, p. 40) clarified that alpha motor neurons transmit signals to the muscle group in a ploymetric exercise. The amortization phase in the plyometric activity is crucial in developing the production of power (Ploeg et al. 2010, p. 40). Craig and Judge (2009, p. 75) explained that several studies have shown consistently that overloading the body with a progressive training program will increase muscle size and strengthen the bone. Based on the results of their experiments, Villareal et al. (2008) concluded that moderate plyometrics training programs are more efficient than higher plyometrics training volume but the although their study was limited to short-term or 7-weeks of training and may be applicable for that class of training programs, particularly short-period training programs. In contrast, the evidence reviewed by Craig and Judge (2009, p. 75) covered l training programs with longer time periods. 2.0. Training and Conditioning Appropriate and Physiological Adaptation In de signing training programs, Craig and Judge identifed three important aspects of designing a training program: periodization, resistance training, and training sets (2009, p. 75-76). Turner (2011, p. 34) emphasized on the importance of periodization as an â€Å"optimal strategy for organizing strength and conditioning programs.† Periodization involves the variation of training methods and volume loads for the purpose of â€Å"potentiation of biomotors and the management of fatigue and accommodation† (Turner 2011, p. 34). Turner pointed out that periodization manipulate volume loads and progresses from general to sport-specific training (2011, p. 34). For Turner, although scientific studies are required to establish the use and

Nursing articles on HIV Annotated Bibliography Example | Topics and Well Written Essays - 2500 words

Nursing articles on HIV - Annotated Bibliography Example In this article he has discussed in detail that not human immunodeficiency virus is a virus that can be present not only in young people but is increasingly being present in older aged people. In this article a research has been shown which states that HIV positive cases in people over fifty years are dangerously raising and this particular trend have been extensively observed in UK and US. As human immunodeficiency virus is increasing in older aged people it is giving birth to a new challenge in the field of health care for nurses. It is definitely an extremely difficult task to handle aged patients. Through a research conducted in UK it has been concluded that nurses are facing an extremely difficult time handling the aged patients. The article then discusses that although it is a challenging task to handle aged patients but it is necessary that nurses must be trained such that they can handle all sorts of cases and provide every patient with high quality care, attention and devoti on. Nurses cannot neglect any patient or pay less attention towards any patient. It is her duty to pay equal and high quality care and attention towards each and every patient. In the article it has been clearly mentioned, the age of people who are referred to as aged. The article also explains that aged people are morally weak and they need more attention and care and it is the duty of nurses to provide them with such care. He has concluded by mentioning new researches that are being carried out for HIV patients and that more awareness needs to be created in nurses regarding health care roles. Walsh, E. C., Horvath, K. J., Fisher, H., & Courtenay-Quirk, C. (January 01,... This essay stresses that as human immunodeficiency virus is increasing in older aged people it is giving birth to a new challenge in the field of health care for nurses. It is definitely an extremely difficult task to handle aged patients. Through a research conducted in UK it has been concluded that nurses are facing an extremely difficult time handling the aged patients. The article then discusses that although it is a challenging task to handle aged patients but it is necessary that nurses must be trained such that they can handle all sorts of cases and provide every patient with high quality care, attention and devotion. Nurses cannot neglect any patient or pay less attention towards any patient. It is her duty to pay equal and high quality care and attention towards each and every patient. This paper declares that human immunodeficiency virus/ acquired immune deficiency syndrome are becoming an epidemic in most parts of the world. The articles discusses that through research it has been observed that in countries where the cases of human immunodeficiency virus/acquired immune deficiency syndrome were minimal in the past years, now are a place of rapidly increasing cases of HIV/ AIDS and in those countries where the cases of HIV/ AIDS were already high, human immunodeficiency virus have become an epidemic in those areas. Certain modifications were made in the policy so as to help the nurses to properly manage, interfere, and ink out the results of HIV rapid testing.

Theory of Strength and Conditioning and Vertical Jump Essay

Theory of Strength and Conditioning and Vertical Jump - Essay Example Young (2006, p. 74) reported that exercises involving bilateral contractions of leg muscles for vertical movements, like squats and jump squats, are not effective in improving performance. In contrast, according to Young (2006, p. 74), plyometric training can lead to â€Å"significant increases in sprint acceleration performance, thus highlighting the importance of movement pattern and contraction velocity specificity.† Further, Harris et al. (2008, p. 691) reported that based on an experiment they conducted among thirty elite rugby athletes, the correlation between sprint ability and jumping ability is generally positive and of moderate to strong magnitude. Adopting the definitions reported by earlier works, Ploeg et al. (2010, p. 39) explained that plyometric exercises or plyometrics are exercises in phases that begins with intense eccentric muscular contractions followed by rapid concentric muscular contraction. Drawing on various works, Ploeg et al. (2010, p. 39) explained that when muscle is stretched, the muscle stores elastic energy briefly and plyometric exercises use the stored energy to assist the concentric contraction to produce more force than what can be provided by a plain concentric action or a concentric contraction.... (2010, p. 40) clarified that alpha motor neurons transmit signals to the muscle group in a ploymetric exercise. The amortization phase in the plyometric activity is crucial in developing the production of power (Ploeg et al. 2010, p. 40). Craig and Judge (2009, p. 75) explained that several studies have shown consistently that overloading the body with a progressive training program will increase muscle size and strengthen the bone. Based on the results of their experiments, Villareal et al. (2008) concluded that moderate plyometrics training programs are more efficient than higher plyometrics training volume but the although their study was limited to short-term or 7-weeks of training and may be applicable for that class of training programs, particularly short-period training programs. In contrast, the evidence reviewed by Craig and Judge (2009, p. 75) covered l training programs with longer time periods. 2.0. Training and Conditioning Appropriate and Physiological Adaptation In de signing training programs, Craig and Judge identifed three important aspects of designing a training program: periodization, resistance training, and training sets (2009, p. 75-76). Turner (2011, p. 34) emphasized on the importance of periodization as an â€Å"optimal strategy for organizing strength and conditioning programs.† Periodization involves the variation of training methods and volume loads for the purpose of â€Å"potentiation of biomotors and the management of fatigue and accommodation† (Turner 2011, p. 34). Turner pointed out that periodization manipulate volume loads and progresses from general to sport-specific training (2011, p. 34). For Turner, although scientific studies are required to establish the use and

Vietnamese telecom market Essay Example for Free

Vietnamese telecom market Essay Introduction Together with breakthroughs in technology, mobile telecom has been showing great innovations and bringing enormous benefits to consumers. Vietnamese mobile telecom market, through only a few decades of development, has proven to be an extremely potential industry. With analysis from the microeconomic standpoint, I would like to clarify some notable matters seen in Vietnamese mobile telecom market today. This essay is organised in three parts: * Part I: Market Overview. This part provides brief information about development history of the market and what the situation of the market is nowadays. * Part II: Market Trends. This part deals with recent movements in Vietnamese mobile telecom market. * Part III: Consumers: Gain or Lose? The final part of this essay analyses the benefits and losses that consumers face as a result of recent changes in the market. PART I – Market Overview 1. Vietnamese Mobile Telecom Market: A Brief History As a developing country, Vietnam has its mobile telecom market started quite late. Though the demand for mobile services arose in the beginning of the 1990s, the first mobile telecom company of Vietnam – MobiFone – did not come into operation until 1994. This year marked the foundation of Vietnamese mobile telecom market. Following steps of MobiFone, two more company joined the market: Vinaphone (1997) and Viettel Telecom (â€Å"Viettel† for short) (2004). However, before 2000, the use of mobile phones seemed to be restricted for urban and rich people. At that time, only the rich could afford the cost of using mobile service. The cost for a postpaid subscription reached almost VND1,000,000 and the money consumed in one minute’s mobile phone call could cover the cost of food in a day for a rural family. One of the reasons for this extremely high cost was that the market at that time was highly monopolistic. Until 2000, there were only two mobile service providers in Vietnam, MobiFone and Vinaphone – both of which are subsidiaries of Vietnam Posts and Telecoms Group (VNPT). Most consumers were not wealthy enough to access mobile service, so they stuck to the use of landlines, which, in fact, were also not very popular especially in the countryside. The emergence of Viettel as a mobile service provider in 2004 was one of the biggest jump in the history of Vietnamese mobile telecom market. Viettel started to provide mobile services at a shockingly low price: a mobile phone user might pay as little as VND50,000/month only. This low price encouraged the quantity demanded for mobile services to increase sharply. As time goes by, the cost of using mobile phones has become cheaper and cheaper, causing the number of mobile subscribers to soar: at the end of January 2012, there were 118. 5 million mobile subscribers compared to only 0. 3 million in 2000. The number of service providers has also increased to 7: MobiFone, Vinaphone, Viettel, S-Fone, Vietnamobile, EVN Telecom and Beeline. Over 19 years of development, from a market exclusively for high-income consumers, the mobile telecom market has been recognised as one of the most active market in Vietnam and almost everybody, rich or poor, is capable of owning and maintaining a mobile phone. Why do service providers seek to increase their number of subscribers by lowering prices and giving big promotions? The answer is, in the short run, most costs incurred by a telecom firm are fixed costs, such as costs for infrastructure and bandwidth. Average total cost, as a result, decreases as the number of subscribers increases, thus making larger profit for the firm. Hence, firms have strong motivations to attract more and more people to use their services. 2. How the Market Pie Is Divided Today The current mobile telecom market in Vietnam can be seen as a typical monopolistic competition. Three biggest suppliers in the market are the ones with longest histories: MobiFone, Vinaphone and Viettel. All these companies are state-owned; MobiFone and Vinaphone are under control of VNPT, while Viettel is a subsidiary of Vietnamese Military Telecom Corporation. Together they control almost the whole mobile service market. According from statistics of the Ministry of Information and Communications, in 2011, Viettel was the leading firm with a market share of 36. 72%. MobiFone and Vinaphone stood at the second and third positions with 29. 11% and 28. 71%, respectively. In total, the three state-owned companies took up nearly 95% of the mobile service market, leaving just over 5% for the remaining service providers, namely EVN Telecom, Vietnamobile, Beeline and S-Fone. The reputation of these firms is so huge that once a person starts using a mobile phone, his first thought of what provider’s service to use that crosses his mind would generally be one of them. Three leading firms in the market pursue different business objectives. Aiming at low-income consumers, Viettel has applied low-cost packages to meet the needs of the majority of consumers. On the contrary, MobiFone and Vinaphone focus mainly on providing high-quality services to people with higher income. Below are the ranks in market shares and service quality of the three biggest providers of mobile services in Vietnam according to an examination conducted by Department of Information Technology and Communications Quality Management (under the Ministry of Information and Communications) in 2009: Provider| Market Share| Service Quality| MobiFone| 2| 1| Vinaphone| 3| 2| Viettel| 1| 3| Overwhelmed by big firms in the market, small firms such as S-Fone, EVN Telecom, Beeline and Vietnamobile have had to struggle to survive. Sharing only 5% of the market, these providers have been facing enormous difficulties in increasing the number of subscribers and profits. Two of them, EVN Telecom and Beeline, are eventually sold to other firms. These MA’s will be analysed in the following part. PART II – Market Trends The three leading firms in Vietnamese mobile telecom market – MobiFone, Vinaphone and Viettel – now possess great market powers, and naturally they desire to take over the small firms in order to have more control of the market. Below are three notable events that have occurred recently in the market which would have lasting effects on its path of development in the future. 1. Viettel’s Acquisition of EVN Telecom EVN Telecom is a company belonging to Electricity of Vietnam Group (EVN). Joining the mobile telecom market in June 2010, after just over one year of operation, EVN Telecom faced the risk of being acquired due to poor business outcome (slow subscriber growth, unsatisfactory revenue, pressure on EVN to focus on its major field, etc. ) and substantial liabilities to Viettel and VNPT. Some telecom firms had the intention of acquire EVN Telecom, such as Viettel, FPT Group and Hanoi Telecom (the owner of Vietnamobile). After many speculations about what firm would take over EVN Telecom, it was officially announced that EVN Telecom was going to be sold to Viettel. However, the acquisition was not smooth right from the beginning. In November 2011, Hanoi Telecom expressed its view that Viettel’s acquisition of EVN Telecom might violate Competition Law, emphasising that it would probably make Viettel a monopolistic firm in the market. Until December 2011, Government eventually agreed on Viettel’s plan as in this case, Viettel was merely a market leader, not a monopolistic firm. 2. Beeline Disappeared in the Market. In 2009, GTel Mobile Company, a joint venture of GTel Global Telecom Corporation of Vietnam and VimpelCom Group of Russia, brought Beeline mobile telecom service into operation in Vietnamese market. However, after three years, VimpelCom decided to sold all of its 49% of shares in the joint venture at US$45 million to GTel â€Å"in order to focus on our key markets†, said the Vice President of VimpelCom. Of course this is not the real answer to the question of why VimpelCom withdrew from Vietnamese market while it had not broken even, regarding its total investment of up to US$463 million. Right after its debut in the market, Beeline conducted many discount programmes and promotions to raise the number of subscribers, such as Big Zero and Millionaire’s Cost Package. These policies thus lowered its ARPU to less than US$1. Moreover, its shockingly low prices cannot help them surpass the â€Å"giants† in Vietnamese mobile telecom market whose brands have been set in minds of consumers though its subscriber growth was exceptional: about 15,000 new subscribers per day in 2011. The fact that Beeline’s profit did not live up to its VimpelCom’s expectation caused it to constrain Beeline’s operation and eventually to sell out its shares to GTel, making Beeline a completely domestic brand. Many people would doubt whether Vietnamese mobile service market has become â€Å"immune† to foreign investment as VimpelCom has failed to make profit here while it has been extremely successful in Russian and Eastern European markets. Is the market so saturated that no new firm could possibly achieve a market share from the hands of established firms? Will VimpelCom’s failure warn foreign investors against entering Vietnamese telecom market although we have been a member of WTO for five years? 3. MobiFone and Vinaphone to be Merged March 2012 was a month of vibrancy in Vietnamese mobile telecom market when rumour had it that MobiFone and Vinaphone, two out of the three biggest service providers, would be merged as a step to restructure VNPT. MobiFone and Vinaphone have followed different development directions despite being subsidiaries of the same group, which has been an enormous waste in infrastructure. A merger of the two companies is expected to improve service quality and efficiency, thus lowering the prices charged on consumers. This information was confirmed by VNPT’s management though an official decision of Government has not yet been made for fear that this merge might violate Competition Law. If the merger of MobiFone and Vinaphone is successful, the new company will constitute almost 58% of the market, threatening the survival of other companies, especially small firms like S-Fone and Vietnamobile. Earlier in 2011, according to the regulations of Telecommunications Law – an individual or organisation is not allowed to own more than 20% of shares in each of two telecom firms operating in the same telecom market – VNPT stood between two options: equitising either of MobiFone and Vinaphone or merging the two. If choosing to equitise MobiFone, VNPT still could not own more than 20% of shares and might have to sacrifice a large amount of profit as MobiFone contributed to over 50% of its profit while taking up only about 4% of human resources. The second option – a merger – would subject VNPT to violation of Competition Law. On the other hand, according to the Vice Head of Department of Competition Management (Ministry of Industry and Trade), market share is not the only criterion to examine VNPT’s merger scheme as it may vary from year to year. Competition power, market access capacity, opportunity seizure, etc. are vital elements to be considered. The cornerstone of the merger, if successful, is a close supervision and control of Ministry of Industry and Trade as well as Ministry of Information and Communications. 4. What Are the Trends? Along development steps of the market are the shifts showing what its trend is. Overall, Vietnamese mobile telecom market, although service quality has been greatly improved and price never stop falling, has hardly ever been viewed as a competitive market. At first, it was a complete monopoly, and then reached the peak of competitiveness with 7 suppliers; now it is getting closer and closer to an oligopoly. (For illustration purpose only) The market now is the race between VNPT and Viettel. Nevertheless, this is a counterfeit competition as both are state-owned firms. Government ought to study this matter intensively since it has both advantages and disadvantages. If it continues to let the two compete with each other, consumers will benefit while state funds invested in them will be partly wasted due to self-competition and vice versa. PART III – Consumers: Gain or Lose? 1. Competition Makes Consumers Better off Most mobile phone users would agree that they are benefiting more and more from service providers’ policies. Ten years ago, only wealthy people could own a mobile phone and afford the use of mobile telecom service, which is a completely distinct from today’s situation where mobile technology is nothing strange to most people, regardless of their income. The shift of the market from a monopoly to a more competitive one enables consumers to choose the service provider which suits them best in quality and price. Landlines services are being outnumbered by mobile services and will probably soon become obsolete as now they cannot compete with mobile services in price, let alone in convenience, diversity and flexibility. In addition, telecom services are the only items whose prices have constantly decreased, moving against the storm of inflation in Vietnamese economy. D2 S11 S2 D1 E1 P1 P2 E2 Q2 Q1 (For illustration purpose only)| The increase of quantity supplied is greater than the increase of quantity demanded, making the equilibrium point move from E1 to E2. At E2, P2 is lower than P1 and Q2 is larger than Q1, which makes consumers better off. | 2. The Trend of Monopolisation: Would Consumers Suffer? Monopoly causes deadweight losses – this is undeniably true. Though consumers have been enjoying more and more benefits from service providers at least in the past few years, we may wonder if this could last for long when it comes to the trend of monopolisation which is becoming clearer and clearer in the market. After EVN Telecom and Beeline, will there be another acquisition that makes another small brand disappear? Will big firms take over all the small ones to rule the whole market? If someday there are only state-owned companies providing mobile services, will they agree with each other to raise service prices and prevent new firms from entering the market, which undoubtedly shrinks consumer surplus? Suppose that day would come, consumers may try to constrain their use of mobile services. However, the amount of reduction would be negligible since mobile services are now so necessary that the demand for them is relatively inelastic. Consumers today are richer and much more dependent upon mobile services than they used to be; therefore, it would not be easy for them to cut down on using mobile phones to save money. Service providers would keep earning more and more profits from consumer welfare. In general, monopolisation harms the benefits of most people while benefiting only a small group of people. Monopolisation is a two-edged trend, so it is important to balance the benefits between suppliers and consumers. An ideal mobile service market may be one with a small number of firms, i. e. three or four, but with comparatively uniform market shares. This enables infrastructure to be effectively exploited as well as market power to be evenly distributed among suppliers, reducing the probability of a monopoly arising. Conclusion There would be not enough space to discuss all factors of a market within a short essay; however, I have tried to apply microeconomic theories to analyse notable features and remarkable changes in the market that have had significant influences on consumers, together with given personal evaluations and opinions about the development trend of the market. I hope that eventually I have achieved a clarification of economic principles hidden in daily-life matters such as behaviours of firms and consumers in the mobile telecom market in Vietnam. Due to time pressure as well as inexperience in researching and writing, my essay may contain errors and misunderstanding. I would like to receive your feedbacks and suggestions to help me improve its accuracy and quality. Reference * Gregory Mankiw, Principles of Microeconomics (5th Edition). * VnExpress. net, Development of Vietnamese Telecom Market. * CafeF. vn, Viettel’s Aquisition of EVN Telecom Might Violate the Law. * Tuoitre. vn, Beeline Is to Disappear. * Tienphong. vn, Merging MobiFone and Vinaphone: Good and Harm. * Vcci. com. vn, Telecom Market: Back to Monopoly? * National Assembly, Competition Law, 2005.

Computer Crime Legislation in the UK

Computer Crime Legislation in the UK Computer crime is on the increase as there are many users of the internet and social-networking sites. Evaluate the extent to which relevant legislation has intended to serve as a deterrent to such offences. Since the launch of the computers in the mid 1970s, they have played a major role in todays society as it is impossible to live without a computer as most of us are so dependent on them. Computers is used in a number ways such as booking a flight, buying insurance, reading the news, communicating with other people. Another reason people use a computer is to commit crimes. Computer crime has risen at an alarming rate as people think they can be undetected and be anonymous. This is because it is easier to commit a crime in the cyber world than in the real world. When a crime is committed in the real world, physical evidence is always left behind such as blood and fingerprints. In the cyber world there isnt any physical evidence. The thought of their tracks would not be traced, however they are mistaken as tracking down an IP address has become easy to track making it hard for criminals to stay invisible while they are online. An IP address is short for internet protocol address and this identifies a computer on network. The IP addresses are based on the networks that use the TCP/IP protocol. Various activities are committed by not just by criminals but ordinary people as well. These activities would consist of crimes linked to child pornography such as downloading images, stealing identities, hacking to other account to gain information for the third pa rty, creating a virus and money frauds are known to become easier by the use of computers. Credit card numbers, personal id information can also be targeted by programmed automated software. People commit these crimes as they have a thrill of taking advantage of a computer system. Distributed Denial of Service (DDoS) is a common form of attack on computers. This process involves criminals can have controlled access to multiple computers and use them to attack a number of targets or one target. Another form of attack is malicious software (malware). This consists of software that allows criminal to have full control of a system and allowing the malware creator to do whatever they want. The malware can be a number of things such as a virus, worm, Trojan, adware, spyware and a root kit. A virus is the most serious form of attack. This consists the virus affecting the computer or other electronic devices that are passed by other user activity e.g. an email attachment being opened. http://www.seas.ucla.edu/2011, http://www.webopedia.com/2013 As computer crime has risen, the cost of cyber crime is also a threat to the government and the nation. According to the Cabinet office, cyber crime in the UK costs  £27bn a year. These costs are made up of  £21bn to businesses; which is more than the offices annual budget,  £2.2bn to the government and  £3.1bn to public. Baroness Neville-Jones the Security minister stated in a briefing the government was determined to work with industry to tackle cyber crime. At the moment, cyber criminals are fearless because they do not think they will be caught The Police and Justice act 2006 is an act of parliament in the UK. Part 5 of the act the miscellaneous section under chapter 48 introduced the Computer Misuse Act 1990 (CMA). The Computer Misuse Act 1990 (CMA) was passed in 1990 and is part of the UK Parliament. The principle of the act to is frame legislation and controls any activity linked to computer crime and internet fraud. The act was introduced to deal with issues that have occurred by the misuse of computers. The act are based on three offences that cover Unauthorized access to computer material unauthorised access to a computer with intent to commit or facilitate the commission or a further offence and unauthorised modification of computer material The first act Unauthorised access to computer material even though there isnt any physical damage, its an offence when a person is found guilty of using any computer material without permission which makes it illegal. An example of this would be the case of R v Astrid Curzon. Curzon 49 was found guilty of gaining access to a schools email system. She gained access from her home and therefore found private emails from the head teacher to staff members. The email contained discussions about employment of other staff members. Another example of this would be the case of DPP v Bignell [1998]. Two police officers already had access to the police national computer (PNC) that is only used for police purposes. The pair asked the computer operator who used to the computer to obtain information from the DVLA through the police national computer without knowing it was for their own pleasure purposes. The divisional court had stated that the two polices officers didnt commit a crime under section 1 Unauthorized access to computer material. the divisional court believe that the two police officers didnt commit a crime and their conclusions were right, as the decision wasnt over ruled by the House of Lords in Bignell. It was a possible view of the facts that the role of the officers in Bignell had merely been to request another to obtain information by using the computer. The computer operator did not exceed his authority. His authority permitted him to access the data on the computer for the purpose of responding to requests made to him in proper form by police officers. No offence had been committed under section 1 of the CMA. In a more recent article in the Daily Mail online(PUBLISHED: 05:00, 17 December 2012) Hollywood stars Scarlett Johansson, Mila Kunis and Christina Aguilera computer was hacked by Christopher Chaney 36, was arrested for wiretapping and unauthorised access when he hacked into their email accounts. He managed to gain access by using Google and then using the i got forgot my password button. He tried a number of combinations of names and then he reset account passwords by finding pet names, where they were born, and the name of their schools. The most serious incident when Chaney posted nude photographs of Johansson and her then husband all over the internet. The second act unauthorised access to a computer with intent to commit or facilitate the commission or a further offence as stated in the first act no actual physical damage to the computer material. Using the system without permission would make it illegal and committing a on the system would be illegal too. This act mainly covers actions such as using email contents for blackmail. An example of these would be the case of R v Delamare [2003] the defendant was working in bank and was offered  £100 to use the banks computer systems to gain information of other bank details. The third act unauthorised modification of computer material an example of this act would be the case of R v Pavel Cyganok and Ilja Zakrevski [2012].( published 2 July 2012 Last updated at 11:23 2 July) Cyganok and Zakrevski were arrested and convicted of masterminding hi-tech crimes. The pair used a SpyEye Trojan to obtain login details for online accounts. The stolen data was then uploaded to servers which the pair had access to.  £100,000 of the stolen money was stolen and laundered through online accounts allowing criminals to access. The acts are associated with penalties for both individuals and groups of people that are part of a gang. The penalties can be severe for breaching the three offences. The penalties are varied based on what act have been breached. Each of the offences are divided into summary penalties a trail without a jury and an indictment penalties a trail with a jury. In the first act if the individual was found guilty the summary conviction in England and Wales the prison sentence would be a term of 12 months or a fine up to the statutory maximum ( £5000) or both. On a conviction, the prison sentence would be of two years that shouldnt be exceeded or a fine or both. In the second act, the summary conviction is a prison sentence of 6 months or a fine that is not allowed to be exceeded the statutory maximum or both. On a conviction, the prison sentence would be term of five years or a fine or both. In the third act, if the individual was found guilty the summary conviction would be prison sentence of one year or a fine that is not allowed to be exceeded the statutory maximum or both. On a conviction, the prison sentence would be 10 years or a fine or both. Section 35 of the Police and Justice 2006 had amended the Computer misuse act 1990. The amended act looks at new offences which offences 1 and 2 are now combined together into a new offence. A new offence was added into the act 3a offence. This affect took place on 1st October 2008. The three new offences are as follows: Unauthorised access to computer materials (hacking), Carrying out unauthorised acts in relation to a computer and Making, supplying or obtaining articles for use in computer misuse offences. The penalties were also added to the new offences. The police and justice act increased the penalties for the first offence unauthorised access to computer material. The computer misuse act can be compared to other laws and legislations. The Computer Crime Act (CCA) was passed in 1997 is an act of the Malaysian government introduced the legal framework to ease the growth of ICT systems called Cyber laws of Malaysia. The act was given a Royal Assent on June 18, 1997 but didnt come into force on June 1, 2000. This act was introduced purpose of protecting consumers and people that provide a service. The act also protects online businesses and owners of intellectual property. The act was designed to stop offences as computers are misused in a number of ways, as this was added to other existing criminal legislation. The Computer Crime Act and the Computer Misuse Act do have a number of similarities in the case of the three offences; however it differs in more ways. As the Computer Misuse Act as the three offences, the computer crime act looks at a wider range of offences. The CCA looks at the understanding of computers, the computer network, output, c omputer data and the functions it uses. The act looks at computer programs and premises. The definition of a computer in CCA is summarised as any electronic devices that are programmable and has the ability to store data. The CCA looks at more severe penalties compared to the CMA. For the first offence, unauthorised access to computer material the Malaysian law states that if the individual were found guilty the prison sentence would be a maximum sentence that shouldnt be exceeded five years and or a fine of not exceeding RM 50,000 ( £10,273,45) for the 2nd offence, the Malaysian law states for the offence of unauthorised access with intent to commit or facilitate commission of further offences if the individual were found guilty the prison sentence would be a maximum sentence ten years that shouldnt be exceeded and or a fine not exceeding RM 150,000( £30,820,35). For the 3rd offence unauthorized modification of the contents of any computer the Malaysian law states that if the individual was found guilty the prison sentence would be not exceeding seven years and or a fine not exceeding RM 100,000( £20, 546, 90) On a liable prison sentence not exceeding ten years if the act was intentionally brok en and or a fine not exceeding RM 150,000, which is the equivalent to ( £30, 820, 35)   The computer misuse act can also compared to the American law the Computer fraud and abuse act 1986. The act was passed by the united congress. The act is a federal legislation that is aimed to restrict computer crimes that come under the federal jurisdiction.the whole purpose of the act was to strengthen, widen, and clarify to protect computer systems from vandalism. The act also includes the usage of virus and programs that have been intended to destroy a computer system. The law prevents the unauthorized access of any computer system and the obtainment of classified government information. http://ecommerce.hostip.info.2013 Comparing to The Computer Misuse Act and The Computer Crime Act (CCA) 1997, the Computer fraud and abuse act 1986 has more severe penalties. If the individual were guilty of physical damage to a computer system, the prison sentence would be a term of 20 years that shouldnt be exceeded and the fine reaching $250000 ( £155,870.00). Under this law, Prosecutors are challenged to prove that the defendant intentionally caused damages to a computer. The other acts are not so severe than this act.   Even though the computer misuse act is in place, the act still does not stop criminals from committing an offence. In the BBc news online (4 July 2011 Last updated at 19:24 ) The crimes are committed as people want to gain information and sell to a third party. In 2011 it was reported back in 2002 the News of the World newspaper had hacked in to Milly Dowler mobile phone and had listened to the voicemails and then deleted the messages. Later the news of the world was forced to shut down the paper after the hacking scandal as they had admitted interfering with teenagers phone. The victims family and friends said it gave them false hope that she was still alive and Milly had deleted the messages herself. By the time the messages were deleted. By this time, the teenager was already murdered. The hacking was classed as an unlawful interception of communications. This comes under Section 1 of the Regulation of Investigatory Powers Act 2000. In an article in the Daily Mail online, (PUBLISHED: 02:08, 9 June 2012 ) 11,000 people are believed to hunted by the police for using a service of a cyber-crime gangs website that offered false identification and tips on how to commit a crime. The gang had cloned a number the identities of people who a high credit rating. Pay slips bank statements, passports and driving licenses was also sold to the gangs members. The website also offered other services such as different tiers of access as the users where trusted to use the website. One of the services included a platinum profile that cost  £5,500 that came with instructions on how to commit identity fraud. For  £2,000, Confidential Access (CA) offered a 100% Creditmaster profile, which was exclusive to VIP members of the website. The website was claimed to worth be  £200million and had a turnover of  £11m between 2004 and 2008. The paying customers paid from around  £50 for a utility bill to  £800 for a set of three year s professionally sealed. Detective Inspector Tim Dowdeswell said: This was a sophisticated operation which has netted millions of pounds over the years. These cyber criminals not only provided the tools to commit fraud, they instructed their clients in how to use them to make the maximum amount of money, whilst ruining real peoples credit histories into the bargain. We have already brought many of their students in crime to court and will continue to work with other police forces and partners to bring those people who bought and used these identities in their own frauds to justice.   Concluding this essay, computer crime will still be on the increase. Crimes will be committed depending what the motivation is such as greed and pleasurable need. The Computer misuse act 1990 has a number of flaws as it failed in the case of DPP v Bignell [1998] as the prosecutor felt that no crime was committed under section 1 of authorised access. The police national computer (PNC) was used when a police officer obtained information for their own pleasurable needs, even though police officers had access to the PNC. The Computer misuse act 1990 should not have failed, as the police national computer should be used for policing only. Another way it can fail is the source of the crime such as the IP address and hackers would find ways and use another IP address to avoid them getting caught. I do believe that the computer misuse act can work as a deterrent, as it has a high knowledge that projects any computer system that involves criminating activities. The act helps to keep people safe and their personal information safe too. My views on the Computer misuse act 1990 that their punishment should be severe as the Computer fraud and abuse act 1986. I say this because i feel with a harsher punishment people will learn their lesson on not to commit a crime. If an individual served a 12 month prison sentence with a small fine, they would be tempted to commit another crime as they would feel that their punishment was not harsh enough. My recommendations would be that the Computer misuse act 1990 should have harsher punishments matching up to the penalties of the Computer Misuse Act and the Computer Crime Act (CCA) 1997. I also believe that the government should have more power over the individuals who commit crime as 27bn was wasted on computer crimes. I also i believe that the act should at other aspects and not focusing on three sections. If prosecutors are dealing with computer crime cases, they themselves should have an understanding of the act and not allow anymore cases to be dismissed. References BBC News News of the World hacked Milly Dowler phone. 2013. BBC News News of the World hacked Milly Dowler phone. [ONLINE] Available at: http://www.bbc.co.uk/news/uk-14017661. [Accessed 29 December 2012]. Cyber-criminal fraud gang who lived lavish lifestyles jailed for multi-million pound ID scam | Mail Online. 2013. 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