Wednesday, August 26, 2020

Ideas for Young Activists Free Essays

Straightforwardness International, 2014 Philippines: A Million New Inspectors About 1 million kid and young lady scouts in Philippines have tallied course books and led quality investigations all through the nation. Working inseparably with government and non-government organizations, the developer disheartens burglary of course books and advances long haul straightforwardness in the nation schools. The Department of Education gave an open way to developer coordinators, including access to spending data, agreements, and conveyance focuses, just as giving examination locales. We will compose a custom exposition test on Thoughts for Young Activists or on the other hand any comparable theme just for you Request Now Nearby associations and volunteers that incorporate schoolchildren likewise do the observing †including shock assessments †during the course reading creation process. The software engineer has demonstrated effective at diminishing debasement In the course book conveyance process. India: I Paid a Bribe On www. Freed. Com. Residents can report their encounters of defilement. The site got just about 22,500 reports somewhere in the range of 2010 and 2012, some of which were kicked up by the media and brought about captures and feelings. On the flipped, residents can likewise report positive encounters they’ve had with legitimate officials. Solomon Islands: Comics against Corruption The Solomon Islands government, in organization with Transparency Solomon Islands, ran a software engineer that pre-owned comic-style banners and funny cartoons in papers to build consciousness of defilement in the nation. It urged Solomon Islanders to state â€Å"Nap Ana! To debasement by detailing anybody they accept to be associated with degenerate practices. The comic was planned to harmonize with International Ann-defilement Day on 9 December. Every comic recounted to the account of normal Solomon Islanders In regular circumstances, and how their lives can be profoundly influenced by apparently basic demonstrations of defilement. The battle secured the subjects of p ay off, partiality, abuse of assets and what you can do to stop debasement. The arrangement of hostile to defilement funnies ran in each of the three of Solomon Islands’ significant papers †and was even accessible as a draw out banner supplement in the Solomon Star. Afghanistan: Kabuki’s Corruption Marathon Afghan youth Atari Equatorial uses long distance races to battle debasement. He considers game to be the most ideal approach to spread mindfulness among Afghan youth, so he sorted out his first large long distance race against debasement. The group had the option to assemble around 500 youthful Afghan young men and young ladies In one of Kabuki’s numerous dusty roads. Their message was noisy and clear: â€Å"Don’t pay or acknowledge bribes†. The members didn't run a significant distance, however an enormous group saw the gathering. Strider additionally included neighborhood radio broadcasts in his effort helped them pass on their message to a significantly bigger crowd. India: The â€Å"Zero Rupee† Movement The â€Å"zero rupee† note was made by an Indian material science teacher who was badgering by interminable blackmail requests. He gave out the â€Å"zero rupee† notes as a neighborly method of saying â€Å"no† to authorities who held out their hands. Imprinted on the note was â€Å"Eliminate Corruption at all levels† and â€Å"l guarantee to neither acknowledge nor give a bribe†. At the point when a degenerate authority proposes to a resident that they should offer an incentive to complete something, the resident can hand over the â€Å"zero rupee† note and its belongings have grabbed hold. The Indian MONGO fifth Pillar has now appropriated more than 1 million bills in five dialects since 2007. Solomon Islands: Clean Election Pledge A gathering of youthful volunteers built up the â€Å"Clean Election Campaign† in the Solomon Islands. Their methodology was to accumulate voter vows, each being a guarantee to not partake in degenerate exercises during that year’s political race. Their vow states: â€Å"l vow that I will dismiss all pay-offs. I won't acknowledge any bogus guarantees. I won't sell my vote. I won't include myself in any degenerate exercises during, when the races. And furthermore I promise that I will utilize my full soul to settle on my cast a ballot and request that God help me to choose my vote. Also, I vow that I will just decide in favor of a legit pioneer. † Kenya: Mapping the Election Jacuzzi is an open-source stage intended to courseware data by means of SMS and internet informing and shows up on an intelligent guide. Spearheaded in Kenya after the drop out of the destructive 2008 races, the site had 45,000 clients in Kenya investigating the two cases of appointive extortion and demonstrations of trustworthiness during the accompanying presidential decisions. Activists propelled the stage to courseware information by means of Twitter, SMS, Android, email and the web. In excess of 4,500 reports were thrown †and an amazing 58 percent of these cases have been checked. The discoveries were alluded to by Jenny’s appointive commission and worldwide media. Venezuela: Tweeting the Election Twitter is a straightforward method to screen decisions with your companions and network. Utilize or make a dependable twitter name with the goal that kindred tweeters realize whom to contact for subtleties on political decision observing. Plan a washrag with the goal that voters tweeting cases of political race misrepresentation are smoothed out (e. #Pomegranate or #Cafeteria). In Venezuela, common society associations met up to take a gander at an attentive gaze on the national races by means of Twitter. They got tweets †including photographs †from around the nation to accumulate information on political race infringement at the surveyin g stations through a few prisoner. They got in excess of 1,000 tweets asserting appointive misrepresentation. These techniques do you believe be the best in managing debasement? Pick two and clarify why. 3. What different methodologies do you figure neighborhood individuals could use to manage defilement in their legislature? The most effective method to refer to Ideas for Young Activists, Papers

Saturday, August 22, 2020

No Sugar by Jack Davis: Exposes the Mistreatment of Australian Aborigi

Today, in the twentieth Century, it is a usually known certainty in Australia, and all through the remainder of the world, that Aborigines were abused from since western culture initially settled, and for a long time after that. It is the primary reason for stage dramatizations to bring issues, for example, the one referenced above, and thoughts regarding these issues to life through sensational exhibitions and the utilization of various different strategies. No Sugar, a revisionist content composed by Jack Davis in 1985, is one of these stage shows. Jack Davis brings issues and even communicates his own thoughts regarding issues, for example, the shameful acts of Aboriginal treatment during the 1930's, to life in No Sugar very well in light of the fact that No Sugar is a revisionist content, and accordingly offers another viewpoint of an Aboriginal perspective, on occasions which happened during the hour of the current issue. No Sugar, the revisionist stage dramatization composed by Jack Davis, is about the abuse of Aborigines in Australia during the 1930's. All the more explicitly, it is about the Millimurra family, and their battle against white Â'protection' and being dealt with like articles in their own property. The stage show is for the most part set in Northam, and Moore River, in Western Australia. Davis investigated issues encompassing the treatment of Aborigines during this period, and mirrors his own thoughts regarding these issues. One issue that is featured about this period in No Sugar is the way Aborigines were oppressed, for reasons unknown other than having shaded skin. A case of this is in Act One, Scene One, when Cissie is whining in light of the fact that when her and her sibling go to purchase apples they get given terrible, wilted ones, and the white kids get enormous, delicious ones. Aw Mum, Old Tony the ding consistently sells us little s... ...f the downturn and that numerous individuals are experiencing craving and hardship of numerous fundamental components which make for a battled presence. In any case, you in this little corner of the Empire are lucky enough in being furnished for with sufficient food and sanctuary. Act IV. Sc. (v) Page 97. Utilizing exchange, Davis again shows to the most noteworthy degree the sum that Aborigines were dismissed and minimized in the public eye. Since the peruser realizes that Aborigines are underprovided, and need to take and chase for adequate food, they see that, as expressed by Jimmy, A.O. Neville is talkin' outa his kwon and totally ignoring the Aborigines as residents of Australia. In his revisionary stage dramatization No Sugar Jack Davis has controlled story and showy components, for example, characterisation, imagery and discourse to introduce the plays numerous issues all through the content.

Sunday, August 16, 2020

That wasnt skiing, that was falling with style!

That wasn’t skiing, that was falling with style! Hello everybody! My name is Katy and I’m a senior studying electrical engineering (6-1). Joel has kindly let me write a blog post for him about my favorite thing about MIT â€" the ski team! For those of you who don’t know, at MIT the month of January is not part of the normal school year. Instead, we have Independent Activities Period (IAP). During IAP students can choose to take condensed classes, conduct research, work on projects, work at an externship, travel, or really whatever the hell they want. I prefer to spend the duration of IAP with the MIT Alpine Ski team, living in a cabin in New Hampshire, and skiing all day every day. Yeah, I’m pretty much living the dream. I’ve always been a somewhat cautious person, or to put it another way, a total wuss. I avoid compromising situations, whether it be going to a party where I don’t know many people, or refusing to try a back dive off the board even when all the younger kids do it no problem. I guess you could say I have a finely tuned fight or flight (mostly flight) response. Freshman year, I avoided committing to extracurriculars, and the ones I did attempt didn’t really feel right. Desperate for something to distract myself from endless psets, I joined the Ski Team completely on a whim Sophomore Fall. I’d always enjoyed skiing growing up, though I’d never competed or formally trained in any way. As Winter Break drew to a close and the start of the season approached, I began to panic. WHAT WAS I THINKING I CAN’T SKI RACE. I didn’t even really know anybody on the team! I had no idea what to expect. I’d already paid team dues, bought a race license, and two new(ish) pairs of skis though, one for each event I’d be skiing (slalom giant slalom), so I was committed. Here goes nothing. We only had 3 short training days before our first race of the season (my first race ever!!!), but luckily I had two incredibly awesome and supportive ski coaches to show me the ropes â€" Ben ’07 and JC ’05. Naturally, I picked it up immediately. I’m a bit of a skiing savant. I mean, just look at me shred. Rule #1: Look good. Rule #2: Ski Fast. Rule #3: Safety Third HAHAHAHAHAHAHAHAHHAHAHAHAH JUST KIDDING I WAS TRULY HORRENDOUS. As a club sport, the MIT ski team accepts any confident skier, which means that at least half the team has little to no ski racing experience. We do have some people on the team who have raced previously and are pretty good though! (Shoutout to Mikey, whose body my head is subtly photoshopped onto above.) The first race of my ski racing career arrived incredibly quickly â€" after only 3 days of practice and less than one day in actual gates (the things we ski around), I was deposited on the top of an icy race course at Okemo, scared out of my mind. I frantically texted my dad on the verge of tears, sincerely regretting ever signing up. Somehow I managed to get myself through the start gate. I have no memory of that first race, but I must have made it down in one piece. I may have been DFL (dead [redacted] last), but I’D JUST SKI RACED. I was so, so proud of myself. If you want to get better at something fast, do it six hours a day, six days a week, for several weeks in a row. It’s hard to find words to describe how much better I’ve gotten at skiing since that first week. Let’s just say that I’m an unrecognizable skier. I obviously still have a long way to go before I turn pro (I’m so much better than them) (that was a Gnar reference I’m not actually better), but I’ve improved so much. Not without a lot of hard work though. Every morning during the season, we wake up at 7:15 am, scarf down some eggs and oatmeal, grab our gear and head out the door. We drive to our home turf, Ragged Mountain (also Chris Peterson’s home mountain!!!), and we’re on the first lift at 9am. We ski for most of the day, doing some combination of freeskiing, drills, and running practice courses. With a break for lunch, when we eat grilled sandwiches (ALL HAIL THE GEORGE FOREMAN), we often ski ‘til the mountain closes at 4pm. We head back to the cabin, go on a run, and then do a core workout. Each night, a different team member takes a turn at being head chef and cooking dinner for the entire team. It’s a very important job â€" we eat a lot. The rest of the team tunes their skis, or just enjoys each other’s company. Improvement took more than just hours spent skiing â€" it took falling. A lot. Lots of falling. Falling every day. I spend most of ski season with big, purple bruises on my hips. My first year on the team, I didn’t make it down back to back slalom runs all season. I fell every time. But each time I picked myself up and I put whatever gear back on I’d inevitably left strewn about the slope, and kept going. Ski team taught me how to fall. One of my most spectacular wipeouts wasn’t during the season. Sophomore spring, some ski teamers and I decided to conquer the legendary Tuckerman’s Ravine â€" famous back country ski route in the White Mountains. We woke up early in the morning, strapped our skis to our backs, and hiked several  hours up Mount Washington to get to the Tuckerman’s Bowl. The hike up is worth the ski down Johannes and Ben conquer the bowl Climbing up that bowl was utterly terrifying. It was so steep I had to kick my ski boots into the face to make little ice shelves. Halfway up I started hyperventilating I was so scared. I eventually made it up to a spot flat enough to put on my skis. We hadn’t started our hike early enough, so by the time we got up there, the slushy spring snow had started to crust over with ice as the sun sank. I took one turn, hit an ice bump, my ski popped off, and I screaming tomahawked down the length of the bowl â€" at least a 20 second fall â€" before finally coming to a stop. When I arrived at Ring Delivery a few days later in my cute short dress, it looked like someone had taken a baseball bat to my legs. Score 1 Mount Washington. Of course, it wouldn’t be the MIT ski team if we didn’t put our engineering skills to good use. Last year, then team Captain, Val (MIT ’15) and I decided we wanted to make a lightsuit, inspired by the Afterglow Lightsuit Segment video. (Watch it â€" seriously breathtaking). We bought a large black hoodie from Walmart, several LED strips, and a massive battery, and spent much of our free time that season sewing LEDs and sketchily soldering in the poor light. It turned out pretty awesome! We were a huge hit while night skiing at Pat’s Peak, and even took it to Beacon Hill in Boston for some street skiing laps during last year’s Snowmageddon! MIT ski urban segment We race in the McConnell Division in the Northeast, which is USCSA, and we have 10 races in the regular season â€" two per weekend. We race the tech events, which are slalom and giant slalom, and four of our races this year were FIS, which means we raced against great racers not in our league as well! It’s tradition in our league (and many other leagues) for seniors to dress up and race their final slalom race in costume. This year, 5 out of 13 of our racers were seniors, so we decided to do something extra special. We spent many hours hand sanding molds out of dense green foam, and pulled some pseudo all-nighters in the Edgerton Center thermoforming and laser cutting when we probably should have been psetting, but in the end it was all worth it. We took over Pat’s Peak by storm(troopers). I’m Luke Ski-walker, I’m here to rescue you! We race at a number of different mountains all over New England. They range from the tiny, T-bar served hill at Proctor Academy, to the notoriously steep icy run at Whiteface â€" the same hill they raced on in the 1980 Olympics, affectionately called “IceFace.” As we travel all over the Northeast we make sure to do our duty and test and rank as many breakfast sandwiches at rest stops and ski lodges as possible. Make sure if you’re in New Hampshire you check out Jake’s Market and Deli’s “special:” egg, cheese, shaved steak onion on a Portuguese muffin. To die for. Skiing doesn’t end when the season ends! For spring break two years ago and this year, the majority of the team traveled to Lake Tahoe together, where we stayed and skied at Squaw Valley for the week. I just got back from this year’s trip last week, and it was probably the best skiing I’ve ever had. We had a pow day early in the week and got fresh tracks through the glades in several places, and finished out the week with a day skiing in our swimsuits at Heavenly (spring break wooo!) I also skied the scariest thing I’ve ever skied in my life. There’s a rock formation at Squaw called the Palisades, and it’s about a 10 minute hike up from one of the lifts. Between these rocks are a number of steep chutes. Somehow I let my teammates talk me into doing it. I stood at the edge, looking at the “slope” below. It was pretty much straight down! My heart was beating out of my chest. I gathered myself and went, and somehow by some miracle remained standing! I successfully skied the Main Chute of the Palisades! Hyped on adrenaline I decided to go again. This time, more confident, I decided to try to take a straighter line. I dropped in, with my teammate Sophia Wu dropping in in the adjacent chute at the exact same moment unbeknownst to me. We simultaneously fell, lost skis, and tumbled down the face. Of course, the one where I made it down there’s no footage to prove it, but there’s a full video of the one where I ate it. You can watch the spectacle below (I’m the one on the right). Yes that’s me screaming, yes the sound carried to everyone on the mountain, yes I’m a tad ashamed. Despite the wipeout, the Palisades were a big deal for me. There’s no way in hell two years ago Katy would have skied that. Ski team has become such a huge part of my life at MIT I have trouble imagining what my college experience would be without it. During the season, all my worries fall away. I don’t think about psets or classes or grad school or jobs or anything â€" I eat, ski, sleep, and repeat. It’s like a month long therapeutic retreat. When I ski, I don’t think, my mind goes blank and I feel the icy wind on my face and the rhythmic turns. It’s pure joy. I’m not a very good racer, I will never be competitive in my league, but I don’t care. There aren’t many activities that are so inherently fun that even if you suck and fail you keep coming back for more with a grin on your face. The song that best describes my three years on the ski team is Chumbawumba’s “Tubthumping.” I get knocked down, but I get up again. I’m so glad I joined the team on a whim and got over my fears to actually do it. It’s the best decision I’ve made at MIT, and I’m so lucky to have had this experien ce. If you want to learn more about the MIT Alpine Ski Team, come say hi to us at our booth at CPW and Orientation! Pew! Pew pew!

Sunday, May 24, 2020

Business Opportunities for Deja Vu Cafe - Free Essay Example

Sample details Pages: 9 Words: 2611 Downloads: 3 Date added: 2017/06/26 Category Business Essay Type Research paper Did you like this example? Introduction: Definition of Partnership: Partnership is a business built up with two or more people. Owners share the responsibilities on both the operation of the firm and financial problems. Each person may invest equal or unequal money and share both in the profits or losses of their business. Don’t waste time! Our writers will create an original "Business Opportunities for Deja Vu Cafe" essay for you Create order For example, if your partners cannot afford to pay for their liabilities, you may be requested to pay all the debts. Sometimes, partners share the profits equally or in percentage of share they hold of the business. If someone owns 50 percent of the share and the business succeed, he or she will gain the profits based on the portion of share he or she had. The profits also can be shared based on other things. For instance, a well-known person could lend his or her name to the partnership and because of his or her popularity, the business grows rapidly. This person may earn more profits even though they do not contribute skills or invest money. Someone who invests all the money needed to start up a business without involve in management and operating the business is known as a silent partner. The other partners might invest nothing but contribute all the skills and labor to the business. Silent partner looks like he or she owns the entire business fully while the person who contrib utes skills and labor like owns nothing. But the labor partner will gradually takes the ownership of the whole business over time. This is usually called as sweat equity. Partnership may have a limited life span. When one partner dies or withdraws, the partnership will dissolve even other partners want to continue the business. Business management of partnership is unrestricted and based on agreement. Partners will share opinions with each other and make a final decision. This allows more creative ideas and brainstorming. Partner cannot sell or transfer his or her share of the business to the public without an agreement from all partners. Introduction of Company: DÃÆ' ©jÃÆ'   vu CafÃÆ' © is the name of our coffee shop. DÃÆ' ©jÃÆ'   vu is a French term which simply means à ¢Ã¢â€š ¬Ã…“already seenà ¢Ã¢â€š ¬Ã‚ . It is usually used to describe the strange feeling you get when you are in a situation which you have never experienced before but you feel like yo u have been in the exact same situation. We would like our customers to experience dÃÆ' ©jÃÆ'   vu when they make their very first visit to our cafÃÆ' © because of its design both the interior and the exterior as well as the environment there. We would want them to feel calm and comfortable, to feel as if they have been to our cafÃÆ' © before and to remind them of their home whenever they are at our cafÃÆ' ©. We serve coffee beverages as well as desserts because the combination of both of the above is definitely a great satisfaction for our stomach! Examples of coffee beverages served are espresso, cappuccino, latte, and others while examples of the desserts served at DÃÆ' ©jÃÆ'   vu CafÃÆ' © are cakes, pies, cupcakes, macaroons, and others. Our desserts are all homemade and certainly no preservatives could be found in them. This also enables us to take note on the ingredients used in making the desserts. We make sure that the desserts are all freshly bake d everyday before serving it to our dearest customers. We would also be selling coffee beans for those who would prefer to prepare their coffee at home. Besides, what makes our cafÃÆ' © so special is that we provide a variety of coffee beans and coffee powders as well as coffee makers for customers who would like to prepare their own coffee. Customers get to enjoy the process of making their own coffee and sharing it with their friends just like what they would do when a friend of theirs makes a visit. In addition, on specific days, we would have some professionals in our cafÃÆ' © to teach the customers to make Latte art. Next, we have a small shelf full of books at the corner of our cafÃÆ' ©. Since we do not provide WIFI at our cafÃÆ' ©, we encourage customers to bring their own novels or they could just grab a book from our reading corner and start reading while enjoying our coffee. With the smell of the books and our coffee, plus the soft music background playin g and a quiet environment, customers could take a deep breath and a new journey begins! Also, we would be more than happy if customers would like to donate their books to us and in return, we would give away a free cup of our signature coffee to them. In addition, the employees that we recruit are mostly disabled people. We try to create job opportunities to those who are unable to speak or move properly so that they would not feel abandoned by the society and to prove that they are also capable of doing things that normal people can do. Aim / Objectives of Company: Build a strong customer base in the first two months of business. Turn in profits from the first six months of operation. Owners Portfolio: Jin Yuan is the operating manager. He is full of self-motivation and is willing to work hard. He never gives up easily when he is faced with problems and challenges. He would set high but realistic goals and motivate himself and also the employees to work hard to achieve them. Besides, he has a great passion in coffee and is also very talented at making coffee latte art. He has self-confidence and never gets discouraged easily. He is also very committed and determined in his work. Our marketing and management director is Wen Yan. She knows how to manage the people and the system so that everything runs smoothly and she has interesting ideas to promote our cafÃÆ' ©. Next, she is good in interpersonal relations. She gets along with people easily and has a good communication skill. She is open-minded and has the ability to adapt. She welcomes comments or feedbacks from our customers so that we know their satisfactions and dissatisfactions and could figure ou t ways to improve ourselves. Ee Shien is our production manager. She is very creative and talented. She has many interesting ideas in creating our menus. She likes to invent new things and create something different from others to attract customers. She is good in cooking and also an expert in dessert making. Moreover, she is willing to sacrifice her time on creating new desserts for our cafÃÆ' ©. She never stops trying to improve the quality of our desserts. Yuh Fang is the financial director of our business. She is multi-skilled. Since she has majored in accountings in a famous accounting university, she is very good at handling money and keeping accounting records. She is always aware of the changes in economics. In addition, she is also very sensitive with market. She has the intimate knowledge of customersà ¢Ã¢â€š ¬Ã¢â€ž ¢ needs and also how the market is driven. Characteristics of Entrepreneur: Secret Recipe is one of the successfullargest cakes and cafÃÆ'  © chain in Malaysia. It has more than 280 outlets in major cities including Singapore, Kuala Lumpur, Jakarta, Bangkok, Manila, Brunei, Shanghai and Melbourne with about 3500 employees. The founder of Secret Recipe is Datoà ¢Ã¢â€š ¬Ã¢â€ž ¢ Steven Sim. He started his franchise business in the year of 1997, and has the characteristic of commitment and self-motivation while doing his Secret Recipe business. In 2000, he started his franchise business with spending almost 15 years of effort to gauge the standard of service offered by his franchise. To become a worldwide franchise, he was also willing to take risks when he intended to expand his business. His first franchise in foreign country started in Singapore. Initially, he was actually quite worried about this because it was a new challenge for him to compete with other Singaporeà ¢Ã¢â€š ¬Ã¢â€ž ¢s competitors as well. Their brand was not known at the moment so they were only few malls willing to offer storey to them. Be sides, he was also an open-minded person and was able to adapt to the demographic in when he expanded his business in other countries. For example, he knew that only few were exposed to Western food in China, so helocalized some of the dishes in the menu such as à ¢Ã¢â€š ¬Ã…“mee goring mamakà ¢Ã¢â€š ¬Ã‚  and à ¢Ã¢â€š ¬Ã…“hokkien meeà ¢Ã¢â€š ¬Ã‚  which are more noodle-based products. In Australia, he had to introduce some local Australian food so that it could attract some great chefs there to make good dishes for them. Lastly, he has self-confidence in his business after he had succeeded because a lot of people tried to copy what he did. In fact, he said it was okay and also it was the time to improve himself and to push more forward in his business. Pappa Rich is a local food and beverage chain, also known as one of the successful franchise businesses in Malaysia. It has almost 100 outlets have been opened in Malaysia and rest of the world such as Sydney, Melbou rne, Canberra, Perth, Singapore, Shanghai, Brunei, and Los Angeles. Pappa Rich was established in 2005, and its founder, Rich Tan is an innovative person by revolutionizing the concept of a traditional coffee shop into a more modern dining experience with a premium feel.Besides, he also made their brandà ¢Ã¢â€š ¬Ã¢â€ž ¢s name become franchise and result a good advertisement in his business. When he wanted to expand his business to foreign countries, he also had motivation to achieve his goals such as he set a goal about the expansion plan in Australia which was opening six outlets in this year and five more next year. At the same time, he also wants to bring the Malaysianà ¢Ã¢â€š ¬Ã¢â€ž ¢s dishes and promote it into foreign markets. Ità ¢Ã¢â€š ¬Ã¢â€ž ¢s one of the goals he had set too. Lastly, he also knows clearly about what customers need. For example, the interior design in his Australian franchise is similar to the Malaysiaà ¢Ã¢â€š ¬Ã¢â€ž ¢s, what is different is th e food choices in the menu. For example, the curry in the Australia outlets is milder than our Malaysian version while the food portions are bigger. Business Opportunities: To attract customers and to fight competitions of the same business, we ensure that our employees are all well trained with skills. We hire professionals to provide trainings on making coffee and coffee latte art to our employees. Employees are trained to always give a sincere greeting or farewell to our dearest customers and also to always wear a smile on their faces. This is because friendly customer service is very important to strengthen our customer base. Besides, we would do some promotions on special seasons and time. We would also give out some discount vouchers at times to attract customers. In addition, our cafÃÆ' © provides a comfortable environment for our dearest customers to escape from reality and daily stresses, it is a suitable place for customers to read a book and to chat with frien ds while enjoying our coffee beverages because we do not provide internet connection or WIFI, most people would call it. Our cafÃÆ' © is separated into two floors, upstairs is a quiet place for those who would want to enjoy the peacefulness complimented with the smell of books and the soft background music. We also encourage customers to exchange their books with a free cup of coffee to increase the genres of books in our reading corner. They could also customize their own playlist or request to play their own CDà ¢Ã¢â€š ¬Ã¢â€ž ¢s. While downstairs is more of a friend-gathering place. Customers could socialize with each other and a guitar or saxophone would be prepared if any customer is interested to entertain. Our cafÃÆ' © concerns about the quality of our coffee beverages and desserts as well as the ingredients used and also coffee beans. For example, our director likes travelling around the world and whenever he discovers high quality of coffee beans from other countri es, he would always import them to Malaysia. Besides, our cafÃÆ' © served food and beverages at a reasonable price. We ensure that our customers enjoy both the quality of our coffee as well as the price that they pay for to satisfy our customers. On specific days, we would also have some professionals to come over to teach those who are interested to make coffee latte art! Lastly, the location of our cafÃÆ' © is just a walking distance from a college. Our cafÃÆ' © is also located in a housing area. We aim to build a core group of repeat customers. It is a convenient location for the students from the college or the people working in offices near that area to make a visit to our cafÃÆ' © whenever they have a break. Students could do revisions or meet peers at our cafÃÆ' ©. Moreover, our cafÃÆ' © is vintage themed and has a classic, elegant interior design with wooden dÃÆ' ©cor. We decorate our walls with Polaroid photos which are taken when customers make thei r first visit. The clear windows would grab the attention of passerby because they would be able to see clearly through the windows. Our cafÃÆ' © is also designed for fast and efficient operations for take-away. Financial Resources: Conclusion: Building a strong customer base In order to build a strong customer base for our cafÃÆ' ©, we would do some promotions. For example, we will have a à ¢Ã¢â€š ¬Ã…“Buy 1 Free 1à ¢Ã¢â€š ¬Ã‚  for all types of coffee beverages from 7am-10 am and 3pm-5pm. Besides, we would work together with bloggers as they promote our cafÃÆ' © on their blogs and we could give them a special discount on the bill. We also run a website of our own to keep our dearest customers updated about our promotions. We interact with our customers on the internet to make sure that we are aware of any dissatisfaction and try to improve ourselves. To ensure that customers will return to our cafÃÆ' ©, we will give out some additional discount vouchers to customers. We also emphasize on friendly customer service to establish a loyal customer base. Trainings Our cafÃÆ' © will provide suitable and professional trainings to our employees so that they will be able to provide better and satisfied services to our customers. One of the examples of training provided is proper coffee preparation techniques as it affects the quality of our brewed coffee. With all the trainings provided to our employees, they would be multi-skilled and would able to overcome any problems. Research and development From time to time, we would always do researches to keep our cafÃÆ' © up to date. We would always make sure that our cafÃÆ' © is able to follow the trend of the modern world. We would do some surveys to evaluate the quality of our products as well as the customer services. We need to know the satisfactions and dissatisfactions of customers so that we could improve ourselves better. We would also be open-mined to accept new ideas or comments from customers in order to attract new customers and also retain the existing ones. Managing skills On the other hand, our management team would always observe the daily operations of our cafÃÆ' ©. They are responsible to manage the employees and motivate them. Besides, our management team would also be in charge of ordering inventory as well as dealing with supplies. The management team would make sure that the system runs smoothly and so does our business operation. Be aware of the changes in business environment (changes in technology, legal, new competitors as well as economic changes) Furthermore, our cafÃÆ' © would always be aware of the changes in the business environment. We would do our best and provide good services to our customer in order to fight with our competitors.

Wednesday, May 13, 2020

Profile of Joseph Lister, Father of Modern Surgery

English surgeon Joseph Lister  (April 5, 1827–February 10, 1912), Baron Lister of Lyme Regis, is considered the father of modern surgery for his  work developing sterilization procedures that saved countless lives. Lister pioneered the use of carbolic acid for sanitizing operating rooms and employed antiseptic surgical procedures to prevent deadly postoperative infections. Early Years Born on April 5, 1827 in Essex, England, Joseph Lister was the fourth of seven children born to Joseph Jackson Lister and Isabella Harris. Listers parents were devout Quakers, and his father was a successful wine merchant with scientific interests of his own: he invented the first achromatic microscope lens, an endeavor that earned him the honor of being elected a Fellow of the Royal Society. The young Listers love for science grew as he became fascinated with the microscopic world introduced to him by his father. Lister decided at an early age that he wanted to become a surgeon and thus prepared for this eventual career by delving into science and mathematics subjects at the Quaker schools he attended in London.   After entering the University of London in 1844, Lister earned a Bachelor of Arts degree in 1847 and a Bachelor of Medicine and Surgery in 1852. Listers achievements during this time included serving as house surgeon at the University College Hospital of the University of London and being selected as a Fellow of the Royal College of Surgeons. Research and Personal Life In 1854, Lister went to the University of Edinburgh, Edinburgh Royal Infirmary in Scotland to study under the famous surgeon James Syme. Under Syme, Listers professional and personal life flourished: he met and married Symes daughter, Agnes, in 1856. Agnes was  invaluable as a wife and partner, assisting Joseph with  his medical research and laboratory experiments. Joseph Listers research was centered on inflammation and its impact on wound healing. He published a number of papers regarding muscle activity in the skin and eyes, coagulation of blood, and blood vessel engorgement during inflammation. Listers research led to his appointment as Regius Professor of Surgery at the University of Glasgow in 1859. In 1860, he was named a Fellow of the Royal Society. Implementation of Antisepsis By 1861, Lister was leading the surgical ward at the Glasgow Royal Infirmary. During this time in history, surgery was performed only when absolutely necessary due to high death rates associated with infections. With little understanding of how germs like bacteria caused disease, surgical procedures were regularly performed in  unsanitary conditions. In an attempt to combat wound infections, Lister began to employ cleanliness techniques used by Florence Nightingale and others. This process involved keeping the environment clean, changing dressings, and washing hands. However, it was not until he read the works of  Louis Pasteur that Lister began to link germs with surgical wounds. While Lister was not the first to suggest that microorganisms were the cause of hospital associated diseases or that infections could be reduced through antiseptic methods, he was able to marry these ideas and effectively implement treatment for wound infections. In 1865, Lister began using carbolic acid (phenol), a substance used in sewage treatment, as an antiseptic to treat compound fracture wounds. These injuries were commonly treated by amputation, as they involved penetration of the skin and significant tissue damage. Lister used carbolic acid for hand washing and treatment of surgical incisions and dressings. He even developed an instrument for spraying carbolic acid into the air in the operating room. Lifesaving Antiseptic Success Listers first success case was  an eleven year old boy who had suffered injuries from a horse cart accident. Lister employed antiseptic procedures during treatment, then found that the boys fractures and wounds healed without infection. Further success ensued as nine of eleven other cases where carbolic acid was used to treat wounds showed no signs of infection. In 1867, three articles written by Lister were published in Londons weekly medical journal, The Lancet. The articles outlined Listers method of antiseptic treatment based on the germ theory. In August of 1867, Lister announced at the Dublin meeting of the British Medical Association that no deaths associated with blood poisoning or gangrene had occurred since antiseptic methods had been fully employed in his wards at Glasgows Royal Infirmary. Later Life and Honors In 1877, Lister assumed the chair of Clinical Surgery at Kings College in London and began practicing at Kings College Hospital. There, he continued to research ways to improve his antiseptic methods and develop new methods for treating injuries. He popularized the use of gauze bandages for wound treatment, developed rubber drainage tubes, and created ligatures made from sterile catgut for stitching wounds. While Listers ideas of antisepsis were not immediately accepted by many of his peers, his ideas eventually gained nearly worldwide acceptance. For his outstanding achievements in surgery and medicine, Joseph Lister was ennobled a Baronet by Queen Victoria  in 1883 and  received  the title Sir Joseph Lister. In 1897, he was made Baron Lister of Lyme Regis and awarded the Order of Merit by King Edward VII in 1902. Death and Legacy Joseph Lister retired in 1893 following the death of his beloved wife Agnes. He later suffered a stroke, but was still able to consult on treatment for King Edward VIIs appendicitis surgery in 1902. By 1909, Lister had lost the ability to read or write. Nineteen years after the passing of his wife, Joseph Lister died on February 10, 1912 at Walmer in Kent, England. He was 84 years old. Joseph Lister revolutionized surgical practices by applying the germ theory to surgery. His willingness to experiment with new surgical techniques led to the development of antiseptic methods that focused on keeping wounds free of pathogens. While changes have been made to Listers antisepsis methods and materials, his antiseptic principles remain the foundation for todays medical practice of asepsis (total elimination of microbes) in surgery. Joseph Lister Fast Facts Full Name: Joseph ListerAlso Known As: Sir Joseph Lister, Baron Lister of Lyme RegisKnown For: First to implement antiseptic method in surgery; father of modern surgeryBorn: April 5, 1827 in Essex, EnglandParents Names: Joseph Jackson Lister and Isabella HarrisDied: February 10, 1912 in Kent, EnglandEducation: University of London, Bachelor of Medicine and SurgeryPublished Works: On a New Method of Treating Compound Fracture, Abscess, etc. with Observation on the Conditions of Suppuration (1867); On the Antiseptic Principle in the Practice of Surgery (1867); and Illustrations of the Antiseptic System of Treatment in Surgery (1867)Spouse Name: Agnes Syme (1856-1893)Fun Fact: Listerine mouthwash and the bacterial genus Listeria were named after Lister Sources Fitzharris, Lindsey. The Butchering Art: Joseph Listers Quest to Transform the Grisly World of Victorian Medicine. Scientific American / Farrar, Straus and Giroux, 2017. Gaw, Jerry L. A Time to Heal: the Diffusion of Listerism in Victorian Britain. American Philosophical Society, 1999. Pitt, Dennis, and Jean-Michel Aubin. Joseph Lister: Father of Modern Surgery. National Center for Biotechnology Information, U.S. National Library of Medicine, Oct. 2012, www.ncbi.nlm.nih.gov/pmc/articles/PMC3468637/. Simmons, John Galbraith. Doctors and Discoveries: Lives That Created Todays Medicine.  Houghton Mifflin, 2002.

Wednesday, May 6, 2020

Hegemonic masculinity Free Essays

Hegemonic masculinity refers to the culturally normative ideal behaviours of males. This concept is based on the assumption that there is a hierarchy of masculine behaviour, suggesting that most societies encourage men to exemplify a dominant version of masculinity. Hegemonic masculinity is competitive and reflects an inclination for males to pursue domination over other males and subordinate females. We will write a custom essay sample on Hegemonic masculinity or any similar topic only for you Order Now Contrary to feminism, anti-femininity demonstrates a male’s strong aversion and fear of being attributed to feminine characteristics. Men’s identity strategies are stablished through their complicit or resistant stance to prescribed dominant masculine styles. Masculine characters are not given. Rather, a range of possible styles and personae emerge from the gender regimes found in different cultures and periods of time. It is undeniable that the definition of a man is the same today as it was a decade ago. Among the possible ways of being masculine, some become winning style and it is this with which men must engage. This manufactured image of the male projected the appearance of an educated man, the talented athlete, hardworking good family man, with the ability to always provide. This has become the standard definition of manhood. The workplace became the arena that allowed manhood to be tested and, proving to other males. It provided the space for which men could prove opposite characteristic of women, although women were one of many vehicles available to males for the purpose of exhibiting levels of success. Through the gender identity model, demonstrated by Christopher T. Kilmartin, this paper will view the different dimensions of male and female gender roles. Moreover, through the work of Ann Ferguson, the crucial interpretation of gender performance nd transgressive acts will be fundamental in identifying how hegemonic masculinity is identified as anti-femininity. In all societies the obvious biological difference between men and women is used as a Justification for forcing them into different social roles which limit and shape their attitudes and behavior. That is to say, no society is content with the natural difference of sex, but each insists on adding to it a cultural difference of gender. The simple physical facts therefore always become associated with complex psychological qualities. It is not enough for a man to be male; he also has to appear masculine. A woman, in addition to being female, must also be feminine. However, once the contrast between men and women has been increased and accentuated in this fashion, it is usually taken as a further manifestation of biological differences, which confirm the need for different social roles. Thus, from an early age, boys are helped to acquire a masculinity that allows them to assume and maintain that position. By the same token, girls are taught to cultivate a submissive femininity. The resulting difference in the male and female character is then described as inborn and used to defend the existing power rrangement. Only those who accept it are normal, and only they can expect to succeed. The male social role is designed to reward masculine men, while the female social role offers its relative advantages only to feminine women. Gender identity is ultimately derived from both chromosomal makeup and physical appearance, but this does not mean that psychosocial influences are missing. Socialization, or the process whereby a child learns the norms and roles that society nas created tor his or her gender, plays a significant role in the establishment of her or his sense of emaleness or maleness. If a child learns she is a female and is raised as a female, the child believes she is female; if told he is a male and raised as a male, the child believes he is male. Beginning at birth, most parents treat their children according to the child’s gender as determined by the appearance of their genitals. Parents even handle their baby girls less aggressively than their baby boys. Children quickly develop a clear understanding that they are either female or male, as well as a strong desire to adopt gender-appropriate mannerisms and behaviors. This normally occurs ithin two years, according to many authorities. In short, biology sets the stage, but children’s interactions with the social environment actually determine the nature of gender identity. The gender identity model also carries the assumption that, ‘being like a woman’ is a negative outcome in personality development† (Kilmartin, 39). Early psychoanalytic theorists were quick in assuming that poor motherhood was the primary drawback in a male child being overly feminine. Other Justifications point to an absent father who was away often or very distant from his children. The feminine male has been demonstrated as a scary unwanted image. A teenage boy is not supposed to cry during a romantic movie. If a young boy associates with too many feminine things, he may end up identifying more with women than with men. All females are not necessarily feminine and all males are not necessarily masculine. We are never provided with a definitive answer to what constitutes masculinity, but instead we are provided with details and examples of how an why masculinity cannot be reduced to the male body and its effects, asserting as well that dominant asculinity relies on alternate masculinities, such as female masculinity. Masculinity in this society inevitably conjures up notions of power, legitimacy and privilege, a fact which closely ties the idea of masculinity to conceptions of race gender, sexuality and class, yet this power is only recognizable in opposition where masculinity only become legible as masculinity only in certain social settings. Ann Ferguson highlights three strategies in which males display masculinity. Heterosexual power; â€Å"always marked as a male† (Ferguson, 81). This refers to the social theory that men ave unearned advantages or rights granted to them solely on the basis of their sex, but usually denied to women. In societies with male privilege, men are afforded social, economic, and political benefits because they are male. Second involves role reversal, which is described by Ferguson as the disruption of the normal direction of the flow of power. Girls are outperforming boys at every level of education; women are overtaking men in the workplace in both status and pay. More men are becoming househusbands. Girls are becoming more assertive and aggressive whilst boys are becoming more feminine. Females are graceful in becoming the dominant gender. Third, Ferguson identifies violence as a strategy in displaying masculinity. This displays the conflict between authority and masculinity. These masculine strategies reassert the notion that gender is a performance. Contrary to feminine behavior, males are at constant battle to upkeep the masculine image. C. J. Pascoe’s representation of the anti-feminine male exemplified the anxiety males have of being labeled as feminine. She implied through her research that it is acceptable to be gay, under the conditions that you are masculine as well. Her rendition ot the tag discourse argues that labeling other’s as a tag is central to boys’ joking relationships. Joking about the â€Å"fag† both strengthens relationships among boys and soothes their social anxiety. The high school boys from Pascoe’s study bond by throwing the fag nickname at one another where boys call their peers fag for a number of reasons, such as being incompetent, showing emotion, caring about appearances, dancing or expressing interest in other guys, all these trait subjective to the female identity. Another aspect of fag discourse is the enactment of the fag, in hich high school boys would act out exaggerated femininity or pretend to be sexually attracted to men. Through this behavior, boys reminded themselves and each other that at any moment they could become fags if they were not sufficiently masculine† (Pascoe, 60). The notion of compulsive heterosexuality is based on the idea that one’s sexuality is not chosen, but rather forced through society. This term does not refer to a sexual orientation. Rather, it refers to a variety of behaviors, social interactions, and institutional structures. This is a good umbrella term for a lot of different physical, erbal, and emotional actions. Pascoe describes how male students exhibit compulsive heterosexuality verbally when referring to their sexual interests. It is all about â€Å"the ability to exercise mastery and dominance literally and figuratively over girls’ bodies† (Pascoe, 78). Whether a boy is objectifying, privately or publicly, a woman’s body directly at her or in the company of other men/boys, these are forms of compulsive heterosexuality. Pascoe examines how masculinity is present in not only in media, sexual practices, and desire but also in politics. This leads to how it also ffects economics and gender inequality in both physical and emotion ways. It can be seen in television shows, clothing ads, or unequal pay wages between men and women. In terms of anti femininity, hegemonic masculinity is the display of behaviors opposite to those deemed feminine. A hegemonic male will allow himself to suppress feelings of emotion and vulnerability to qualify as a manly man. Through the works of Pascoe, Ferguson and Kilmartin we have understood that the social construction of a male is what defines hegemonic masculinity rather than biological features. The egemonic male is seen as anti-feminine because of the social pressures he is presented. A male’s fear of being labeled as feminine is primary in defining hegemonic masculinity as anti-femininity. The competitive male who seeks dominance over others and especially females, demonstrates the strong aversion a male has over becoming a subordinate himself. Through Kilmartin’s gender identity model, it was argued that being like a woman is negative in any way, shape or form. Ann Ferguson’s three strategies argue that gender is a performance and one that must be up kept through constant displays of power. Pascoe’s fag discourse and ompulsive heterosexuality concepts present the anti-feminine in males through name-calling and, again, displays of dominance. How to cite Hegemonic masculinity, Papers

Monday, May 4, 2020

Workplace Of Kenoss Construction company †MyAssignmenthelp.com

Question: Discuss about the Workplace Of Kenoss Construction company. Answer: Description of the workplace Kenoss Construction Limited is a private limited company that was founded in 1995, and it is located in Australia, Canberra. The company is mostly involved with highway and street construction and also, custom home design, home construction, wine cellar design and other services. The company consists of 11 to 50 employees. Regarding the workplace of Kenoss, since it mostly deals with civil engineering, it involves workers getting in contact with machines which can be unsafe and carry out hazardous practices. The workplace has many things that present danger to the employees because many physical materials may not have been placed well. Therefore, the workplace can be said to be sensitive and requires the adoption of safety precautions for the smooth operation. The hazards and how safety breach could have been avoided Every workplace has some health and security hazards. The only problem is that there are some risks that put the workers at risk of getting an accident. It is the duty of the employer to ensure all the workers are protected against any health and safety hazards and ensure that employees are aware of any potential hazards in the workplace. The workers have a right and responsibility of ensuring they work in safe places and in case the workplace is dangerous, they can refuse to work (Walters Nichols, 2009). This can help avoid accidents, injuries and property damage and in some extreme cases death. Any workplace hazard should not be ignored like the case of Michael Booth who was electrocuted at work because of slung power lines. There are different types of workplace hazards, especially in a construction workplace. Safety hazards Safety hazards are common at construction workplaces because they involve unsafe working conditions that can lead to injury illness and death. Examples of safety hazards are spills and tripping due to stairways, anything that may result in falling example ladders, scaffolds and raised worksites, unguarded machinery, confined spaces and electrical hazards. In the case of Kenos Construction employee died because of the electrical risks (McNamara, Bohle Quinlan, 2011). Tripping and slipping can be avoided by ensuring that the stairway treads and walkways are free of dangerous materials and objects. In case of and slippery conditions, it is corrected with an immediate effect. People should also use proper ladders for their tasks and ensure they are long enough to allow safe reaching of the work area. Any ladder with metallic components should be avoided if it is near an electrical place (Walters Nichols, 2009). Unguarded machinery should be put in place like a store where workers do not visit frequently, and that machinery in use should be well taken care of. This will prevent workers from getting accidents and falling. All electrical tools should be properly handled (Access Economics, 2008). Scaffolding is one of the hazards that have many reported injuries and accidents. This is because when scaffolds are not used properly, people fall. This can be avoided by ensuring that any damaged part that can affect the strength of the scaffold is replaced or taken out of service. More weight should not be loaded on scaffolds. During bad weather or high winds, employees should not be permitted to work. Workers should be trained on proper procedures of moving platforms horizontally. All scaffolds should be fully plunked, and no extra material should be allowed to build upon scaffold platforms. Therefore taking into consideration all these precautions, accidents will be avoided (Johnstone, 2008). Physical hazards These are the hazards that are common and present in the workplace. These hazards can cause harm to the body without being in contact (Allen Consulting Group, 2007). Examples of these hazards are loud noise that can lead to communication hazard, radiation, temperature extremes, and exposure to sunlight. At construction workplaces, exposure to extreme temperatures, sunlight and radiation can be avoided by workers wearing the necessary protective garments and wearing hard hats (Peetz Alexander, 2010). This way, the workers are protected from radiation and sunlight. Communication hazard is one of the physical hazards that affect construction workplaces because of noise and unawareness. At construction places, there is a lot of noise that makes people unable to communicate clearly. These can be avoided by employers looking for special communication devices for workers to use instead of shouting at each other. For work to be done efficiently workers need to communicate, examples of the devices are, high noise blue tooth headsets, electronic communication earplugs and face-to-face great noise communications (Price, 2011). Another communication hazard is the failure of workers to recognize chemically related substances because they can lead to burns, fires, respiratory problems, and explosions. These hazards can be prevented by the employer providing a list of hazardous substances found at the worksite and coming up with a program that trains employees on hazardous materials (Quinlan, Bohle Lamm, 2010). The employer can also ensure all containers with hazardous chemicals are labeled and staff trained on how to read and use Material Safety Data Sheets (MSDS). This way there will be awareness. Ergonomic hazards Ergonomic hazards occur when the body is strained because of the working condition. Someone cannot identify them easily because one cannot know the harm they are causing. There are those short-term exposures that may lead to sore muscles, and there are those long-term exposures that can result in serious illness. Examples are frequent lifting, using too much force especially when lifting and awkward movements (Gallagher Underhill, 2012). This can be prevented by ensuring that lighting used is enough and in the case of lifting heavy materials, it is not done daily. Chemical hazards They are present in the liquid, solid and gaseous form. Chemical hazards come in when one is exposed to chemicals during chemical preparation. Some chemicals are safe while others are dangerous because there are those who are sensitive to chemicals. Exposure to chemicals comes in during cleaning of products, using paint, vapors and fumes come in during welding and being exposed to solvents, and flammable materials like explosives (Walters, Wadsworth, Marsh, Davies Lloyd, 2012). This can be prevented by ensuring all flammable material are handled away from flames. People should wear protective garments when cleaning products. Work organizational hazards Work organizational hazards are problems that come due to workplace issues due lack of respect and workload. For example, sexual harassment, lack of control on what you say, social support and workplace violence. At the construction workplace, men tend to look down upon women, therefore, losing respect. Men tend to be violent at workplaces. All these can be avoided if workers will respect each other irrespective of gender and ranks (Kaine, 2012). What happened at Kenoss and how safe work resolved the issue Kenoss Contractors were fined over the death of their co-worker. Mr. Michael Booth who was 48 years old died in 2012 because he was electrocuted during his line of duty. Mr. Booth was a subcontractor and was delivering a load of gravel-type material to a fenced compound. The tip truck touched low-slung power lines at the work site leading to an electrocution. This was concluded because an electrical arc was high enough to deflate the tires and leave burn marks. He jumped out of the truck and died later on. This was a sad incidence that could have been avoided. The safe work resolved the issue by the court. The company was found guilty as it had not given a warning about the wires. The court fined Canberra Construction $1.1 million. It also gave a strong warning to company leaders around the country on negligence. The workers were informed about the wires and told not to use tall equipment in the compound. The employee sensitization about their safety made them have confidence and know their rights so that they can advocate for them in the case violated (Safe Work Australia, 2012). Therefore, this was important in making other companies learn a lesson from the incidence and thus, ensure that they make a safe workplace for their employees. What could have been done differently There are various aspects that Kenoss could have done differently to improve the safety of the workplace. Some of these practices include the organization having replaced the frayed, damaged or worn electrical cables. The electrical tools should have been properly grounded unless they are double insulated. The electrical devices and appliances should be checked frequently for defects and serviced regularly. The organization ignored the safety measures when dealing with electricity in any environment. The electric power is dangerous and risky to human life, and thus, it is important for every organization to put in place sufficient precautions to reduce its damage. Observing precautions can significantly reduce the damage caused by electricity (Safe Work Australia, 2010). The company should have placed a notice about the tip for workers to know. Signs are critical in avoiding the issues of the workplace health and safety. They help people to read and interpret the hazards and thus avoid them (Productivity Commission, 2010). The son of the general manager should not have been appointed as a safety officer because he was not qualified for the job. Unqualified staff cannot be the best people to handle the workplace health and safety. Thus, companies need to employ only the qualified staff. Therefore, the company can avoid health and safety issues if it considers the necessary precautions (Blewett Dorrian, 2011). How I could do to address the issue if I worked for Kenoss I would advise workers to always work as a team. This is because when people work in groups of at least two and more another person can easily notice things that another one does not. The employers and the managers should also be involved in what is done so that they can be on the ground to notice what happens. For example, if Mr. Booth had someone else they were working with maybe the person could have noticed the slung power lines and warned him. The fact that he was alone could not allow him to concentrate on something else but just on where he was going (Workplace Relations Ministers Council, 2009). It is recommended to the company managers to review any past accidents or any incident that was reported and determine the cause of those accidents or incidents. The employer should also always talk to the employees to find out if there is any threat when carrying out their daily duties. When given this type of information it can be easy to prevent any hazards in the future. I would advise the company to plan an assessment workflow where by people can assess on hazards in advance. Accidents may still occur but this way they will be reduced, and it will be rare to encounter serious accidents. If this was done, then the employees could have informed the employer that the power line was not in a good condition. Employees should be involved when dealing with issues concerning hazards around the workplace. The employees working in hazardous areas can point out the risky areas and practices and also offer suggestions on how the hazards can be controlled. Assumptions should also not be made one's employees feel there is a risk because no one has been injured yet. The son of the general manager, who was the safety officer, should not have assumed the issue about the slung power line even though he was not qualified. He should have reported about the treatment so that it can be dealt with. Conclusion In conclusion, workplace health and safety should be taken into consideration by both the employers and employees. It is everyone's responsibility to ensure they are safe and try their best to escape the hazardous environment. In every workplace, there are hazards that exist from the physical, safety, biological, chemical and work organizational hazards. There is no better workplace than another that one could prefer because there are no dangers. It should be easy for all people to get along with one another because this helps to save each other. Respect should be something that no one should overlook as it helps people to treat each other equally. This way a fellow worker will not let another get an accident just because of different cultures. An employee will allow the employer to go to use flammable materials near a flame because they are not aware, but instead, the employee will caution them. This hazard can be prevented if people work as a team and treat each other as they wish to be treated. References Access Economics (2008). Falls Prevention in the General Construction Sector Regulation Impact Statement, Report for the Office of the ASCC. Allen Consulting Group (2007). Regulatory Impact Statement: proposed occupational health and safety regulations Blewett, V. Dorrian, J. (2011). Partnering for OHS: Volume 1: Health and Safety Representatives at Work, Centre for Sleep Research - University of South Australia Adelaide. Gallagher, C. Underhill, E. (2012). Managing work health and safety: recent developments and future directions,' Asia Pacific Journal of Human Resources, vol. 50, no. 2, p. 227. Johnstone, R. (2008). Harmonising Occupational Health and Safety Regulation in Australia: the First Report of the National OHS Review Journal of Applied Law and Policy 2008 ISSN 1836-6953. Kaine, S. (2012), Employee voice and regulation in the residential aged care sector,' Human Resource Management Journal, vol. 22, no. 3, pp. 316-331. McNamara, M., Bohle, P. Quinlan, M. (2011). Precarious employment, working hours, work-life conflict and health in hotel work,' Applied Ergonomics, vol. 42, no. 2, pp. 225-232. Peetz, D. Alexander, M. (2010). Ten Propositions About Union Education and Training,' 47th CIRA Annual Congress / CRIMT International Conference, Universit Laval, Quebec, Canada, 16 - 18 June Price, R. (2011). Young people and work, Ashgate Pub., Burlington, VT Productivity Commission (2010). Performance Benchmarking of Australian Business Regulation: Occupational Health Safety. Productivity Commission Research Report Quinlan, M., Bohle, P. Lamm, F. (2010). Managing occupational health and safety: a multidisciplinary approach, 3rd ed, Palgrave Macmillan, South Yarra, Vic. Safe Work Australia (2010). Model work health and safety regulations: electricity policy proposal, SIG-OHS meeting 29-30 Safe Work Australia (2012), Australian work-related injury experience by sex and age, 2009 - 2010, Canberra. Tucker, S. Turner, N. (2013). Waiting for safety: Responses by young Canadian workers to unsafe work,' Journal of Safety Research, vol. 45, no. 0, pp. 103-110. Underhill, E. Quinlan, M. (2011). How Precarious Employment Affects Health and Safety at Work: The Case of Temporary Agency Workers, Relations industrialism/Industrial Relations, vol. 66, no. 3, pp. 397-421. Walters, D. Nichols, T. (2009). Workplace health and safety: international perspectives on worker representation, Palgrave Macmillan, Basingstoke, UK; New York. Walters, D. (2010). The Role of Workers representation and Consultation in Managing Health and Safety in the Construction Industry,' ILO, 2010. Walters, D., Wadsworth, E., Marsh, K., Davies, R. Lloyd, W. (2012). Worker Representation and consultation on health and safety, European Agency for Safety and Health at Work, Luxembourg Workplace Relations Ministers Council (2009). Comparative Performance Monitoring Report.

Saturday, March 28, 2020

ACT Score Ranges Understand Your Score vs. Class Grades

ACT Score Ranges Understand Your Score vs. Class Grades SAT / ACT Prep Online Guides and Tips Are you wondering what the highest and lowest possible scores you can get on the ACTare? And, once you receive your score, what does it mean? Many people find it difficult to understand their ACTscore because the exam doesn't usethe same kinds of grades your classes do. In this guide, we've converted ACTscores into class grades to make them easier for you to understand. What'sthe Total Range of ACT Scores? For each section of the ACT, the lowest score you can get is a 1, and the highest score you can get is a 36. The ACT contains four required sections, English, Math, Reading, and Science, and scores from each of those sections are then averaged to get a total composite score for the entire exam. The range of the composite score is also 1-36. However, that still doesn't tell you all the information you need to know. This is because it's quite uncommon for someone to get a perfect score of 36 or a low score of 1 on the ACT. Also, you're probably more used to letter grades, like A- or B+, because that's whatyou see in class. To give you a better understanding of the ACT, we've converted ACT scoresinto letter grades as well asnumericalclass grades, like 85% or 55%, that you've likely seen throughout your time in school. How Can You Interpret Your ACT Score? In the table below, we've mappedACT scores to numerical and letter class grades. We thenexplain how to interpret the results and also how we created the table. In the final section of this guide, we also discuss what a good ACT score is. Conversion of ACTScores to Class Grade Equivalents ACT Composite Score Numerical Class Grade Letter Class Grade 36 100.0 A+ 35 99.9 A+ 34 99.8 A+ 33 99.6 A+ 32 99.3 A+ 31 99.0 A+ 30 98.5 A+ 29 98.0 A+ 28 97.4 A+ 27 96.6 A 26 95.7 A 25 94.7 A 24 93.5 A 23 92.1 A- 22 90.6 A- 21 88.9 B+ 20 87.2 B+ 19 85.5 B 18 83.7 B 17 81.5 B- 16 78.7 C+ 15 75.5 C 14 71.6 C- 13 64.1 D 12 45.1 F 27.3 F 10 15.9 F 9 9.9 F 8 6.4 F 7 4.0 F 6 2.5 F 5 1.5 F 4 0.8 F 3 0.5 F 2 0.3 F 1 0.0 F How can you use this table? For example, say you got a 17 on the ACT. You'd then want to find this row: ACT Composite Score Numerical Class Grade Letter Class Grade 17 81.5 B- From the table, we can see that getting a 17 on the ACT is roughly equivalent to getting a score of 81.5% or a letter grade of B- for a class. What DoesThis Table Really Mean? Put simply, the above table takes ACT scores and converts them to class grades. This gives you a rough idea of what letter grade or percentage you would have gotten on the ACT if the exam had used those types of scoring methods. Class grades are familiar to you because you've used them your whole life, but you may not have any experience with the ACT grading scale. The table takes information you may not completely understand and converts it to something you're more familiar with. More precisely, the above table convertsACT scores to class grades based on percentiles. These percentiles were calculated based on scores of previous ACT exam-takers. The class grades percentiles were based on a large academic survey of grading trends in college (which typically closely match high school grades). So, to go from an ACT score of 17 to a class grade of a B-, we found the ACT percentile for 17, then used the survey to determine what letter grade corresponded to that same percentile. Things to Note inthe Table First, note that the distribution ofACT scores and their class grade equivalents are quite different. At the top of the ACT scale, a 36 and a 28 are 8 points apart, yet, after the conversion, they all map to an A+. That's not a typo; both a 36 and a 28 are equivalent to an A+. Why is this true? It's due to the fact that classes often don't do a great job of differentiating between great students andtruly stand-out ones. In a hypothetical class of 20 students, you might have two people earn an A+. That may seem like a small number at first, however; if that same class represented all the students in the US, only two would score a 28 or above on the ACT. This is one of the reasons the ACT is very useful to colleges, particularly highly selective colleges, because it distinguishes between great students and the very best. Another thing to note is that both class grades and ACT scores do a good job of resolving middle-of-the-pack students.Ifyou go from an ACT score of 13 to a 22 just a range of 9 that's equivalent togoing from a straight D to an A-. For students who are about average in their class or a bit below, both ACT scores and class grades have solidresolution. You may also have noted that neither ACT scores nor class grades begin at zero. Why not? Think about what you know about grading patterns and scores you and your classmates have received. When did you last hear of someone getting a 10 out of 100 as their final class grade? Failing grades are given out less than 4% of the time for class grades. Similarly, when did you last hear of someone getting less than a 10 on the ACT? Neither case is common. Even though, technically, the lowest ACT score is a 1, less than 1% of people taking the ACT get lower than a 10.Therefore, it's more realistic tothink of the ACT as starting from 13, not 1. Can You Really Convert ACT Scores to Class Grades? Yes, it's completely possible to convert ACT scores to class grades; however, it's not an exact science, and there are a few things you should be aware of. First, remember that ACTsand your school classes don't testthe same thing. The ACT is a multiple-choice exam takenin one sitting. Classes, on the other hand, require hours of learning and schoolwork over a long period of time. Additionally, you take the ACT alone, but in your classes you work with teachers and classmates every day. Because the two measure very different things, getting a B- in a class does NOT automatically equala 17 on the ACT, and vice versa. Additionally, class grades aren't as rigorous as the ACT. If you got an A- in a class, would you consider that a good grade? If half the class got an A or an A+, then your A- would be considered a bad grade. Conversely, if you were the only person to get an A in that class all year, that A- would be a great grade. Therefore, you shouldn't view the conversion too rigidly. However, those notes aside, you're correct if you think about the table as "lining up," say, different varieties of races at a track meet. For example, you can't compare someone's performance in the 100-meter dash with a marathoner, but you could say that someone who completed the 100-meter dash in 10 seconds was at an Olympic level, while 2 hours 10 minutes would also be considered an Olympic level marathon time. What’s Next? Not sure what ACT score you should be aiming for? Read this guide to figure out your target ACT score. Want to begin or continue prepping for the ACT? We have a guide that explains every single question type on the ACTso that you're completely prepared for the test! Looking for an easy way to boost your ACT score? Learn aboutthe most common mistakes students make when guessing on the ACTand how you can avoid them. Want to improve your ACT score by 4+ points? Download our free guide to the top 5 strategies you need in your prep to improve your ACT score dramatically.

Saturday, March 7, 2020

The eNotes Blog Understanding To Kill a Mockingbird Top QA fromStudents

Understanding To Kill a Mockingbird Top QA fromStudents It may just be impossible to consider classic American literature without delving into the story of  To Kill a Mockingbird. Written by Harper Lee and published in 1960, To Kill a Mockingbird remains one of the most well-known and impactful works of literature within the last century, and arguably on a more historical level as well.  The novel tackles the realities of racial inequalities, gender roles, and class-based hierarchies as they existed in the 1930s, particularly in the  American  Deep South. Harper Lee was raised in the small town of Monroeville, Alabama and grew up experiencing life as it appears in her  novel. Her father was even a lawyer who may have provided  a great deal of inspiration for the character Atticus; in his day, Lees father  worked  to  defend two black men accused of the murder of a white store clerk. To Kill a Mockingbird became an immediate success, winning the Pulitzer Prize in 1961 after being published only a year prior in 1960. Despite this work being Lees only published novel, the author was awarded the Presidential Medal of Freedom for her literary contribution in  2007. All of this success certainly came as a surprise to Lee, who was quoted in 1964 as saying, I never expected any sort of success with  Mockingbird. I was hoping for a quick and merciful death at the hands of the reviewers but, at the same time, I sort of hoped someone would like it enough to give me encouragement. Public encouragement. I hoped for a little, as I said, but I got rather a whole lot, and in some ways this was just about as frightening as the quick, merciful death I had expected. For her contribution to literature and the awareness she provoked of issues of race and class, its safe to say that the attention Lee and her novel received was (and is) more than deserved. To aid in the understanding of this timeless  novel, weve put together this cohesive  To Kill a Mockingbird guidebook. Read on to learn some more in-depth information about this piece of literature. What is  To Kill a Mockingbird even  about? The title is a little misleading; there have been countless jokes about the confusion of readers believing they had found themselves a guide for the killing of mockingbirds (which is actually quite sad- mockingbirds are fabulous). Regardless, its pretty obvious that this story has very little to do with birds and more to do with handling issues of  race, religion, society, justice, and education. To Kill a Mockingbird follows two main plots, one focusing on the lives of two children discovering the identity of a reclusive neighbor, and the other the trial of an African American man named Tom Robinson. Both of these themes directly speak to the coming of age of the two kids as well as provide a depiction of true societal values during this time period. Whos the hero? Weve grown  accustomed to the idea that the supposed hero of a novel is the protagonist, i.e. the main character. In  To Kill a Mockingbird, that would be Scout, as the story is narrated from  her point of view as an adult looking back on her experiences. But this is an interesting novel in more ways than one: it becomes arguable that Scout is not actually the hero of this novel, but rather something of a bystander, watching the action unfold and experiencing the story much as we, the readers, do. Instead, we can look to two other characters as our heroes, Atticus Finch and Boo Radley. Atticus is perhaps the more obvious choice. Hes possibly the most famous character of the story- the strong father figure, beloved by his children and a voice for societys underrepresented. These descriptors are absolutely true, and it is hard to deny that Atticus is a hero in this novel. But we cant ignore the primarily faceless Boo Radley. For the majority of  To Kill a Mockingbird, the man exists only in  rumors, and negative rumors at that. But he helps Scout and Jem, leaving them gifts and trinkets, and even eventually saving their lives. Boo, through his transformation as a character, is able to teach the children the difference between rumor and truth, and thereby helps them mature and grow. Lets consider a motif To put it very simply, a motif is a theme, in other words, an element that is recurring or repeated throughout a story. A motif can be just about anything, be it an image, a color, an object, or even a concept, so long as it is seen with some frequency and holds importance within a work. It would be wrong to say that  To Kill a Mockingbird  has only one motif, but there are certainly some more prevalent than others, and perhaps none more so than the ongoing appearance of darkness. Throughout the novel, darkness encompasses much of the story. Places like the courthouse, the jail, and the Radley house are all described as dark spaces, ambiguous characters such as Boo Radley are depicted as dark and scary, and it likely isnt coincidental that much of the storys action occurs in the darkness of night. But is that the overall theme? With any work, it can be difficult to isolate a theme, particularly an overarching and constantly prevalent one that applies to all characters all the time. But that doesnt mean it cant be done. In  To Kill a Mockingbird the universal theme is  coming of age.  More often than not, universal themes have something to do with overcoming an obstacle or conflict- in the case of Lees novel, there are two main conflicts that must be overcome, and for Scout, these conflicts and her understanding of them have much to do with her growth as a person and learning about the real world as an adult. What can we learn from  To Kill a Mockingbird? Anyone with even a slight familiarity with the story knows that this novel deals with some pretty difficult topics, such as racism, which still exists as a social problem even in todays society. On this topic alone,  To Kill a Mockingbird offers readers the perspective of  racial injustice before the law. Readers see two men wrongfully convicted of violent crimes they did not commit, based on the color of their skin. Atticus also serves as a figure that readers can learn from. As a character, not only is Atticus a respectable father, but he also serves as inspiration to the reader as well as his children in terms of behaving with courage, tolerance, and justice- including to those different from yourself. What are some important quotes from  To Kill a Mockingbird? Like many great novels, this book is chock full of lines that highlight and articulate the more important aspects of the story.  Click here to go to a list of eight of the most important quotes from  To Kill a Mockingbird. Why is this book so heavily recommended even 50+ years post publication? Well, the short answer would be that there are many important themes tackled in  To Kill a Mockingbird that are still relevant to  todays society, such as racism, racial injustice, wage gaps, gender roles, etc. Yes, its true that this novel was published more than half a century ago, but with so many of the same social problems existing today as they did then, it seems we still have a lot to learn, and Lees novel may be a good place to start. On a slightly less depressing note,  To Kill a Mockingbird can be recommended simply because it is an amazing novel and a representation of great writing. They say (and we at agree) that the best way to learn to write is through reading- and theres a lot any aspiring writer could learn from emulating Lees style.

Wednesday, February 19, 2020

How Gambling, Chemical Dependency, and Racial Discrimination Affect Essay

How Gambling, Chemical Dependency, and Racial Discrimination Affect our Urban Community - Essay Example Associated to the gambling menace have been the overindulgence in alcohol and other chemical substance whose effects are wholesomely detrimental not only to the individuals in addiction but also to the state at large (ONDCP, n.d., 1-4). Dependence on chemical influence has been in the rise with efforts to curb the menace in the city raising costs of living. Addiction to chemical and substance abuse in Cleveland have been pointed to raise levels of unemployment and in effect poor standards of living. The resources committed to management of these vices by the authorities have detrimental effects to the economy and the outcome is retarded growth to the economy and failure to offer basic services to the citizens. On the other hand, racial prejudice in Cleveland, Ohio has long history with adverse effects recorded. For instance, the issue of racial discrimination fueled the Cleveland Hough uprising of 1966. In like manner to the vices of gambling as well as the overindulgence in chemical substance, the racial discrimination has been associated with great adverse effects to the healthy living of the urban dwellers in Cleveland and the entire Ohio. Discussion In view of the existence of addiction into gambling, chemical substance use as well as the prejudice in racial orientation within Cleveland, this paper seeks to evaluate the effects resultant to the communities living in the urban areas. In particular, this paper will analyze the social, economic as well as cultural impacts that the three vices have on the communities living within the urban areas in Ohio especially in Cleveland. A significant population of the adults in Ohio suffers gambling addiction and the estimate is projected to keep rising every year with increase in Casinos. The gambling disorders are projected to keep rising in years to come with the probability of many adults developing these disorders at one point in their lives. The social economic effects of the conditions developed in gambling diso rders include high levels of debts among others. These are seen to increase the likelihood of these persons to file bankruptcy protection through research support to link gambling and the personal bankruptcy is yet to be revealed. Study have shown that persons with chronic gambling problems suffer high unemployment rates with research revealing that the addiction counts for 8% of the total unemployment problems for these persons. In matters of crime and incarceration within the urban community, the people with the gambling complications have higher likelihood to have been victims at least once in their lives. People with the gambling disorders have higher chances of exhibiting physical ailments, high divorce rates, high suicidal rates, familial abuse as well as higher divorce rates as compared to the rest of the urban dwellers. However, this has not had any empirical evidence as per se. besides, the gambling problem cost the society highly in matters of caring for the economically u nproductive (dependent) working populations as addicts to gambling. Many resources are also directed towards treatment and counseling such persons which in essence affects development, which would otherwise be realized through such resources. Koo and friends in a report show that Ohio in general has not committed enough resources to the management of the gambling prob

Tuesday, February 4, 2020

Project Management Essay Example | Topics and Well Written Essays - 1500 words - 13

Project Management - Essay Example An ineffective project planning can lead to a lot of risk management since, the processes such as monitoring and coordination lacks much seriousness. Therefore, importance of project management in organizations is a vital factor in the realization of the firm’s objectives and targets. A good project management leads to the business services of an organization gaining a lot of advantage, which appears through good attainment of goals, utilization of optimal resources and the making of informed business decisions. Another importance is that, a competitive advantage takes toll through an energized workforce through the execution and collaboration of a business culture, which, ensures the customers are satisfied fully. A well planned and a systematic project management plan can create a source of the organization’s tangible profits. Another importance is that, top management is able to attain exact and accurate timely data for the purposes of making informed decisions in business related matters. The project management cycle undergoes a five-step approach; they are initiation, planning, execution, monitoring/control and closure. Initiation is a process involving the giving of an overview of how the project looks like, and the strategy implemented in the organizations plan. This is done to achieve the desired results and in addition, it is where a project manager is appointed to guide the rest of project members due to his or her experience and skills. Planning is the second step, which includes risk assessment alongside defining the system used in order complete the plan. Execution and control are the third and fourth step respectively, which involves planning a solution used for the implementation of solving problems noted in the requirements of a project. Closure, which is the fifth and last step, involves a manager ensuring the

Monday, January 27, 2020

Case Study On A Patient With Pulmonary Tuberculosis

Case Study On A Patient With Pulmonary Tuberculosis The case that is about to be discussed here revolves around a patient diagnosed with pulmonary tuberculosis. The patient that was clerked, Mrs A, was a 61 year old woman. She was a Malay housewife. Her Body Mass Index value of 26.0 kg/m2 based on her height of 1.58 m and weight of 65 kg indicated that she fell into the overweight range. The patient was admitted to the Accident Emergency mode transferred in from another hospital via an ambulance. She presented symptoms such as shortness of breath(SOB) and her respiratory rate was 20 breaths per minute. She appeared pale and weak and her blood glucose levels were low (2.1 mmol/l) and her blood pressure values indicated she was hypertensive with a value of 152/93 mmHg. Upon physical examination, mild leg swelling was observed. Based on her past medical history, patient was diagnosed with pulmonary tuberculosis for the past 3 months, hypertension for the past 5 years, diabetes for the past 5 years and advanced renal failure for the past 6 months. Upon enquiry, she was seen to be a non-smoker and a non alcoholic. Patient lived with her daughter. Several investigations were performed to evaluate the patients condition. A positive sputum smear test indicated that the patients tuberculosis was still active. Upon renal function assessment, creatinine clearance was calculated and a value of 5.5 ml/min indicated Stage 5 renal failure. Her potassium and urea levels were also above range based on Table 1. Upon haematology assessment, her low blood sugar levels indicated hypoglycaemia and patients haemoglobin count was also low signifying anemia. Chest X ray was conducted on this patient and minor lesions at the apical segments of the upper lobe were seen. This is a typical radiographic representation of patients with tuberculosis. Table 1: Results of the investigations performed Laboratory Test Readings Normal range Sputum Smear Test Positive Renal Function Creatinine, Cr Urea Potassium, K+ 912 ÃŽÂ ¼mol/l 37.8 mmol/l 5.5 mmol/l 44-80 ÃŽÂ ¼mol/l 1.7 8.5 mmol/l 3.5 5.0 mmol/l Haematology Assessment Blood Sugar Level Haemoglobin 2.1 mmol/l 9.8 g/dl 4.5 6.0 mmol/l 13.5 18 g/dl Table 2 provides details about patients drug history giving information about patients drugs and their respective doses. Upon interview, patient informed that she had not been purchasing any over the counter medications. She also has no known drug allergy. Table 2 : Drug History and their respective doses and their indication Drug Dose Duration Indication Rifampicin 300 mg OD 2 months Anti TB Isoniazid 200 mg OD 2 months Anti TB Pyrazinamide 750 mg OD 2 months Anti TB Ethambutol 600 mg OD 2 months Anti TB Pyridoxine 20 mg OD 2 months Treatment of neuropathy Gliclazide 40 mg OD 5 years Anti diabetic Prazosin 2 mg TDS 5 years Anti Hypertensive Furosemide 80 mg OD 5 years Anti Hypertensive Nifedipine 20 mg TDS 5 years Anti Hypertensive Based on the investigations performed, the patient was diagnosed to be suffering from pulmonary tuberculosis and diabetes mellitus. Patients daily condition was monitored and appropriate management was undertaken to control the patients condition. Patients overall progress is tabulated in the table 3 and the observation is recorded. Table 3 : Patients clinical progress and management Day Clinical Progress Management 1 Hypoglycemia = 2.1 mmol/L AFB test positive Chest X ray performed SOB Hyperkalaemia ( 5.5 mol/L) Anemic ( 9.8 g/dL) BP : 152/93 mmHg Strict fluid intake IV Dextrose 10%/24 hours Refer to chest physician Lesions at upper lobes NPO2 to resolve SOB Start on Calcium polystyrene Start Ferrous (IV) sulphate Start antihypertensives Monitor input output 2 AFB test +ve Blood Sugar Level = 3.0 mmol/L BP : 140/90 mmHg Start TB regimen (EHRZ) Continue IV Dextrose 10% Monitor Blood Glucose Continue antihypertensives 3 Blood Sugar level = 3.2 mmol/L Severe renal impairment ( CrCl =5.6 ml/min ) Chest X ray done time to time BP : 130/70 mmHg Continue dextrose infusion Send patient for dialysis Lesions still present Continue antihypertensives 4 No SOB Hypoglycaemia resolved = 5.5 mmol/L AFB +ve BP : 130/75 mmHg Remove nasal prongs Stop Dextrose. Monitor blood glucose Continue TB regimen 6 K+ level in normal range ( 4.5 mmol/L) Blood Sugar level = 6.0 mmol/L CrCl = 7.7 ml/min BP : 130/65 mmHg Stop Calcium polystyrene. Monitor blood glucose Send patient for dialysis 8 Hyperglycemia = 11.1 mmol/L BP : 125/75 mmHg Start on Insulin DM counselling 13 AFB -ve DXT = 10.2 mmol/L BP : 120/70 mmHg Transfer out of isolation Continue insulin. Monitor blood glucose Based on patients presentation and results from investigations performed on day 1, patient was started on dextrose and her blood glucose levels were regularly monitored. Based on patients previous history, a sputum smear test was ordered and two consecutive positive results resulted in the patient being referred to the chest physician. A chest X ray was performed and lesions in the apical segment were present. To resolve patients SOB, patient was started on Nasal Prongs at 3L/min. To control her hyperkalemia, patient was given calcium polystyrene sulphonate powder. Patient was also started on ferrous sulphate infusion to help her cope with her anaemia. A strict fluid intake was imposed on patient to resolve her leg swelling and this was monitored through an input output chart. Her blood pressure (BP) levels were also elevated and patient was given antihypertensives such as nifedipine, prazosin and furosemide to control her BP. On day 2, her sputum smear remained positive and patient was commenced on the intial phase therapy for tuberculosis which consists of isoniazid, rifampicin, pyrazinamide and ethambutol. There was not much improvement in her blood glucose levels and patient was remained on the dextrose infusion. Moving on to day 3, not much improvement was observed and due to patients deteriorating renal function, patient was sent for peritoneal dialysis. By day 4, patient could breath normally and no shortness of breath was seen. Nasal prongs were removed. When her blood glucose levels were monitored, the results indicated patient was within the normal range and dextrose was withheld. Blood glucose levels were still monitored to prevent sudden drops and increase in blood glucose. Her potassium levels were within range by day 6 and calcium polystyrene sulphonate was stopped and potassium levels were monitored as well. Patient suffered from a hyperglycemia episode on day 8 and the patient was given biphasic insulin to treat this condition. By this day, her BP was also in the normal range but the antihypertensives were still continued. On day 13, patient was transferred out of the isolation ward as her sputum smear test produced negative results. Patients condition for tuberculosis was still being monitored. Her blood glucose levels were still in the high range and patient was to be continued on insulin. To summarize this case, patients active tuberculosis state should be managed well to ensure patient does not suffer from further complications that might arise in the future. Patients history was well noted and this helped in treating the patient in early stages. Adequate investigations were performed to assist the healthcare professional team to diagnose the patient and also to manage the patient. Patient was admitted for a long period but the appropriate management that was undertaken resulted in improvement in patients condition. Further care for the patient would improve the patients quality of life in the future Pathophysiology and Incidence Tuberculosis (TB) is an infectious disease that has plagued many nations across the world. Based on the report by World Health Organization (WHO), almost 9.4 million cases of TB were reported 3. It is highly common of those with TB to contract the Human Immunodeficiency Virus (HIV) and a prevalence of almost 1.7 million deaths from TB among HIV-negative people was recorded around the globe 3. In the United Kingdom, an increasing trend in TB incidence has been reported and this is shown in Figure 1. In 2008, a rate of 14 per 100 000 population in the UK were reported to be suffering from TB 4. Malaysia on the other hand has a higher record of TB cases with 103 per 100 000 population being reported in 2007. Table 1 summarizes some of the data obtained from World Health Organization 3. Figure 1: Number of TB cases reported in the UK from 2000 to 2008 4 Table 1: Statistics displaying number of TB cases in Malaysia in 2007 3 All In HIV + people Incidence All forms of TB (per 100 000 population) 103 17 Mortality All forms of TB (per 100 000 population) 121 8.3 Multi-drug Resistant TB (MDR-TB) MDR-TB among new cases (%) 0.1 Notified relapse cases (per 100 000 pop/yr) 61 The bacteria that is responsible for this disease is the acid fast bacilli aerobic bacterium Mycobacterium tuberculosis 1. A key feature that enables this bacterium to survive would be its unique cell wall. Mycolic acids are linked covalently to arabinogalactan that provides a barrier to host defense mechanism. Antigens such as lipoarabinomannan present on the exterior of the cell wall facilitate the survival of the organism within macrophages 1. Tuberculosis is spread usually spread within droplets containing the microorganism that are produced when an infected person coughs, sneezes or even talks 1,2. Figure 1 gives a schematic impression of the progression of the disease. The inhaled droplets are initially trapped by dendritic cells that act to expel any foreign particles out. Most mycobacteria are able to surpass this defense mechanism and travels further to the alveoli where it gets ingested by macrophages 1. It then undergoes intracellular replication that might take duration o f 4 to 6 weeks. Cytokines are further released during this period and this attracts T lymphocytes that are involved in mediating a cell immune response. The next natural defense system step would be the formation of granuloma that contains the activated T lymphocytes and macrophages. These nodular lesions disable further spread of the disease as the environment within restricts the growth of the bacilli and a latent period occurs 1. For less immunocompetent individuals, the granuloma will not be able to contain the bacilli and the active disease takes form 1. Figure 1: Image depicting the progress of tuberculosis 2 The diagnostic tests available are summarized in Table 2. TB can be divided to latent and active and to diagnose each different test has been recommended. For latent TB, Mantoux test can be carried out and those with positive results can be considered for QuantiFERON TB test 5. To diagnose active pulmonary TB, a chest X-ray would be taken followed by multiple sputum samples that are sent for smear test 5. Table 2: Diagnostic tests available for tuberculosis 1 Variable Purpose Time required for results Sputum smear Detect acid fast bacilli Sputum culture Identify M tuberculosis 3-6 weeks with solid media, 4-14 days with high-pressure liquid chromatography Tuberculin skin test/ Mantoux Detect exposure to mycobacteria 48 72 hours QuantiFERON TB-test Measure immune reactivity to M tuberculosis 12 24 hours Chest radiography Visualize lobar infiltrates with cavitation Minutes The drugs that are commonly used in tuberculosis are isoniazid, rifampicin, pyrazinamide and ethambutol. Rifampicin is a bactericidal agent that inhibits RNA synthesis by binding to the ß subunit of RNA polymerase. It can be given via oral administration and can even be distributed to the central nervous system due to its lipophilicity. Metabolism of this drug occurs in the liver and it is usually excreted in the urine. Isoniazid is a bactericidal pro-drug that inhibits ketoenoylreductase enzyme, InhA, that is responsible in synthesizing mycolic acids. Isoniazid can be administered orally, intramuscularly or intravenously and is acetylated in the liver and subsequently excreted in the urine. Pyridoxine 10 mg is given concurrently to minimize this risk. Pyrazinamide is another prodrug that is activated by nicotinamidase to pyrazinoic acid. This component at low pH carries proton into the cell and collapses the proton motive force present in the mycobacterium which results in cell d eath. It is only bactericidal against non growing bacilli forms.. Ethambutol works by binding to arabinosyl transferase enzyme and inhibits the polymerization of the cell wall arabinan component. Table 3 gives the details of the dose and side effects reported with the administration of the tuberculosis drugs. Table 3: Tuberculosis drugs with their respective doses and side effects 6,7 Drug Dose Side effects Isoniazid 5 -8 mg/kg (max 300 mg) Peripheral neuropathy, hepatotoxicty Rifampicin 10 15 mg/kg (max 600 mg) Nausea, vomiting, thrombocytopenia, orange discolouration of urine Pyrazinamide 20 40 mg/kg ( max 1.5 g 50 kg) Nausea , vomitting, hyperuricemia Ethambutol 15 25 mg/kg Neuropathy, red green color blindness Evidence based medication review Treatment for Tuberculosis In the past three decades, no new drugs have been discovered in fighting TB. The 4 drugs have been the gold standard in treating TB The chemotherapy regimen available for tuberculosis therapy can be divided to the initial phase and the continuation phase. In the initial phase, drugs such as rifampicin, isoniazid, pyrazinamide and ethambutol are used 6. These drugs act to decrease the amount of bacteria present and also prevent resistance from emerging from the strains. This regimen is usually for 2 months. The continuation phase would consist of drugs such as isoniazid and rifampicin. Isoniazid was the first drug to be introduced into combating tuberculosis back in the 1950s. Rifampicin , an antibiotic, was later added to the market and was added to the isoniazid regimen in 1967. This resulted in shortening the duration of treatment from 12 months to a 6 to 9 month treatment 9. Addition of pyrazinamide to the regimen decreased the chemotherapy duration further. Clinical studies have indicated that a pyrazinamide containing short course regimen had a sputum negative conversion rate of 70-95% in the first two months compared to the treatment without pyrazinamide 11. The relapse rates recorded from these studies also were only 4%. A clinical study conducted in East Africa compared the four 6-month daily regimens that comprised of Streptomycin, Isoniazid and Rifampicin (SHR), Streptomycin, Isoniazid and Pyrazinamide (SHZ); Streptomycin, Isoniazid and thiacetazone (SHZ) and Streptomycin and Isoniazid (SH) 10. The SHZ regimen that was the most effective amongst all the regimens and the SHR regimen had the lowest relapse rate of 2% 30 months post treatment 10. No significant difference results were obtained from the treatment regimen that was carried out for 18 months 10. This study gives an impression of the efficacy of the isoniazid, rifampicin and pyrazinamide regimen when used together In a Poland study, the efficacy of the 4 different drug regimens containing rifampicin, isoniazid and ethambutol were assessed. During the initial phase, patients were given isoniazid 300 mg, rifampicin 600 mg and ethambutol 25 mg/kg 8. In the continuation phase the regimens given to patients comprised of rifampicin 600 mg, isoniazid 15mg/kg(Regimen A), isoniazid 15 mg/kg rifampicin 600 mg twice a week (Regimen B), Isoniazid 15kg/mg, rifampicin 600 mg ethambutol 50mg/kg once a week (Regimen C) and Isoniazid 15mg/kg, rifampicin 600 mg, ethambutol 50mg/kg twice a week (Regimen D) 8. The result of this study demonstrated that Regimen D had 47% of its patients displaying a significant change in their sputum result to a negative result compared to the other regimens. There were no significant differences in rates between all regimens by the end of the fifth month as all patients had their sputum converted to negative. This study had the limitation of not including pyrazinamide in its regi men but it can be seen that to achieve a quicker rate of sputum negative cultures a regimen containing ethambutol could be used in the continuation phase. A trial conducted by Jindani et al. assessed the effectiveness of daily dosing of the intial phase drugs compared to the intermittent thrice weekly dosing. The drugs that were assessed were isoniazid, rifampicin, pyrazinamide and ethambutol. The doses that were given to the patients were based on WHO recommendations. The outcome measured after 2 months had 77% of the patients with negative sputum cultures after their 2 month stint (p=0.001) 13. A similar study was conducted in Hong Kong with the difference being a 12 month follow up period. By the end of the second month, 94% of patient receiving the daily regimen had improved. 90% of those under the intermittent regimen also had improved by the second month. Over the long term follow up, more relapse cases were recorded but the values were not significant 14. Hypoglycemia Treatment Patient was hypoglycemic upon arrival and dextrose infusion was provided to restore the patients normal blood glucose range. Two forms of treatment are usually available for hypoglycemic attacks namely glucagon and dextrose infusion. A study compared the efficacy between both the options and it was observed that both were capable of treating hypoglycemia effectively. The only disparity observed was the recovery. Patients on dextrose infusion are capable of regaining consciousness by 4 minutes compared to 6 minutes for patients that were on glucagon ( p Table 4 : Results of 51 hypoglycemic patients treated with dextrose 10% and dextrose 50% 27 Dextrose 10% Dextrose 50% Median time needed to attain recovery (minutes) 8 8 Median total dose administered 10g ( p 25g (p Median post treatment blood sugar levels 6.2 mmol/l (p=0.003) 9.4 mmol/l (p=0.003) Diabetes Treatment Oral antidiabetic agents such as gliclazide in the patients drug history would not be sufficient for her to have proper control over her glycemic levels. It was reported that tuberculosis affects the hormonal secretion by interfering with endocrinal organs such as pancreas 15. Rifampicin reduces the concentration of gliclazide by inducing liver microsomal enzymes CYP 2C9 that rapidly eliminates gliclazide from circulating in the system 15,16,17. In a study by Park et al., patients given with 80 mg gliclazide had the concentration of the drug present in the body reduced by 70% on day 7. The elimination half life of the drug also increased 3 fold 17. All these contribute to the inability of the sulfonyluea to reduce the glucose levels in this patient. According to the stepwise approach in NICE guidelines, the next step to manage this patient would be to start the insulin regimen18. The type of insulin that was given was biphasic Mixtard insulin analogue that consists of a short acting analogue and also a long acting analogue. P.V. Rao reported that, due to the insulin resistance present in patients started on anti Tb therapy, the doses of insulin needed to manage these patients increase 15. It is well proven that insulin can achieve better HbA1c levels as a clinical trial by United Kingdom Prospective Diabetes Study (UKPDS) revealed that after 9 years monotherapy with insulin, 28% of patients achieved HbA1c levels below 7% and 42% patients achieved fasting plasma glucose levels below 7.8 mmol/l 19. Hypertension Treatment Patient was suffering from Stage 5 renal disease and the target for blood pressure in this patient would be 125/75 mm Hg 20. First line treatment for this patient would be loop diuretic, furosemide 20. They act by inhibiting the Na+/K+/2Cl- transporter on the ascending limb of loop of Henle which results in natriuresis and hence a fall in blood volume 21. This loop diuretic also performs its vasodilator actions via prostaglandin (PGE2 and prostacyclin) formation. This results in an increased blood flow in the medulla 21. In accordance to SIGN guidelines as well, long acting dihyrdopyridines such as nifedipine and ÃŽÂ ± blockers can be added as supplementary therapy 20. Nifedipine, a calcium antagonist acts by causing vasodilatation due to reduction in peripheral resistance. ÃŽÂ ± blockers such as prazosin block ÃŽÂ ±1 receptors and this results in vasodilation. A study by Vadasz displayed that Furosemide doses at 40 mg did not display any significant changes in systolic blood pressure. However, when the dose was increased to 60 mg, there was a significant reduction in blood pressure 21,22. A combined dose of 40 mg and 60 mg were effective in reducing the diastolic blood pressure. Based on this evidence, it is clear that furosemide on its own is not capable of decreasing blood pressure. When nifedipine was combined with diuretics it was observed that a statistically significant lower risk of cardiovascular events was observed compared to the non-statistically significant difference that was noted with nifedipine monotherapy 22. In another study by Psaty et al, nifedipine did not demonstrate an increase of risk in myocardial infarction compared to the other calcium channel blockers 25. Prazosins efficacy in lowering blood pressure was studied and the lowest effective dose that is capable of reducing blood pressure was noted to be 10mg 26. Doses below 10 mg per day did not significantly reduce the blood pressure compared to the placebo arm. Treatment of Anaemia Patient had very low haemoglobin levels and this was indicative of anaemia. NICE guidelines have recommended that in order to manage anemia, patients are usually given eryhtropoetin stimulating agents and also iron supplements to help produce haemoglobin 23. There has been no evidence in the use of iron supplements in patients with chronic kidney disease prior to treatment with erythropoietin. But it is recommended that the erythropoietin therapy should not be commenced in conditions of complete iron absence 23. In some conditions, where patients were in Stage 5 renal failure also diagnosed with other co-morbidities, treatment with erythropoietin stimulating agents is decided based on clinical judgment by the professional team if the patient were to benefit from the treatment 23. Treatment of Hyperkalaemia Patient was suffering from mild hyperkalemia and it was necessary that this was be treated before it progresses to severe hyperkalemia that might lead to adverse events such as cardiac arrest. A study compared the effectiveness between sodium polystyrene sulfonate and calcium polysterene sulfonate and it is noted that treatement with sodium increases sodium concentration in the body and this escalates the risk of hypertension 24. Treatment with calcium polystyrene sulfonate resulted in 50% decrease in potassium content and an additional advantage of increase in calcium concentration was observed as well 24. Conclusion Based on all the evidence provided for the patients condition, it is clear that the guidelines were adhered in treating the patients individual disease with some minor differences. Tuberculosis treatment for the initial phase was extended for more than 2 months due to the positive result obtained from sputum smear. Patient eventually achieved negative sputum smear and the patient was to be monitored before the patient was commenced on the continuous phase drugs. Effective treatment was undertaken to treat patients hypoglycemia condition, and based on the evidence gathered, dextrose 10% is the suitable treatment option for the patient. The antihypertensive regimen that was chosen was due to the patients renal failure. Nifedipine, prazosin and furosemide collectively controlled the blood pressure of the patient. Ferrous sulphate was chosen as her treatment compared to erythropoietin and this was based on the doctors clinical judgement. Her hyperkalemia which was treated with calcium su lfonate did benefit the patient as her potassium levels were within the normal range at the end of the treatment. PATIENT MEDICATION PROFILE PATIENT DETAILS Name Mrs A Consultant General Practitioner Address Kuala Lumpur Gender Female Weight 65 Height 158 Community Pharmacist Date of Birth (Age) 61 Known Sensitivities None Social History Non smoker Non Alcoholic PATIENT HOSPITAL STAY Presenting complaint in primary care / reason for admission Admission date April Low Sugar Level : 2.1 mmol/L Discharge Date Discharged to Not Known Shortness of breath RELEVANT MEDICAL HISTORY RELEVANT DRUG HISTORY Date Problem Description Date Medication Comments Feb Pulmonary Tuberculosis Feb Rifampicin 6 months Advanced Renal Failure Feb Isoniazid 5 years Hypertension Feb Pyrazinamide 5 years Diabetes Mellitus Feb Ethambutol Feb Pyridoxine 6 months Prazosin 6 months Nifedipine 6 months Furosemide Gliclazide RELEVANT NON DRUG TREATMENT Peritoneal Dialysis Prescribed Medication Start Stop Clinical/Laboratory Tests Date Result 1 Rifampicin Day 1 Sputum Smear Test Day 1 Positive 2 Isoniazid Day 1 Creatinine Day 1 912 Â µmol 3 Pyrazinamide Day 1 Urea Day 1 37.8 mmol/l 4 Ethambutol Day 1 Potassium Day 1 5.5 mmol/l 5 Pyridoxine Day 1 Blood Glucose Day 1 2.1 mmol/l 6 Prazosin Day 1 Blood Pressure Day 1 152/93 7 Nifedipine Day 1 Haemoglobin Day 1 9.8 g/dl 8 Furosemide Day 1 Chest Xray Day 1 Lesions in the apical segment 9 Dextrose Solution Day 1 Day 4 Blood Glucose Day 8 11.1 mmol/l 10 Ferrous sulphate Day 1 Sputum Smear Day 13 Negative 11 Calcium polystyrene sulphate powder Day 1 Day 6 12 Insulin Mixtard Day 8 CLINCIAL MANAGEMENT Diagnosis Pharmaceutical Need Pulmonary Tuberculosis Continue patient on intial phase drugs Hypoglycemia Start patient on dextrose Hypertension Continue antihypertensive treatment Hyperkalaemia Start calcium polystyrene sulphonate powder Anaemia Start ferrous sulphate Advanced Renal Failure Send patient for peritoneal dialysis PHARMACEUTICAL CARE PLAN Date Care Issue/Desired Output Action Output Sub therapeutic doses For Anti TB drugs Discussed with the pharmacist and patients diabetic condition was the reason for the dose regimen Doses were not changed Drug sensitivity testing was not performed Patient is diabetic and is more susceptible for MDR-TB No test was performed Management of patients compliance towards anti tuberculosis drugs -Patient might be hospitalised for a long period of time due to renal failure -DOTS scheme to be implemented upon discharge -Adequate patient education on the importance of completing the regimen is important Hospitalisation or DOTS scheme Renal failure Ethambutol excreted by kidney. Suggest change of medication to 2 Isoniazid + Rifampicin + Pyrazinamide -If treatment continued, monitoring essential Continue treatment as before and patient being monitored AFB test Another 2 samples should be taken for AFB tests before switching to the continuous phase Action yet to be taken Monitor drug toxicity Lab investigations on full blood count, liver function, serum uric acid, serum bilirubin, should be done to ensure no toxicity Eye examination for ethambutol side effects Scheduled appointments for patient Education on side effects of drugs To inform patient about anti Tb drugs side effect and advise patient not to stop the drug and side effects can be controlled ( PZA and arthralgia ) Counseling by pharm