Fedex - Management Case Study - 9964 Words

Absolutely, Positively Operations Research: The Federal Express Story RICHARD O . MASON Edwin L. COX school of Business Southern Methodist University Dallas, Texas 75275 JAMES L . M C K E N N E Y Harvard Business School Soldiers Field Boston, Massachusetts 02163 216 west miton Drive Bolder Creek, California 95006 School of Business Administration University of Western Ontario London, Ontario N6A 3K7 Canada WALTER CARLSON DUNCAN COPELAND Federal Express Corporation has used operations research (OR) to help make its major business decisions since its overnight package delivery operations began in 1973. An early failure pointed out the need for scientific analysis. Subsequently, a successful origin-destination model followed†¦show more content†¦When Smith was contemplating his new business in 1972, he asked Brandon, Could you use a computer to better schedule the aircraft? Definitely, was Bronsons reply. Brandon soon thereafter became an advisor to FedEx and an early employee. Smiths charge to Brandon was straightforward: Where have we failed? What should we do now? The team members closeted themselves in a conference room at Little Rocks Worthen Bank to begin their soul-searching, working 18 to 20 hours a day for 15 days straight. Their approach was classic. They began by challenging the assumption that the cities the founders knew best were best for doing business. This led them to focus on what characteris tics made a city a good candidate for their route structure, and they concluded that they should include some cities because they generated a large volume of outbound small packages; others because they received a lot of small packages. Moreover, the final set of cities should account for a substantial amount of the total volume within the system. Given these guidelines, they next acted on their intuitive ideas in a systematic way to find data or indicators they could use to select cities and to decide on a route system. First, they formulated the problem in terms of an origin-destination flow model. They evaluated approximately 112 cities (yielding 12,422 cells = 112 X 112 - 112) to determine which cities they should include in the system. They developed data on originsShow MoreRelatedStrategy Management/Case study/FedEx2379 Words   |  10 Pagesassess FedEx case with Strategy Management, the first question should be asked is What is strategy? Johnson and Scholes said: Strategy is the direction and scope of an organization over the long-term: which achieves advantage for the organization through its configuration of resources within a challenging environment, to meet the needs of markets and to fulfil stakeholder expectations. How Strategy is Managed is why we study Strategic Management. In its broadest sense, strategic management is aboutRead MoreSupply Chain For Manufacturing Facilities Essay911 Words   |  4 Pageswith the product, including distributors and suppliers. 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Lim Chai* Ping * A115924 Case study Questions for discussion: Which three environmental forces are likely to have the greatest effects on FedEx? Explain your answer. Environmental forces are the unpredictable forces that cannot be controlled and it can be detrimental to the company’s position. Three of the following forces have the greatest impacts on FedEx: Competitors Intense competition from the U.S Postal Service, UPS, EmeryRead MoreOperations Management Essay examples1459 Words   |  6 PagesNAME: MITCH B. MENDEZ DATE: NOV. 26, 2015 CASE STUDY: ALDI 1. How does ALDI’S strategy lead to competitive advantage? How does the company achieve this strategy? *   A competitive advantage  is one that distinguishes a firm or a business from the competitors in the minds of the customers. 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FedEx is responsible for providing outsourced transportation services to 11 Deere facilities across the US and Canada. The 11 Deere facilities have different service agreements with FedEx in terms of cost and service depending on the type of business unit. With different prices and services across the facilities, management is trying to identify opportunities to standardize

The Guiding Three Favorite Characters From Chaucer s Of...

The Guiding Three (Three favorite characters from Chaucer’s General Prologue) There are often times in your life where you look up to some certain people. Normally these people are called your role models. Kids growing up have all different sorts of role models, it can range from athletes, to singers, to just everyday people in their life. Always looking up to these people, you begin to adapt to their ways and aspire to be like them. There are a ton of characters in Chaucer’s story of Canterbury Tales, many of these people which could easily be looked up to, or easily looked down upon as well. Geoffery Chaucer is an extremely important author in English history. He is known as the father of the English language, because he was one that began to actually write in down in ways that we talked. Canterbury Tales is one of his most known and important writings of his time, because of the message and ways he was trying to get his message across. Satire was one of his favorite ways of writing poetry, hints the reason his best work is a classic satire by Chauce r. One way or another, I have three favorite characters from the story: the Knight, Parson, and Oxford Cleric. To begin with, the Knight is one of my favorites because of his honor. This is something that I really aspire to be known for. Whenever you hear of someone that is an honorable person, you immediately begin to think highly of that person. The hard work that is put into getting there is definitely not easy either.

Feminism In Frankenstein Essay Example For Students

Feminism In Frankenstein Essay After reading the book Mary Shelleys Frankenstein, and then seeing several adaptations done for the silver screen, there are changes that the films make to the book. The most evident change that jumps out at me is the portrayal of Dr. Victor Frankenstein. The common missing element in all of the film versions of the classic novel is the way they treat the character of Victor. The films all tend to downplay what a monster Victor is and instead stress how much of a monster the Creature is. The films seem to stress less on the responsibility and guilt that Victor feels over his creation, which is shown in the book. Instead of taking the stance on a crime against nature for trying to play God, the films spin the film as a science experiment gone wrong. When reading the book Frankenstein, and looking at the character of Victor, one can not help but see his character flaws. Dr. Frankenstein is portrayed as selfish, ego manic bent on restoring life to his stitched together creature, and doesnt stop to think of the consequences. Though not till later in the book, as Victor and Elizabeth are to be wed, his true selfish nature emerges once again. Victor believes that the Creature is coming to seek revenge on him, not for a moment thinking about the well being of his bride to be, Elizabeth (144). In the novel it is all about Victor and his selfishness, where as in the film versions, it looks as though Victor is trying to protect Elizabeth. Whether it had been a noise outside or a quick motion of a shadow, in the films its looks as if Victor is trying to protect Elizabeth. A place in the book where it couldnt be more evident of his guilt and shame of his creature is after it rises up, the birth of the Creature (35). Instead of feeding off this power scene and theme from the book, the directors of the films missed this opportunity. In the 1994 film Frankenstein, directed by Kenneth Branagh, Branagh changes this scene in the movie by having Victor believe he has accidentally killed the creature, and that all his guilt is believed to be gone. By changing this scene, Kenneth Branagh failed to capture the sense of out casting and lack of feelings Victor shows toward the Creature as he did in the book. The biggest change in the novel to film adaptations is undisputedly the Creature. Obviously for time constraints, the time in the movie had to be speed up. In the, novel it takes the Creature a long time to learn how to speak and read. On a more in depth scale, the Creature in the films was portrayed a killing machine, killing random people that were not connected with Victors life. James Whales does this in the famous scene of the little girl being thrown into the river in the 1931 film. Whales takes away the intelligence t hat the Creature posses in the novel, in my opinion, which makes him scarier than just this mindless killer. The Creature systematically targets people close to Victor Frankenstein in the novel where as in the movie he kills people who are not connected to Dr. Frankenstein. The complex and depth character was stripped from the movies and replaced with a popcorn movie monster. The theme of loneliness and abandonment toward the Creature that was in the novel was pushed aside. Instead the films choose to take sympathy on Victor for being terrorized by the Creature. The Creature as no one to connect with, no constant human interaction in his life, which is the opposite of what Victor, has later in the novel. Just as when Victor was alone and working on the Creature, he could do nothing but focus on that one thing. He didnt want to talk to anyone; all he wanted to do was concentrate on his work. Very similarly the Creature lived alone and had but one thing on his mind, to get revenge wit h his father, Dr. Frankenstein. In this way the two share a connection; however Victor could walk outside and be accepted by society, where the Creature had to live in the shadows because he was different. The films, overall, didnt show the true depth of horror that Mary Shelley originally showed in her novel. I think that the directors didnt capture the depth and true themes of the novel. 3)There is nothing against the attainment of knowledge, its when that knowledge is abused and used for the wrong things. That is a very pertinent theme even in todays society. Films of today have explored that same theme, such as Steven Spielbergs Jurassic Park; this theme of playing God through knowledge and technology. In Frankenstein, I dont think that Mary Shelley is against the attainment of knowledge, but rather the abuse of it. Shelley seems to have not tipped the scale in one direction, but given both sides equal representation. On one end, Elizabeth and Henry embody the attainment of know ledge and on the other hand Victor and Walton embody the abuse of knowledge. Elizabeth is given more knowledge than most women of this time period and does not abuse it. Henry even goes to the same university with Victor, but he as well does not abuse the knowledge that he knows. On the opposite end of the spectrum are Victor and Walton. Victor has taken the knowledge he has learned and used it to play God, he does not think of the moral repercussions or the feelings of the Creature. Walton is a wreck lose and has no care for his crew, only of finding the North Pole, however this changes when he talks with Victor, and decides to turn around. The Creature however, is somewhere in the middle. He studies the interactions of people, such as the family in the woods and attains knowledge by reading and watching his surroundings. The Creature wants nothing more than to be accepted by society. He has no father figure to show him the rights and wrongs of life. He kills people close to Victor and in that way he does not use his knowledge for good. However he does try to use the knowledge he gains for good, by trying to help out the family in the woods, but because society rejects him he lashes out against them and his creator, Victor. .u419580facabadb7e5cb4eb0417ca084f , .u419580facabadb7e5cb4eb0417ca084f .postImageUrl , .u419580facabadb7e5cb4eb0417ca084f .centered-text-area { min-height: 80px; position: relative; } .u419580facabadb7e5cb4eb0417ca084f , .u419580facabadb7e5cb4eb0417ca084f:hover , .u419580facabadb7e5cb4eb0417ca084f:visited , .u419580facabadb7e5cb4eb0417ca084f:active { border:0!important; } .u419580facabadb7e5cb4eb0417ca084f .clearfix:after { content: ""; display: table; clear: both; } .u419580facabadb7e5cb4eb0417ca084f { display: block; transition: background-color 250ms; webkit-transition: background-color 250ms; width: 100%; opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #95A5A6; } .u419580facabadb7e5cb4eb0417ca084f:active , .u419580facabadb7e5cb4eb0417ca084f:hover { opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #2C3E50; } .u419580facabadb7e5cb4eb0417ca084f .centered-text-area { width: 100%; position: relative ; } .u419580facabadb7e5cb4eb0417ca084f .ctaText { border-bottom: 0 solid #fff; color: #2980B9; font-size: 16px; font-weight: bold; margin: 0; padding: 0; text-decoration: underline; } .u419580facabadb7e5cb4eb0417ca084f .postTitle { color: #FFFFFF; font-size: 16px; font-weight: 600; margin: 0; padding: 0; width: 100%; } .u419580facabadb7e5cb4eb0417ca084f .ctaButton { background-color: #7F8C8D!important; color: #2980B9; border: none; border-radius: 3px; box-shadow: none; font-size: 14px; font-weight: bold; line-height: 26px; moz-border-radius: 3px; text-align: center; text-decoration: none; text-shadow: none; width: 80px; min-height: 80px; background: url(https://artscolumbia.org/wp-content/plugins/intelly-related-posts/assets/images/simple-arrow.png)no-repeat; position: absolute; right: 0; top: 0; } .u419580facabadb7e5cb4eb0417ca084f:hover .ctaButton { background-color: #34495E!important; } .u419580facabadb7e5cb4eb0417ca084f .centered-text { display: table; height: 80px; padding-left : 18px; top: 0; } .u419580facabadb7e5cb4eb0417ca084f .u419580facabadb7e5cb4eb0417ca084f-content { display: table-cell; margin: 0; padding: 0; padding-right: 108px; position: relative; vertical-align: middle; width: 100%; } .u419580facabadb7e5cb4eb0417ca084f:after { content: ""; display: block; clear: both; } READ: Helping Others EssayMost of the film versions of Frankenstein have chosen to not take the theme of attainment/abuse of knowledge as a major theme. They have mainly tended to focus on the aspect of a monster movie theme; this less intelligent monster terrorizing the country-side and on the hunt after its creator. However the most recent movie of Frankenstein, done by Hallmark Pictures, is the closest representation of the original Mary Shelley novel. This movie tends to add elements that are not in previous films, such as showing glimpses of Elizabeths and Henrys positive use of their knowledge. The monstrous nature of the Creature is amplified in my opinion by actually sho wing his higher intelligence in the Hallmark version of the film. He comes off as more sinister because of his high intelligence level. Though the Hallmark version of Frankenstein is one of the better to date, none of the film versions of Frankenstein have used knowledge, the abuse and attainment of it, as a major theme.

William Bradford Argumentative Essay Example For Students

William Bradford Argumentative Essay William Bradford If a tree falls but no one is there to see it, does it really fall? This quote explains the very logic of history. Throughout the course of history, many significant occurrences have shaped our society to what it is today: free. William Bradford not only lived through a symbolic historical cornerstone of America, but wrote about it too. William Bradford, the second governor of Plymouth colony elected, was accountable for the young colonys success through great hardships. The Pilgrims were signified as complete abdicates from the Church of England. The success of the Plymouth was based on covenantalism the belief that men could form compacts or covenants in the sight of God as a basis for government without the consent of a higher authority. According to Bradfords expose, the Pilgrims: shook off this yoke of antichristian bondage, and as theLords free people joined themselves (by a covenant of the Lord) into a church estate, in the fellowship of the gospel, to walk in all His ways made known, or to be made known unto them, according to their best endeavors, whatsoever it should cost them, the Lord assisting them. And that it cost them something this ensuing history will declare. But after these things they could not long continue in any peaceable condition, but were hunted and persecuted on every side, so as their f ormer afflictions were but as flea-bitings in comparison of these, which now came upon them. For some were taken and clapped up in prison, others had their houses beset and watched night and day, and hardly escaped their hands; and the most were fain to flee and leave their houses and habitations, and the means of their livelihood. Yet these and many other sharper things which afterward befell them, were no other than they looked for, and therefore were the better prepared to bear them by the assistance of Gods grace and Spirit. Yet seeing themselves thus molested, and that there was no hope of their continuance there, by a joint consent they resolved to go into the Low Countries, where they heard was freedom of religion for all men; they resolved to get over into Holland as they could. (W. Brad Home Page). We will write a custom essay on William Bradford Argumentative specifically for you for only $16.38 $13.9/page Order now Once in Holland, the Pilgrims discovered that religious persecution was being diffused. They picked up once again on another brave journey in search for a land that was seemingly impossible to find: a land of religious freedom. They came to America on another perilous journey. Their perseverance and faith in God led them through. Being thus arrived in a good harbor and brought safe to land, they fell upon their knees and blessed the God of heaven, who had brought them over the vast and furious ocean, and delivered them from all the perils and miseries thereof, again to set their feet on the firm and stable earth, their proper element. William Bradford wrote Of Plymouth Plantation, recording the history of the Plymouth Colony, and the calamities that led up to their leaving England for Holland, and later to New England. He also recorded some of the important letters he wrote and received in a letter-book, which still partially exists. William Bradfords letter-book was despoiled during the Revolutionary War, and was later discovered in Nova Scotia in the 1790s, ironically, being used as wrapping paper in a smelly fish market. What was left of the book was saved and later on used as a source of first hand information of the Pilgrims and daily life. Also in his books he interprets the Mayflower Compact, an import ant document which was a rough base of their ultimate goal- freedom. Although initially the purpose of the Mayflower Compact was to control renegades aboard the Mayflower who were threatening to go their own way when the ship reached land, the Mayflower Compact succeeded in keeping the Pilgrims united as one. .u920f7cf8e04b4a30b17f1f3a4e3c1e51 , .u920f7cf8e04b4a30b17f1f3a4e3c1e51 .postImageUrl , .u920f7cf8e04b4a30b17f1f3a4e3c1e51 .centered-text-area { min-height: 80px; position: relative; } .u920f7cf8e04b4a30b17f1f3a4e3c1e51 , .u920f7cf8e04b4a30b17f1f3a4e3c1e51:hover , .u920f7cf8e04b4a30b17f1f3a4e3c1e51:visited , .u920f7cf8e04b4a30b17f1f3a4e3c1e51:active { border:0!important; } .u920f7cf8e04b4a30b17f1f3a4e3c1e51 .clearfix:after { content: ""; display: table; clear: both; } .u920f7cf8e04b4a30b17f1f3a4e3c1e51 { display: block; transition: background-color 250ms; webkit-transition: background-color 250ms; width: 100%; opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #95A5A6; } .u920f7cf8e04b4a30b17f1f3a4e3c1e51:active , .u920f7cf8e04b4a30b17f1f3a4e3c1e51:hover { opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #2C3E50; } .u920f7cf8e04b4a30b17f1f3a4e3c1e51 .centered-text-area { width: 100%; position: relative ; } .u920f7cf8e04b4a30b17f1f3a4e3c1e51 .ctaText { border-bottom: 0 solid #fff; color: #2980B9; font-size: 16px; font-weight: bold; margin: 0; padding: 0; text-decoration: underline; } .u920f7cf8e04b4a30b17f1f3a4e3c1e51 .postTitle { color: #FFFFFF; font-size: 16px; font-weight: 600; margin: 0; padding: 0; width: 100%; } .u920f7cf8e04b4a30b17f1f3a4e3c1e51 .ctaButton { background-color: #7F8C8D!important; color: #2980B9; border: none; border-radius: 3px; box-shadow: none; font-size: 14px; font-weight: bold; line-height: 26px; moz-border-radius: 3px; text-align: center; text-decoration: none; text-shadow: none; width: 80px; min-height: 80px; background: url(https://artscolumbia.org/wp-content/plugins/intelly-related-posts/assets/images/simple-arrow.png)no-repeat; position: absolute; right: 0; top: 0; } .u920f7cf8e04b4a30b17f1f3a4e3c1e51:hover .ctaButton { background-color: #34495E!important; } .u920f7cf8e04b4a30b17f1f3a4e3c1e51 .centered-text { display: table; height: 80px; padding-left : 18px; top: 0; } .u920f7cf8e04b4a30b17f1f3a4e3c1e51 .u920f7cf8e04b4a30b17f1f3a4e3c1e51-content { display: table-cell; margin: 0; padding: 0; padding-right: 108px; position: relative; vertical-align: middle; width: 100%; } .u920f7cf8e04b4a30b17f1f3a4e3c1e51:after { content: ""; display: block; clear: both; } READ: Effects of the Atomic Bomb EssayThe Mayflower Compact endorsed the right of everyone, who signed a share in the making and administering of laws and the right of the majority to rule. It was the beginning of a constitution of pure democracy. Although William Bradford died in 1657, having been governor of the Plymouth Colony for almost the entire period since 1621, the success of the Pilgrims and his writings will live on in American history for years to come. Cotton Mather in his Magnalia Christi Americana wrote that William Bradford: was a Person for Study as well as Action; and hence, notwithstanding the Difficulties through which he passed in his Youth, he attained unto a notable Skill in Languages; the Dutch Tongue was become almost as Vernacular to him as the English; the French Tongue he could also manage; the Latin and the Greek he had Mastered; but the Hebrew he most of all studied, Because, he said, he would see with his own Eyes the Ancient Oracles of God in their Native Beauty.

Free Essays on Apple

One of the most innovative and exciting fields in our current society is the PC industry. In the last thirty years, the computer industry has developed at an astounding rate- nearly two out of three people over the age of 18 in the US either own or have access to a computer on a regular basis. This incredible invention, however, is the result of inauspicious beginnings and inept primary marketing by one of the most successful manufacturers of personal computers- Apple. Despite disastrous losses in the 80s and 90s to their main competitor, IBM, Apple recently re-vamped the entire company- focusing on marketing and product developmentand introduced the iMac in 1998- the most successful personal computer launch ever. Despite this success, the rapid rate of development within the computer industry indicates that Apple must analyze their previous marketing techniques in order to maintain the high level of success achieved in the late twentieth century. The PC was invented on April Fool’s Day in 1976. The two inventors, Steven Jobs and Stephan Wozniak, were working out of a garage and possessed very little knowledge of the importance of marketing in successful product production and distribution. They were primarily interested in their products- showing â€Å"little concern for its markets.† The introduction of IBM in 1981, however, was a strong wakeup call for the unprofessional company- forcing them into competition against strong and well-managed opponents. For several years after IBM launched its first PC, it dominated the market- focusing on a synergistic relationship with Microsoft. After hearing the dire predictions regarding the probability of Apple surviving IBM domination, Steven Jobs realized that professional marketing help was vital. John Scully, a professional in marketing, concluded that Apple desperately needed a keen update on its marketing-product strategies. The resulting solution consisted of diffe... Free Essays on Apple Free Essays on Apple Apple In past years, Apple was on a downward spiral, but now the Mac is back on the right track. The interim CEO Steve Jobs has brought them from expected quarterly loses to now, first quarter net income of some 150 millions dollars. The question still remains, is Apple back to stay? With the Windows driven world of today, can Apple assert them self to claim market share? Apple’s stunning new hardware, user-friendly operating system, and drive for incredible new technology, will not only compare Apple to traditional PC and software maker but will stun the rest of the computer world along the way. On July 21, 1999, PC Data released a report stating the iMac, Apple’s entry level personal computer, was the best selling retail and mail order computer in the month of June. There are a number of different reasons why this computer beat out all other PC’s on the market. One reason is the new and exciting colors the iMac is being offered in. Instead of the traditio nal color, beige, being offered by Dell or Gateway, the iMac comes in strawberry, blueberry, grape, tangerine and lime. Another feature for the iMac is the speed of the computer compared to the computers in its class. According to the BYTEmark integer test, the 333- MHz G3 processor in the iMac is almost twice as fast as the 500-MHz Intel Pentium III found in professional computers found today. The iMac is not the only computer offered by Apple. They have a line of professional personal computers called the G3 series. These computers are the fastest personal computers on the market today, beating other computers such as the Gateway 550-MHz Pentium III PC. Another main reason the iMac is such a big success and Apple in general is coming back is their operating system called the MacOS. Its number one feature is its user-friendliness. Apple computers such as the iMac are called plug-and-play computers. This means you plug a device into your computer, like a zip drive, ... Free Essays on Apple One of the most innovative and exciting fields in our current society is the PC industry. In the last thirty years, the computer industry has developed at an astounding rate- nearly two out of three people over the age of 18 in the US either own or have access to a computer on a regular basis. This incredible invention, however, is the result of inauspicious beginnings and inept primary marketing by one of the most successful manufacturers of personal computers- Apple. Despite disastrous losses in the 80s and 90s to their main competitor, IBM, Apple recently re-vamped the entire company- focusing on marketing and product developmentand introduced the iMac in 1998- the most successful personal computer launch ever. Despite this success, the rapid rate of development within the computer industry indicates that Apple must analyze their previous marketing techniques in order to maintain the high level of success achieved in the late twentieth century. The PC was invented on April Fool’s Day in 1976. The two inventors, Steven Jobs and Stephan Wozniak, were working out of a garage and possessed very little knowledge of the importance of marketing in successful product production and distribution. They were primarily interested in their products- showing â€Å"little concern for its markets.† The introduction of IBM in 1981, however, was a strong wakeup call for the unprofessional company- forcing them into competition against strong and well-managed opponents. For several years after IBM launched its first PC, it dominated the market- focusing on a synergistic relationship with Microsoft. After hearing the dire predictions regarding the probability of Apple surviving IBM domination, Steven Jobs realized that professional marketing help was vital. John Scully, a professional in marketing, concluded that Apple desperately needed a keen update on its marketing-product strategies. The resulting solution consisted of diffe...

How to Calculate Atomic Weight

How to Calculate Atomic Weight The atomic weight of an element depends on the abundance of its isotopes. If you know the mass of the isotopes and the fractional abundance of the isotopes, you can calculate the elements atomic weight in atomic mass units (expressed as u, Da, or amu). The atomic weight is calculated by adding the mass of each isotope multiplied by its fractional abundance. For example, for an element with 2 isotopes: atomic weight massa x fracta massb x fractb If there were three isotopes, you would add a c entry. If there were four isotopes, youd add a d, etc. Atomic Weight Calculation Example If chlorine has two naturally-occurring isotopes where: Cl-35 mass is 34.968852 and fract is 0.7577Cl-37 mass is 36.965303 and fract is 0.2423 atomic weight massa x fracta massb x fracb atomic weight 34.968852 x 0.7577 36.965303 x 0.2423 atomic weight 26.496 amu 8.9566 amu atomic weight 35.45 amu Tips for Calculating Atomic Weight The sum of the fractional abundance values must equal 1.Be sure to use the mass or weight of each isotope and not its mass number.

David Christopher, Orthopedic Surgeon Essay Example | Topics and Well Written Essays - 500 words

David Christopher, Orthopedic Surgeon - Essay Example e second to most in demand whereas surgeon B takes as long as 60 minutes for the most required and the second to most required surgery that he executes. In addition, surgeon B is more skilled as he does surgeries of a greater variety as compared to the surgeon A. Keeping these facts into consideration, one way for Dr. Christopher to increase the patient throughput and accordingly the revenues without compromising upon the quality of care is to add a surgeon who is skilled in the surgeries of ACL ligament repair, Achilles tendon repair, and knee replacement since these are the surgeries with a lot of demand. The second approach can be to use the surgeons A and B only for the surgeries that are more in demand and stop doing surgeries in areas that have no demand. The record shows that no patient has been scheduled for the surgeries of big toe replacement and fractured hip, so the changeover time of 45 minutes consumed by surgeon A and B in these surgeries can be utilized more efficiently by doing more surgeries of ACL ligament repair that, though Dr. Christopher needs to train surgeon A to perform this surgery. Dr. Christopher can also increase the revenues without compromising upon the quality of service by better management of time. Presently, the surgeries are done only from 7:00 am to 12:00 noon whereas in the time thereafter, patients are seen either in the hospital or the clinic. After noon till break-off, there is plenty of time that can be availed in actually performing surgeries rather than just checking patients. At least, this time can be used to perform the surgeries that take equal to or less than 1 hour to perform and are high in demand like the ACL ligament repair surgery, the Achilles tendon repair surgery or the rotator cuff repair surgery. Yet another way is to keep the number of surgeons the same but divide the surgeries between before noon and after noon time depending upon the time they take. For example, Dr. Christopher should make the

The Role Of The Catholic Religious Education Specialist Teacher Article

The Role Of The Catholic Religious Education Specialist Teacher - Article Example Religious education encompasses various areas such as evangelisation, catechesis, giving witness, introduction to church, prayer, experience of faith, and knowledge of other faiths. At the same time, the Religious Education specialist teacher’s duties need to be performed on the basis of what the Catholic church teaches; what the government states: the curriculum for excellence; and what schools expect from them in the context of any extracurricular duties which are not expected of other teachers in the school. Thesis Statement: The purpose of this paper is to investigate the role of the Catholic Religious Education (RE) specialist teacher, the various areas of religious education, and the influence on the RE’s role by the Church, the government and the school. Religious teaching can be understood as a ministry with a professional dimension (Cook & Hudson, 2006). Catholic educators need to think and act sentire cum ecclesia which refers to the ideal form of thinking and feeling with the church on the basis of individuals’ identity as Catholics. ... ng to Cook & Hudson (2006: 399), assessment of religious teaching as a profession can be based on a framework composed of the following characteristics: "essential service to society, motivation by a call to serve, special knowledge and skills, specialized and advanced university training, public trust and status, code of ethics and performance standards, and professional organization".Religious Education helps in students' development of the self, socially, morally and spiritually (SCAA, 1994). Research conducted by Sikes & Everington (2001) indicates that a religious education teacher's life history plays a vital part in determining their teaching skills and approach to work. Further, "the quality, range and flexibility of teachers' classroom work are closely tied up with their professional growth - with the way they develop as people and as professionals" (Hargreaves, 1994: xi). This evidence would be useful in screening potential candidates for training as RE specialist teachers, by addressing negative identities unsuitable to carry out the important work. Evangelisation and Catechesis Ecumenism is the essential task of the whole Church to bring the Gospel to the entire world. Ecumenism and mission, evangelisation and Church community converge in a common witness to the same God (Houtepen, 1998). The Church's evangelistic mission is expected to be carried forward by the RE instructor by imparting the Faith to all students in the classroom, including those students who do not share the Christian faith, in the interests of sharing the wisdom and benefits of the Catholic religion (Francis et al, 1996). Teachings of the Catholic Church are mainly through catechesis. Bishop O' Donoghue (2008) believes that the key element or essence of the aims of a

Modern Family Essay Example for Free

Modern Family Essay Modern Family is a documentary-style comedy about three branches of the extended Pritchett family: Dad Jay has married a younger woman and is now raising a teenage stepson; his daughter Claire has a husband and three kids of her own; and his gay son Mitchell has just adopted a Vietnamese baby with his partner. Modern Family premiered on ABC in September 2009 as part of the networks new Wednesday comedy lineup, and was immediately met with positive reviews and strong ratings, becoming the breakout show of the night. Modern Family was created and is executive-produced by Steven Levitan and Christopher Lloyd, who worked together as writers and producers on Frasier, and co-created the short-lived sitcom Back to You; Levitan was also the creator of Just Shoot Me. This investigation will highlight the key aspects which has made Modern Family a very likable program over the last few years. the way in how the show appeals to viewers will be discussed as well as the values and attitudes of society are re? ected through the main characters. I Will also indicate some of the controls and constraints that Modern Family has to deal with in order to make their show successful and appropriate. Also featured will be the discussion of some of the obvious stereotypes which the show portrays and the impact of Modern Family on Todays society. But to be able to understand all these aspects, you will need to familiarise yourself with the main characters ? rst. Characters Jay Pritchett: The father of Claire and Mitchell, husband of Gloria, grandfather of Lily, Luke, Alex, and Haley, and the stepfather of Manny. He is the owner of a construction ? rm and is presumably the wealthiest family member. Jay has a dry and sarcastic sense of humor. Like both his son and daughter, Jay is generally more realistic, mild mannered, and sensible than his partner, Gloria, who is unashamed of the fact Jay is many years her senior. A recurring plot involves Jays relationship with his son Mitchell, which became more complicated due to Jays reaction to Mitchells sexual orientation. Gloria Pritchett: Jays wife and Mannys mother. She is from a small village in Columbia. She is a very loving wife and mother despite the age difference between her and her husband. Her voluptuous ? gure and overall beauty is often remarked or noticed by other characters on the show. One of her most distinctive traits is her very thick Colombian accent, which sometimes leads her to mispronounce English words, such as ultimatum as old-tomato and earrings as hair-rings. She often supports Manny when Jay tries to tell him to be less sensitive or hide his cultural background. Manny Delgado: Glorias 14-year-old son from her ? rst marriage. He is very outgoing and not the least bit self-conscious. He is very intelligent, mature and intuitive for his age and is often shown doing adult-like things, such as having conversations with Claire about her marriage and kids, and drinking coffee. He has inherited his mothers passion for life, though Gloria has also said, Manny is passionate, just like his father. This causes Manny to be very romantic. Manny is not afraid to take chances, leading him to ask out older girls, and develop a crush on Haley. Phil Dunphy: Claires husband of 20 years who sees himself as the cool dad. He dotes on his wife Claire and constantly tries to ? nd ways to bond with his three kids. He is seen as very competitive, one example being his nature of always beating his son at basketball. He has a very juvenile attitude, and is referred to by Claire as the kid [shes] married to. He uses a parenting method that he calls peerenting, which is a combination of talking like a peer but acting like a parent. He is a real estate agent who is very con? dent in his work, once saying I could sell a fur coat to an Eskimo. Claire Dunphy: the daughter of Jay, Mitchells older sister, and the helicopter soccer mom of the Dunphy family and its three very different kids. She was once a wild-child who made a lot of mistakes over the years, and she is fearful that her children could make the same mistakes, especially her oldest daughter, Haley. She is often exhausted from stress created by her family but is still a loving mother. When it comes to her kids she has dif? culty controlling Haleys independence and irresponsibility, Alexs manipulative nature, and Lukes lack of common sense. She also gets annoyed with her husband, Phil, constantly. Claire is a very competitive person, much like her husband, and is portrayed with a personality that causes her to freak out easily, and get angry. She is very strict about a clean house. She is seen as an experienced parent by Cameron and Mitchell, so she is called upon for her parenting advice Haley Dunphy: the daughter of Claire and Phil, who is portrayed as the stereotypical teenager who is often embarrassed by the presence of her parents. Haley is 15 at the beginning of the series, and is a freshman in college as of Season 4. Haley is depicted as being a bit of a bimbo, who focuses more on social status than studies. She is a little naive, especially when it comes to arguing with her parents. She is concerned about her popularity at school, as well as her social and sexual life, which contributes to her being embarrassed by her parents. Alex Dunphy: the 15-year-old daughter of Claire and Phil, and also the most erudite and intelligent of the three siblings. She is very bright and cares much more about her studies than friends/social life and boys. As the middle child to a shallow big sister and a goofy younger brother, she enjoys messing with them when they are rude to her, which is fairly often. Often taking advantage of their naivete by fooling them into believing unrealistic things, she at one time convinced Haley and Luke that they could charge electronics by rubbing the battery on their heads (Haley) and putting it in their mouths (Luke). She, as a stereotypical precocious kid, displays a sense of superiority because of her erudition, constantly putting her accomplishments on display and demanding recognition for them. Luke Dunphy: Phil and Claire? s 14-year-old son, who is often doing his own thing. At times, he can be a troublemaker, once shooting his sister with a toy gun and getting into a ? ht with Manny at school. Luke is playful, very innocent and does not always understand the repercussions of his actions, like most children; he once announced at a family gathering that his mom thought her dads new wife was a gold digger, although he misheard it as coal digger. Mitchell Pritchett: Also referred to as Mitch, is Jays son, Claires younger brother, Luke, Alex and Haleys uncle, one of Lilys fathers, and partner of eight years to Cameron. He is a low-key, mild-mannered person. At most times he is the exact opposite of Cameron which usually causes disagreements. Cameron acts as a counterbalance to Mitchells uptight, worrying ways. He usually responds to homophobia (whether real or perceived) by giving speeches. Because of his mild-mannered, uptight nature, he is sometimes embarrassed by Camerons ? amboyance. Cameron Tucker: Also referred to as Cam, is Mitchells partner of eight years, and one of Lilys fathers, who has a very big dramatic personality. His bubbly outgoing personality contrasts to Mitchells uptight manner, which causes them to have opposing character traits. Cameron was born on February 29, 1972 and grew up on a farm in Missouri. Lilly Tucker-Pritchett: the adopted Vietnamese daughter of Cameron and Mitchell. When she was introduced to the family, they accepted her with open arms, although Mitchell originally wanted to wait to tell them about her. She is at times doing activities with both of her fathers but remains with Cam at home while Mitchell works. How Does It Appeal? A key aspect of the show? s appeal is the similarities people ? nd between the extended family and their own family. Some characters from the show are Phil Dunphy, Claire Dunphy, Jay Pritchett, Gloria Pritchett, Mitchell Pritchett, and Cam Tucker. There are many other characters that make up this family, which make for much more diversity. The dynamic between these different immediate families and their values (including traditional, gay, straight, and multicultural) are what gives Modern Family its large demographic. The diversity of the Pritchetts helps reach a large audience. The ? rst part of this family is the Pritchett-Delgado family. This consists of Jay, the family patriarch, Gloria, the younger second wife, and Manny, her son. The fun part in watching this family is the culture clash between Jay and Gloria. Gloria and Manny are Hispanic, while Jay is white. It is interesting as they try to make sure that Manny gets a combination of both cultures in his life. Next in this family is the Dunphy family. This has Claire, Jay? s daughter and mother of three, and Phil, Claire? s fun husband. Their children are also in the show. First is Haley, the epitome of some teenage girls who seem to only care about their social lives as opposed to spending time with their family. Second is Alex, the smart child and Haley? s opposite. Last is Luke, the youngest and most rambunctious of the three. He is very close to Manny. The Dunphy? s are a very traditional family, but has had some of the more memorable moments in the show. Some of them come from Phil, who is known for having a very fun sense of humor. Finally there is the Pritchett-Ticker family. This is made up of Mitchell, Jay? s gay son and Claire? s younger brother, Cam, his partner, and Lily, their adoptive daughter from Vietnam. It is fun to watch their family and see how different they are from the other two parts of the family. It? s also important because it helps to put the similarities into perspective for many viewers, and that is very valuable these days. Stereotypes Stereotypes are an inevitable part of modern culture. They are standardized and simpli? ed views of groups and minorities based on prior assumptions. â€Å"Modern Family† constantly utilises and plays with the notions of Stereotypes. â€Å"Modern Family† attempts to create a new stereotype by conforming and altering old stereotypes. There is Jay, the Grandfather who remarried to a beautiful, busty Colombian woman Gloria and her son, Manny. Jay? s daughter, Claire, married to Phil, who have 3 children, Haley, Alex and Luke. Finally, Jay? s on Mitchell has an adopted Vietnamese daughter with boyfriend Cameron. The entire program works by challenging and changing stereotypes, in particular that of Gay parents, Cam and Mitch. Cameron and Mitchell are, in a way, a stereotypical gay couple. However, the humour and the message is portrayed through their confrontation of that stereotype. In one episode, they are confronted with the notion that one of them in the couple is â€Å"the woman. † This stereotypical view, that society is asking them to conform to, forces not only a humorous situation, but also challenges the characters? Gender and Identity. The show cleverly alters the ideas of stereotypes, and plays to into them, but also puts â€Å"name to a face† as it were. Stereotypes are not necessarily formed solely on against minorities, and this show challenges every one. Each character is a â€Å"stereotype† in their own right – be that â€Å"the dumb socialite,† or â€Å"the only child† or â€Å"the loud Colombian woman†. In season 4 there is an episode titled â€Å"Fulgencio† Which con? rms the perception that Latinos working in America are poor and struggle for money but still work very hard. Gloria? family comes to visit the new born baby in the family and the Columbian family endeavors the entire episode to clearing the house, especially Gloria? s sister. it is a positive representation of Latinos because they want to work even if they are on a holiday. But the beauty and hilarity of Modern Family is that each character confronts each of their stereotypes and we, as an audience, see that there is a lot more than meets the eye. Instead of simply accepting some of these stereotypes, Modern Family challenges some of these and in doing so creates a new opinion on the viewers Controls and Constraints There are many controls and constraints that will affect any media production, and Modern Family is no exception. Time: Time is one of the main factors that affects the production. Each episode is meant to run for approximately 20-23 minutes excluding ad-breaks. This means that the group of people who are putting together an episode, must avoid making a very long plot and address the main issue of the episode almost immediately. Another constraint of the show is its budget. Budget: The budget of any program is an outline of how much that production will cost, or how much the director is willing to spend. In its ? st three seasons. There has been episodes ? lmed in Hawaii, and a ranch. These episodes were have been ? lmed in these locations and not a studio with a backdrop of that location. This would have possibly meant that the budget for those 2 episodes would have been greater than some of their other episodes. It is also rumored that the ABC is planning to ? lm a future episode in Columbia in which the viewers will be introduced to Gloria Pritchett? s family. Taking into account the budget of a normal episode, and adding to that international ? ights for the cast and crew, this could very well be the most expensive episode yet. Rating/Audience: One of the most important controls and constraints which affect a media production, is the audience and their expectations. The producers of the show will give a classi? cation or rating so that viewers have some idea of what to expect. Modern Family has a rating of PG13. A PG-rated motion picture should be investigated by parents before they let their younger children attend. The PG rating indicates, in the view of the Rating Board, that parents may consider some material unsuitable for their children, and parents should make that decision. The more mature themes in some PG-rated motion pictures may call for parental guidance. There may be some profanity and some depictions of violence or brief nudity. However, these elements are not deemed so intense as to require that parents be strongly cautioned beyond the suggestion of parental guidance. There is no drug use content in a PG-rated motion picture. Since people under the age of 13 are still likely to watch the show, The writers of an episode must be very careful about any potential jokes that might affect a child. E. g. Modern Family is not allowed to make a joke about Santa Claus, the Easter Bunny, or the tooth fairy not existing because a young person watching the show who believed they existed could end up being very upset. An example of this is from an episode from season 1 when Cameron and Mitchell take their adopted daughter Lilly to go an see Santa Claus at the local mall. The reason all types of ? lm media have these ratings, is to protect the viewer from seeing something they might not want to see. Values and Attitudes Re? ected Through Characters In mainstream media, there seems to be different views on gay marriage, but it seems to be slightly more in favour of accepting the life choices made by these people. In Modern Family, there is a gay couple called Cameron and Mitchell. The way that they positively re? ect the values and attitudes of society is the fact that they are very open about being gay. Another way it is positively re? ected is through the other main characters. They all seem to be very accepting even the Patriarch of the family Jay Pritchett, he accepts his sons choice even though he is uncomfortable with it. In one of the early episodes of season 2, the couple shared a kiss which pleased the audience. Ultimately, then, the show re? ects the experiences and insecurities of its creators and assumed audience, middleclass, middle-aged straight white men. Also in its Pilot episode, Cam and Mitch announce to the family that they have adopted a baby from Vietnam and the whole family (Including Mictchell? s homophobic father Jay) are very accepting of their choice. It reassures them that being tolerant is as good as being inclusive and that heterosexual white families with shrill stay-at-home wives are the norm. Its exploration of the pressures of feminine ideals is considerably less sympathetic meaning that Phil? s wife Claire Dunphy is arguably the least likable character, and story lines have included three women getting their period at the same time and going crazy, and ? ery Latina Gloria needing to be chaperoned because her pregnancy brain makes her too forgetful to function. Modern Family is one of very few to feature main characters who are gay (one of whom is played by a character who is actually gay outside of the production) and people of color, and it shows Cam and Mitch to be caring, capable parents. t challenges some of the values and attitudes which are evident, and the fact that Modern Family presents this unit in such a non-threatening way may be the key to its acceptance. Impact On Society Jesse Tyler Ferguson (Casted as Mitchell Pritchett) said that Modern Family might be doing a lot to change the views on gay marriage. The actor said he has had several people approach him and remark how the show has had an impact their lives and their views. Its impossible to measure how wide the impact is, but the fact that even one person changed their mind says a lot about the depth of the show. Modern Family is hardly the ? rst show to feature gay characters. However, it is one of the ? rst that doesnt really make an issue out of it. In fact, it is easy to forget that Cameron and Mitchell are a gay couple. There are no political statements or agendas. They are just two people living their lives. The fact that it has affected the views of other people indicates that it is a very important show. It takes something special to alter the mindset of an individual. This show ? ts the bill. They keep doing what they do. Modern Family shouldnt try to change the world. However, if they change a few minds while carrying on as normal then there is nothing wrong with that. Modern Family has also made people who watch the show feel better about themselves because viewers now know that there own family isn? t the only family who has troubles. It is happening all around them. This helps us to understand that Modern family is one of the most realistic television sitcoms going around at the moment. Conclusion It is quite evident that Modern family has had an impact on todays society in a positive way along with providing the viewers with plenty of laughs along the way. For people to want watch a program and understand some of the meaning it constructs, then the show must appeal to the viewer in the ? rst place, and Modern Family does this by creating a storyline that most people can generally relate to. Once people become immersed in the show they start to pick up some of the stereotypes that are evident, e. g. Gay couple, loud South Americans etc. Because we relate with the characters, we feel inclined to display the same values and attitudes that the characters do which is respecting people even if they? re gay or of a different nationality. This leads to its impact on society which is without a doubt a positive one. Perhaps Modern Family is changing the views towards gay marriage and it is better that they? re doing it in a way where people can watch a television program that people can enjoy, but also learn from it. It is amazing to consider how successful a TV show can be due to the controls and constraints it faces, and Modern Family perfects it.

Lottery Is Good Essay -- essays research papers

  Ã‚  Ã‚  Ã‚  Ã‚  State lotteries have been around for awhile to help build up state revenue. In such things as scratch off instant tickets or daily number drawings. To some these things are evil, but to some others who’s lives aren’t the greatest, it’s a shimmer of hope that most people don’t have. Now the thing about the lottery is a lot of people don’t win, but those few that do could be put into a nice situation that they’ve never been in before. This is the land of freedom and opportunity, isn’t that we are giving the commonwealth?   Ã‚  Ã‚  Ã‚  Ã‚  If we would take away the lottery it would take away from the retired people who the lottery money goes to as well. I don’t like to know that the money is going to them, I rather see the state invest into the future instead of wasting money away on the past. Either way the lottery does help out certain people. â€Å"If nobody ever won the lottery, then nobody would play it. The public appreciates that the odds against them are very high indeed, but the purchase of a ticket gives them a chance of a fortune, however remote, and the opportunity to dream of a different life. As other forms of gambling are legal, along with many other ways of harmlessly but enjoyably wasting money, there is nothing wrong with the government benefitting from the pursuit.†The odds against the common man are very great, so to them to have a real chance at overcoming everything in life with a purchase of a one dollar power ball tic...

A Critical Analysis of an Ethical Proposition Based

Ethical situations on the subject of killing and the sacrifice of human lives are always subject to critical analysis and intensive argumentation. The so-called sacrifice of the few for the good of the many is usually founded upon Aquinas’ Natural Law and Doctrine of Double Effect, both of which were logically formulated by the philosopher yet both also lend themselves to criticisms.Aquinas defines the Natural Law based on the Eternal Law. He formulated the Eternal Law in his Summa Theologiae and defines it as â€Å"the idea in God’s intellect by which He governs the world† (Magee, 1999). The Natural Law according to Aquinas is â€Å"humans’ participation in the Eternal Law through reason and will† (Magee, 1999).The Doctrine of Double Effect, on the other hand, is defined as a set of ethical criteria for evaluating whether one should do an act that would, in the process of producing a positive effect, also produce a negative effect (McIntyre, 2009). Our ethical proposition â€Å"It is always wrong to kill innocent people, even if you could save many other lives by doing so† is a rather weak proposition after it is analyzed with reference to Aquinas’ two aforementioned doctrines.Critical AnalysisWith Reference to the Natural Law. There are various different levels of precepts that the Natural Law entails. The first of which is â€Å"Good is to be done and pursued and evil avoided† (Magee, 1999).However, Aquinas has specified that a â€Å"good† thing is something â€Å"that we know immediately, by inclination†¦that [would] count as good and thus to be pursued† (Murphy, 2008). Aquinas specifies these things as life, knowledge, procreation, society, and reasonable conduct.First Precept. Applying the above precept to the given ethical situation, â€Å"It is always wrong to kill innocent people, even if you could save many other lives by doing so,† one can see that the whole proposition logically satisfies the first part of the precept â€Å"Good is to be done and pursued.† Both the act of not killing innocent people and saving many other lives are believed to be inherently good, that is, good in itself. However, the proposition might not in a way satisfy the second part of the precept â€Å"[that] evil [should be] avoided.†This is because the proposition implies a prohibition of killing innocent people, which, if done, would result in a possible non-fulfillment of the second part of the proposition: â€Å"You could save many other lives by doing so.† If many other lives are not saved, then this means one has allowed the evil of death to take lives away, thus evil is not avoided, which is the second part of the precept. In short, our proposition fails the first precept of the Natural Law.Second Precept. Another precept of the Natural Law is that it â€Å"commands that we preserve ourselves in being† and one thing that can be deduced fro m this is that one is required to â€Å"take care of [his life] and transmit that life to the next generation† (Magee, 1999).This may obviously refer to the goodness of procreation but it may not be necessarily the case because such a statement may translate to the preservation of the self for the benefit of the next generation. This precept on preservation may agree with the first part of the given ethical proposition: â€Å"it is always wrong to kill innocent people,† for the killing of people, whether innocent or not, opposes the idea of self-preservation. However, the second part of the proposition, â€Å"you could save many other lives by doing so, or by killing innocent people,† does not agree with the precept on preservation.The reason is that if you decide to preserve the lives of the innocent, then your action may result in the non-preservation of the lives of many others. This now serves as another proof of the weakness of the given proposition vis-à  -vis the precept of the Natural Law on preservation.With Reference to the Doctrine of Double Effect. The proposition, â€Å"It is always wrong to kill innocent people, even if you could save many other lives by doing so,† lends itself to more criticisms on the weakness of its argument when criticized with reference to the Doctrine of Double Effect.The doctrine consists of four conditions that must be met before one can declare an act morally permissible (McIntyre, 2009). And for this the proposition should be constructed into a conditional sentence: If one kills innocent people, it is wrong and hence presumed to be not morally permissible. Therefore the moral permissibility of the killing of innocent people will be evaluated vis-à  -vis the four conditions of the Doctrine of Double Effect. Furthermore, the claim of the proposition that killing innocent people is morally wrong under all circumstances will be logically investigated.First Condition. The first condition is the nature-of-the-act condition, which states that â€Å"the action must be either morally good or indifferent† (McIntyre, 2009). This may somehow oppose what we are intending to prove. It is indeed true that the killing of innocent people is not morally good nor is it morally indifferent.Second Condition. The second condition is the means-end condition, which states that â€Å"the bad effect must not be the means by which one achieves the good effect† (McIntyre, 2009).This is also a proof in favor of the proposition. If the goal is to avoid the death of many other lives, then it follows, according to the second condition, that death should not be meted out on innocent people just for the sake of the many others. Based on the second condition, death must not be utilized to avoid death. With the second condition, he proposition remains solid.Third Condition. The third condition is the right-intention condition, which states that â€Å"the intention must be the achieving of only the good effect, with the bad effect being only an unintended side effect† (McIntyre, 2009). It is now here that the proposition weakens.Based on the context of the proposition, the killing of innocent people, without any regard to the inherent morality or immorality of the act, has the intention of achieving only the good effect of saving many other people’s lives, thus making the killing of the innocent a morally permissible act. The bad effect, which is the death of the innocent, is anyway simply a side effect.Fourth Condition. The last condition is the proportionality condition, which states that â€Å"the good effect must be at least equivalent in importance to the bad effect† (McIntyre, 2009).Although there will always be a question about the exactness of such an equivalence of importance, the majority may agree that, in the proposition, the saving of the lives of many far outweighs the killing of the lives of but a few innocent people. This therefore dismisses the killing of the innocent as a morally permissible act and such an argument counters the proposition.

Auditing Chapter Two

(TCO 4) To succeed in an action against the auditor, the client must be able to show that: Student Answer: the auditor was fraudulent. the auditor was grossly negligent. there was a written contract. there is a close causal connection between the auditor's behavior and the damages suffered by the client. Instructor Explanation: Page 121 Points Received: 2 of 2 Comments: 2. Question : (TCO 4) The principal issue to be resolved in cases involving alleged negligence is usually: Student Answer: the amount of the damages suffered by plaintiff. whether to impose punitive damages on defendant. he level of care exercised by the CPA. whether defendant was involved in fraud. Instructor Explanation: Page 119 Points Received: 2 of 2 Comments: 3. Question : (TCO 4) A third-party beneficiary is one which: Student Answer: has failed to establish legal standing before the court does not have privity of contract and is unknown to the contracting parties. does not have privity of contract, but is know n to the contracting parties and intended to benefit under the contract. may establish legal standing before the court after a contract has been consummated. Instructor Explanation: Page 121 Points Received: 2 of 2 Comments: 4. Question : (TCO 4) The objective of the ordinary audit of financial statements is the expression of an opinion on: Student Answer: the fairness of the financial statements. the accuracy of the financial statements. the accuracy of the annual report. the accuracy of the annual report. Instructor Explanation: Page 142 Points Received: 2 of 2 Comments: 5. Question : (TCO 4) The responsibility for adopting sound accounting policies and maintaining adequate internal control rests with the: Student Answer: board of directors. company management. financial statement auditor. company’s internal audit department Instructor Explanation: Page 143 Points Received: 2 of 2 Comments: 6. Question : (TCO 3) Which of the following statements is most correct regarding errors and fraud? Student Answer: An error is unintentional, whereas fraud is intentional. Frauds occur more often than errors in financial statements. Errors are always fraud and frauds are always errors. Auditors have more responsibility for finding fraud than errors. Instructor Explanation: Page 145 Points Received: 2 of 2 Comments: 7. Question : (TCO 3) Which of the following is not one of the conditions for fraud described in SAS No. 99? Student Answer: Attitudes/rationalization. Opportunities. Incentives/pressures. Each of the above is a condition for fraud. Instructor Explanation: Page 337 Points Received: 2 of 2 Comments: 8. Question : (TCO 3) Fraudulent financial reporting may be accomplished through the manipulation of: Student Answer: assets. liabilities. revenues. all of the above. Instructor Explanation: Page 336 Points Received: 2 of 2 Comments: 9. Question : (TCO 3) Which of the following is a factor that relates to incentives to misappropriate assets? Student Answer: Significant accounting estimates involving subjective judgments. Significant personal financial obligations. Management's practice of making overly aggressive forecasts. High turnover of accounting, internal audit and information technology staff. Instructor Explanation: Page 339 Points Received: 2 of 2 Comments: 10. Question : (TCO 3) Auditors may identify conclusions during fieldwork that change or support a judgment about the initial assessment of fraud risk. Which of the following conditions should alert an auditor about the initial assessment? Student Answer: Missing or conflicting evidence. Discrepancies in the accounting records. Unusual relationships between the auditor and management. All of the above.

Eli Whtiney essays

Eli Whtiney essays Eli Whitney and Interchangeable Parts The year was 1765. One of the most influential inventors in American history, Eli Whitney, was born in Westboro, Massachusetts. He contributed some of the greatest innovations to American society. There are many different situations that helped shape or inspire Eli. Being exposed to his father's workshop, Eli accumulated an immense amount of knowledge on craftsmanship and mechanics. During college, Whitney's experiences at Yale also had many influences on him. When his pursuit of a law degree failed he began to become distracted by his affinity for mechanics. He also received an education involving advanced science and graduated with honors. Whitney was probably most influenced, though, by earlier attempts at mass production. The British textile manufacturing process inspired him as did a French man named LeBlanc, who had attempted the process of interchangeability but died before seeing its effect. Even though Eli was not certain if it was his own genuine concept, he did obtain cre dit for putting the process into action. Though perhaps best known for his invention of the cotton gin, Eli Whitney's greatest accomplishment was successfully introducing interchangeable parts to America. Until then, every rifle's part had been hand made, thus the parts of one gun did not fit any other gun. Whitney made the parts to his rifles so nearly identical that the machine parts could be interchangeable from one gun to another. For each part of the gun, a template was made. Whitney then invented a machine that allowed a man to cut metal according to a pattern. It was composed of a wheel with its cutting teeth that were driven around the edge of the template. No expert mechanical skill was needed. This machine was known as the milling machine. He first tested his invention on muskets. The federal government's investment and support enabled Whitney to prove the feasibility of his system and establish it as the ...

Helpling With Organization Skills in LD Students

Helpling With Organization Skills in LD Students Helping students with the organization is important. Organization skills are worthwhile life-long skills. Some people have a knack for great organization skills and some dont. Students with learning disabilities can benefit from the following strategies to help with organization. Helping the child to develop a routine will ultimately lead to organization success. The goal of the organization is to eliminate tardiness, forgetfulness, lack of preparedness and procrastination. These habits need to be eliminated and replaced with strategies to ensure the student is utilizing good organization skills. Once again, a consistent approach that is reinforced on a regular basis will be a tremendous help. A daily agenda or timetable should be with the student at all times during the school day and every effort should be in place to ensure that its used regularly.If you have extra texts, it would benefit the student to have a copy at home.Checklists to ensure that all steps or procedures are followed should be plain view.Give the student organizers - graphic organizers, checklists, subtitles, outlines etc. that assist with written work and assignments. Sample Agenda Type List PDFBreak down all items that are to be included in assignments and provide goals to be reached and ensure that checkpoints are in place.Teach the child how to highlight pertinent information and take notes that are meaningful.Communicate regularly about progress and strategies for improvement.Make sure that you have a positive home-school connection with the support needed to ensure success.Provide verbal prompts and cues to ensure the student is prepared. For example, ask the student what needs to be done on the given night. If he answers math, ask what is needed to complete the math. Help with verbal cues often which will eventually lead to the student reflecting back on whats needed. Sometimes a checklist stating what needs to be done and whats needed to do it is very helpful. At the end of each day, the child will ensure that both are complete.Some children have great organizational skills, however, many dont. Children need to be taught that everything has a place. Organization starts at home and there are many opportunities that parents can seize to help keep a child organized. Be sure that the child knows where his belongings go. Have a spot for books, toys, writing tools, collections etc. Remind the child where things go and how to create a home for belongings that dont yet have that special place.

Annotated Bibliography and Thesis Example | Topics and Well Written Essays - 500 words

And Thesis - Annotated Bibliography Example The US government role in Vietnam was to offer the Vietnam government with much needed military help in order to enable it overcomes the guerrilla leaders who wanted to advance the communist agenda. In addition, the government wanted to create a country that was viable and one that upheld the democratic views. However, I think the role of US in Vietnam was one of its foreign strategies to cement its dominance in other parts of the world. The Vietnam War was used by US to test its military strength and response of the Soviet Union on matters of national interest. However, after the eruption of war, the US government was unable to withdraw on time as the opposition groups in Vietnam responded vigorously. With the marine being unfamiliar with the local terrain, they suffered heavy casualties. Nevertheless, retreating from this war would have encouraged the Soviet that the US is weakening militarily, an aspect that would have created more space for Soviet insurgence. I think the fear that the Soviet could gain ground in Vietnam made the United State intensify its military aid towards Vietnam. President John F. Kennedy believed that the US has a mandate of preventing the communist-led insurgencies from subverting and overthrowing the shaky new government of Vietnam. Therefore, it offered itself to help Vietnam establish its authority in the land through strengthening its financial and military position in the country. However, this did not auger well with the Diem who tried to seek help from communist countries in order to reduce US insurgence. This led to eruption of war that was sparked by ideological differences. Nevertheless, I think US was not well prepared to fight this war. Instead, its initial strategy is to play an outside role in stabilizing the Vietnam government. The Role of US in Vietnam was to reduce the influence of the Soviet Union in the land. In

Fundamental elements of business Essay Example | Topics and Well Written Essays - 500 words

Fundamental elements of business - Essay Example Cost of equity does not necessarily involve repayment of funds raised unlike debt. It basically involves rising of funds through interests which not mount pressures on the organization. More pronounced is the fact that cost of equity gives the business organization a sense of expression which allows the organization room to go to all ends to acquire funds. They are not restricted by debt or anything. If a company is successful, the higher the cost of equity which will definitely leave the company little. There is no stipulated cost of equity; it therefore depends on the interest rate which renders the company rather helpless. In this case the cost of equity of a company puts the organization in the position of always requiring votes from shareholders before taking certain decisions "wise use of debt may lower a firms weighted average cost of capital (WACC) during inflation debt is repaid with 'cheap dollars'". In this case raising debt capital is easier and less complicated because the company is not required to comply with state, federal security's laws and regulations. "Interest and principal must always be met when due regardless of a firms financial position, also poor u

National Cancer Institute Research Paper Example | Topics and Well Written Essays - 2500 words

National Cancer Institute - Research Paper Example The theory was grounded on the 1978 physical book The External Control of Organization. The theory of Both Pfeffer and Salancik espoused that external factors controlled or affected the organization’s achievement of its goals and objectives. The entities’ need for external resources was the external control. For example, the restaurants need the food ingredients in order to cook the customer’s food. Consequently, entities implement strategies to maximize the dependence on external resources to efficiently enhance achievement the entities goals and objectives. To accomplish this, both authors insists entities must enter into joint ventures, diversifications, integration, co-optation, and mergers (Johnson, 2009). Question 7: Development of Institutional Theory. Powell, Meyer, Scott, DiMaggion, and Rowan developed the Institutional theory. The theory was developed to explain the cognitive as well as cultural aspect of organizations. The authors insist that the entities’ responses are grounded of factors having miniscule or no relationship to the entities’ organizational efficiency. The authors insist that the entities must fit into an established framework, environment, or system in order to survive. The entities include the normative, cognitive, as well as regulative structures and routines (pillars). For example, the entities must obey the government institutions’ laws rules and sanctions. The entities must not sell cocaine or pollute the environment. Scott observed that the government institutions shaped how entities operate. The government institutions will penalize entities that violate established laws and other statutes. The theory states that as the entity’ s field starts, there is diversity of approach as well as form. As the entities’ environment becomes well established, homogeneity among the entities within a segment starts to develop (Johnson, 2009). The theory indicates that the organization,

Case Study On A Patient With Oesophagitis Nursing Essay

Case Study On A Patient With Oesophagitis Nursing Essay The patient was a female, age 89, with a BMI of 15.4 kg/m2 (underweight). Her presenting complaint was nausea and vomiting, bringing up coffee ground vomit, fatigue and loss of appetite since two days ago. Her past medical history included atrial fibrillation, paranoid psychosis and iron deficiency anaemia. She also had a cholestectomy done in year 2000. She was single and lived alone; she neither smoked nor drank. There was no relevant family history recorded for her case. On admission she was taking medication stated in Table 1 below. She was known to be allergic to ciprofloxacin. Table 1 Repeat medication taken on admission Drug Dose Digoxin 125 Â µg once daily Lisinopril 2.5 mg once in the morning Furosemide 40 mg once daily Clopidrogel 75 mg once daily Quetiapine fumarate 125 mg twice daily Tramadol hydrochloride 100 mg twice daily Codeine phosphate 60 mg one to be taken as required Paracetamol 500 mg four times daily Folic acid 5 mg once daily Ferrous fumarate 322 mg twice daily (Last prescription dated three months ago) Clinical data and diagnosis On admission, her temperature was 36.4Â °C, pulse was 83 beats per minute, and her blood pressure was 124/46 mmHg. Her Abbreviated Mental Test (AMT) score was 7 out of 10, indicating mild confusion. A full blood count, renal function test, liver function test, and an electrocardiogram (ECG) were carried out. Her liver function test came back normal. The ECG showed some ST depression, but the patient denied any chest discomfort. Her haemoglobin levels were low at 9 g/dl (11.5-16.5 g/dl), while platelets were low at 108109/l 150-400109/l). her plasma urea was elevated at 38.2 mmol/l (2.5-7.5 mmol/l), and her creatinine was 273 Â µmol/l (50-80 Â µmol/l for female). Her creatinine clearance was calculated to be 8.1 ml/min, which indicated severe renal impairment. The diagnosis was acute renal failure, and gastritis or peptic ulcer disease. Clinical progress On day 1, patient was dehydrated and had some upper abdominal discomfort (Dyspepsia). The plan was to stop tramadol, clopidogrel, lisinopril and furosemide, due to the coffee ground vomit and acute renal failure. Two units of RCC (Red cell concentrate) and IV fluids were given. A urinary catheter was used to monitor urine output. Patient was continued on ferrous fumarate and given gaviscon 10mls. Quetiapine fumarate was not given as it was not available. On day 3, patient was paranoid; as quetiapine fumarate was still not available, haloperidol 1 mg was given as an intramuscular injection according to the hospital guidelines. Her haemoglobin levels were back to normal (12 g/dl) and her creatinine clearance improved to 33.3 ml/min; measurements were taken again because the values were so different. The catheter was taken out, but she was to receive subcutaneous fluids hourly. Patient was passing black stools. She was given Peptac 10mls for abdominal discomfort and was scheduled for an endoscopy the next day. Quetiapine fumarate was given on day 4 and patient was taken off haloperidol. On day 6, the patients confusion was thought to be influenced by digoxin; levels were checked and found to be 1.1 Â µg/l (0.5-2.0 Â µg/l); however dose of digoxin was decreased to 62.5 Â µg. a rectum examination was conducted to make sure patient was not bleeding from the lower gastrointestinal tract. The gastroscopy report came back stating patient had grade D oesophagitis (Reflux oesophagitis), that is an extenxive mucosal breaks engaging at least 75% of oesophageal circumference. She was also found to have a large chronic duodenal ulcer, non-bleeding with visible vessels. The plan was to start the patient on IV proton-pump inhibitor (PPI, pantoprazole 8 mg/hr) for 72 hours, oral omeprazole 20 mg daily, and eradicate H. pylori if infection was present (CLO test). On day 9, the CLO test came back negative. Patient was taken off IV PPI and put onto oral PPI (Omeprazole 40 mg daily). A repeat endoscopy was scheduled for the week after. Disease Overview Prevalence Oesophagitis is the inflammation of the lining of the oesophagus, usually caused by irritation due to stomach acid reflux.1,2 It is included under the boarder term of gastro-oesophageal reflux disease (GORD), which also includes endoscopy-negative reflux disease.3 In the UK, there is a 28.7% prevalence of GORD, and the risk is found to increase with age, especially for those over 40 years of age. There is an estimated of over 50% of GORD patients between 45 and 60 years of age.4 About 25 to 40% of people with GORD are found to have oesophagitis on endoscopy.5 Pathophysiology, risk and diagnosis Acid reflux can occur because of incompetence of the lower oesophageal sphincter, a transient complete relaxation resulting from a failed swallow, that is, a swallow without the usual peristalsis wave (Found in 65% of patients). It can also be caused by a transient increase in intra-abdominal pressure (17% of patients), or a spontaneous free reflux due to the lower oesophageal sphincter having a low resting pressure (18% of patients).6 Possible risk factors for GORD are pregnancy, excess alcohol consumption, smoking and hiatus hernia. Obesity is thought to be a risk factor, as well as certain foods like onions, citrus fruits and coffee. Drugs that are thought to relax the lower oesophageal sphincter like calcium channel blockers are thought to play a role in promoting GORD. There is however very limited evidence to support these claims.4,5 It is now thought that more than 50% of GORD risk is genetic, as it is found that a first degree relative of a person with GORD is four times more at risk of getting the disease.4 Diagnosis of GORD is based mainly on the patients symptoms, predominantly acid regurgitation or heartburn.7 An endoscopy is usually the main diagnostic procedure done to confirm GORD. Pharmacological treatments and mechanisms of action The main drug used for this disease is a proton-pump inhibitor (PPI). PPIs are one of the most prescribed drugs for the treatment of acid-peptic diseases, including GORD and peptic ulcer disease.8,9 They are substituted 2-pyridyl methysulfinyl benzimidazoles, with pKa around 4, and have a very short plasma half life of one to two hours. They are weak bases that are lipophilic, which allows them to cross the membranes of the parietal cells easily. Once inside the parietal cells, where the pH value is less than 4, they protonate into the activated tetracyclic sulphenamide form of the drug and accumulate inside the cells. Here they form covalent bonds with the cysteine residues in the hydrogen/potassium adenosine triphosphatase (H+/K+ ATPase) enzymes, forming disulphide bonds, inhibiting the acid secretion activity of the pump irreversibly. Due to the covalent bonds, their duration of action exceeds their plasma half life. To resume acid production, the parietal cells must then generate , or activate, new proton pumps.8,9 Examples of PPIs are omeprazole, lansoprazole, pantoprazole, and rabeprazole, the last of which has a pKa of 5, and is activated at a broader range of pH compared to the other three, leading to a higher acid-suppression activity. The common side-effects of PPIs are nausea, diarrhoea, abdominal pain and headache. Diarrhea seems to occur because of a change in the gut flora brought about by the PPI, and appears to be age-related.8 PPIs, especially omeprazole, are known to alter the activity of cytochrome P in the liver, an important consideration for patients taking drugs with narrow therapeutic windows like warfarin and phenytoin. They also cause a prominent gastric pH increase, and are able to inhibit or decrease the absorption of weak bases that require acid for absorption, like iron salts, griseofulvin, and vitamin B12.8 Other drugs that may be used in this case are H2 receptor antagonists, which inhibit the secretion of acid by stopping histamine from binding to the H2 receptors on the parietal cells; and prokinetic drugs, usual examples like cisapride, metoclopramide and domperidone, which work by increasing the pressure of the lower oesophageal sphincter, and accelerating gastric emptying.10 Evidence for treatment of the condition The National Institute for Health and Clinical Excellence (NICE) guidelines state that, for the management of oesophagitis on endoscopy, patients are to be given full dose PPI for one to two months. If there is a response to the treatment, low dose PPI is given, probably on an as required basis. If there is no response, the dose of PPI is doubled for another month, before switching to low dose PPI. If there is no response to the doubled dose of PPI, treatment is then switched to a histamine H2 receptor antagonist or a prokinetic.11 Klinkenberg-Knol EC et al1 compared the effects of omeprazole and ranitidine in a randomised, double-blind, endoscopically-controlled trial done on patients with reflux oesophagitis. Omeprazole was given at a dose of 60 mg daily while ranitidine was given at 150 mg twice daily. The symptoms were evaluated before starting the trial, and at the second, fourth and eighth week. Endoscopy was done at the start of the trial, and repeated during week 4, with another after 8 weeks if there was an absence of healing at week 4. For patients taking omeprazole, 19 out of 25 patients improved from Grade 2 or 3 (erosions or ulcerations) to Grade 0 or 1 (erythema and friability)12 after 4 weeks; while for patients taking ranitidine 7 out of 26 showed similar improvement (P = 0.002). At week 8, corresponding improvement was shown in 22 out of 25 for the omeprazole group, and 10 out of 26 for the ranitidine group (P = 0.001). Omeprazole showed a significantly higher healing rate, which was reflected in a better improvement of reflux symptoms as well. Patients receiving omeprazole experienced a more profound and faster relief of heartburn, which was the most common symptom complained by the patients (P = 0.0001). After 2 weeks, 92% (23 out of 25 patients) of patients receiving omeprazole reported that their reflux symptoms were either gone or had improved, while only 65 % (17 out of 26) of the ranitidine group reported the same (P = 0.01). This study however, only showed the superiority of omeprazole over ranitidine in the short term treatment of reflux oesophagitis. Further studies were needed to evaluate the effects of omeprazole in long term management and at a lower dose. Havelund T et al12 performed a double blind study on patients with Grade 1, 2 and 3 reflux oesophagitis. Patients were allocated randomly in this study to a treatment with omeprazole (40 mg once daily), and ranitidine (150 twice daily), for a period of 12 weeks. It was found that patients treated with omeprazole had a faster response to the treatment than those taking ranitidine (P < 0.0001). For the omeprazole group, healing rates were reported at 4, 8 and 12 weeks to be 90%, 100% and 100% respectively for those with Grade 1 reflux oesophagitis. For Grade 2 and 3, corresponding healing rates were 70%, 85% amd 91%. While for the ranitidine group, healing rates were 55%, 79% and 88% for Grade 1, and 26%, 44% and 54% for Grade 2 and 3. This pointed to a superiority of omeprazole at a lower dose (40 mg) over ranitidine. Sandmark S et al13 did a similar study, but with an omeprazole dose of 20 mg daily. Healing of oesophagitis was targeted in this study to be a complete healing of all ul cerative and erosive lesions in the oesophagus. At 4 weeks, healing rates were shown to be 67% in the patients taking omeprazole and 31% in those taking ranitidine (P < 0.0001). Corresponding healing rates were 85% (Omeprazole group) and 50% (Ranitidine group) after 8 weeks (P < 0.0001). This was also reflected in a more profound and faster- improvement in reflux symptoms in the patients taking omeprazole (51% by the end of the first week compared to 27% for patients taking ranitidine). Robinson M et al14 conducted a study to compare, in patients with erosive oesophagitis the efficacy and tolerability of omeprazole at a dose of 20 mg daily to ranitidine at a dose of 150 mg twice daily together with a prokinetic drug metoclopramide at a dose of 10 mg four times daily. It was found that healing rates for omeprazole were significantly greater than that for ranitidine in combination with metoclopramide. Omeprazole also provided a more profound relief for patients with reflux symptoms. More side effects and treatment-related withdrawals were found among the patients allocated the ranitidine-metoclopramide combination. Omeprazole was thus found to be more effective and better tolerated. Iskedjian M and Einarson TR conducted a meta-analysis15 of the three drugs cisapride, omeprazole and ranitidine for GORD treatment. At 12 weeks, 95% of patients were cured in the omeprazole group (40 mg daily), 81% in the ranitidine group (600 mg daily), and approximately 60% in the cisapr ide group (40 mg daily). In mild GORD, healing rate was 56% for cisapride versus 38% for ranitidine, while healing rates for cisapride and omeprazole showed no significant difference. In severe GORD, the healing rate for cisapride was only a half of that of omeprazole (43% versus 87%), while showing no significant difference when compared to that of ranitidine (50%). Thus it was concluded that omeprazole is favoured for treating severe GORD, while cisapride may be that of mild GORD. Vigneri S et al16 compared 5 maintenance therapies after an initial treatment of omeprazole 40 mg daily for 1 to 2 months, and healing was confirmed by endoscopy. Patients were then randomly assigned 12 months of treatment in the 5 following groups: cisapride (10 mg three times daily), ranitidine (150 mg three times daily), omeprazole (20 mg daily), ranitidine and cisapride, or omeprazole and cisapride. At 12 months 54% of the cisapride group, 49% of the ranitidine group, 80% of the omeprazole group, 66% of the ranitidine-cisapride group, and 89% of the omeprazole-cisapride group were found to be in remission at 12 months of maintenance therapy. Omeprazole showed a significantly better efficacy than cisapride (P = 0.02), and ranitidine (P = 0.003). Ranitidine-cisapride combination therapy was found to show a more profound improvement than ranitidine alone (P = 0.05). Omeprazole-cisapride combination therapy showed better efficacy than cisapride (P = 0.003), ranitidine (P < 0.001), an d also ranitidine and cisapride combination therapy (P = 0.03). Omeprazole as monotherapy or in combination with cisapride is found to be more effective for maintenance therapy of reflux oesophagitis, compared to ranitidine or cisapride alone. Omeprazole in combination with cisapride shows more efficacy than ranitidine and cisapride. The effects of newer PPIs lansoprazole (30 mg daily), rabeprazole (20 mg daily) and pantoprazole (40 mg daily) were compared with that of omeprazole (20 mg daily), ranitidine (300mg daily) and placebo in randomised clinical trials brought together by Caro JJ et al.17 The healing rate ratios noted for the newer PPIs as well as omeprazole were as follow: lansoprazole 1.62; rabeprazole 1.36; pantoprazole 1.60; and omeprazole 1.58. There was a greater decrease in the heartburn symptoms in patients taking PPIs than those taking ranitidine (P < 0.002), as well as in the healing of ulcers (P < 0.05), and relapse (P < 0,01). Compared to placebo, the PPIs obtained a much more profound relief of reflux symptoms (P < 0.01), healing of ulcers (P < 0.001) and relapse (P < 0.006). From this study, it was found that there is not much difference between the newer PPIs and omeprazole when it comes to relief of reflux symptoms, ulcer healing and rate of relapse, while all PPIs are better than ranitidi ne and of course, placebo in terms of treatment for erosive oesophagitis. Kahrilas PJ et al18 compared esomeprazole and omeprazole efficacies in reflux oesophagitis patients. It was found that more patients (P < 0.05) on esomeprazole 40 mg and esmoprazole 20 mg were healed after 8 weeks of treatment compared to omeprazole (94.1% and 89.9% compared to 86.9%). Adverse effects were common in both treatments. Esomeprazole was found to have a greater efficacy compared to omeprazole in reflux oesophagitis and both have a similar tolerability profile. Rohss K et al19 showed that esomeprazole at 40 mg daily had better acid control than omeprazole 40 mg daily. Since maintenance of intragastric pH > 4 is important for the effective management of GORD, the mean percentage of a 24 hour period with intragastric pH > 4 was taken as an indication of the efficacy of the treatments. Measurements were taken on day 1 and day 5, and on both days esomeprazole showed a greater mean percentage (P < 0.001) at 48.6% and 68.4% versus 40.6% and 62.0% for omeprazole. Wahlqvist P et al20 compared,from the perspective of the National Health Service (NHS),the cost effectiveness of the actue treatment of esomeprazole (40 mg daily) with omeprazole (20 mg daily) in reflux oesophagitis patients.It was estimated that, taking into consideration of the healing probabilities over 8 weeks, treatment with esomeprazole saves up toa total of 1290 pounds compared to treatment with omeprazole. Esomeprazole was found to provide a greater effectiveness at a lower cost. This is reflected in another study conducted by Plumb JM and Edwards SJ,21 which found that esomeprazole is cost effective in comparison to all other PPIs for the treatment of reflux oesophagitis. Conclusion The treatment given to this patient was appropriate in terms of the algorithms stated in the NICE guidelines; she was started on a full dose PPI after eosophagitis was confirmed on the endoscopy. As stated above, PPIs are proven to have superior effects in comparison with histamine H2 receptor antagonists and prokinetic drugs, both providing relief of reflux symptoms but not healing the oesophagitis itself.10 Among all the PPIs currently available, esomeprazole, the S-isomer of omeprazole, has been found to show more improvement than all other PPIs. Current studies have shown that the treatment of reflux oesophagitis with esomeprazole is more cost effective than treatments using any other PPI, providing a greater healing rate at a lower cost. Thus it might be in the interest of the NHS to treat this patient with esomeprazole than omeprazole. (2271 words)

Pride and Prejudice :: essays research papers fc

Pride and Prejudice Pride and Prejudice has many ways to make you laugh, but at the same time this novel makes you think. The character that I thought caused the most thoughtful laughter was Miss Bingley and her admiration of Mr. Darcy. When she was first introduced into the story she thought she was so much better than the families in the area, but it was at the second dance that she made her feelings known to Mr. Darcy, who by this time already had his eye on Elizabeth.  ¡Ã‚ ° I was never more annoyed! The insipidity and yet the noise; the nothingness and yet the self-importance of all these people! ¡Ã‚ ± (19)*. I laughed when I thought of Miss Bingley ¡Ã‚ ¯s family and how they started out as working class people, they were just more successful at it than most. Miss Bingley makes many personal attacks on Elizabeth ¡Ã‚ ¯s character, most of which are disregarded by Mr. Darcy. Elizabeth walking to Netherfield to visit Jane when she was ill gave Miss Bingley occasion to make one of her nasty com ments to Darcy,  ¡Ã‚ °I am afraid, Mr. Darcy, ¡Ã‚ ­ that this adventure has rather affected your admiration of her fine eyes. ¡Ã‚ ±(26)* Darcy told Miss Bingley how wrong she was, as well as praising Elizabeth . Miss Bingley works very hard on complimenting Darcy on everything he does, she makes quite a silly fool of herself by doing so. Mr. Darcy brushes aside her attentions as frequently as she gives them. When he is writing a letter to his sister during he first stay at Netherfield, she showers him with praise and he seems most annoyed with her continuous talking. From this readers point of view she tries so hard to attain her goal of acquiring his affections, that in fact she earns his disdain. Miss Bingley continues in her assaults on Elizabeth's appearance and character, and in doing so lowers herself in Darcy esteem even further.  ¡Ã‚ °How very ill Eliza Bennet looks this morning ¡Ã‚ ­I must confess for my own part I could never see any beauty in her ¡Ã‚ ­and in h er air altogether, there is a self-sufficiency without fashion, which is intolerable ¡Ã‚ ­  ¡Ã‚ ®She a beauty!-I should have soon have called her mother a wit. ¡Ã‚ ¯ But afterwards she seemed to improve on you, and I believe you thought her rather pretty at one time. ¡Ã‚ ±(200-201)* This was not the best method of recommending herself to Darcy, but angry and jealous people are not always insightful when it comes to others feelings.