Academic Honesty, Who is responsible the student the teachers or the Essay

Academic Honesty, Who is responsible the student the teachers or the admission - Essay Example    According to McCabe, in his essay â€Å"it takes a village,† he considered the problem in African tribal way that it is the responsibility of the society or village to raise a child. Therefore, he argued that it should be the responsibility of the whole campus community including the administrators, the students, and the faculty to shape and effectively educate a student by employing simple strategies to reduce cheating, â€Å"†¦I would argue†¦it takes the whole campus community†¦.to reduce cheating.†. The main issue that he addresses is to enable the institutions, to find innovative ways of using academic integrity as a constructive way of developing more responsible students and citizens. McCabe further argued that in order to enable the students develop honesty and positive behaviour towards education, the entire body of the students, administration and faculty ought to work together to achieve the goal set. â€Å"†¦the village, communityâ⠂¬ ¦actively works together to achieve this goal†¦Ã¢â‚¬  In order to work actively, each body plays an important role in ensuring that the students are well developed in academic matters and reduce cheating actions among them (Choong, and Bob 98). As for teachers, they are expected to teach students moral values and share their responsibility with the students especially during consultations. Students are expected to discover their talents and ability in academic matters. Teachers are therefore helpful in improving the climate of academic honesty in their institutions. Similarly, the administration also plays a role in ensuring that academic integrity has improved in the community. The administration looks out at the roles of both teachers and students in enabling academic honesty in the community and they punish the students involved in dishonesty or cheating. Additionally, students also play a role of their own. For instance, students are expected to

The Computer Forensics Investigator Career Essay Example for Free

The Computer Forensics Investigator Career Essay The career of a computer Forensics Investigator is that of a specially trained professional who works with various law enforcement agencies as well as private firms to retrieve information from computers and other types of data storage devices. Computers and equipment can often be damaged externally as well as internally corrupted by hacking or viruses. The Computer Forensics Investigator is most well-known for working within the law enforcement industry. They can also be tasked to test the security of a private companys information systems. The Investigator should have an excellent knowledge of all aspects of the computer including hard drives, networking, and encryption. The Computer Forensics Investigator recovers and examines data from computers and other electronic storage devices in order to use the data as evidence in criminal prosecutions. Following data retrieval, the Investigator writes up technical reports detailing how the computer evidence was discovered and all of the steps taken during the retrieval process. Patience and willingness to work long hours are qualities that are well suited for this profession. Common Certifications for a Computer Forensics Investigator Some common Certifications for a Computer Forensics Investigator are the Certifications of Ethical Hacker, Penetration Tester, Computer Forensics Examiner and Reverse Engineering Analyst. The Certification of Ethical Hacker is achieved after completing a program involved with popular information security and hacking training. Investigators are taught techniques that are used by malicious, black hat hackers. The Certification of Penetration Tester is achieved after taking a course that is designed to certify that candidates have expert level knowledge and skills in relation to penetration testing. An expert penetration tester is a person who is highly skilled in methods of evaluating the security of computer systems, networks and software by simulating attacks by a malicious user. An Investigator can earn the Certified Computer Forensics Examiner Certificate by taking a course that tests a candidates fundamental knowledge of the computer forensics evidence recovery and analysis process. The Certified Reverse Engineering Analyst Certification is gained by taking a multiple part exam. The first portion consists of multiple choice style questions. Candidates have 2 hours to complete the exam and must achieve a 70% score or higher in order to pass this part of the exam. Candidates that pass the first portion of the exam can receive the practical portion part of the exam. The practical examination consists of an encrypted archived zip file which contains a live malware sample collected in the wild. The password for the file is infected. Investigators must solve the issues to pass the second part of the exam. Links to all these certifications are listed below: * Certified Ethical Hacker (CEH) * Certified Penetration Tester (CPT) * Certified Computer Forensics Examiner (CCFE) * Certified Reverse Engineering Analyst (CREA) Associations that Support Computer Forensics Some associations that support this career are the IACIS, the ISFCE and the National Center for Forensic Science. The IACIS is The International Association of Computer Investigative Specialists. IACIS is an international volunteer nonprofit corporation composed of law enforcement professionals dedicated to education in the field of forensic computer science. The ISFCE is The International Society of Forensic Computer Examiners. The ISFCE’s members conduct research and produce developments of new and emerging technologies and methods used in the science of computer forensics. This development is reflected in the certifications that are offered by this organization at a minimal fee to Computer Forensics Investigators. The third association that supports Computer Forensics is the National Center for Forensic Science. This association provides innovative solutions to forensic science problems through high quality research. This association’s members are dedicated to pushing back the frontiers of forensic science by integrating high level research, technology, and scientific working groups. Certification testing is offered to Computer Forensics Investigators at a minimal fee by this association.

Case Study On A Patient With Pulmonary Tuberculosis

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

Skipping Christmas Essay -- essays research papers

Skipping Christmas starts out at the gate in an airport. Luther and Nora Krank are there with their daughter Blair, waiting for a flight to Miami that will eventually bring her to eastern Peru, where she is going with the Peace Corps. They all say their goodbyes and the parents leave. Nora is very upset, while Luther isn’t so much. On the way home they stop at a store for white chocolate and pistachios. Luther unwillingly goes in to get it and finds every little thing a hindrance. He is easily annoyed, and doesn’t get the white chocolate. Nora then has to go in the store to get it, and she does so with much annoyance. While Nora is in the store, Luther daydreams about not having to do the Christmas season. That night, Nora was restless. She was pacing and going from room to room. She finally lay back in bed, rolling and flinching and moving, trying to get the attention of Luther so she could talk about Blair’s safety again. Luther didn’t move, and when Nora was finally asleep, he snuck out of the room to the basement office to evaluate last Christmas’s spending. He found that $6,100 was spent on Christmas. With this new information, he took a trip down to the travel agency during work the next day. He made his choice the 10 day Island Princess cruise. That night, during dinner he attacked Nora with the idea. Using brochures and spreadsheets, he showed her the facts. She finally accepted to skip Christmas, as long as she could still donate $600 to charitable donations.   Ã‚  Ã‚  Ã‚  Ã‚  Later, Nora received a call from the Card Store owner, and had to tell him she was not ordering cards, but did not tell him why. Luther, the same day, was writing a letter to his colleagues, telling them that he would not be participating in the normal Christmas rituals. The next day, the boy scouts came by, selling their Christmas trees. Luther had to tell them they were skipping Christmas, and a few minutes later they found a crowd congregated at their driveway, staring up at the house. That night, Luther went for a walk. He noticed his neighbors doing what the Kranks were avoiding, and he felt good about it.   Ã‚  Ã‚  Ã‚  Ã‚  It was lunchtime, and Nora was at lunch with two of her friends. The card man called her again, and she was forced to tell her friends about skipping Christmas, which meant everyone will know by dinner. During work, Luther wa... ...d Luther dangling painfully by his ankle.   Ã‚  Ã‚  Ã‚  Ã‚  The medics came and got Luther down, and he explained to the entire watching neighborhood what they were doing. Vic Frohmeyer organized a party quickly and sent everyone to work. He sent the policeman to go get Blair, and the Kranks went inside to rest.   Ã‚  Ã‚  Ã‚  Ã‚  Enrique and Blair came into the airport and were found by the police officers, who raced them home. When they got home they were greeted by the whole neighborhood. They talked to everybody and her parents were very impressed with him. Enrique received a lot of reissued gifts from the neighbors and they then went to dinner. Afterwards, they sang a few carols before Enrique and Martin, the man Nora saw in the store, sang and played guitar to a few Peruvian Christmas carols.   Ã‚  Ã‚  Ã‚  Ã‚  As the Peruvian songs continued, Luther snuck out to the Scheel’s house. He gave them his cruise vacation as a Christmas present. Bev had been given six month’s by her doctor. They were overwhelmed with joy when they were given this. As Luther walked back across the street, for the first time, he was filled with the joy of Christmas.

Henry Adams :: essays research papers

The Education of the Henry Adams reviews Adams’s and the United States’s education and growth during the 19th century. Adams was an old man who had Puritan beliefs about sex and religion. In this autobiography, Adams voices his skepticism about man’s newfound power to control the direction of history, in particular, the exploding world of science and technology, where all certainties of the future have vanished (anb.org, 1).   Ã‚  Ã‚  Ã‚  Ã‚  Adams grew up in the United Stated where he was a Puritan. Puritans believed that sex (women especially) was just a form of fertility and reproduction; otherwise “sex was a sin'; (Adams, 384). “American art, like the American language and American education, was as far as possible sexless'; (Adams, 385). The only sculptures and paintings of women that Adams viewed with understanding were those like the Virgin Mary, who was always seen as non-sexual. For example, “America was ashamed of her…have strewn fig-leaves so profusely all over her'; (Adams, 384). However, during this time of the technology revolution, women were beginning to be viewed differently, especially in Europe. Women were viewed as beautiful and mortal beings. People such as Rodin were representing women in paintings and sculptures sexually. Sex was becoming something more than just a means of reproduction. Suddenly Adams was far, far away from his Puritan custom-bound life.   Ã‚  Ã‚  Ã‚  Ã‚  People were no longer motivated by religion, being saved by God, and going to heaven; science, technology, money, and power had taken over the drives of man. Religion (a common “scale'; of the past) had taken the backseat to science, technology, money, power, and the new ideas and art of sex (all new “scales'; of the present and the future). “In opposition to the medieval Virgin, Adams saw a new godhead—the dynamo—symbol of the modern history’s anarchic energies'; (anova.org, 1). Adams desperately wanted to learn about the new world of technology, the “dynamos';, yet he felt helpless to find this new knowledge and to comprehend it.   Ã‚  Ã‚  Ã‚  Ã‚  Adams was overwhelmed by the technology of the dynamos. When Adams saw the dynamo, it became a symbol of the future, of infinity (Adams, 380).

HOW ARE TENSION AND SUSPENSE BUILT UP AND MAINTAINED IN AT LEAST TWO :: English Literature

HOW ARE TENSION AND SUSPENSE BUILT UP AND MAINTAINED IN AT LEAST TWO GOTHIC HORROR STORIES? The original use of the term `Gothic Horror' was applied to a group of novels, including Mary Shelley's `Frankenstein', written before 1914. These novels usually included some or all of the following characteristics, which seem demonstrative of the original use of the term `Gothic': An emphasis on portraying the terrifying, a common insistence on archaic settings, a prominent use of the supernatural, the presence of highly stereotyped characters, barbarism as opposed to elegance, and the attempt to set up and perfect techniques of literary suspense. Bram Stoker's `Dracula' would be another example as the novel includes most of the characteristics above. The setting would generally have a sense of eeriness and darkness and there is usually a lack of an escape route. This can make a character experience a dramatic loss of self-control and overwhelming emotions. A sense of helplessness or vulnerability heightens the dramatic climaxes of these stories. As well as vulnerable characters appearing in these stories there would also be a rational, scientifically thinking character. He, or she, would represent the newly literate middle class and would have lent credibility to the tale. ‘The Monkey’s Paw’ is an example of a pre 1914 Gothic Horror story. It is about a man who receives a paw which can allow people to make a wish but can also cause evil things to happen. Mr White wished for two hundred pounds, which he was given, but as compensation for the coincidental death of his son. Mrs White came up with the idea to wish for their son to come back. Mr White, knowing that his son would be mutilated after being buried for nine days, wished for everything to be back to normal after they received a strange knock on their door in the early hours of the morning. ‘The Red Room’ is about a protagonist who visits ‘Lorraine Castle’, in a deserted place, to see whether the stories of a haunted room were true. After a long walk through the castle he gets to the room. On his way there he encounters ordinary objects which look menacing due to the contrast of the moonlight. Once in the red room strange things started happening. What made the room feel haunted was fear. In the Victorian era, pre 1914, people were very rational. People in the 19th Century had just come out of the Industrial Revolution, they were more educated than before and by then they had became less superstitious ‘of the myths about earls, countesses or the timid wife’, mockingly alluded to in 'The Red Room'.

Merton Truck Company’s Financial Performance and Product Mix

Introduction In response to your report and request regarding Merton’s financial performance and product mix, I have met with your controller, sales manager and production manager, and have provided a solution that will improve the company in these two areas. Using a systematic approach, I was able to analyze the current machine hours, standard costs, and overhead budget. My findings have allowed me to determine the best monthly product mix that will maximize Merton’s total monthly contribution.Furthermore, I have addressed the decision regarding outsourcing, and have provided both the maximum rent your company should pay in addition to the maximum number of hours that should be rented. When determining the product mix, I took careful consideration of the machine hour constraints that your factory must account for. The following sections will provide further information in regards to my analytical technique, and how I was able to determine these figures. Current Situation Mertonâ₠¬â„¢s third and fourth quarters of last year should not be deemed a failure, but rather an area where the company can improve.It is evident your company’s current product mix is not meeting the financial standards that the company expects. As your sales manager pointed out, Model 101 trucks currently cost $40,205 to produce and are selling at a price of $39,000, meaning the company is producing this model at a loss. Some other issues to point out are the current capacity levels. Although the company is profiting on each Model 102 sold, maxing out capacity for this model may not be the best solution, as suggested by the controller.An analysis of the provided budget will allow us to track where the company’s money is being spent, and will suggest certain areas where possible changes can be made. Evaluating the different scenarios will answer our current questions on whether to stop producing Model 101’s all together, to continue producing both models but at differ ent amounts, and/or to consider the use of an outside supplier. Data Used in the Analysis To address the main goal of increasing financial performance, I had to define the objective of the current situation.Simply put, the objective is to maximize total contribution from the two models, which will directly improve Merton’s financial performance. Our focus is contribution rather than profit because contribution deals only with variables costs and variable costs are costs that we can manipulate to better Merton’s financial position. By determining exactly how much contribution Merton receives from producing one Model 101 and one Model 102, we can attempt to maximize these figures. A product’s contribution is the amount of money the company receives after subtracting out the variable production costs.Figure 1 shows the contribution received for producing one truck of Models 101 and 102. I was able to calculate this figure using the data provided from Tables B and C in your report. Table B listed the variable costs which include the direct materials and direct labor costs per model. I then added the variable overhead costs per unit that were listed in Table C. Subtracting these variable costs from the total selling price leaves us with Model 101 attributing $3,000 in contribution and Model 102 attributing $5,000. The second goal is to determine an optimal product mix.In order to do so, I had to account for any constraints, or parameters that limit production and affect total monthly contribution. Table A from your report provided these constraints, which are the production capacities of the four departments, engine assembly, metal stamping, Model 101 assembly and Model 102 assembly. These constraints, which will be discussed in the following sections, are provided in Figure 2. Finding both the contribution per model and the constraints allows us to determine the decision variables.Decision variables help us do exactly that, make decisions. Sin ce product mix is the decision we are making, the decision variables represent the number of 101 and 102 units that Merton should produce each month. These variables are represented as X101 and X102. Having identified our variables I was now able to setup a mathematical equation that will calculate Merton’s maximum contribution per month. The equation is as follow: Maximum Contribution = $3,000*X101 + $5000*X102 Method of Analysis: Linear ProgrammingAfter reading the report and understanding the variables involved, I realized that linear programming would be a useful tool in this situation. Linear programming (LP) is beneficial because it assists in decision making when resource allocation is involved. Our situation calls for a better approach when allocating labor, machinery, money, time and materials, thus making LP the perfect fit. For this situation, linear programming is more than an option. It is a must. Due to our number of constraints, using a linear program will comp ute exact outputs that will save time and eliminate the risk of human error.The program will allow us to input the known variables (101 and 102 contribution), and will calculate the optimal product mix, while staying within the parameters of our listed constraints (Figure 2). Analyzing the Options with Solver Optimal Product Mix Now that you have an understanding of the capabilities of linear programming, I will explain how I was able to use this model when persuading your sales manager, controller and production manager. Although these three do not agree on how Merton is currently allocating its resources, one aspect where they do agree is that maximizing contribution is Merton’s main focus.After explaining that this linear program, known as â€Å"Solver,† can calculate optimal product mix on the basis of maximum contribution, I received their undivided attention. Solver’s product mix calculation stated that Merton Truck Co. should produce 2,000 Model 101 truck s and 1,000 Model 102 trucks each month. Using this product mix will provide a maximum contribution of $11,000,000 per month. The objective formula that was presented above shows this calculation: $3,000*(2,000101)+5000*(1,000102)= $11,000,000 total contribution per month.Remember, this formula is calculated while staying within each of Merton’s production constraints. Simply producing more or less of either model will do one of two things. One, it would exceed one of our given constraints, or two, it would produce a total contribution that is lower than $11 million. Solver’s suggestion to produce 2,000 Model 101’s proves that the controller was correct in his objection of the sales manager. The model confirms that doubling Model 101 production allows the fixed overhead of 2. 7 million to be absorbed over 2,000 models instead of 1,000 as the company is currently doing.Since Merton pays fixed overhead of 2. 7M. for 101’s and only 1. 5M for 102’s, it makes sense to â€Å"get your money’s worth† by producing more 101’s. Renting Additional Capacity In addition to providing the optimal product mix, Solver has a number of other capabilities that help support my recommendations. One capability is that Solver can help us determine whether the production manager was correct when suggesting to rent additional capacity from an outside supplier. After the variables are input into the Solver program, I run the calculation.Once the program has calculated the data, it provides us with a â€Å"sensitivity report† that focuses on our available resources (constraints) and tests a number of â€Å"what-if scenarios. † For this situation, it will help us determine the amount to pay per rented hour and exactly how many additional hours to rent. Two relevant categories to note from the sensitivity report are the â€Å"shadow price† and the â€Å"allowable increase†. The program provides a shadow pric e which states that for each additional unit produced, Merton will receive ‘X’ dollars in contribution. The shadow price for engine assembly was $2,000.Therefore, for each additional unit of capacity (rented hours), Merton can afford to pay a maximum of $2,000. In regards to the allowable increase, Solver suggests that Merton should purchase a maximum of 500 rented hours. After 500 hours have been purchased, there is no further increase in contribution. The use of Solver has once again proven beneficial. Although the production manager’s suggestion was correct, Solver has strengthened his argument by providing objective data that tells us a max price to pay in addition to the maximum number of hours to rent.Additional Constraint – Producing at a 3:1? After finding out from the optimal product mix that it is more beneficial to produce two times the number of Model 101’s than Model 102’s, why not increase production to three to one? We can test this proposal by simply adding an additional constraint to our linear program. As expected, the optimal product mix was forced to change to a 3:1 ratio. Adhering to this constraint provided a product mix of 2,250 Model 101’s and 750 Model 102’s. However, the unwanted consequence is noticed in total monthly contribution.Plugging this product mix into our objective equation shows that contribution actually decreases. $3,000*(2,250101)+$5000*(750102) = $10,500,000. Seeing this drop in monthly contribution further proves that our previous optimal product mix of a 2:1 ratio should remain in place. Closing As mentioned in the previous sections, linear programming is a useful technique that should be applied to help improve Merton’s financial performance. My recommendation is that the company immediately implements a product mix of 2,000 Model 101 trucks and 1,000 Model 102’s.Secondly, the company should rent additional capacity from an outside supplier. Howeve r, your company must not pay more than $2,000 per hour, and not rent more than 500 hours because this would no longer increase total contribution. Although linear programming is widely used and often very accurate, no model is perfect. One disadvantage of linear programming is that it does not take into account industry trends. Choosing to produce two times the amount of Model 101’s does not guarantee this model will sell two times as much. Furthermore, linear programming is only useful in solving linear scenarios.Real world constraints are not always linear. For instance, a constraint that involves â€Å"number of staff members required per model† would be impossible to calculate when the other constraints are based on hours. Additionally, linear programming does not account for risk. What if the supplier cannot provide materials for one month’s time? What if Model 101 is using defective parts and the line becomes halted? These are items to consider when implem enting LP, but by no means should they prevent Merton Trucks from implementing the model. Figure 1: Contribution per Model Model 101|Sell Price| $39,000| Direct Materials| $24,000| Direct Labor| $4,000| Variable Overhead| * $8,000| Contribution| $3,000| Model 102| Sell Price| $38,000| Direct Materials| $20,000| Direct Labor| $4,500| Variable Overhead| * $8,500| Contribution| $5,000| Figure 2: Constraints Machine-Hours: Requirements and Availability| Department| Required Machine Hrs. Model 101 Model 102| | Total Machine Hrs. Available per Month| Engine Assembly| 1| 2|